HomeMy WebLinkAboutRes-2018-183 Amended Emergency Operations PlanBOARD OF COUNTY COMMISSIONERS
COUNTY OF KITTITAS
STATE OF WASHINGTON
RESOLU1i; NO. 2018·-
RESOLUTION TO ADOPT THE KITTITAS COUNTY PUBLIC HEALTH
DEPARTMENT'S EMERGENCY OPERATIONS PLAN
WHEREAS, Kittitas County, through the Kittitas County Public Health Department (KCPHD),
is charged with the preservation, promotion, and improvement of health in the
County; and
WHEREAS, the preservation, promotion, and improvement of health includes emergency
response and preparedness; and
WHEREAS, KCPHD has developed a comprehensive Emergency Operation Plan (EOP) that
provides guidelines for coordinated preparedness and response to emergency
incidents that may have public health implications in Kittitas County, which is
attached hereto and incorporated herein by reference.
NOW THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Kittitas
County, Washington, adopts the Kittitas County Health Department's Emergency Operations
Plan that is attached hereto, and in 0rporate I herein by reference.
DATED this 00-(J.),-day of t0<»e.w....-be::::C , 2018, at Ellensburg, Washington.
BOARD OF COUNTY COMMISSIONERS
T,-.--.,UNTY, WASHINGTON
I
Cory Wright, Commissioner
Kittitas County Public Health Department
Emergency Operation Plan
(Updated: 6/2018)
1
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
The Kittitas County Public Health Department on this day hereby adopts this Kittitas County
Public Health Department Emergency Operations Plan for emergency preparedness by majority
vote of the Board of Health.
B3akJ
q~: John Asriel
B'oa rd of Health
Date \\ \ tm\l~
bie O'Brien, Vice Chair
Board of Health
Ric h Elliott
Board of Health
(
It is the responsibility of the Kittitas County Public Health Department to prepare and maintain
procedures and guidelines in order to provide KCPHD emergency preparedness staff training,
exercises, and an updated emergency operation plan.
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Kittitas County
Department
To Protect and Promote the Health and the Environment of the People of Kittitas Co unty
June 2018
The Kittitas County Public Health Department Emergency Operation Plan is a practical guide
that helps you prepare for an emergency and defines your role and responsibilities as a
department employee in the event of an emergency or disaster. The 2018 updated plan
supersedes all previous emergency operation or emergency response plans.
As a Kittitas County Public Health Department employee, you are a vital and important member
of the department's Emergency Response Team. Without you, the careful plans and preparations
we have made to provide assistance to our residents may not succeed.
This plan is designed to guide you in how to respond to emergencies and disasters as a first
responder under the public health agency. As an employee, you are required to know the goals,
roles, and responsibilities assigned to the public health department in the event of a disaster.
Even though we may not be able to prevent a disaster such as a catastrophic earthquake, we can
be prepared. When disaster strikes, the speed and efficiency with which the department responds
and the skill with which we perform our assigned duties will lessen the impact on the people of
Kittitas County.
Your help and cooperation is greatly appreciated!
Dr. Mark Larson
Health Officer
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Record of Changes Change linked to AAR?
Incident Name?
Text formatting changes, updated
officials information
1. 7.19.2011 Sarah Bedsaul
Plan restructuring to follow
Comprehensive Preparedness
2 . 1.22.14 Kasey Knutson Guide 101 recommendations
3 . 6.30.2015 Kasey Knutson Annual Updates
Zach Vavricka Addition of Point of Distribution
forms, CD and EH annex, mass
fatality annex.
4 . 9.10.15 Kasey Knutson Procedures defining how KCPHD
will request assistance during
disasters from the local
Emergency Operations Center
(EOC), neighboring LHJs, and
DOH.
5. 10.5.2015 Kasey Knutson Added column to show revisions
Zach Vavricka made that are linked to an AAR
6 . 10.5.2015 Kasey Knutson Included decision making protocol
Zach Vavricka language for health officer to make
policy level decisions during
emergency.
7 . 4.27 .17 Kasey Knutson Updated general information about
people with access and functional
needs.
-
8. 4.27.17 Kasey Knutson Language around rapid detection
and response and addition of
Annex L, which includes all MAA
and MOU documents.
9 . 5.1.17 Kasey Knutson Added State DOH required
information about situational
awareness
10. 5.12.17 Kasey Knutson Updated shipping and handling for
24/7 lab procedures to mirror
KCPHD internal policy.
Added MOU and MAA info into
Organization and Assignment of
Responsibilities section.
11. 5.22.17 Tristen Lamb Added COOP
Basic Formatting Changes
12 . 5 .30.17 Kasey Knutson Spontaneous volunteer
information added in
Coordination, Control
4
13 . 11.27.17 Kasey Knutson Identified how to coordinate
logistical issues for resources .
14 . 06.08.18 Zach Vavricka Updated Media Release templates
15 . 6.8.18 Kasey Knutson Updated general information
(population info) and contact
information
16 . 10 .2 .18 Zach Vavricka Added Substandard Air Quality
Kasey Knutson Response Annex
Record of Distribution
10.2.14 Mary Small Chelan Douglas Health
1. District.
10.2.14 Theresa Adkinson Grant County Health District
2 .
3. 10.2.14 Jon Ness Grant County Health District
4. 10.2.14 Douglas Hale Okanogan County Health
District
5. 10.2.14 Alma Castillo Chelan Douglas Health
District
6. 10.2.14 Dan Banks Washington State Emergency
Management
7 . 10.2.14 Darren Higashiyama Kittitas County Sheriffs
Office
8. 10.2.14 Rachel McKinlay Washington State Department
of Health
9. 12.19.2016 Concon deliverables Washington State Department
email of Health
-
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Record of Exercises and Incidents
Annual Drive Thru Ellensburg
10.6.2010 Clinic
1.
10 .1.2011 Annual Drive Thru Ellensburg
Clinic
2 .
3 . 10.9.2012 Annual Drive Thru Ellensburg
Flu Clinic
4 . 11.6.2012 Annual Drive Thru Cle Elum/Roslyn
Flu Clinic
5. 1.25.2013 Flu/Pertussis Clinic Ellensburg High School
6. 10.17.2014 Annual Drive Thru Ellensburg
Flu Clinic
7 , 10.30.2015 Annual Drive Thru Ellensburg
Flu Clinic
8. 10.21.2016 Annual Drive Thru Ellensburg
Flu Clinic
9 . 10.20.2017 Annual Drive Thru Ellensburg
Flu Clinic
10.
11.
12.
13 .
14 .
15.
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I. Purpose
II. Scope
III. Situation Overview
TABLE OF CONTENTS
A. Hazard Analysis Summary
B. Capability Assessment
C. Limitations
D. Memorandum of Understanding/Mutual Aid Agreements
IV. Planning Assumptions
V. Concept of Operations
VI. Organization and Assignment of Responsibilities
VII. Direction, Control, and Coordination
VIII. Information Collection, Analysis, and Dissemination
IX. Communications
X. Administration, Finance, and Logistics
XI. Plan Development and Maintenance
XII. Authorities and References
XIII. Functional Annexes
A. 24/7 Laboratory Procedures
General Packing and Transportation Procedures
DOH Laboratory Certification
B. Isolation and Quarantine
C. Medical Countermeasures/Material Mgmt.
Medical Countermeasures Points of Distribution (POD)
POD Calculator
POD Agency Partnerships
Surge Capacity Staffing List
Patient Registration Form
Local Mass Clinic Facility Worksheet
Antiviral Withdrawal Form
D. Pandemic Flu Response
E. Emergency Communication Plan
Press Release Template
9
9
9-10
9
9
9-10
10
10-11
11-12
12-14
14-16
17
17
17
17-18
18-28
29-109
29-35
32-33
35
36-43
44-50
51
52
53
54
55
56
57-58
59-66
67-
70-71
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Common Press Releases
Fax Machine Speed Dial Numbers
24/7 Emergency Contact List
Regional Satellite Phone List
Common Media Questions
Recording Hotline Greeting
Emergency Notification Tree
F. Shelter/Mass Care
Shelter-Tool form
G. Continuity of Operations (COOP)
Emergency Succession Plan
Organizational Chart
Identified Essential Services
H. Environmental Health
I. Communicable Disease
J. Mass Casualty
Death Certificate Process
K. Investigation Protocol
L. Substandard Air Quality Response
72-75
76-78
79
80
81-82
83-84
85
86-87
88
89-96
92-93
94
95-96
97-99
-100-102
103-105
106
107-109
110-114
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I. PURPOSE:
The purpose of the Kittitas County Public Health Department's (KCPHD) Emergency Operation
Plan (BOP) is to provide guidelines for coordinated preparedness and response to emergency
incidents that fall under Emergency Support Function (ESF) 8, Public Health and Medical
Services , or incidents that may have public health implications in Kittitas County.
II. SCOPE:
The plan is specific to KCPHD employees. KCPHD emergency response works in conjunction
with the Kittitas County Comprehensive Emergency Management Plan (CEMP) in coordination
with the Kittitas County Emergency Management Department as well as under the Regional lead
of Public Health Emergency Preparedness and Response Region 7 , including Chelan, Douglas ,
Grant, Okanogan, and Kittitas County.
III. SITUATION OVERVIEW:
A. Population estimates by the Office of Financial management as of April 1, 2017 put Kittitas
County at 44,730. According to the US Census, approximately 8,224 residents are persons under
the age of eighteen. In addition, Central Washington University (CWU) has 11,376 enrolled
students. For People with Access and Functional Needs (PAFN), KCPHD has identified some
general numbers, which will be annually updated and expanded:
Pop\1latior. Subset · • Percentage of Population ~ --.. Nu ~r-of People 1;;;; ~
Disability Status 13.2% 5,623
Horine Dlfflculty 5.0%,, 2,180
Vision Dlfflculty 1 .8% 776
Cognitive Dlfflculty 5.3~ 2,140
Ambulatory Difficulty 6.1% 2;dd3
Independent Living Difficulty 4 .0% 1,405
Limited English Speaking 1.2%' wr·
Households
HouHholds without• vehicle 1 .0%; 462**
Sln alc Parent Ho1uoholds 11,.0% 1,896**
*U.S. Census 2016 estimates
0 Number of Households, not individuals
B. According to the Hazard Identification and Vulnerability Assessment (HIV A) 2012 ,
completed by the Kittitas County Emergency Management, focus areas of potential emergency
incidences range from civil disturbance to wild land fire.
C. KCPHD does not have adequate staff to respond to a community wide epidemic . KCPHD
expects to receive assistance from local emergency management located within the Kittitas
County Sheriffs Office (KCSO), in addition to partners within Region 7. In t_he event of a
pandemic or large incident, local response will be quickly overwhelmed and require mutual aid ,
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state, and possibly federal assistance. If an incident results in the need for equipment or
personnel, requests are made to the Kittitas County Emergency Operation Center (EOC)
(Emergency Contact List in Annex E/ Attachment C)
Limitations for requests for personnel or equipment include the following:
1. Damage to facilities and infrastructure
2. Transportation services
3. Staff availability
4. Damage to or disruption of communication systems
5. Fiscal constraints
6. Possible civil unrest
7. Other County/Local Agency Limitations
8. Other hazards may exist that are not addressed by this plan
D. The use of Memorandums of Understanding (MOU) and Mutual Aid Agreements (MAA) can
mitigate some of the incident limitations. However, each situation or incident will dictate the
extent that agreements will be implemented.
IV. PLANNING ASSUMPTIONS:
A. There is a surveillance system in place for the prompt detection, identification, and reporting
of epidemic disease or a bioterrorism incident.
B. Individuals/institutions required to report disease are doing so within the time frame required
bylaw.
C. Potential outbreaks/epidemics of disease are being investigated promptly and as required by
statute.
D. KCPHD, Emergency Management, healthcare, law enforcement, emergency medical
response, and other agencies will work cooperatively to reduce the impact of epidemic
disease/bioterrorism in the community.
E. KCPHD staff is adequately trained to respond to epidemic disease .
F. Responders will be properly trained and issued the appropriate personal protective equipment,
and are aware of the threat of a secondary incident. Within Kittitas County, responders will most
likely be exposed to risks including physical injury, exposure to vaccine preventable diseases
such as pertussis, chronic health problems if exposed to hazardous materials, as well as mental
health issues resulting from disasters.
G. Governmental agencies and officials will respond as outlined in the appropriate Revised Code
of Washington (RCW) and Washington Administrative Code (WAC).
H. In situations not specifically addressed in this plan, KCPHD and other emergency
management officials will improvise and carry out their responsibilities to the best of their
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abilities using the Kittitas County Comprehensive Emergency Management Plan/Emergency
Operations Plan.
I. Memoranda Agreements and Mutual Aid Agreements will be in place and honored between
the organizations named in this plan and between neighboring governmental agencies.
J. As KCPHD may not have sufficient staff to respond adequately to an emergency situation,
local agencies such as Kittitas Valley Fire and Rescue (KVFR) may partner with KCPHD to
provide both staff support and logistical support.
V. CONCEPT OF OPERATIONS:
A. The Pre-Incident Phase
The pre-incident phase of an incident may be activated in the following ways:
1. National Terrorism Advisory System (NTAS)
a. Elevated -no specific information about timing or location of credible threat.
b. Imminent -if the threat is impending or very soon.
2 . Kittitas County Sheriff's Department/Emergency Management
3 . KITTCOM -Kittitas County 911
4. Kittitas County Public Works
5. Complaint from the general public
B. Rapid Detection and Response
KCPHD works with various partners to ensure rapid detection and response of public health
emergencies, including but not limited to the Kittitas County Sheriff's Office , Region7 Partners
along with Region 7 epidemiologist, and Washington State Department of Health, (Mutual Aid
Agreements (MAA) and Memorandum of Understanding (MOU) documents are attached in
Annex L). Notification of a potential incident or epidemic disease could happen in several
ways:
1. Notification from regional, state, or national level authorities.
2. Notification by healthcare provider.
3. Notification by general public.
4. Notification by a law enforcement agency.
5. Detection by KCPHD staff.
6. KCPHD staff will notify Washington State Department of Health (DOH) in a timely
manner of events or disease findings indicative of an emergency incident or an epidemic .
7. Increased surveillance may be necessary to confirm existence of an incident and
KCPHD will use local healthcare providers, regional partners and State DOH as needed .
8. If indicated, KCPHD may activate its Emergency Coordination Center (ECC) to
coordinate activities. The Incident Commander will be responsible for coordinating a
response within the department in an emergency. The Incident Commander will
determine the appropriate activation level, staffing, and roles. Incident Commander will
utilize the Federal Emergency Management Agency's (FEMA) Incident typing to
determine activation of the EOP or activation of the ECC. Response will act according to
the following incident types:
a. Type 5 -No incident Command System (ICS) staff activated.
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b. Type 4 -Command/general staff activated, only as needed.
c. Type 3 -Some or all Command/general staff activated. Written Incident
Action Plan (IA) may be required.
d. Type 2 -Regional resources required. Many Command/general staff positions
filled. IAP required for each operational period.
e. Type 1 -National resources required. All positions activated. Written IAP
required for each operational period.
9. If agencies other than KCPHD are needed to participate in disease control, the Health
Officer/Commander may request activation of the county Emergency Operation Center.
10. Patient isolation and quarantine may be used per WAC 246-100-040 "Procedures for
Isolation or Quarantine." (Annex B).
11. Procedures for requesting laboratory support for establishment of diagnoses and to
help determine the scope of the potential bioterrorism incident/epidemic disease are
found in Functional Annex A, 24/7 Laboratory Procedures.
12. Healthcare support and mass casualty management: The Incident Commander will
coordinate with Kittitas Valley Healthcare (KVH) and Emergency Medical Service
providers to determine the ability of the local community to respond to the disease. If
community resources are about to be or are already overwhelmed, the Incident
Commander may request assistance through the Emergency Management Division.
Request for assistance is completed through the Emergency Management office via the
Kittitas County Sheriffs Office. (Emergency Contact List in Annex E/Attachment C)
C. Recovery Phase
1. Environmental Restoration. Steps for environmental restoration may be determined at
the time of the incident by the Incident Commander and the Command Staff, based on the
Centers for Disease Control and Prevention (CDC) protocols for the organism or agent
involved. The County Health Officer will give final approval for all protocols performed.
2. Re-entry Authorization. Re-entry authorization will be determined at the time of the
incident by the County Health Officer or Health Officer designee. Determination will be
based on CDC protocols for the organism or agent involved. The County Health Officer
will give final approval for all protocols performed.
D. Surge Capacity
1. All KCPHD staff may be expected to respond to provide surge capacity. Training will
be provided to personnel using Just in Time (JIT) training during the initial briefing. JIT
will be performed by the Incident Commander or designee and will include relevant
safety information as well as other necessary instructions.
2. Training to prepare KCPHD personnel will be completed via FEMA independent
study courses. Additional training may include exercises with Region 7 partners,
KCPHD annual emergency exercise, or additional FEMA trainings.
3. A staffing list for surge capacity to provide staffing needed and how KCPHD will
fulfill those needs is provided in
VI. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES:
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All emergency response activities will follow the National Incident Management System (NIMS)
guidelines.
Health Officer: The Health Officer assumes a leading role during an incident involving
bioterrorism, infectious disease, or other medical emergency. The Health Officer in consultation
with the Public Health Administrator and Board of Health will decide policy, maintain contact
with other agencies, and develop public health priorities. In all other emergency incidences, the
Health Officer provides information and support to the Incident Commander as needed.
Resolution 2005-03 appoints an acting Health Officer from either Chelan-Douglas, Grant
County, or Okanogan County) during the absence of KCPHD's Health Officer for periods of
leave, illness, or other excused absences at the written request of the County Administrator or the
Chair of the Board of Health.
Other KCPHD Staff: Other KCPHD staff or trained volunteers, including Medical Reserve
Corps (MRC) volunteers, will assume the appropriate NIMS roles
Kittitas Valley I ealtbcare: KVH will activate its Emergency Operations Center (EOC) and will
be responsible for the coordination of the overall operations of the hospital in any disaster
situation. KVH will have primary responsibility for staffing the hospital and will assist with any
auxiliary areas created to manage the medical needs of the public during an emergency (i.e.,
mass casualties, quarantine and isolation, etc.). KVH will support an alternate care facility
(ACF), if possible, through provision of medical expertise and resources.
lnterlocal Cooperative Agreement for emergency storage of vaccine in the event of power or
equipment failure at KCPHD. KVH will provide emergency storage for KCPHD's vaccine.
Kittitas County Sheriffs Office: Memorandum of Understanding in place to establish utilization
of KCSO for the investigation, monitoring, and enforcement of disease investigations and other
public health hazards, which also includes isolation and/or quarantine of a patient or patients.
KlTTCOM (911): KITTCOM (911) shall serve as the primary notifier of bioterrorist incidents or
other public health emergencies in Kittitas County, responsible for notifying the primary
emergency service agencies, including public health.
Grant County People for People (211): Memorandum of Understanding in place to coordinate
public health information during emergencies, provides non-emergency information about
KCPHD services, and serves as a regional call center.
Walter Strom Middle School: Memorandum of Understanding in place to establish Walter Strom
Middles School as a Point of Distribution (POD) to distribute medical countermeasure materials.
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Kittitas County Emergency Medical Serv ices Svstem (EMS): Kittitas County Emergency
Medical Services (EMS) System will facilitate the county's transportation and pre hospital
medical needs. The system consists of 11 licensed EMS agencies (primarily local fire
departments) and 5 affiliated-level services. Coordination between licensed EMS agencies to
meet the local EMS needs will be facilitated through KITTCOM and based on the Regional
County Patient Care Operating Procedures and the Kittitas County Mass Casualty Incident Plan
(MCI Run Cards). These documents are part of the South Central Region Trauma Plan,
available through Kittitas County EMS.
Eme.r:gency Management : If a bioterrorism incident is suspected, KCPHD will make prompt
notification to the Kittitas County Sheriff as the Director of Emergency management for Kittitas
County. The Sheriff or his designee will direct the county EOC with the Health Officer assisting
with direction, control, and management of the emergency as appropriate. Emergency
Management will attempt to acquire the resources and supplies needed to respond to an incident
when local resources are exceeded.
Local, County, and State Law Enforcement: Local and county law enforcement, Search and
Rescue (SAR), and Fire District #1 will assist KVH and KCPHD with site security, perimeter
control, and facility access. In an evacuation of the hospital, local, county, and state law
enforcement agencies may be called upon to assist in the coordination of the evacuation. Should
the need for an alternate care facility (quarantine or mass vaccination, etc.) or mass dispensing
operations arise in Kittitas County, local, county, and state law enforcement may be requested to
assist with site security, perimeter control, facility access, isolation and quarantine orders, and
for the maintaining of order.
Region 7 Healthcare Coalition: Mutual Aid Agreement with partners in Okanogan, Grant,
Chelan, Douglas, and Kittitas County to provide mutual assistance during emergencies to include
personnel (includes Region 7 Epidemiologist), equipment (includes Alternate Care Facilities to
address surge capacity), materials, supplies, facilities, services, and/or related resources.
Washington State Department of Health (DOH): DOH will coordinate statewide emergency
planning and preparedness efforts and statewide surveillance activities. Samples collected by
KCPHD will be tested by the public health laboratory network operated by DOH. DOH will
coordinate with CDC and disseminate appropriate data and situation updates to KCPHD. DOH
will coordinate development and implementation of disease containment strategies across
multiple counties and regions within the state. DOH will supplement and support local effort to
educate and inform the public about public health emergencies and preventative measures.
VII. DIRECTION, CONTROL, AND COORDINATION:
A. Kittitas County Public Health Department
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1. During a bioterrorism, chemical, or radiological incident; communicable disease
outbreak or public health emergency; KCPHD will respond based on the complexity of
the incident.
2. KCPHD may activate the Emergency Coordination Center (ECC). (The ECC is
located in room 115, with KCPHD Panaboard). However, there may be situations
where KCPHD ECC is not activated. If the KCPHD ECC is not activated, the Kittitas
County EOC will be used for operations.
3. All communications with the general public will be distributed through the Public
Information Officer (PIO). If the EOC is activated, the PIO will coordinate messaging
via the EOC.
4. Shifts during operation of Kittitas County Public Health Department ECC will
normally be 12 hours during activation.
5. Security for the ECC will be provided by the Ellensburg Police Department, Kittitas
County Sheriffs Office, or Search and Rescue (SAR) if needed.
6. KCPHD will provide support to, and take guidance from, the Kittitas County EOC in
public health emergencies. All public health activities will be coordinated with the
Kittitas County EOC ifKCPHD's ECC is functioning.
B. Kittitas County Public Health Department Representation In On Scene Incident Command
System
1. On-scene Incident Command representation will depend on which agency will have
the lead in the incident.
2. If the incident is an actual bioterrorism incident, communicable disease outbreak, or
public health emergency where a crime has been committed, law enforcement will be the
lead agency. In this case, KCPHD will be represented on the Command Staff by the
County Health Officer/Public Health Administrator, or a designee, who will be
involved in various aspects of the response.
C. Coordination with Region 7 Public Health Agencies
KCPHD will immediately notify Chelan-Douglas Health District, headquarters for Region7
Public Health Agencies, when a bioterrorism incident is suspected or confirmed in Kittitas
County. The Administrator of KCPHD will coordinate with Chelan-Douglas in determining
when support personnel from the regional partners may be needed in Kittitas County.
D. Coordination with Region 7 Hospital Network
KVH will notify its Region 7 partners when a bioterrorism incident is suspected or confirmed in
Kittitas County.
E. Coordination with Kittitas County Emergency Medical Services
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Kittitas County falls under the South Central Region (SCR) Trauma Plan for regional planning
and coordination. The request for resources from outside the county will be made through
KITTCOM.
F . Coordination with Kittitas County EOC
Requests for assets to support a local emergency are made through the Kittitas County EOC. If
the County EOC has not been activated, requests should be made directly to the Kittitas County
Emergency Management Department via the Kittitas County Sheriffs Office. Requests can be
made via phone, email, or in person. All requests made with a declaration of emergency will be
handled via Emergency Management. If the request cannot be handled locally, or through mutual
aid, they are then sent to the Washington State Emergency Operations Center at the Washington
State Emergency Management Division, Camp Murray, Washington.
If the request is specific to Emergency Support Function (ESP) 8, Public Health and medical,
that desk will then address the issue as appropriate, working with the requisition agency to best
meet that need. Washington State Department of Health serves as the lead for ESP 8 along with
other state agencies in a supporting role.
The Kittitas County Emergency Management Department (KCSO) must be aware of any
potential requests for assistance in order to determine the need for a declaration of emergency
within the county. Resources received from DOH and other partners without a declaration of
emergency will be handled by KCPHD and KCPHD will notify Emergency Management.
G. Health Officer
The Health Officer or designee may assume the role of Incident Commander during an epidemic
disease or bioterrorism incident. The Health Officer, Public Health Administrator, and Board of
Health will consult to decide policy pertaining to health and medical decisions during
emergencies. The Health Officer in consultation with the Board of County Commissioners will
make decisions if there is a financial implication to public health policy decisions during an
emergency. The Health Officer may also maintain contact with other agencies, develop public
health priorities, lead incident response, and delegate tasks. Managing spontaneous volunteers
who may request to support the public health agency's response either by incorporation or
triaging to other volunteer resources.
H. Volunteers
KCPHD may utilize trained MRC volunteers or spontaneous volunteers for incidents that exceed
our response capacity. The use of spontaneous volunteers will be coordinated with Kittitas
County Emergency Management. All medical personnel must be verified using the Emergency
System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), or WA Serv,
prior to volunteering. All volunteers will be required to sign and submit an Emergency Worker
16
Registration Card and a Kittitas County Emergency Management Certificate of Authorization
and Photograph and Media Consent form.
VIII. INFORMATION COLLECTION, ANALYSIS, AND DISSEMINATION:
Critical information that will be collected for situational awareness will include functionality of
public health operations, healthcare facilities, infrastructure, along with number of disease cases
and/or fatalities attributed to the incident. Additional information may include client or patient
identification, location of client or patient, the identified potential or confirmed disease or health
risk, date of onset, any related symptoms associated with the potential or identified disease, as
well as individuals who may also have been potentially exposed. Sources of information may
include local law enforcement, local healthcare providers, laboratories, KITTCOM, a complaint
from the general public, national, state, or regional partner.
Collected information will be used only for the investigation and response of any identified
disease threats or health risks. Information will be shared in accordance with the Health
Insurance Portability and Accountability Act (HIP AA) regulations. Only emergency responders
who are required to comply with HIP AA regulations will receive confidential medical
information relating to the investigation or response.
IX. COMMUNICATIONS:
KCPHD has access to 24/7 support services and resources outside of the department, which
require communication in a timely manner. Communication may be through various means
including by fax, telephone landline, and in person requests. Communications procedures are
outlined in the Communications Annex, Annex E.
Staff will be notified of an incident or mobilization either via the emergency phone tree, email,
WA Secures, or in person.
X. ADMINISTRATION, FINANCE, AND LOGISTICS:
Memorandum of Understandings as well as local resources will be utilized first in response to
emergencies. KCPHD and Kittitas County polices for financial accounting and auditing will be
adhered to in regards to financial records, reporting, and tracking resources. All financial
records will be kept in accordance with archiving requirements. Special purchasing policies
under Kittitas County will require a Board of County Commissioners' declaration of emergency
in order to utilize.
XI. PLAN DEVELOPMENT AND MAINTENANCE:
A. KCPHD staff training regarding this plan will be performed regularly.
B. This plan will be exercised, evaluated, and updated at least once annually based on after
action reports completed after KCPHD and/or county wide drills and exercises. Evaluations will
17
include improvements as a result from exercise analysis completed and challenges identified.
Updates will be based on recommended changes .
C. Recommended changes to this plan should be submitted to the Local Emergency Response
Specialist at KCPHD, located at 507 N Nanum Street Suite 102 in Ellensburg, Washington,
98926. The phone number is 509-962-7515. Post exercise and or/incident debriefmg will be
utilized to review effectiveness and need for revision of this plan. The report will recommend
changes, which if adopted, will be incorporated immediately.
D. At a minimum, this plan will be reviewed by the Kittitas County Emergency Management
Council after annual review and the Local Emergency Response Specialist is responsible for the
annual review of the Emergency Operation Plan. Updated plans must be sent to the Region 7
Emergency Response Coordinator and to the Kittitas County Emergency Management via
Kittitas County Sheriffs Office (KCSO).
XII. AUTHORITIES AND REFERENCES:
,---
Primary Statutes Governing Public H ealth: Revised Code of
nistrative Code (WAC),
(KCC)
Washington (RCW), Washington Admi
RCW
70.58.020
246-490-010
43.20 State
Board of
Health
43.20.050-
powers and
duties of state
board of health
246-100
communicable
and certain
other diseases
RCW
70.05.070
246-100-036
43.20.050
246-100-040
49.17 -
Kittitas County Code
Deputy Registrar
Vital Records
Communicable
and Certain other
Diseases
Local Health
Officer-powers
and duties -
Isolation and
Quarantine
Blood borne
Vital records means reco rds of birth, death, fetal death, marriage,
nd legal separation, maintained under the
state registrar of vital statistics.
dissolution, annulment, a
supervision of the
To protect the healt hand well-being of the public by
unicable and certain other diseases. controlling comm
-------------1
Enforce laws and
Local Health Officer m
person
control spread of disease within
jurisdiction.
ay issue an emergency detention of a
or group of persons.
Requires that all emp loyees with occupational exposure
18
Washington
Industrial
Safety and
Health Act
296-823
Occupational
Exposure to
Blood borne
Pathogens
Pathogens
----
participate in a training program that is provided at no cost to
them and conducted during compensated working hours.
--+--------+-------------------------4
18.79
Nursing Care
246-840-700
246-840
Practical and
Registered
Nursing
26.44 Abuse of
Children
26.44.030
246-840
RCW 70.28
246-170
RCW
43.20.050
WAC246-
110-020
43.20.050 (d
and f)
70.05.070
246-215 WAC
43.20.050
RCW 69.06
Food and
beverage
establishment
workers'
permit
246-217 WAC
Standards of Identify responsibilities of the professional registered nurse
Nursing Conduct and the licensed practical nurse in health care settings and as
or practice provided in the Nursing Practice Act.
Duty to report
child abuse
Practical
Registered
Nursing
When a healthcare professional has reasonable cause to
believe that a child has suffered abuse or neglect, he or she
shall report such incident, or cause a report to be made, to the
proper law enforcement agency or to the department.
Licensing process and requirements of registered nurses.
.
•·1------------------------1
Tuberculosis (TB)
Control of
Communicable
disease
Food Service
TB Prevention, Treatment, and Control
Guidelines specific to controlling outbreak within a school
and/or daycare.
-
The purpose of chapter 246-215 WAC is to establish state
board of health standards for food service under RCW
43.20.050 to promote and protect the health, etc. Chapter
246-215 includes 11 sections specific to food service. ------+------
Food Worker
Cards
The purpose of chapter 246-217 WAC is to establish state
board of health standards for the issuance of food worker
cards (food worker permits) under chapter 69.06 RCW and
RCW 43.20.050.
Chapter 246-217 includes 8 sections specific to food worker
cards.
RCW 69.06 includes 9 sections regarding service workers'
permits including validity, diseased persons, and limited duty
permit.
19
The Board of County Commissioners hereby adopts by
KCC Title reference the Washington State Board of Health Rules and
8.041: Health, Food Handling Regulations for Food Service Standards (Chapter 246-215
Welfare, and Rules and WAC) effective May 2, 2005, and as hereafter amended.
Sanitation Regulations
WAC 246-215 ' 8 .04 .020 Penalty section regarding violation of 246-215
WAC .
KCC Title
8.08: Health, Health Permits -
Welfare, and Food Handling Establishes standards for permitting food establishments.
Sanitation Establishments
40.20.050
43 .70.310
246-272A
WAC On-Site
Sewage
Systems
WAC
coordinates
withRCW The purpose of the chapter is to protect the health by 18.210 and On-Site Sewage
WAC 196-33 minimizing and regulating onsite sewage systems.
for design and
RCW 36.70
and 58.17 for
land use.
246-270
through 246-
274 Sewer
System WACS
KCC Title Protect public health by minimizing potential for public and
13.04: Water On-Site Sewage ground water exposure to sewage from on-site sewage
and Sewers Disposal Systems systems . Chapter 13 .04 contains 31 sections from permitting
to health hazards and health emergencies. --
KCC Title Private Sewage Chapter 13.08 contains 9 sections pertaining to plats
13 .08: Water Disposal Systems connecting to septic tanks from applications to plat size
and Sewers in Plats requirements. ·-
43.20 Protect the health of consumers using public drinking water
Public Law 93-supplies by establishing requirements for persons operating
523, the Public Water small public water systems.
Federal Safe Supplies (1) The purpose of this chapter is to define basic regulatory
Drinking requirements and to protect the health of consumers using
Water Act of public drinking water supplies .
20
1974,and
Public Law 99-(2) The rules ofthis chapter are specifically designed to
339, the Safe ensure:
Drinking
Water Act (a) Adequate design, construction, sampling,
Amendments management, maintenance, and operation practices; and
of1986,and (b) Provision of safe and high quality drinking water in a
certain reliable manner and in a quantity suitable for intended use .
provisions of
Public Law (3) Purveyors shall be responsible for complying with the
1 04-182, the regulatory requirements ofthis chapter.
Safe Drinking
Water Act
Amendments
of 1996.
246-290 WAC
Protect the health of consumers using public drinking water
supplies by establishing requirements for persons operating
public water systems.
( 1) The purpose of these rules is to define basic regulatory
requirements to protect the health of consumers using Group
B public drinking water supplies. These rules are specifically
designed to ensure the provision of high quality drinking
water in a reliable manner and in a quantity suitable for
intended use.
(2) The rules set forth are adopted under chapter 43.20
RCW and owners of Group B public water systems shall be
43.20.050 responsible for ensuring compliance with these rules. Other
70.05.070 Group B Public statutes relating to this chapter are:
70.116
70.119 Water Systems (a) RCW 43.20B.020, Fees for services --Department of
246-291 WAC health and department of social and health services;
(b) Chapter 43.70 RCW, Department of health;
(c) Chapter 70.05 RCW, Local health departments,
boards, officers --Regulations;
(d) Chapter 70.116 RCW, Public Water System
Coordination Act of 1977; and
(e) Chapter 70.119A RCW, Public water systems --
Penalties and compliance.
21
(3) Prior to expanding a Group B public water system to a
Group A public water system, the entire system shall be
brought into compliance with chapter 246-290 WAC
This chapter is promulgated pursuant to the authority granted
70.116 in the Public Water System Coordination Act of 1977,
Public Water chapter 70 .116 RCW, for the purpose of implementing a
System Water System program relating to public water system coordination within
Coordination Coordination Act the state of Washington, for evaluation and determination of
Act of 1977 critical water supply service areas, and assistance for orderly
246-293 WAC and efficient public water system planning.
Authority to act when well, spring, stream, river or lake used
for drinking water source is being polluted.
Authority to act when landlord is furnishing impure water.
Every person who shall deposit or suffer to be deposited in
any spring, well, stream, river or lake, the water of which is
or may be used for drinking purposes, or on any property
70.54.010 Polluting Water owned, leased or otherwise controlled by any municipal
Supply corporation, corporation or person as a watershed or drainage
basin for a public or private water system, any matter or thing
whatever, dangerous or deleterious to health, or any matter or
thing which may or could pollute the waters of such spring,
well, stream, river, lake or water system, shall be guilty of a
gross misdemeanor.
The regulation and licensing of well contractors and
operators and for the regulation of well design and
construction. The legislature declares that the drilling,
Water Well making or constructing of wells within the state is a business
18.104 Construction and activity of vital interest to the public . In order to protect
the public health, welfare, and safety of the people it is
necessary that provision be made for the regulation and
licensing of well contractors and operators and for the
regulation of well design and construction.
KCC Title Well construction Allows the developer of a plat to bond for completion of the 1320: Water
and Sewers and reconstruction water system infrastructure.
Well Setbacks:
OSS Regulations-Prior to approving any development, the health officer shall
246-272A-Developments , require establishment of a 100 foot radius water supply
0320WAC subdivisions, and protection zone to fit within the lot lines OR Establishes a
minimum land wellhead protection zone around each existing or proposed
area requirements well site. (1) A person proposing a subdivision where the use
of OSS is planned shall obtain a recommendation for -
22
approval from the local health officer as required by RCW
58.17.150.
(2) The local health officer shall require the following
prior to approving any development:
(a) Site evaluations as required under WAC 246-272A-
0220, excluding subsections (3)(a)(i) and (4)(d);
(b) Where a subdivision with individual wells is proposed:
(i) Configuration of each lot to allow a one hundred-foot
radius water supply protection zone to fit within the lot lines;
or
(ii) Establishment of a one hundred-foot protection zone
around each existing and proposed well site;
( c) Where preliminary approval of a subdivision is
requested, provision of at least one soil log per proposed lot,
unless the local health officer determines existing soils
information allows fewer soil logs; -
KCC Chapter Well head Well Setbacks: Wellhead protection areas . All non-
community wells must be placed a minimum of fifty feet 17A.08.025 protection areas from property lines.
Well Head Protection Zones: 1) The department may
require monitoring and controls in addition to those specified
in this section if the department determines a potential risk
exists to the water quality of a source.
(2) SCA.
(a) The purveyor shall maintain an SCA around all
246-290-135 sources for the purpose of protecting them from existing and
WAC&246-Source Water potential sources of contamination.
291 WAC Protection
(b) For wells and springs, the minimum SCA shall have a
radius of one hundred feet ( thirty meters) and two hundred
feet (sixty meters) respectively, unless engineering
justification demonstrates that a smaller area can provide an
adequate level of source water protection. The justification
shall address geological and hydrological data, well
construction details, mitigation measures, and other relevant
factors necessary to assure adequate sanitary control.
23
I
246-290-221 Water Demand
WAC Criteria
( c) The department may require a larger SCA than
ed in (b) of this subsection, or additional mitigation specifi
measure s if land use, geological, or hydrological data support
sion. It shall be the purveyor's responsibility to obtain the deci
the protection needed.
(d) The purveyor shall prohibit the construction, storage,
disposal , or application of any source of contamination within
e SCA without the permission of the purveyor. th
(
sim
comp
e) The SCA shall be owned by the purveyor in fee
ple, or the purveyor shall have the right to exercise
lete sanitary control of the land through other legal
provisions.
( f) A purveyor, owning all or part of the SCA in fee
simpl
depart
e or having possession and control, shall send to the
ment copies of legal documentation, such as a duly
ed declaration of covenant, restricting the use of the
land . This legal documentation shall state:
record
(i ) Constructing, storing, disposing, or applying any
source of contamination is prohibited without the permission
of the purveyor; and
(ii) If any change in ownership of the system or SCA is
dered, all affected parties shall be informed of these cons1
requirements.
(g) Where portions of the control area are in the
possess1 on and control of another, the purveyor shall obtain a
corded restrictive covenant which shall run with the
estricting the use of the land in accordance with this
duly re
land, r
cha pter and provide the department with copies of the
appropriate documentation.
Mini mal Daily Production of Well Water: (1) Except as
ed in this section, expanding systems shall use water provid
dem and design for average day demand (ADD), and peak
period s of demand such as maximum day demand (MDD),
ak hourly demand (PHD) that are based upon actual
ered water use records. The data collected shall be
andpe
met
suffici
water de
ent to account for seasonal or other cyclic changes in
mand, and shall correlate to the maximum number of
e or part-time equivalent residential units in service at full-tim
any time.
24
(2) For seasonally used, transitory non-community, or
recreational developments the design for ADD, MDD, and
PHD shall be based upon metered water uses whenever such
data is available. The data must account for the daily
population using the water over the time that records are
collected, and must reflect the uses associated with maximum
occupancy for the development. The design demands for
these developments apply only to part-time uses, and may not
be applied to structures or dwellings that can be permanently
occupied.
I (3) In the absence of metered use or other comparable
information, the following sources of design information may
be used:
(a) Comparable metered water use data from analogous
water systems. Analogous systems are those with similar
characteristics, such as demographics, housing sizes, income
levels, lot sizes, climate, water pricing structure, water use
efficiency practices, use restrictions, and soils and
landscaping; or
(b) Design criteria or guidelines in the most recent edition
of the department manual for design of Group A public water
systems.
( 4) The design for water systems based upon metered
water use records shall have an MDD no lower than three
hundred fifty gallons per day per equivalent residential unit
(ERU), except for the design of any expansion to an existing
water system that has a minimum of two years of meter
records that clearly demonstrate that a lower design value for
MDD may be used without significant risk of pressure loss.
The meter records must correlate the demand data to the
actual level of occupancy for the periods covered by the
records.
(5) The minimum water demand and duration required for
fire flow and/or fire suppression storage shall be determined
by the local fire control authority or chapter 246-293 WAC
for systems within the boundaries of a designated critical
water supply service area (CWSSA). Public water systems
that are not required to comply with minimum fire flow
standards shall coordinate with the local fire control
authorities to ensure that any hydrants on the system, if they
25
90.44
58.17.150
58.17.060
58.17.110
246-272A-
0320 WAC
Regulation of
public ground
waters ( exempt
wells)
Plats,
Subdivisions,
Dedications
can possibly be used in the course of fire suppression
activities, do not create adverse pressure problems within the
water system as a result of fire control actions.
Allows withdrawal of public ground waters for stock
watering purposes, or the watering of a lawn or a
noncommercial garden not exceeding ½ acre in area or for
single or group domestic uses in an amount not exceeding
5000 gallons a day. Authority granting Department of
Ecology to require water metering as well.
Local health department or other agency must provide
recommendations for approval or disapproval as to the
adequacy of the proposed means of sewage disposal and
water supply (before final plat approval).
The legislative body shall provide that a short plat and short Short plats& short subdivisions subdivision may be approved only if written findings fhat
Approval or
disapproval of
subdivision
OSS Regulations-
Developments,
subdivisions, and
minimum land
area requirements
are appropriate as provided in RCW 5 8 .17 .110
A proposed subdivision and dedication shall not be approved
unless the county legislative body makes written findings
that (a) appropriate provisions are made for the public health,
j safety, and general welfare and for potable water supplies.
OSS regulations for developments, subdivisions and
minimum land areas.
,__, ___ __, __
KCC Chapter
16.12.150
Road, sewer,
water and fire
system
recommendations -------------WAC 173-
539A
KC Resolution
2004-36
CDS
administrative
policy related I
to potable I
water supply ,
for
subdivisions 1 1---------
AGO 1997 No. WA f~T:~~TS !
6' O~t~~;r lO, -~ELLS -_Status
m water nghts
The county health officer shall certify to the planning
commission prior to the hearing their recommendations as to
the adequacy of the proposed sewage disposal and potable
water supply systems.
Moratorium on use of ground water in upper Kittitas County.
Requires water budget neutrality for land subdivisions.
1. Public Water Supplies -must be constructed, letter from
purveyor
2. Group B Public Water Supply -Well site inspection
provided, Group B Workbook submitted and approved,
well tag ID assigned approval from WA DOH.
Individual wells -well log or hydrogeological report
required.
Provides interpretation of use of exempt ground water for
subdivisions of land.
--------------
26
19.27.097
system of exempt
ground water
withdrawals
Building permit
application -
Evidence of an
adequate water
supply-
Each building permit applicant of a building needing potable
water shall provide evidence of an adequate water supply for
the intended use of the building in the form of a water right
permit from Ecology, letter from an approved water
purveyor, another form sufficient to verify the existence of an
adequate water supply. ,t-----------
365-196-825
(GMA)
>---------
AGO 1992 No .
17-July 28,
1992
WAC 173-
539A
AGO2002No.
70279-9 28-
March, 2002
43.20.050
246-366 WAC
43.20.050
246-376 WAC
70.90.120
43.20.050
246-260 WAC
70.160
KCC Title
8 .24: Health,
Welfare and
Sanitation
Each building permit applicant shall provide evidence of an I
adequate water supply consistent with RCW 19.27.097 for a
Potable Water building needing potable water. If Ecology has adopted rules
on this subject, or any part of it, local regulations should be
consistent with those rules.
Requirement of
Adequate Water
Supply before a
Building Permit is
Issued
Campbell&
Gwinn
Primary and
Secondary
Schools
Camps
Water Recreation
Facilities
Smoking in
Public Places
Smoking in
Public Places
The local building department must satisfy itself that the
potable water source is reliable, of sufficient quality and
quantity. This requires demonstration that water actually will
be made available to the building for a reasonable period of
time.
Moratorium on use of ground water in upper Kittitas County.
Requires water b ud get neutr ality for building permits and
requires metering for new residential connections and/or new
use of exempt groundwater.
Decision made by the Attorney General related to a case
between Washington State Department of Ecology and local
government about contiguous plats and use of exempt wells.
Maintain minimum environmental health and safety
standards for school facilities until legislative action.
------------1
Requirements for environmental conditions in camps.
Protect the health, safety, and welfare of users of water
recreation facilities.
To protect the health and welfare of all citizens, including
workers in their places of employment, by prohibiting
smoking in public places and workplaces. ----t
27
I 10.05, 10 .95
Chapter
173-351
WAC
Criteria for
municipal
solid waste
landfills
Establish minimum statewide standards for all municipal
solid waste landfill (MSWLF) units
1---------------------·--·-
70.05, 70.95
Chapter
173-303
WAC
I 43.21A.080
91.11.090
70.95
173-312 WAC
Dangerous
Waste
Regulations
Coordinated
Prevention Grant
Establishes and designates sitting, design, operation, tracking,
and handling responsibilities for hazardous waste
management.
-------
Provides guidance and funding to local health for monitoring
and enforcing solid waste violations.
-----. -
64 44 Decontamination
Chapt~r 246 _ of Illegal D~g Requires local health agency to post warnings and supervise
and Storage Sites 205 WAC j Manufactu~g clean-up of contaminated properties
,_ _____ ,__________ -------
Chapter 246-General Establishes rules for public or common nuisances that are set
203 WAC Sanitation up, maintained or continued so as to be injurious to the health
or an obstruction to the use of property including disposal of
dead animals. I ------t--------+------------------Residential
RCW 59.18 Landlord Tenant Requires local health jurisdiction to respond to complaints
Act I -
70.94 Washington Clean
Air Act
KCC Title 18: Chapter 18 .
Preserve, protect, and enhance the air quality for current and
future generations
Establishes enforcement actions for violations.
28
XIII. FUNCTIONAL ANNEXES:
Kittitas County Public Health Department
Laboratory Procedures Plan
Annex A
I. INTRODUCTION
II. PLANNING ASSUMPTIONS
III. RESPONSIBILITIES
IV. CONCEPT OF OPERATIONS
V. ATTACHMENT
Table of Contents
Attachment A General Packing and Transportation Procedures
Attachment B DOH Laboratory Certification
I. INTRODUCTION:
29
29
30
30-31
32-35
32-34
35
The use of laboratory services refers to classifying, handling, packing, and shipping hazardous
materials to local, state, and/or private laboratories in order to identify disease agents and
environmental health hazards. 24/7 Access to laboratory services will assist KCPHD in the
surveillance of diseases or environmental health hazards affecting Kittitas County during
outbreaks and emergency incidents.
II. PLANNING ASSUMPTIONS:
KCPHD has very limited capacity to collect specimens and has no testing capacity, internally.
This plan applies to incidents requiring services that exceed the capacity of KCPHD as well as
local health care providers and KVH. Local laboratory services will be overwhelmed in the case
of an outbreak. The Washington State Department of Health Public Health Laboratories in
Shoreline (accredited by the College of American Pathologists), Washington will be the main
laboratory contact. During a statewide disaster, KCPHD may utilize out of state laboratory
services. If a scene has been designated hazardous and a HAZMA T team is responding, KCPHD
will not collect samples and will defer to the appropriate agency.
29
III. RESPONSIBILTIES:
A. KCPHD will be responsible for the following activities:
1. Initiating the use of laboratory services.
2. Choosing the appropriate laboratory site to utilize for testing.
3. Coordinating with the laboratory regarding supplies, shipping, and results.
4. KCPHD staff may collect the samples or coordinate with the public or agencies in the
collection of samples.
5. KCPHD staff that collect samples will follow the appropriate collection method as
listed by Washington State Department of Health or the Environmental Protection
Agency, or other appropriate agency.
6. Receive testing samples including, but not limited to, samples involving stool, blood,
sputum, nasal swabs, water, or wastewater.
7. Communicate with the appropriate laboratory regarding supplies, shipping, and testing
results.
8. Act as courier for shipping and handling of specimens.
9. Ensuring staff are trained in Packaging and Shipping Division 6.2 materials and
trained staff is available to send emergency biologics 24/7.
a. Staff members whose position may require them to handle and ship more
dangerous Category A substances, and/or dry ice in quantities greater than 5.5
pounds, will complete formal training and receive a certificate in "Packaging and
Shipping Division 6.2 Materials." The training is available at no cost through the
Centers for Disease Control (CDC) online at
bttps://www.edc.gov/Jabtraining/cdc-lab-training-
courses/packing . hipping 62 materials.html . and periodically in person through
the Washington State Department of Health. Public Health Laboratories (PHL).
Currently. the positions requiring this training are the Community Health
Supervisor, Public Health Nurses, and the Health Officer.
b. Formal training and testing is not required of staff members who only handle
less dangerous Category B and Exempt substances. In this case, staff may receive
training from other staff members trained as described in section II.B above.
IV. CONCEPT OF OPERATIONS:
A. KCPHD staff will follow internal policy around procedures for shipping and handling of
hazardous materials.
B. KCPHD will coordinate with local labs such as KVH or other clinics within. Kittitas County
for laboratory collection of samples and specimens.
C. The local Health Officer, Community Health Supervisor, Environmental Health Supervisor,
and/or Public Health Administrator will authorize the use of laboratory services for KCPHD
submitted specimens or samples.
30
D. The above staff will initiate request for testing and the appropriate laboratory site.
E. In suspected bioterrorism situations, a law enforcement agency may transport the specimen
directly to the laboratory site.
F. Staff will utilize emergency contact number list for laboratory 24/7 coverage, which is
located in the Emergency Communication Plan annex. Should contact be unavailable via phone
or email, staff will utilize alternate means of communication including SAT Phone or partner
agencies for assistance such as Kittitas County Sheriffs Office or ARES/RACES HAM radio
operators.
31
Attachment A: General Packing and Transportation Procedures
1. The points of contact for shipping of laboratory samples for KCPHD are :
Primary: Community Health Supervisor
Alternate: Public Health Nurse
2 . Questions on shipping of environmental and clinical samples should be directed to the
Washington State Public Health Laboratory at (206) 418-5400 during business hours or (206)
418-5500 , a 24-hour number.
3. The following are the general procedures for packaging and transportation of suspected
bioterrorism and other infectious laboratory samples to the Washington State Department of
Public Health Laboratory (WSPHL).
a. All suspected specimens that meet the criteria for submission must be coordinated
with KCPHD first and then the Public Health Laboratory by calling (206) 418-
5400 during business hours or (206) 418-5500 a 24-hour emergency phone
number. No specimens will be accepted unless the Public Health Laboratory
has been contacted prior to arrival of the specimen.
b . In suspected bioterrorism situations, local law enforcement, HAZMAT,
Washington Sta te Patrol, or an FBI re presen tativ e will transport the specimen
directly to the Public Health Lab oratory at 1610 150 th treec N , Shoreljn , WA
98155 (north of downtown Seattle). However, public health employees may also
transport specimens as indicated.
Driving directions to the Washington State Department of Health Public Laboratories:
1-5 Northbound
Take NE 145th St. exit (Exit #175). After exiting, move to the far right lane . Tum right at the
traffic light onto NE 145th St. (eastbound). Proceed in the left lane on 145th St. to the next traffic
light at 15th Ave. NE. Tum left onto 15th Ave. NE, travel four blocks on 15th Ave. NE
(northbound) to NE 150th St. Tum right onto NE 150th. You will see the state laboratories on
the left at the intersection of 17th Ave. NE and NE 150th St.
1-5 Southbound
Take NE 145th St. exit (Exit #175). After exiting, stay in the left lane of the off ramp. Tum left
at the traffic light onto NE 145th St. (eastbound). Proceed in the left lane on 145th St. to the next
traffic light at 15th Ave. NE . Tum left onto 15th Ave . NE and travel four blocks until you reach
NE 150th St. Turn right onto NE 150th St. You will see the state laboratories on the left at the
intersection of 17th Ave . NE and NE 150th St. In cases where the specimen is shipped by
commercial carrier, State and Federal shipping regulations pertaining to infectious substances
must be followed.
A. Packaging specimens for testing at the Washington State Department of Health
Public Health Laboratories
1. Infectious substances must be packaged and labeled according to certain specifications as
outlined by the Washington State DOH Public Health Laboratories "packing and
shipping of infectious substances ." Material must be packaged "to withstand leakage of
contents, shocks, pressure changes and other conditions incident to ordinary handling in
32
transportation." The figure below shows how to triple package (primary receptacle,
watertight secondary packaging, and durable outer packaging) according to the
regulations.
a. Primary Package
The primary receptacle contains the infectious substance and must be watertight to
prevent leakage. These can be made of glass, metal, or plastic and should include
screw-top tubes, flame-sealed glass ampoules, or rubber-stopped glass vials fitted
with metal seals. Screw caps should be fastened with tape for extra safety.
b. Secondary Package
One or more primary receptacles are placed in a water-tight secondary package.
Absorbent material, sufficient to absorb the entire contents of the primary
container(s ), must be placed between the primary and secondary package. The
secondary package should be labeled with name, address, and telephone number of
the shipper.
c. Outside Package
The secondary package is placed into the outer packaging, which must be of
sufficient strength to contain and protect the contents within. Outer packages must be
UN-certified, signified by having a UN specification mark on the outside of the
package. Shipping regulations require that an itemized list of contents be placed
between the secondary package and outer package.
Below is an example of packing for shipping of samples to the Washington State Public
Health Laboratory.
Packing and Labeling of Infectious Substances
Environmental Samples
Collection of environmental samples of concern is normally done by HAZMA T teams as
part of their response to a contaminated scene. HAZMAT teams should follow their
normal procedures for sampling and packaging of the materials.
33
B. Clinical Samples
1. Collection of diagnostic samples is normally done in clinical facilities. Confirmatory
testing is done by WPHL. WPHL will perform confirmatory testing for the following
diseases: Anthrax, Botulinum toxin, Tularemia, Plague, Brucellosis, Meliodosis, and
Vaccinia.
2. Confirmatory testing for smallpox is currently performed only by the CDC.
3. Currently, DOH has guidelines for clinical laboratories for the following diseases:
Smallpox, Anthrax, and Plague, Tularemia, and Botulinum toxin.
C. Questions on shipping of environmental and clinical samples should be directed to the
Washington State Public Health Laboratory at (206) 418-5400 during business hours or
(206) 418-5500, a 24-hour number.
34
Attachment B: Washington State Department of Health Lab Accreditation Certification
..•.
Washington State Department of Health
This organization
Department of Health Public Health Laboratories
is authorized by RCW 70.42 to have a
Medical Test Site Accredited License
Operated by Washington State Department of Health CUA# 50D0661453
Located at 1610 NE 150th SI
Shoreline, WA 98155-7224
Secrelary
MTS < Calegory J
Stalus
ACTIVE
Cre<lenllal Number
MTSA.FS.00001327
Effeclive Dale
07/01/2017
THIS LICENSE IS NON-TRANSFERABLE
Expiration Date
06/30/2019
:::::::. COLLEGE of AMERICAN
~::::;:: PATHOLOGISTS ·•··
The College of American Pathologists
certifies that the laboratory named below
Washington State Department of Health
Public Health Laboratories
Shoreline, Washington
WIiiiam A. Glover, II, PhD,D(ABMM),MT(ASCP)
CAP Number: 2462601
AU-!D: 1188564
CLIA Number: 50D0661453
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35
Kittitas County Public Health Department
Isolation and Quarantine
(Adapted from: Public Health -Seattle & King County Isolation and Quarantine Response Plan
Version 2)
AnnexB
Table of Contents
I. INTRODUCTION
II. PURPOSE OF PLAN
III. PLANNING ASSUMPTIONS
IV. RESPONSIBILITIES
A. Kittitas County Public Health Department
B. Local Law Enforcement
C. Prosecuting Attorney's Office
D. Community Based Organizations
V. CONCEPT OF OPERATIONS
A. Determination of Need for Isolation or Quarantine
B. Initiation of Requests for Voluntary Compliance
C. Involuntary Detention
D. Release from Isolation or Quarantine
37
37
37-38
38-39
39-43
36
I. INTRODUCTION:
Isolation is the separation of infected persons from others during the period of communicability.
Quarantine is the limitation of freedom of movement of well persons who are suspected to have
been exposed to an infectious agent. Quarantine lasts as long as the usual incubation period of
the infectious agent. Persons assigned to care for infectious or potentially infectious individuals
must be protected as well as patients.
II. PURPOSE OF THE ISOLATION AND QUARANTINE RESPONSE PLAN:
A. Establish the decision making criteria used by the County Health Officer to determine when
isolation and/or quarantine beyond the capacities of communicable disease practices is necessary
to minimize health impact of a disease outbreak.
B. Identify the authorities, roles, and responsibilities of KCPHD and partner agencies in the
situation of a disease outbreak requiring isolation and quarantine (I & Q) of one or more
individuals.
C. Describe procedures and activities for accomplishing I & Q oflarge numbers of individuals in
the county.
E. Describe procedures for staffing a dedicated facility for I & Q of persons who cannot stay in
their homes or who do not have a suitable home environment.
F. Define roles and responsibilities for KCPHD, local health care partners, and local response
agencies during an outbreak requiring isolation and/or quarantine.
G. Describe how communications and coordination will occur between KCPHD, local and state
entities during such an incident_.
H. Assist KCPHD and response partners to limit the spread of infectious diseases, illness, and
death within Kittitas County.
III. PLANNING ASSUMPTIONS:
This plan applies to communicable disease occurrences requiring isolation and quarantine that
may exceed day to day capabilities. While I & Q are techniques used in the everyday
management of infectious disease, this plan does not apply to the prevention and control of
sexually transmitted diseases, or routine operation of communicable disease management.
A. Isolation and quarantine planning efforts must incorporate and address the unique needs and
circumstances of vulnerable populations including the homeless, limited English proficiency
populations, persons with special medical needs, etc.
37
B. All policies and procedures to assure the care of protected health information apply. Policies
and procedures recognize that KCPHD may make necessary disclosures to protect the health of
the public.
C. Isolation and quarantine may be necessary beyond Kittitas County; therefore KCPHD will
coordinate with other counties and regions, but is not responsible for planning or execution of I
& Q efforts beyond county lines.
D. Large scale I & Q incidences will require many public health resources and volunteers as well
as coordination with multiple communities, health care and first responder agencies.
E. KCPHD may utilize I & Q as one of several tools to reduce the spread of communicable
disease; KCPHD will focus on gaining voluntary compliance from ill or exposed persons and
implementing the least restrictive means possible to reduce the spread of infection.
F. KCPHD will coordinate closely with healthcare providers and healthcare facilities to assist
with achieving voluntary compliance of ill or exposed persons.
G. I & Q may require the involuntary detention of individuals who may pose a threat to the
public's health and whom do not cooperate with requests from the Health Officer.
H. An individual's cooperation with voluntary isolation and quarantine will be assumed in good
faith unless there is evidence to the contrary. Depending on the circumstances, information
collected by KCPHD during monitoring may be used as evidence of non-cooperation.
VII. RESPONSIBILITIES:
A. In the event of a reported or suspected case of a communicable disease, which requires
isolation or quarantine, the Health Officer may at his or her sole discretion issue an emergency
detention (health order) causing a person or group of persons to be immediately detained for
purposes of isolation or quarantine. The local Health Officer has three options for initiating the
quarantine or isolation of an individual including issuing a voluntary request, an emergency
involuntary detention order, or a court order for an involuntary isolation or quarantine. KCPHD
will be responsible for the following activities:
1. KCPHD will be the lead agency in the management of a communicable disease
outbreak.
2. The Health Officer will assess the public health threat, evaluate potential
consequences based on established criteria, and determine whether isolation and/or
quarantine are necessary in any given outbreak situation.
3. The local Health Officer may initiate the isolation or quarantine of individuals as a
protective action to limit the spread of infectious agents or contaminants to others.
4. When possible, KCPHD will seek the cooperation and compliance of infected or
exposed individuals in abiding by I & Q requests. However, under specific
circumstances, KCPHD may immediately order or seek a court order to detain infected or
exposed individuals and place them in isolation or quarantine.
38
5. In all cases where I & Qare considered, KCPHD will ensure basic needs are
addressed .
6. KCPHD will implement local and regional surveillance and disease and health
management services that comply with clinical protocols and federal, state, regional and
local regulations, laws and guidelines.
7. KCPHD will be the lead clinical and administrative manager of any non-hospital
isolation or quarantine facilities that are established.
B. Local Law Enforcement agencies will be responsible for the following activities ;
1. Assist with service of Notice of Civil Detention to clients, if needed.
2. Consult with KCPHD for cases requiring transportation for the purposes of
involuntary isolation or quarantine.
3. Execute arrest warrants related to I & Q cases.
C. The Prosecuting Attorney's Office will be responsible for the following activities:
1. Petition the court ex parte to authorize involuntary detention, once need is determined
by the local Health Officer.
2. Represent KCPHD in any petition or appeal hearings required to carry out involuntary
isolation or quarantine of individuals.
3. Coordinate with KCPHD and local law enforcement to serve notice necessary to
achieve isolation or quarantine.
D. Community based organizations may be requested to assist with personal needs of patients
affected by I & Q.
VIII. CONCEPT OF OPERATIONS:
Determination of Need for Isolation or Quarantine
A. The local Health Officer will determine the need for and authorize the use of isolation and/or
quarantine as strategies to control or slow a communicable disease outbreak.
B. The Incident Commander with advice from the local Health Officer will determine whether
an isolation or quarantine facility should be activated.
C. KCPHD will seek voluntary compliance with requests for isolation or quarantine, unless the
local Health Officer determines the following conditions are present, making it necessary to
immediately initiate involuntary detention for the purposes of isolation or quarantine:
1. There is reason to believe that the individual or group is, or is suspected to be, infected
with, exposed to, or contaminated with a communicable disease or chemical, biological,
or radiological agent that could spread to or contaminate others if remedial action is not
taken; and
39
2. There is a reason to believe that the individual or group would pose a serious and
imminent risk to the health and safety of others if not isolated or quarantined; and
3. Seeking voluntary compliance would create a risk of serious harm.
D. Initiation of Requests for Voluntary Compliance with Isolation or Quarantine
The Communicable Disease (CD) Investigations Team (consisting of the Community Health
Supervisor, other public health nurses, regional epidemiologist, public health clerk, and other
staff as necessary) will:
1. Initiate contact with the individual or group suspected of being infected or exposed.
2. Determine whether interpretation services are needed to facilitate communication with
the person; if so, coordinate this issue with interpreter services to provide a certified
medical interpreter.
3. Maintain documentation related to cases including dates and times of all verbal and
written communications.
4. Verbally communicate the following information to the individual or group:
a. Explain the circumstances regarding the infection or exposure, the nature and
characteristics of the illness, and the potential for infection of others. (Provide
written material when available.)
b. Request that the individual or group isolate or quarantine themselves.
c. Explain the process isolation and quarantine, what is expected of each
individual, how KCPHD will support their needs, and how long they must remain
under isolationor quarantine.
d. If necessary, explain that the local Health Officer has authority to issue an
emergency detention order or petition the court ex parte for an order authorizing
involuntary detention if the individual or group does not comply with the request
for isolation or quarantine.
E. If an individual is a patient in a hospital, make contact with hospital staff as well as the
patient to ensure hospital-based isolation and appropriate infection control measures are
practiced, if indicated.
F. Complete a written request for voluntary compliance with isolation or quarantine instructions
to include the location and dates of isolation or quarantine, suspected disease, medical basis for
isolation or quarantine, and relevant patient information. Provide copies to the local Health
Officer, Prosecuting Attorney, and patient.
G. Alert the local Health Officer and Prosecuting Attorney about situations in which a person or
group indicate unwillingness to comply. Recommend consideration of the initiation of
involuntary detention if warranted.
H. Coordinate with the Regional Epidemiologist regarding the issuance of requests for voluntary
compliance with isolation or quarantine instructions.
40
I. Contact the identified individual to evaluate the suitability of their residence for isolation or
quarantine; determine whether evaluation can be implemented using a telephone questionnaire or
if an in-person review is necessary.
J. Immediately deliver an informational packet to the individual placed in isolation or
quarantine. Provide appropriate instructions and training, if needed, regarding the packet
contents, KCPHD expectations, and infection control measures [Note: patients isolated within
healthcare facilities may only require an informational packet; the healthcare facility may
address training needs and infection control issues for the patient].
K. Verify that the individual is at a specific location and monitor their health status .
1. Develop a schedule of daily check-in calls for each individual under isolation or
quarantine.
2. Continue conducting daily check-in calls with each individual until they are released
from isolation or quarantine.
L. Record information gathered during check in calls .
M. Respond to irregularities such as changes in health status and failure to respond to call(s)
[e.g. request law enforcement or KCPHD staff to drive by; make contact with the patient's
healthcare provider, personal contacts or employer, etc.].
If repeated attempts to locate individuals subject to isolation or quarantine, including telephone
calls and site visits, are unsuccessful, coordinate with the Incident Commander, Prosecuting
Attorney, and the local Health Officer regarding the need to pursue involuntary detention.
N. Document all requests for assistance. Include the nature and specific type of assistance
requested, and the date and time the request was made, including contact and phone number.
Reasonable requests for assistance could include food, water, clothing, shelter, means of
communication, medication, medical care, special needs related to cultural and religious beliefs,
and legal representation.
0. Follow up with referral agencies on requests for assistance as staffing and time allow .
P. Coordinate with hospital discharge planners to provide KCPHD with appropriate notice
regarding the discharge of isolated patients.
Q. Ensure that patients are aware of the continuing requirements of isolation and appropriate
infection control measures.
R. Involuntary Detention for Purposes of Isolation or Quarantine.
The local Health Officer may authorize initiation of involuntary detention for the purposes of
isolation or quarantine under the following conditions:
41
1. There is reason to believe that the individual or group is, or is suspected to be, infected
with, exposed to, or contaminated with a communicable disease or chemical, biological,
or radiological agent that could spread to or contaminate others if remedial action is not
taken; and
2. There is reason to believe that the individual or group would pose a serious and
imminent risk to the health and safety of others if not detained for purposes of isolation or
quarantine; and
3. KCPHD has made reasonable efforts, which have been documented, to obtain
cooperation and compliance from the individual or group with requests for medical
examination, testing, treatment, counseling, vaccination, decontamination of persons or
animals, isolation, quarantine, or inspection and closure of facilities, or the local Health
Officer has determined that seeking voluntary compliance would create a risk of serious
harm.
S. The local Health Officer may petition the Superior Court for an order authorizing continued
detention for up to 30 days following the initial 10-day detention, pursuant to WAC 246-100-
040( 5). In order to grant the petition, the court must find clear, cogent, and convincing evidence
that isolation or quarantine is necessary to prevent a serious and imminent risk to the health and
safety of others. If necessary, the local Health Officer may petition the Superior Court for one
additional 30-day period of detention, pursuant to WAC 246-100-040(6).
T. The Kittitas County Prosecuting Attorney's Office will represent the local Health Officer in
court proceedings for involuntary detention.
U. The Kittitas County Prosecuting Attorney will coordinate with and brief law enforcement
officials for the jurisdiction(s) in which emergency detention orders or court orders will be
served. If necessary, the Prosecuting Attorney will request law enforcement support for
enforcement of detention orders.
V. The Communicable Disease Investigation Team Leader will provide technical information to
law enforcement regarding the nature of the illness and appropriate protective actions and
equipment to be used during enforcement of orders.
W. The Incident Commander, local Health Officer, Prosecuting Attorney, and logistics will
resolve issues related to locations for detained persons. Detentions will occur in the least
restrictive settings possible that do not endanger the health of the public.
X. KCPHD will provide monitoring and support services to persons involuntarily detained,
using the protocols applicable to persons who are voluntarily complying with requests for
isolation or quarantine. Modified protocols may be necessary if the location for detention is a
correctional facility or other secure residential facility.
Y. Release from Isolation or quarantine will include the following:
42
1. The local Health Officer will release an individual or group from voluntary
compliance with isolation or quarantine when isolation or quarantine is no longer
necessary as a strategy to control a communicable disease.
2. The local Health Officer will release an individual or group from involuntary
detention for purposes of isolation or quarantine based on if the individual is no longer
suspected to be infected with, exposed to, or contaminated with a communicable disease
or chemical, biological, or radiological agent; or the individual is no longer deemed to
pose a serious and imminent risk to the health and safety of others if released from
isolation or quarantine.
3. If release of a detained person is authorized before the expiration of a detention order,
the Prosecuting Attorney's office will coordinate the activities necessary to accomplish
release.
43
Kittitas County Public Health Department
Medical Countermeasures and Material Management
Annexe
Table of Contents
I. PURPOSE
II. ASSUMPTIONS AND LIMIT A TIO NS
III. COMMAND AND CONTROL
IV. RESPONSIBILITIES
V. OPERATIONS
VI. ATTACHMENTS
45
45
45-46
46-47
47-50
Attachment A Medical Countermeasure Points of Dispensing 51-52
Attachment B POD Agreements 53
Attachment C Agency Partnerships 53
Attachment C Surge Capacity Staffing List 54
Attachment D Patient Registration Form 55
Attachment E Local Mass Clinic Facility Worksheet 56
Attachment F Antiviral Withdrawal Form 57-58
44
I.PURPOSE:
This plan describes the process for requesting, receiving, managing, distributing, and dispensing
medication in an emergency, including any supplies from State, Federal, or private sources. The
US Department of Homeland Defense and US Centers for Disease Control and Prevention
(CDC) manage the Strategic National Stockpile (SNS) at the national level; the Washington
State Department of Health (DOH) manages the SNS at the Washington State level, and KCPHD
manages the SNS within Kittitas County.
II. ASSUMPTIONS AND LIMITATIONS:
A. From the time DOH receives the request for supplies, it will take approximately 6 to 18 hours
to distribute its contents to the local health jurisdiction (LHJ). Managed inventory deployed
from the federal level would take from 12 to 24 hours.
B. Additional staffing, supplies, and logistical resources will be needed in a large scale
emergency in Kittitas County to implement medical countermeasures.
C. A successful large-scale distribution of medical resources requires the involvement and
participation of a wide-range of community organizations, businesses, and volunteers.
D. Deployment of medical countermeasures is dependent on an accurate and timely
identification of the disease or bio-terrorist agent that constitutes the public health threat.
E. The number of medical personnel qualified to administer vaccine or dispense
pharmaceuticals, and the number of available volunteers to perform support functions, will
dictate the rate at which residents are treated. Residential estimates within Kittitas County 2014
are as follows:
Unincorporated 18,890
Incorporated 23,210
Cle Elum 1,870
Ellensburg 18,440
Roslyn 895
South Cle Elum 530
F. KCPHD lacks the staffing needed to operate all Points of Dispensing (PODs) required in
immunizing or administering chemoprophylaxis to Kittitas County residents.
G. When chemoprophylaxis supplies are limited, KCPHD will develop a prioritization plan in
accordance with recommendations from the CDC and/or from DOH. The health officer will
coordinate this prioritization.
III. COMMAND AND CONTROL:
A. Specific recommended policies for LHJs and Tribes for the State of Washington concerning
emergency medical countermeasures are listed as follows:
45
1. State of Washington policy dictates that only the Governor or the Governor's designee
may request the assistance of the Centers for Disease Control and Prevention's Division
of Strategic National Stockpile. Local jurisdictions should request specific assistance or
resources from the state. The state processes and determines the source of the needed
resources.
2. DOH recommends to LHJs that a single family member may be allowed to pick up a
regiment of emergency medical countermeasures for each family member or household
member listed on the screening and dispensing form(s). The age and weight of each
person under 75 pounds must be listed.
3. DOH recommends that an unaccompanied minor is any minor over the age of 15 and
may be allowed to pick up any needed emergency medical countermeasures for
themselves and their immediate family members as described above in 2.
4. DOH recommends that the identification needed to receive emergency medical
countermeasures is the name, age, and address recorded on the screening and dispensing
form( s ). Proof of residency is not recommended and should not be used to determine the
need of a medical countermeasure, which may save the life of the citizen in question.
5. DOH is not a law enforcement agency and recommends that the use of force should be
at the discretion of law enforcement professionals and their agencies. Any use of force
should be as a last resort in order to control an aggressive situation, protect citizens from
harm, or to protect the lifesaving resources.
6. DOH policy is that all victims of any public health emergency will be treated with
respect, dignity, and equality. In an incident that the needed countermeasures are in short
supply, medical countermeasures received will be supplied on a prorated allocation based
on the epidemiology of the disease agent.
7. Our nation's military members and their family members are included in population
estimates and will be provided emergency medical countermeasures based on their
exposure to the disease agent. The US Department of Defense may provide
countermeasures to active duty troops initially. In an event that the needed
countermeasures are in short supply, medical countermeasures will be supplied on a
prorated allocation.
IV. RESPONSIBILITIES:
A. KCPHD is the lead agency in Kittitas County for medical countermeasures and medical
material management and distribution. KCPHD is also responsible for an annual review and
update of this plan, for training mass dispensing/vaccination personnel, and for exercising the
medication distribution plan.
B. Other Kittitas County agencies may perform support functions as requested in accordance
with the Kittitas County Emergency Management Plan (CEMP). Specific responsibilities may
include:
1. Law enforcement may provide security and traffic control at PODs. Law enforcement
officer posts will be determined based upon need.
46
2. The Kittitas County Public Works Department or Kittitas County Search and Rescue
may assist with traffic control.
3. Kittitas County Medical Reserve Corp volunteers will assist with vaccine/and or
administer medicine.
4. Emergency Management will direct the County EOC and coordinate emergency
response activities in accordance with existing procedures.
5. Transportation for people with function or access needs may be available through
Hopesource and Ellensburg School District.
6. Fire and Emergency Medical Services and W Aserv volunteers may support clinic
operations, as needed.
V. OPERATIONS:
A . KCPHD (Via Kittitas County Emergency Management) will request deployment of resources
as circumstances warrant when the local Health Officer or designee determines it is necessary to
protect the public's health.
The determination to request resources from the state will be based upon the local Health
Officer's assessment of the need for additional medical materials based upon coordination with
the local hospital and other healthcare entities including pharmacies, healthcare providers, and
local officials.
Requests to the state would be in broad terms, for example, "prophylaxis medical
countermeasures for 30,000 against Tularemia."
B. Within Kittitas County, the following individuals may request the deployment of SNS
material and/or resources:
1. Local Health Officer, KCPHD Administrator, or designee
2. Local Emergency Response Coordinator (LERC) for KCPHD
3. Emergency Management Director for Kittitas County
4. Kittitas County Board of Health
C . Resupply of medical materials will be initiated as circumstances warrant. Any resupply
request will be coordinated by the Inventory Leader and will be approved by the Health Officer.
Requests for additional supplies will also be forwarded to the EOC for records.
D . Receiving SNS Material
1. The Washington State Department will be responsible for the following SNS activities:
a . Formally request the SNS from federal authorities
b. Receive and breakdown the SNS, repackage into unit doses, and affix labels.
c. Ship SNS resources to the POD locations designated by KCPHD
d. Assess resource request from KCPHD or Emergency Management Agency for
supplemental medications, vaccines, medical supplies, and equipment.
47
2. The Kittitas County Public Health Department will be responsible for the following
medication distribution activities:
a. Request needed resources via Kittitas County Emergency Management
b. Identify POD locations to be utilized
c. Prepare POD locations for operation
d. Dispense medications to and/or immunize residents
e. Coordinate security and management for resources deployed to Kittitas County
f. Follow guidelines from DOH and the CDC regarding dissemination of
resources and medication including priority distribution.
E. KCPHD will utilize local and county law enforcement for POD site security, perimeter
control, and facility access.
F. POD site selection will be determined by the local Health Officer. Because several locations
in Kittitas County are identified for possible consideration as medical countermeasure Points of
Dispensing sites (Attachment A) a list of POD site/agency partnerships from previous POD sites
is supplied (Attachment B). These sites provide for distribution of medication/vaccines and
other supplies in both the upper and lower portions of the county.
Depending upon the disease being addressed and the overall situation, the local Health Officer,
or designee, may decide to immunize or provide chemoprophylaxis for populations at risk or the
entire population of Kittitas County. The decision to use any of the mass vaccination/mass
dispensing site or PODs will be dictated by the needs of the emergency, the population to be
served, staffing requirements, and the availability of sites.
Incident Command staff, in conjunction with the local Health Officer may also consider utilizing
alternative push and pull dispensing methods, such as a drive-thru pharmacy, drive thru clinic,
in-house dispensing (large employers, hospital, etc.) or on-site dispensing (jail, nursing homes,
etc.)
G. Site setup will be handled by the appointed Inventory Leader. The Inventory Leader will
manage reception, storage, and maintenance of the supplies provided to the PODs. The number
of vaccination/dispensing stations needed at a site may change depending on the affected
population.
H. Certain pharmaceuticals require proper storage in order to maintain potency. All vaccines
will be kept at the advised temperature, ensuring no breaks in the temperature chain.
Refrigeration for pharmaceuticals will be accomplished by utilizing refrigerators on site at
facilities, by utilizing mobile refrigeration units, or by using temperature monitored (with a
thermometer) Styrofoam containers containing ice packs. The method will vary based on POD
location.
I. The Reception, Storage, and Staging (RSS) facility operated by the Washington State
Department of Health will be responsible for labeling pharmaceuticals. Individual unit of use
bottles are pre-labeled and any bulk material will be repackaged at the RSS or a contractor and
appropriate labeling affixed prior to shipment. The local Health Officer or designee will be
identified as the prescriber.
48
J. Tracking pharmaceuticals and/or vaccines with recipients will be accomplished using the
Patient Registration Form (Attachment C). The form will be used to obtain a patient's health
history, consent for treatment, and to track drugs/vaccines after distribution.
A family member may pick up medication only for other members in their immediate family.
(Recommendations from DOH suggest the widest definition of immediate family member such
as spouse, child, parent, partner, etc.) Situations requiring special consideration will be reviewed
by the Vaccine Administration Leader, pharmacist, or designee at the time of dispensing.
Persons age 15 and up are considered adults. Minors (age 14 and under) must be accompanied
by a parent/guardian to receive medication/vaccination. The parent/guardian will be asked to
sign a consent statement prior to the minor receiving medication/vaccination. Unaccompanied
minors will be evaluated on a case-by-case basis. Specific direction from DOH or CDC may
preempt local plans for distribution.
K. Dispensing may have a predetermined prioritization. Medical and emergency responders,
public health staff, and other critical personnel may receive their immunizations or
chemoprophylaxis before the general public in accordance with a prioritization determined by
the local Health Officer, the Centers for Disease Control and Prevention (CDC), and/or the
Washington State Department of Health.
Any adverse reactions to medication will be noted on the Patient Registration Form and any
adverse reactions to vaccinations will be entered through the Food and Drug Administration
(FDA) Adverse Event Reporting System (F AERS).
L. The decision to cease medical countermeasures operations and to return to normal operations
will be determined by the local Health Officer, or designee, following consultation with the local
hospital, healthcare professionals, and community partners on the status of the incident that
caused activation of the medication distribution.
M. All staff and volunteers must be credentialed prior to responding to an incident. Volunteers
must first register with Kittitas County Emergency Management as an emergency worker prior to
assisting in an emergency. Currently, credentialing of staff and volunteers will be conducted
through the Sheriffs Office in conjunction with WAServ (Emergency System for Advance
Registration of Volunteer Health Professionals) and Washington State Department of Health.
All staff is required to wear their county name badges when participating in a
dispensing/vaccination clinic.
Spontaneous volunteers may be utilized only upon verification of identification and
credentialing, and only if the nature of the crisis exceeds current staff and Medical Reserve
Corps (MRC) capacity. Spontaneous volunteers shall be subject to the same requirements as all
previously credentialed volunteers.
All volunteers will be required to show photo identification upon check-in at each venue.
Volunteers with professional credentialing should bring their licenses. If available, a photo copy
of each license will be made and stored in the volunteer's file. License numbers and expiration
dates will be recorded.
49
N. Sanitation such as medical wastes will be disposed of following the guidelines provided by
the Washington State Department of Health. All sharps will be disposed of in rigid sharps
containers that will be sealed following use. Appropriate medical waste will be "red-bagged,"
and placed in watertight, puncture-resistance containers for transportation. Other wastes will be
disposed of in the trash at the clinic site. If regular trash service is not provided at the clinic site,
KCPHD will contract with a commercial sanitation provider for a dumpster and collection
service.
50
Attachment A: Medical Countermeasure Points of Distribution
Area School/Facility Address City Zip Code Phone Contact
Central Kittitas County 507N Ellensburg 98926 509-962-Administrator
Public Health Nanum 7515
Department Street
Central Grand Meridian 504 East Ellensburg 98926 (509) 962-Private
Mountain 1992 Owner(s)
View
Central Kittitas County 512 N. Ellensburg 98926 (509) 962-Event Center
Teanaway Hall Poplar 7639 Director
Central Ellensburg High 1203 E Ellensburg 98926 (509) 925-School
School Capital 8013 Superintendent
Ave
Upper Cle Elum/Roslyn 2694 SR Cle Elum 98922 509-649-School
School District 903 4850 Superintendent
Walter Strom
Middle School
Upper Cle Elum Senior 719 E Cle Elum 98922 509-674-President
Center Third 7530
51
Number of Drive 1bru Vaccination Centers (DVC) or Points of Distribution Sites (P()Ds)
Per-DVC Patient Processing Rate
Name Formula
Number ofBriefiru, Rooms
Number of Patients per
Briefing
Duration ofllach Briefing
(Minutes)
Maximnn Patient Flow Per
Clinic, Given These
Parameters (Per Minute)
Maxirrum Patient Flow Per
Clinic, Given These
Parameters (Per Hour)
#DIV/0!
#DIV/0!
Clear Number of Briefing
Rooms, Patients, and Duration
Cells
Commmity Wide Flow Rate
Name
Pooulation Size
Number of Days ror
Proohvlaxii
Commmity Wide Patient
Flow Rate (Patients per
Minute)
Community Wide Patient
Flow Rate (Patients per
Formula
Hour) #DIV/0!
Nwmer ofClinics Required
to Achieve Prophylaxis Goal
in Allotted Tim: #DIV/0!
Clear Population Size, Number of
Days, and Patient Flow Rate per
Minute
52
Attachment B: POD Site/Agency Partnerships
Name Role Contact Person Status
Kittitas County Use of Facility 962-7639 9.6.13 spoke to Event Center
Fairgrounds Director. No MOU needed.
Kittitas County Public Traffic 962-7253
Works control/security
Ellensburg School Facility usage and 925-8000
District Transportation
support
Cle Elum/Roslyn Facility usage 649-4850 MOU signed
School District
ARES/RACES Coordination of local 933-8218
operators
Hopesource Transportation 925-1448
assistance
Kittitas County Sheriff Security and traffic 509-962-7525 CEMP
control at all
facilities
I
Search and Rescue
Volunteer
Grand Meridian Parking lot usage for 929-5000 Verbal agreement and
Cinema triage in an 925-7757 previous use of location.
emergency
Upper Kittitas County Facility Usage 674-7530 MOU Signed
Senior Center ( designated
emergency shelter)
Kittitas County Assistance
Pharmacies distributing medical
countermeasures
53
Attachment C: Surge Capacity Staffing List
Staffing Role A2ency/ A2encies Contact Person Status
Nursing Staff KVH Jim Allen
MRC KCPHD 509-962-
7515
Additional Medical KVFR Rich Elliott 509-
Personnel 933-7231
Communications cwu Dawn Alford 509-
KVH 963-5378
KCSO
Veterinarian and/or Request Via EOC Darren
animal caretaker Higashiyama 509-
201-6013
EH Specialist Region 7 County Ray Eickmeyer MOU signed
Partners 509-670-244 l
Administrative Region 7 County Ray Eickmeyer MOU signed
Personnel Partners 509-670-2441
Deputy Registrars Region 7 County Ray Eickmeyer MOU signed
Partners 509-670-2441
54
Attachment D: Patient Registration
Client Information:
Last Name I First Name ~ Middle Initial
Street Address City State/Zip Code Race/Ethnicity
(Mark all that apply)
Mailing Address (if different) City State/Zip Code • Native American or Alaskan
• Asian • White
Phone # 1 May we leave a message? DY • I Phone#2 May we leave a message? 0 Y ON • Black or African American
N • Hispanic/Latino •
Birthdate Sex •M •F Marital Status: • Single • Married • Divorced
(Month/Day/Year) Other • Separated • Widowed •Partnered
Primary Language Do you need an Regular Family Doctor or Clinic
interpreter?
If client is a minor or deoendent. olease fill jn information about oarent or Ie11al mtardian:
Last Name First Name Middle Initial Relationship
• Mother • Father
Address City State/Zip Code • Foster Parent •
Grandparent
Phone # 1 May we leave a message? DY • I Phone #2 May we leave a message? DY ON • Legal Guardian
N • Other:
Health Insurance Information (mark all that anolv):
D No insurance D Medicare D Medicaid D Private Insurance • Tricare • Other
Does the insurance cover immunizations? • Yes •No D I don't know
Is there more than one health insurance company? •Yes •No
Is health insurance provided through an employer? • Yes •No
PLEASE PRESENT INSURANCE CARDS AT TIME OF APPOINTMENT
55
Attachment E: Local Mass Clinic Facility Worksheet
Local Strategic National Stockpile~Jass Clinic Facility Worksheet
±.l:,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!-!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!l!!!!! _____ ....,_!!!!!!!l!!!!!!!!""""lil
County N ame: [ Public Health Region#:
Facility N ame: ! I Facility Code:
Facility Address: ! : Location Cross Street:
Facility Owner:. ! Facility Owner Phone:!
Primary Point of Contact I Alternate Point of Contact !
N ame/Title: Name/Title:: ---------------+------------------------11
DayPh~n_e_: ____________ __,. ________ D_a~y~P_h_o_n_e_: ___________ --1
1
Evening Phone: Evening Phone: --------------+-----------------------.. ,
QCell Phone I O P-ager. 0 Ccll Ph one / O Pa.11er: ---------------+------'=------=-=-----------------11
emai l address: email:
Facility capacity: I Sq. ft.:
_U !_Facility,:u-s ~ a ecmen.1 I~ la ce 0 Etectricity (a d~ua1 e o u.tkl.5 in clinic area) g Ba_cJ(\11?. J)O\\;tr source -
8 Adequat e road access 1 Wa t source: '.Cf -·AoA-rt'.l trcionis , i4 of stalls: ..
0 Sewer or 0' on-site sewage system
Htlicopta landing pad: [lon-site / 0 nearby D athletic fields ·
0 , Alt. tTallSPonaLiorl' available:
N umb er of Puking St·i!.lh : I
, q : :f en_!:~g l..)ar?und fa clli.ty O around loadin_s area 0 Loading d ock
B , !c)_eph o111, a,·aila.bi!it y. P o~~l cruaHi ues :
f (add other items qfmlar,m h ,m,)
,._O j .(a_d_~ '?0 fJ ~.:_tems gf_imemt_!ie;:f) ..
I CL f'!~d oth111: ite1!1~efinterest lien;,, ~ -·· _ D I A d equate RV AC capad1 to mainr~in '1noiuial" temp in
·' , clini c area (as p er dn!_g ~t otagc guiddiu.es, 68-77 ":F)
0 I Plan customized to fit facility, following attachments
, · i (;Ol)).Jll-C l td
D Location map D site plan O clinic p lau D D ~eded e4uip, list
Facilit Plan Co oxd.in.ite d With :
..
L ocal H ealth furisdi.aio11 i ·; ' Law Enforcement Agency: I
------------~ ;---------------111
Emergency Management: 1 Fire Services:
Chief Electe~ Offi~~s: !~----------~· F:~ty ~~vner: j
56
Attachment F:
AnlfriraJ With drawaJ F orm
Date o flre quest:
fo cm l11J1 tructi:an .:
1-. DO Em ~n-c-,• F~e i:-:a re d n :.n711d Ru n10.IEP ] .p, u..ll:1. le to .,ecc i~c ""'I es t.I fo1 11~1ivlt al
mc d~aNnsir-,..;r, 1=1 hn llh Ju ru.:l ldb".
~-To ord en.nf •1r.ils , ;o r•~uestin.; LH! • rn f ly nu s ·to~m pl c~ t lr-fcrm. P na e:i mi:J •t• SOI! the fo rm
.id ,e;m. 1 ll to tusica.b.a;;,;n@:dah .w,uov :and Qurtes copy dahe=Ul@doh r.a.;o • u sto.; ~o.nth• nJ
"ith d ~.iv@ m t h e s u b-j<e ct On e .
3 . UOH Emc rgc n-:y Pr~p a,c:!n-u• and Re sponse l EP ) w1U i::=-nfln ate rc 1 u uts ,Yii h t c W:u h, ;tQn :int:
Ph:mn;o:y Assoc:iaf::n to ve rify• pplf <:;h :rin :r.1Mty . The n, cn::11 ihc r:qu e ,t has bo_u, ,Ffro\l e d by
OOH lc .rd c rih ip~ DO !i EP R s t ~ ,ID work to lcc~tt' the q ue,tcd mi,dbti:i n, in c itherth e cu rt ent
~_u p p,lych ain o r ,t.xk fro m th e_ oo k a ~h,c.
J . lf m c d t fa os arc ;r,·ai J;,b lc, .D O 6'11: :rt.i lh-1111 wn tr.t t h e r-e.qu :,tin;l:r-al h e alth j rbdlctia-n t;:i
a.nfifll" rntpi;io , lou l:bn ~d pol~t o lc,:,n r,;-t.
5 . .OO H El'R wiJl a u i;n a C'IU~me , n~ .;)<d e r n uml:ce to th: r:qu euin .; k:-.a l h.,,.ilt J risdic1~:n. :irnota l c
tile n uri'tl:e r o n p~e M,, .i d san/cmllil 1ttthe JF-p ro~e d q11an1,t ofan,-lr.i1s ~t h i: re c;uc .n ir ;~I
ce-alth ju 1is_di:ti::11 . Estitnmd t im,, <>hntin.l dapv t.:h 11p0n the uq;c nC)"Of t h e ,it1,:11 i~n, t ime re c e ived.
an ~ ;ec;;rp Fhr-l~n.
6, Th e ,e q u u fin ; ~,I hnlth jl!ril:d.:tj~11 ill •~n an d d ate IO r..k/1 v,le d;;e rc.a:lpl <>f an ti-.•iralJ upo:n
de ll very .
7 . Th e reque t in11 ~:;I hc!a lth jo risd i:ti:,n v,il l =-;,u to t1m,r1t llf<e =tock ro DOH fPR wli~in 60 dOY;, Wltl!
a n cxpir.im -n d ate of at le ac t tlm :i: y ear> ov t usm i; th e n tivinil Aet11 rn f<i nn h>a;i! 3 ),
a. DOH fPR wm re t:>iff the ~mp~tul iln tivi,r.l VI, h dram! fo rm fo r 7 ar,.
1Rnque-stln& load ~aaltll )tmclidion :
Otgen-intion p,111 Ut e loo! hnlth jumdiction i> reqm:>tirt1 the mecrlClltlonsfor :
Contact: Title:
!'hone lr: E-Mai l:
R'equutedAntivir;i(s fr ncluil-e typc,WH! and qucanfity): Sh i p'pm 11Aild reu;
(&: T11mif{u, 75mg , !Opad:s ~ j/Jpil.ls)
57
I Requu 1td D•liv"')! Oat~: I Dewery col'llal:t phane I:
OOH Point of 0>11t111:r IPri11 t Nam~J :
Received by Loe.al Health Jurisdiction:
58
Kittitas County Public Health Department
Pandemic Flu Response
AnnexD
I. INTRODUCTION
II. PLANNING ASSUMPTIONS
III. IMPACTS OF A PANDEMIC
IV. PHASES OF A PANDEMIC
V. CONCEPT OF OPERATIONS
Table of Contents
60-61
62-63
63
64
65-66
59
I. INTRODUCTION:
Pandemics are distinct from seasonal influenza epidemics that happen nearly every year.
Seasonal influenza epidemics are caused by influenza viruses that circulate around the world.
Over time, people develop some degree of immunity to these viruses and vaccines are developed
annually to protect people from serious illness. Pandemic influenza refers to a worldwide
epidemic due to a new, dramatically different strain of influenza virus. A pandemic virus strain
can spread rapidly from person to person and, if severe, can cause high levels of disease and
death around the world.
Pandemic viruses develop in two main ways. First, wild birds are the reservoir for all influenza
viruses. Most avian influenza viruses do not infect or cause significant disease in humans.
However, new pandemic influenza viruses can arise when avian influenza viruses acquire the
ability to infect and cause disease in humans and then spread rapidly from person to person.
Secondly, all influenza viruses experience frequent, slight changes to their genetic structure over
time.
The development of a novel virus means that most, if not all, people in the world will have never
been exposed to the new strain and have no immunity to the disease. It also means that new
vaccines must be created and are not likely to be available for months.
Flu pandemics have occurred throughout history. The influenza pandemic of 1918 caused more
than 500,000 deaths in the United States and more than 40 million deaths around the world.
Subsequent pandemics in 1957-58 and 1968-69 caused far fewer fatalities in the US, but caused
significant morbidity and mortality around the world. In 2009, the first US case of HlNl (swine
flu) was diagnosed. The CDC estimates that 43 million to 89 million people had HlNl between
2009 and 2010 with 8,870 and 18,300 HlNl related deaths.
60
Severe influenza versus pandemic influenza:
I Pande,m ic Ellu-II
~ Sea OQ~I Fl u I
Rarel y happens (three times in 20th Happ en s annually and usually peaks in January or
century) February
People have little or no immunity because Usually some immunity built up from previous
they have no previous exposur to the virus expo ure
Healthy people may be at increased risk for Usually only people at high risk, not healthy adults ,
serious compli cations are at risk of serious complications
Health care providers and hospitals may be Health care providers and hospitals can usually
overwhelmed meet p u bli c and patient needs
Vaccine probably would not be available in Vaccine available for annual flu season
the early stages of a pandemic
Effective antivirals may be in limited Adequate supplies of antivirals are usually available
supply
Number of deaths could be high (The U.S . Seasonal flu-associated deaths in the United States
death toll during the 1918 pandemic was over 30 years ending in 2007 have ranged from
approximately 675,000) about 3,000 per season to about 49,000 per season.
I Symptoms may be more severe I Symptom~ include fever, cough, runny nose, and
muscle pam
May cause major impact on the general Usually causes minor impact on the general public,
public, such as widespread travel some schools may close and sick people are
restrictions and school or business closings encouraged to stay home
Potential for severe impact on domestic and Manageable impact on domestic and world
world economy economy
61
II. PLANNING ASSUMPTIONS:
A. An influenza pandemic will result in the rapid spread of infection with outbreaks throughout
the world. Communities across the state and country may be impacted at the same time.
B. Localities may not be able to rely on timely or effective mutual aid resources, State, or
Federal assistance to support local response efforts.
C. An influenza pandemic may occur in waves and last for 12 to 24 months.
D. Residents may be required to stay in their homes for a significant period during an influenza
pandemic; thus, residents will need public information, education and tools, so they are prepared
to take responsibility for basic needs (food, water, prescription medications, etc.)
E. Antiviral medication will be in extreme short supply. Administration of local supplies of
antiviral medication will be prioritized by KCPHD in accordance with CDC and DOH
guidelines.
F. A vaccine for the pandemic influenza strain may not likely be available for the first wave
following the emergence of the novel virus.
G. The number of ill people requiring care may overwhelm the local healthcare system.
1. KVH and clinics may have to modify their operational structure to respond to high
patient volumes.
2. The healthcare system may have to respond to increased demands with a decreased
workforce due to illness.
3. Demand for inpatient beds and assist ventilators could increase ten-fold and patients
will need to be prioritized for services.
4. There will be tremendous demand for urgent care services.
5. Infection control measures specific to management of influenza patients will need to be
developed and implemented in all healthcare facilities.
6. The health system may need to develop alternative care sites to relieve demand on the
hospital emergency department.
7. Emergency Medical Service responders will face extremely high call volumes.
8. The number of fatalities may overwhelm the resources of the Kittitas County
Coroner's Office and funeral home.
H. There will likely be significant disruption of public and privately owned critical infrastructure
including transportation, commerce, utilities, public safety, and communications.
I. Social distancing strategies aimed at reducing the spread of infection such as closing schools,
community centers, and other public gathering points, and canceling public events will likely be
implemented during a pandemic.
62
J. Some persons will be unable or unwilling to comply with isolation directives. For others,
social distancing strategies may be less feasible. It will be important to develop and disseminate
strategies for infection control appropriate for these environments and populations.
K. Risk communication will be critically important during all phases of planning and
implementation of a pandemic influenza response. The general public, healthcare system,
response agencies, and elected leaders will need continuous updates on the status of the
pandemic outbreak, impacts on critical services, the steps being taken to address the incident,
and steps the public can take to protect themselves.
III. IMPACTS OF A PANDEMIC:
Using the CDC's FluAid 2.0 model, calculations are based on current estimates based on
predictions from FluAid 2009.
· Sevcri:Pancleii1ic • -
41,900 41,900
4,815 11,200
88 222
~ l I , I 28 67
63
IV. PHASES OF A PANDEMIC:
1
2
3
4
No circulating animal
influenza virus has been
reported to have spread
to humans.
A circulating animal
influenza virus can
spread to humans and is
considered a threat.
A circulating animal
virus has caused disease
in some people.
I A community-level
outbreak has been
verified.
Plan: Develop, exercise, and revise national influenza pandemic
preparedness and response plans.
M0nilor & Assess : Collaborate with other agencies to develop a
national surveillance system.
Communicate: Communicate real and potential risks of the virus.
fteduce Spread otOisease: Promote healthy behaviors in people
for self-protection. Plan for the use of vaccines.
Health Care Continuity~ Prepare the health system to scale up.
Plan: Lead rapid pandemic containment activities to limit the
spread of infection.
M0nitot & A sess : Increase surveillance and share findings.
Communicate: Promote and communicate recommended
interventions to prevent and reduce risk.
Reduce Spread of Disease: Implement rapid pandemic containment
5
---·---Health Care c;_on_t:inufil'.: Activate contingency plans. ~ operations and other activities.
The virus has caused Plan: Coordinate and lead resources to reduce overall impacts of
the outbreak.
6
~ST
PEAK
PERIOD
community-level
outbreaks in two or more
countries in one WHO
region.
The virus has caused
sustained community-
level outbreaks in at least
one other country in
another WHO region.
Levels of influenza have
dropped below peak
levels in most countries.
POST Levels of influenza have
PANDEMIC I returned to the levels
PERIOD
I
seen for seasonal
influenza in most I w~me,.
Monitor&. Assess: Continue surveillance to detect ensuing waves.
Communicate: Regularly update the public on any changes to the
status of the pandemic.
Reduce pread o( Disease: Implement individual, societal, and
pharmaceutical measures.
Health Care Continuity: Implement contingency plans for health
systems at all levels.-
Plan: Plan for additional resources for possible future waves.
Monitor & Assess:.Continue surveillance to detect subsequent
waves.
Communicate: Regularly update the public on any changes to the
status of the pandemic.
Reduce Spre·a<l of.Disease : Evaluate the effectiveness of the
measures used to update guidelines and protocols.
He.alth Ca:re Continuity: Rest, restock, revise plans, and rebuild.
Plan: Review lessons learned. Share experiences. Replenish
resources.
Monitor.& Asses ; Evaluate the pandemic characteristics for next
time.
Communicate: Acknowledge contributions of all communities,
I
communicate the lessons learned.
Reauee pread of Disease: Evaluate all interventions used.
Health Care Continuity: Evaluate the response of the health
system. Share the lessons learned.
64
V. CONCEPT OF OPERATIONS:
Key response actions by phase as identified by the World Health Organization (WHO),
specifically "phase 4" when "community-level outbreaks has been verified."
A. PHASE4
1. Disseminate surveillance guidelines to physicians, clinics, and hospitals
2. Track possible cases identified in Kittitas County
3. Establish case definition that aligns with Department of Health and Human
Services (HHS), CDC, and DOH.
4. The Public Information Officer (PIO) or designee will develop information
related to pandemic influenza activity and forward to media and news sources.
5. KCPHD will develop and disseminate guidelines regarding antivirals based on
guidance from CDC and DOH.
6. Develop public information messaging based on expected amounts of vaccine and
priority groups.
B. PHASE5
1. Develop or refine protocol for active surveillance at KVH and other facilities.
2. Provide healthcare sites with instructions about gathering samples from individuals
who display symptoms of influenza like illness (ILI) and who are at increased risk for
infection according to established guidelines.
3. PIO or designee will disseminate information regarding status of outbreak to all
healthcare providers and other facilities at regular intervals.
4. Implement plans for requesting any available drugs through state, federal, or private
sources.
5. Monitor adverse reactions to antiviral medications under the guidance of CDC and
DOH.
6. Distribute antivirals to priority groups.
C.PHASE6
1. Screen and/or quarantine international travelers recently arriving in Kittitas County
from an area known and/or suspected to be infected, following federal guidelines.
2. Continue to monitor workforce absenteeism within the community through reporting
from major employers.
3. Review surveillance data for potential risk factors that either prioritize or deprioritize
infected individuals for receiving antivirals and/or vaccine, following state and federal
guidelines.
4. Set up a call-in line for healthcare professionals to answer questions relating to the
pandemic (unpublished call in line-not for general public).
5. Distribute antivirals to priority groups.
6. Monitor adverse reactions as resources permit.
7. Monitor any cases ofresistance to antivirals.
65
8. Coordinate the processing of mass fatalities with Kittitas County Prosecuting
Attorney's Office and Coroner's Office.
D. WORKFOURCE MANAGEMENT AND SUPPORT
It is estimated that 30 to 50 percent of the workforce could be impacted by an influenza
pandemic. Likewise, an emergency on the scale of an influenza pandemic will have an
inevitable psychosocial impact not only on the individuals tasked with directly responding to the
outbreak, but the broader population as well. The stresses placed on the workforce by illness-
induced absenteeism, the long term nature of the emergency, and the mental health consequences
will need to be addressed.
1. Ensure that administrators, managers, and supervisors are familiar with and actively
encourage the use of tools and techniques for supporting staff and their families during
times of crisis.
2. Educate all staff on Mental Health First Aid.
3. Identify additional recourse that can be available to employees and their families
during and after a pandemic.
66
Kittitas County Public Health Department
Emergency Communication Plan
Annex E
I. PURPOSE
II. SCOPE
III. SITUATION OVERVIEW
IV. PLANNING ASSUMPTIONS
V. CONCEPT OF OPERATIONS
VIII. ATTACHMENTS
Table of Contents
Attachment A Press Release Template and Tips
Attachment B Common Press Release Templates
Attachment C Fax Machine Speed Dial Numbers
Attachment D 24/7 Emergency Contact List
Attachment E Regional Satellite Phone Contact List
Attachment F Common Media Questions
Attachment G Recording Hotline Greetings
Attachment H Emergency Notification Tree
68
68
68
68-69
69
70-71
72-75
76-78
79
80
81-82
83-84
85
67
I. PURPOSE:
The purpose of communication from KCPHD is to issue information and respond to requests in a
timely manner and provide information 24/7 during an emergency. KCPHD will strive to
maintain consistency of information distributed and preserve department credibility as well as
protect patient confidentiality and be sensitive to issues within the community.
II. SCOPE:
Information may be shared with various audiences including members of the public, community
partners, Board of Health members, Board of Health Advisory Committee (BOHAC) members,
KCPHD, members of the media, the Washington State Department of Health, and other local
health jurisdictions. KCPHD may use various methods of communication, especially during a
disruption of technology.
III. SITUATION OVERVIEW:
The department has a designated Public Information Officer (PIO) and a designated back-up
PIO. The PIO is responsible for the following during an emergency:
A. Under the direction of the Administrator or Health Officer, the PIO is responsible for all
emergency communications.
B. Represent KCPHD at a Joint Information Center (JIC) if one is activated.
C. Coordinate message release with community partners if a joint release is issued.
D. Create all department press releases in emergency situations, even if the Incident Command
System (ICS) has been initiated.
E. Message clearance may be expedited to be approved by the Administrator of KCPHD only.
Some messages have been preapproved for press releases covering emergencies that routinely
happen in Kittitas County (floods, wildfire).
IV. PLANNING ASSUMPTIONS:
During a large scale incident, technology and certain communications may be unavailable. If
systems are down, the PIO will post regular updates at the front desk of KCPHD. In addition to
physical signage we may use radio stations to broadcast information or HAM radio operators in
the county. People with access and functional needs including people with disabilities and
residents who are non-native English speakers will need to have access to understandable
communication during emergencies. KCPHD will make every attempt to provide information in
68
multiple languages as well as use printed information, including social media graphics from the
Washington State Department of Health.
V. CONCEPT OF OPERATIONS:
A. Reports from the public regarding potential health emergencies can be communicated to
KCPHD staff during business hours (9am to 5 pm, Monday through Friday) by calling the front
desk. After hours, the public should be directed to call 911. KITTCOM (911) has the
emergency contact numbers for KCPHD.
B. Reports from key stakeholders such as healthcare providers or other agencies (law
enforcement, hospital, emergency services, school personnel, etc.) should have access to the
emergency contact number for KCPHD. Communications to KCPHD key stakeholders may also
occur during business hours by fax or reporting through the Next Gen electronic medical records
system. Staff may also receive SECURES messaging alerts from Washington State DOH.
C. Responding to reports should be completed within 15 minutes of notification. All information
that is reported to KCPHD should be reviewed and analyzed as soon as possible. Staff should
follow the appropriate department confidentiality processes to assure data are maintained in a
secure and confidential manner.
D. Outgoing messaging to public and/or partners will be done via the PIO. The PIO will receive
approval from the Administrator and the Health Officer before disseminating information.
E. Information to the public about threats to health and safety will be completed through various
mechanisms, for example, via Emergency Management and KITTCOM to utilize reverse 911 or
IP A WS in large scale emergency. Public service announcements via local radio stations may
also be used in addition to partners' social media sites.
69
Attachment A: Press Release Template and Tips
[ON AGENCY LETTERHEAD]
MEDIA RELEASE
Date: Month day, year
Contact: Name, Title, (509) 962-XXXX
[Title -Size 14 font, Bold]
Your title should capture the essence of your news to give media a "handle" for what information
will be in the news release.
[Lead sentence-Size 12 font, Times New Roman]
Your lead sentence is critical. You need to succinctly summarize the key elements of your news .
Some examples:
• A dead crow found in Snohomish County has tested positive for West Nile Virus (WNV),
according to local health officials.
• Now is the time for families in King County to prepare for going back to school, and
Public Health -Seattle & King County recommends that the best place to start is by
making sure that all of your child's immunizations are up to date.
• Several Walla Walla residents are being treated for possible exposure to rabies after
confirmation of the first case ofrabies in a cat in Washington State since 1976.
• The Centers for Disease Control and Prevention (CDC) today released new guidelines
that advise the use of alcohol-based hand rubs to protect patients in health care settings .
[Second and third paragraph]
Use a quote in your second or third paragraph to support your news and to convey some key
messages. The person quoted should be a leader or expert on the topic. Some examples:
• "The chance of human infection is very low -less than one percent of people who are
bitten by an infected mosquito will become severely ill," said M. Ward Hinds, MD,
MPH, head of the county's health department. "We knew that West Nile Virus would
arrive in western Washington, it was only a matter of when," he said.
• "This campaign will help more residents access this model program which offers
culturally-sensitive diabetes education and services," said King County Executive Ron
Sims.
• "Fortunately in Washington, rabies among both humans and animals is extremely rare,
but it is still a very frightening illness to many people," said Dr. Jo Hofmann, Department
of Health Communicable Disease Epidemiologist. "But rabies in humans can be
prevented if treatment begins soon after exposure."
-more-[indicates more pages follow]
70
The following paragraphs should provide important supporting information. Your news release
should usually be one page, but can be up to two pages. Sometimes a second quote can be used
to convey additional key messages or to incorporate a second person's perspective.
fffl# (indicates end ofrelease)
71
Page 2 of2
Attachment B: Common Press Releases
MEDIA RELEASE
Date: Month, Day, Year
Contact: Kasey Knutson, Public Information Officer, 509-962-7515
P oor Air Quality Conditions in Kittitas County
Kittitas County is currently under a [insert air quality status] air quality advisory, which has been
issued by the Washington State Department of Ecology (Ecology). Smoke as a result of [name
of incident] is affecting the air quality in Kittitas County and the alert issued by Ecology is
effective until further notice.
KCPHD wants residents to be aware of current air quality conditions in order to take necessary
steps to avoid negative health effects . Air quality information can be accessed at any time via
the Washington Air Quality Advisory (WAQA) online https://fortress.wa.gov/ecy/enviwa/.
W AQA is a tool that measures the air quality with categories ranging from "good" to
"hazardous" air. Additional resources include the following:
• Washington Smoke Blog http ://wasmok e.blogspot.com/ contains information about
smoke as well as active wildfires.
• Puget Sound Clean Air's Graphing Tool littp://airgmphing.pscleanair.org/ shows real
time changes for the station in Ellensburg.
• National Weather Service http ://mv,.v .weather.gov/ has weather related alerts, including
air quality.
• Washington State Department of Health's Wildfire Smoke page
http;/ /w:ww .doh . wa.gov/Cornmu.nityand.En i.ronment/AfrOuaJ ity/SmokeF romFires/Wildfi
reSmoke explains the harm of wildfire smoke.
"Outdoor activities should take place when we have "good" air. When air quality changes to
"moderate" or worse, we recommend people start making changes, including moving indoors,"
asserts Kittitas County Health Officer, Dr. Mark Larson.
Attached is the "Air Pollution and School Activities" table for specific recommendations based
on air quality conditions. For more information about health concerns relating to air quality or
informational resources, please contact KCPHD at (509)-962-7515 .
72
MEDIA RELEASE
Date: Month, Day, Year
Contact: Kasey Knutson, Public Information Officer, 509-962-7515
Flood Waters Can Be Harmful to Health
With recent flooding in Kittitas County, the Kittitas County Public Health Department (KCPHD)
is reminding residents that flood water is unsafe. Flood water can create risks including,
exposure to infectious diseases, chemical hazards, and injuries, according to the Centers for
Disease Control and Prevention (CDC).
During clean up after floods; wear rubber boots, rubber gloves, and goggles during cleaning the
affected area. After completing cleanup, wash all clothes worn in hot water and detergent as
well as washing your hands with soap and warm water.
If your well head was covered by flood waters, KCPHD recommends NOT consuming water
from the well until it has been tested and proven to be absent of bacteria. Until you receive test
results that show the water is free of bacteria, you should use bottled water or water that has not
been exposed to flood waters. If bottled water is not available, you should boil water before
using for drinking, preparing food, washing dishes, brushing teeth, et cetera. Boil water for at
least one minute and cool completely before use.
Water testing bottles are available at KCPHD from 9am to 5pm for pick up, Monday through
Friday. Water samples should be taken from your home on the same morning you intend to drop
the sample off at KCPHD. Drop off for samples is between 9 and 11 and the courier picks up
water, daily, from KCPHD at 11am.
Disinfection of your well is necessary if test results show bacterial contamination. For
instructions on disinfecting wells, please visit the Kittitas County Public Health Department's
website at www.co.kittitas.wa.us/health/ for a fact sheet on the disinfection of private water
wells.
For questions about boiling water, disinfecting wells, or water testing, please contact the Kittitas
County Public Health Department at 509-962-7515.
73
MEDIA RELEASE
Date: Month, day, year
Contact: Kasey Knutson, Public Information Officer, 509-962-7515
Wildland Fire Recovery: Returning Home after [Name of
Fire Incident]
The Kittitas County Public Health Department (KCPHD) is urging everyone to be aware of
potential dangers and to take safety measures when returning to their homes after [ name of fire
incident]. Please be cautious that [name of the fire incident] may have created hazards in and
around your home.
To prevent injury when entering your home, be sure to wear Personal Protective Equipment
(PPE). Protective equipment may include sturdy shoes to protect from glass or sharp objects,
longs pants and shirt, hard hat, and a mask to prevent inhalation of dust and ash.
Be advised:
• Wear protective clothing in order to avoid skin contact and inhalation of ash and other
materials.
• Well-fitting dust masks (masks rated N-95 or P-100) are effective at blocking the
particles from ash during cleanup.
• It is not uncommon that animals may take refuge in or near your home during the fire. If
you find animals in your home allow them to return to their natural habitat, or contact
proper authorities for removal.
• If you are in need of disposal or burial of any domesticated animals or livestock, be sure
every part of the carcass is covered by at least three feet of soil; at a location at least 100
feet away from any well, spring, stream, or other surface waters; not in a low-lying area
subject to seasonal flooding or within a 100-year flood plain; and not in a location likely
to contaminate ground water.
• According to the Centers for Disease Control and Prevention (CDC) you should not
consume any food that looks or smells bad. Throw away exposed perishable food that
may be questionable, including canned goods and refrigerated items.
• For those who have an open or closed wound and are returning to the bum area and who
have not had a documented dose of tetanus vaccine within the past ten years should get a
tetanus shot before returning home.
For more information on returning home after a disaster and how to stay safe, visit the Centers
for Disease Control at http://emergency.Gd.c.gov /disaster:s/wildfires/afterfire .asp . Please contact
the Kittitas County Public Health Department if you have concerns about disease and injury
prevention relating to returning home at 509-962-7515.
74
Kittita ~ County
Department
To Protect and Promote the Health and the Environment of the People of Kittitas County
MEDIA RELEASE
Date: Month, day, year
Contact: Kasey Knutson, Public Information Officer, 509-962-7515
------
Shelter in Place Issued for [location]
A shelter in place alert has been ordered for [location] by [agency]. Hazardous materials have
been released and all residents or anyone in the area should remain indoors, effective
immediately. [Brief details of the incident and include symptoms of exposure]
Sheltering in place means:
• Go inside.
• Close all windows and doors.
• Tum off ventilation systems -tum of all air conditioners, fans, etc.
• Go into a room with the fewest doors and windows.
• Stay in the room until told by the authorities it is safe to come out.
Further information will be provided by [agency] at [website] Phone lines should be left open for
emergency responders.
For anyone outside of the area, please avoid driving near [location]. Please give emergency
personnel the right of way.
According to the Washington State Department of Health (DOH), if you have symptoms of
exposure, call 9-1-1 immediately and follow their instructions. If you were outside before taking
shelter and think you may have been exposed to a chemical agent, there are several things you
can do. If you are in a sealed shelter, take off at least your outer clothes, put them in a plastic bag
and seal the bag. If water is available, wash or take a cool to warm (not hot) shower, using lots of
soap and water. Do not put the soap in your eyes, just lots of water. If you leave the area, tell
emergency responders or medical staff at your destination you may have been exposed. Tell the
emergency responders about the sealed bag so that they can arrange for its safe removal after the
emergency.
For more information go to [give location of available information that IS NOT connected to a
phone line].
###
75
Attachment C: List of Fax Machine Speed Dial Numbers
To Send a Fax: (Must place 1 page in fax)
Press Search/Speed Dial and "#"; enter 3-digit speed dial number. Press start.
[Health Care Providers
Kittitas Valley Healthcare Family Medicine 5099338741
Family Health Care 5099622003
Community Health of Central Washington 5099621408
Kittitas Valley Healthcare Family Medicine Cle Elum 5096745034
Ellensburg Pediatrics 5099625438
Emergency Medical Service Coordinator 5096742947
Kittitas Valley Healthcare Internal Medicine 5099257604
Kittitas Valley Healthcare General Surgery 5099256948
OB/GYN of Ellensburg (Dr. Sand) 5099258468
Student Medical & Counseling Clinic 5099631886
Kittitas Valley Healthcare Emergency Department5099337510
Kittitas Valley Healthcare CEO 5099258485
Kittitas Valley Healthcare Laboratory Services509933-8795
Kittitas Valley Healthcare Urgent Care -Cle Elum5096747794
Planned Parenthood 5092483664
Kittitas Valley Healthcare Women's Health 5099338722
Coroner's Office 5099338224
!Region 7
Chelan Douglas Health District 5098666449
Okanogan County Public Health 5094227152
Grant Health District 5097666519
Kittitas Co Media
North Kittitas County Tribune
Daily Record
KCWU 88. l The 'Burg
5096745571
5099726920
5099631688
Central Washington University the Observer 5099631027
Non Local Media
La Grand 96.9 Spanish Radio 5094520541
KAPP-ABC Television 5094533623
KIMA Television News 5092481218
Yakima Herald 5095777767
KNDO 5092252330
KNWR 5093366577
KNDA 5098542223
KCYUFOX41 5094579903
76
Emergency Response
Kittitas County Board of County Commissioners 5099627679
Cle Elum Fire Department 5096745771
Cle Elum/Roslyn Police Department 5096742918
Central Washington University Police
Ellensburg Police
Emergency Medical Service Coordinator
Fire District #1
Fire District #2
Fire District #51
Regional Epidemiologist
Prosecutor Office
KITTCOM911
5099632750
5099627281
5096742947
5099642022
5099337240
4254346355
5098866449
5099627022
5099258540
Fire Marshall 5099627682
Kittitas County Sheriff Public Safety Building 5099627599
City of Kittitas Police & Emergency Services 5099680223
Red Cross 5099259156
Washington State Patrol
Fire District #3
5096654007
5096560121
Fire District #7 5096747263
Kittitas Valley Fire/Rescue-Deputy Chief Elliott 5099337245
Kittitas Valley Community Hospital District #1 5099627351
Comprehensive Healthcare -Mental Health 5099251277
Pharmacies
Bi-mart Pharmacy
Downtown Pharmacy
Fred Meyer Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Super One Pharmacy
Safeway Cle-Elum
!Veterinarians
Critter Care Animal Clinic
Ellensburg Animal Hospital
Mt Stuart Animal
Valley Veterinary
Schools
Ellensburg School District
Ellensburg High School
Lincoln Elementary
Morgan Middle School
5099625322
5099251545
5099620527
5099256063
5099256044
5099627785
5098523010
8316261698
5099257714
8002555067
5099256148
5099258025
5099258305
5099258056
5099258200
77
Mount Stuart Elementary 5099258407
Valley View Elementary 5099258134
Kittitas School Dist 5099684730
Kittitas Elementary School (K-5) 5099683630
Kittitas Sfcomlary School (6-12) 5099683370
Thorp School District 5099642313
Cle Elwn -Roslyn School District 5096492404
CleElwnHS 5096493563
Walter Strom Middle School -Cle Elwn 5096493634
Cle Elwn-Roslyn Elementary School 5096492074
Damman School District 5099252591
Easton School District 5096562585
Long Term are Facilili s
Hearthstone 5099251144
Prestige Post-Acute and Rehab Center 5099254173
Pacifica Senior Living 5099251230
78
Attachment D: 24/7 Emergency Contacts List
Kittitas Coun~ Emergency Contacts List
Kittitas County Information Services (509) 962-7510 JimGoeben
Central Washington University (CWU) Police (509) 963-2959
CWU Public Affairs (509) 963-1384 Linda Schactler
Kittitas Valley Healthcare Public Affairs (509) 933-7593
Kittitas County Sheriff/Emergency Management (509) 933-8206 Darren Higashiyama
Kittitas County Emergency Operation Center (509) 962-7678
Kittitas County Emergency Medical Services (509) 962-7683 Cheryl Burrows
Kittitas County Fire (509) 962-7274 John Sinclair
Kittitas County Fire District #7 (509) 649-3381 Richelle Risdon
Kittitas County Red Cross (509) 929-0331 Martha Read
Central Washington Comprehensive Mental Health (509) 925-9861 Dr. Harry Kramer
Ellensburg Police Department (509) 962-7280 Ken Wade
ARES/RACES (509) 962-3820 Gloria Sharp
24/7 Washington State Department of Health Duty Officer (360-888-0838 DOH Duty Officer
Washington State Department of Health Risk Communications (360) 236-4070 Laura Blaske
WA DOH Epidemiology and surveillance (206) 418-5518 Mike Boysun
Public Health Laboratory 24/7 Emergency Telephone Service (206)418-5500
Drinking Water After-Hours Emergency Hotline 1-877-481-4901
Valley Lab 1-877-242-3999
Last updated 7/31/2018
79
Attachment E: Regional Satellite Phone Numbers
Regional Satellite Phone Numhers
Kittitas County Emergency Management (254) 241-5879 Ellensburg
Region 7 Public Health
Chelan-Douglas Health District (254) 204-0589 Wenatchee
Chelan-Douglas Health District-fixed (254) 377-2969 Wenatchee
I Grant County Health District (254) 204-0620 Moses Lake
Grant County Health District-fixed (254) 377-7250 Moses Lake
Okanogan County Public Health (254) 204-0626 Okanogan
Okanogan County Public Health-fixed (254) 377-5227 Okanogan
Region 7 Hospitals
Kittitas Valley Healthcare (254) 387-9399 Ellensburg
Okanogan Douglas Hospital (254) 387-3385 Brewster
Quincy Valley Med (254) 387-5984 Quincy
Samaritan Healthcare (254) 387-5985 Moses Lake
Wenatchee Valley Med Center (254) 387-3383 Wenatchee
Cascade Medical Center (254) 387-3388 Leavenworth
Coulee Comm. Hospital (254) 387-5783 Grand Coulee
Central Washington Hospital (254) 387-5784 Wenatchee
Columbia Basin Hospital (254) 387-7599 Ephrata
Lake Chelan Community Hospital (254) 387-3389 Chelan
Mid Valley Hospital (254) 387-5781 Omak
North Valley Hospital (254) 387-5780 Tonasket
Moses Lake Community Health (863) 200-5297 Moses Lake
Last updated 12/9/10
80
Attachment F: Common Media Questions
(Reprinted from: Covello, VT., KJwrJ/ng YQllr Hend !11 & Crisfs: Resoo11d/11g .79 Cammim it:u li 011-Clrotll!l1ges f'rmrd By 8J1t-
lf!r ro rismA 11d £11111Yg{,1g J,~feclivusbiseast:s~ Association of State and Territorial Health Officers (ASTHO), 2003 in press)
Journalists are likely to ask six questions in a crisis (who, what, where, when, why, how)
that relate to three broad topics: (1) what happened; (2) what caused it to happen; (3) what
it means. Specific questions include:
1. What is your name and title?
2. What are you job responsibilities?
3. What are your qualifications?
4. Can you tell us what happened?
5. When did it happen?
6. Where did it happen?
7. Who was harmed?
8. How many people were harmed?
9. Are those that were harmed getting help?
10. How certain are you about this information?
11. How are those who were harmed getting help?
12. Is the situation under control?
13. How certain are you that the situation is under control?
14. Is there any immediate danger?
15. What is being done in response to what happened?
16. Who is in charge?
17. What can we expect next?
18. What are you advising people to do?
19. How long will it be before the situation returns to normal?
20. What help has been requested or offered from others?
21. What responses have you received?
22. Can you be specific about the types of harm that occurred?
23. What are the names of those that were harmed?
24. Can we talk to them?
25. How much damage occurred?
26. What other damage may have occurred?
27. How certain are you about damages?
28. How much damage do you expect?
29. What are you doing now?
30. Who else is involved in the response?
31. Why did this happen?
32. What was the cause?
33. Did you have any forewarning that this might happen?
34. Why wasn't this prevented from happening?
35. What else can go wrong?
36. If you are not sure of the cause, what is your best guess?
37. Who caused this to happen?
81
38. Who is to blame?
39. Could this have been avoided?
40. Do you think those involved handled the situation well enough?
41. When did your response to this begin?
42. When were you notified that something had happened?
43. Who is conducting the investigation?
44. What are you going to do after the investigation?
45. What have you found out so far?
46. Why was more not done to prevent this from happening?
47. What is your personal opinion?
48. What are you telling your own family?
49. Are all those involved in agreement?
50. Are people over reacting?
51. Which laws are applicable?
52. Has anyone broken the law?
53. How certain are you about whether laws have been broken?
54. Has anyone made mistakes?
55. How certain are you that mistakes have not been made?
56. Have you told us everything you know?
57. What are you not telling us?
58. What effects will this have on the people involved?
59. What precautionary measures were taken?
60. Do you accept responsibility for what happened?
61. Has this ever happened before?
62. Can this happen elsewhere?
63. What is the worst case scenario?
64. What lessons were learned?
65. Were those lessons implemented?
66. What can be done to prevent this from happening again?
67. What would you like to say to those that have been harmed and to their families?
68. Is there any continuing the danger?
69. Are people out of danger? Are people safe?
70. Will there be inconvenience to employees or to the public?
71. How much will all this cost?
72. Are you able and willing to pay the costs?
73. Who else will pay the costs?
74. When will we find out more?
75. What steps need to be taken to avoid a similar event?
76. Have these steps already been taken? If not, why not?
77. What does this all mean?
82
Attachment G: Recording Hotline Greetings
The contact at Consolidated Communications for additional phone tree assistance is Jackie
Bostick. Phone, 962-0318. Email, jbostick@fairpoint.com. In additional to the phone numbers
below, 933-8245 can be used for a hotline, with password 84250.
Dial 962-0300, press *, enter 9627515, password is 7515. Select 3 to change the greeting, then
1 to change the greeting, and 2 to record a new mailbox greeting.
Hello, you have reached the Kittitas County Public Health Department.
If you have questions A, B, or C press one now. (Transfers to 9627589)
For all other public health questions press 2 now or stay on the line. [Pause up to four seconds,
then press#] (Rings through to 9627515)
Dial 962-0300, press *, enter 9627589, password is 7589. Select 3 to change the greeting, then
1 to change the greeting, and 2 to record a new mailbox greeting.
Please listen to the following three options before making your selections:
For information about A, press one. (Transfers to 5559621)
For information about B, press two. (Transfers to 5559622)
For information about C, press three. [Pause up to four seconds, then press#] (Transfers to
5559623)
Dial 962-0300, press*, enter 5559621, password is 1269. Select 4 for personal options, then 3
for greetings, then 1 to change the greeting, then 2 to record the greeting.
Topic A
During business hours, you will have the opportunity to talk to a staff member at the end of this
call, but please listen to this message first as it may answer your questions.
Message here.
If you would like to speak to a front desk staff member, please press 0 now. [Pause up to four
seconds, then press#] (Transfers directly to 9627515 without initial message again)
Dial 962-0300, press *, enter 5559622, password is 2269. Select 4 for personal options, then 3
for greetings, then 1 to change the greeting, then 2 to record the greeting.
Topic B
During business hours, you will have the opportunity to talk to a staff member at the end of this
call, but please listen to this message first as it may answer your questions.
Message here.
If you would like to speak to a front desk staff member, please press 0 now. [Pause up to four
seconds, then press#] (Transfers directly to 9627515 without initial message again)
83
Dial 962-0300, press *, enter 5559623, password is 3269. Select 4 for personal options, then 3
for greetings, then I to change the greeting, then 2 to record the greeting.
Topic C
During business hours, you will have the opportunity to talk to a staff member at the end of this
call, but please listen to this message first as it may answer your questions.
Message here.
If you would like to speak to a front desk staff member, please press O now. [Pause up to four
seconds, then press#] (Transfers directly to 9627515 without initial message again)
84
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85
I. PURPOSE
II. SCOPE
Kittitas County Public Health Department
Shelter/Mass Care Plan
AnnexF
Table of Contents
III. CONCEPT OF OPERATIONS
Attachment A Shelter-Tool Form
87
87
87
88
86
I. PURPOSE:
KCPHD will be responsible for assessing conditions of emergency shelter facilities during
disasters, which include shelters for displaced individuals or for emergency workers responding
to the incident in order to protect the occupants of the shelter.
II. SCOPE:
Shelters include temporary housing for individuals who are displaced from their homes due to an
emergency or the temporary housing of individuals responding to the emergency that operate
within the local jurisdiction.
III. CONCEPT OF OPERATIONS:
KCPHD will ensure shelters meet appropriate health and safety standards. Staff will utilize the
Centers for Disease Control and Prevention (CDC) standard evaluation form (Attached) to
identify priority health and safety issues along with recommendations for improvements if
needed.
87
State Logo ENVIRONMENTAL HEALTH ASSESSMENT FORM FOR SHELTERS
For Rapid Assessment of Shelter Conditions during Disasters
I • •
'Agency /Organization Name ________________________ _ 90 Jml'flidlate--Needs Identified: • Yes • No
2Assessor Name/Title------------------------------------------
3Phone 4Email or Other Contact
II. FACILITY TYPE , NAME AND CENSUS DATA
5Shelter Type ,, Community/Recovery J Special Needs ::. Other _________ 6ARC Facility ::-Yes _: No 'J Unk/NA 7ARC Code
8Date Shelter Opened __ / __ ! __ (mm/dd/yr) 9Date Assessed __ / __ / __ (mm/dd/yr) 10Time Assessed __ : __ 'J am •~ pm
1I Reason for Assessment _ Preoperational ::.·. Initial ,::. Routine ~Other _______________________ _
I2 Location Name and Description ---------------------------------------
13Street Address --------------------------------------------
14 City / County _____________ 15State 16Zip Code _____ 17Latitude/Longitude -----~} ____ _
18 Facility Contact/ Title _________________ 19Facility Type :.: School . "Arena/Convention center _ Olhe r ____ _
20 Phone ____ 21 Fax ___ ___ _ 22 E-mailorOtherContact __________ _
23 Current Census 24 Estimated Capacity _____ 25 Number of Residents____ 26 Nu mber of Staff/ Volunteers ___ _
Ill. FACILITY VIII. SOLID WASTE GENERATED
21 structural damage
2a security / law enforcement available
29 Water system operational
30Hot water available
31HVAC system operationa l
32Adequate ventilation
33 Adequate space per person
34 Free of injury /occupational hazards
35 F ree of pest / vector issues
36 Acceptable level of cleanliness
37Electrical grid system operational
38 Generator in use, 39 If yes, Type ___ _
401 ndoor tempera ture
42 Served on site
43Safe food source
44 Adequate supply
45Appropriate storage
46Appropriate temperatures
47 Hand-washing facilities available
48Safe food handling
49Dishwashing facilities available
socIean kitchen area
58 Adequate laundry services
59 Adequate number of toilets
60Adequate number of showers
61 Adequate number of hand -w ashing stations
62 Hand-washing supplies available
63Toilet supplies available
·· Yes
:. Yes
··Yes
;--Yes
~ Yes
-:Yes
·Yes
: Yes
:., Yes
-Yes
·::Yes
·Yes
: Yes
._7 Yes
::_; Yes
::.; Yes
::Yes
Yes
::.:Yes
:~Yes
.:: Yes
J Yes
;~ Yes
Yes
_ Yes
Yes
Yes
Yes
Yes
:-No ::. Unk/NA
:.: No ::.• Unk/NA
-No ::: Unk/NA
~-No ~ Unk/NA
. No :_ Unk/NA
No ~ Unk/NA
·No .:: Unk/NA
;:; No .. Unk/NA
-, No . Unk/NA
-No :: Unk/NA
No :: Unk/NA
•••No ,:: Unk/NA
:' No ::: Unk/NA
:::No •: Unk/NA
::No ::. Unk/NA
·::.. No ·J Unk/NA
·,No :: Unk/NA
:: No ::. Unk/NA
:: No -Unk/NA
~ No ,:: Unk/NA
~-= No -Unk/NA
J Unk/NA
,~No c. Unk/NA
No r Unk/NA
.1 No Unk/NA
J No Unk/NA
No Unk/NA
No Urik/NA
J No UnKINA
66 Adequate number of collection receptacles
67 Appropriate separation
68 Appropriate disposal
69A ppropriate storage
70Timely removal
71 T pes
72 Clean diaper-changing facilities
73Hand-washing facilit ie s ava ilable
74 Adequate toy hygiene
75 Safe toys
76 Clean food/bottle preparation area
77 Adequate child/caregiver ratio
18Acce table level of cleanliness
79Adequate number of cots/beds/mats
a0Adequate supply of bedding
81Bedding changed regularly
82Adequate spacing
83Aoceptable level of cleanliness
XI. COMPANION ANIMALS
84 Companion animals present
asAnimal care available
86 Designated animal area
87 Acceptab le level of cleanliness
Yes :-No .J Unk/NA
Yes -_No :: Unk/NA
: Yes -_, No .::: Unk/NA
-Yes :::No '.: Unk/NA
-·Yes ·: No : • Unk/NA
Yes ::.: No UrituNA
Yes -:: No Unk/NA
Yes -_ No Urik/NA
Yes . No Urik/NA
Yes .:: No
-: Yes ::.: No
J Yes := No Un k/NA
..J Yes :::No _ Unk/NA
Yes ::. No Unk/NA
Yes .:; No lJnk/NA
":Yes ""No Unk/NA
Yes 1::. No •::. Unk/NA
·ves ~No -unk/NA
Yes ~ No Unk/NA
88
Kittitas County Public Health Department
Continuity of Operations Plan (COOP)
AnnexG
I. PURPOSE
II. SITUATION OVERVIEW
IV. PLANNING ASSUMPTIONS
V. CONCEPT OF OPERATIONS
VI. SUCCESSION PLAN
VIII. ATTACHMENTS
Table of Contents
Attachment A Organizational Chart
Attachment B Essential Services
90
90
90
91
91-93
94-96
94
95-96
89
I. PURPOSE:
The purpose of the continuity of operations plan is to identify, address, and ensure essential
functions of services from KCPHD are maintained during an emergency or extended incident.
Critical operations during any incident must be maintained and are services that are required by
law . (Essential Services are attached)
II. SITUATION OVERVIEW:
KCPHD operates under the direction of the Kittitas County Board of County Commissioners and
in emergencies under the Kittitas County Emergency Management Office (KCSO). The
KCPHD Administrator, Health Officer, and Board of Health have the authority to determine,
which services are discretional and may be terminated or temporarily stopped during an
emergency.
If KCPHD is required to move as a result of an emergency or incident, the location will be
determined with Emergency Management recommendations and Board of County Commissioner
approval. Essential Functions that will be provided by the Kittitas County Public Health
Department in the event of an emergency or displacement from its regular location are: Food
Safety, Water Mitigation, Drinking Water, On-Site Septic, Vector Borne Disease/Zoonotic,
Pools and Spas, Solid Waste, Camps & Parks, and Schools, Vital Records and Immunizations.
Because oflimited capabilities and capacity, non-essential staff may not need to report for work
until normal operations and location are re-established.
IV. PLANNING ASSUMPTIONS:
During a large scale incident, technology, electricity, and certain communications may be
unavailable. If systems are down, the Public Information Officer will post regular updates at the
front desk of KCPHD. In addition to physical signage we may use radio stations to broadcast
information or HAM radio operators in the county. People with access and functional needs
including people with disabilities and residents who are non-native English speakers will need to
have access to understandable communication during emergencies. KCPHD will make every
attempt to provide information in multiple languages as well as use printed information,
including social media graphics from the Washington State Department of Health.
KCPHD would need to provide a source of power to keep vaccines refrigerated in the event of a
power outage, or if vaccines needed to move offsite because of an emergency incident. If
KCPHD does not have power or equipment failure, vaccine will be stored at Kittitas Valley
Healthcare via an interlocal agreement.
90
V. CONCEPT OF OPERATIONS:
KCPHD will be notified of an alternate work location via EM or BOCC
In the event that electronic capabilities are unavailable, hard copies of records will be taken and
uploaded at a later date when electronic capabilities have been restored. Hard copies are already
kept and stored for essential services provided by the Kittitas County Public Health Department.
If electronic capabilities are available either by VPN or through regular means, financial
transactions will be conducted as usual. If electronic capabilities are not available, cash and
check may be accepted, and hand written receipts will be issued.
Vaccines can be transported via portable plug-in refrigeration units that can be powered by an
external battery.
To-go kits or "Go Box" items will consist of necessary paperwork to conduct essential services,
pens, pencils, highlighters, rubber bands, rubber gloves, bungee cords, stapler, post-it notes, tape,
binder clips, printer paper, power inverter, size D batteries, rubber stamp, and phone and
message books. They are located at the front desk area of the KCPHD office.
VI. SUCCESION PLAN:
In the absence of the KCPHD Administrator, delegation of authority within KCPHD has been
determined below specific to function and assigned personnel in order to continue the
performance of critical functions. Ultimate delegation of authority resides with the Board of
County Commissioners (BOCC). If BOCC is absent, then delegation of authority would follow
the Kittitas County plan via Emergency Management.
91
function StJff Responsible -
Communication
• Serve as the organization's principal leader, Health Officer with support from :
representative, and spokesperson to the greater • Assessment Coordinator I
community. • CHS Supervisor
• EH Supervisor
• HP Manager
• Ensure that key funders/contractors are aware of the CHS Supervisor
change in KCPHD lead contract staff as appropriate. EH Supervisor
HP Manager
• Ensure that accurate information relating to the Health Officer with support from:
condition of the agency is communicated to department • Assessment Coordinator I
staff. • CHS Supervisor
• EH Supervisor
• HP Manager
• Ensure communication between Board of Health and the Health Officer with support from:
Management Team. • CHS Supervisor
• EH Supervisor
• HP Manager
Support the Board of Health
• Assist with preparation of Board of Health agendas, Health Officer with support from:
develop executive reports, and facilitate Board of Health • Administrative Assistant II
meetings. • Assessment Coordinator I
• CHS Supervisor
• EH Supervisor
• HP Manager
• Address Board issues related to clarity of role, CHS Supervisor
governance, bylaws, policies, board structure and EH Supervisor
membership. HP Manager
• Assist with recruitment and orientation of new Board CHS Supervisor
members. EH Supervisor
HP Manager
Management Team Support
• Convene and lead the management team . Health Officer with support from :
• CHS Supervisor
• EH Supervisor
• HP Manager
• Ensure fiscal oversight Fiscal Analyst
• Maintain accountability for financial performance of Fiscal Analyst with support from:
department. • CHS Supervisor
• EH Supervisor
• HP Manager
92
Funcrfon Staff ResPOnsible
• Administrative Assistant II
Operations
• Ensure administrative level support of the overall Chair of the Board of Health
management of the department.
• Ensure continuity of service operations CHS Supervisor
EH Supervisor
HP Manager
Administrative Assistant II
• Ensure ongoing fiscal integrity and operations Fiscal Analyst
• Authorize major expenditures Fiscal Analyst
• Ensure timely billing/collections Fiscal Analyst
• Ensure human resources compliance HR Di rector with support from :
• CHS Supervisor
• EH Supervisor
• HP Manager
• Administrative Assistant II
• Prepare, submit and present department program CHS Supervisor
information to the BOCC Agenda as required. EH Supervisor
HP Manager
• With support from
Administrative Assistant II
• Ensure contract compliance
0 Processing new contracts through Kittitas County Administrative Assistant II
Prosecutor, Auditor and BOH/BOCC Systems
including presentations at BOCC Agenda and BOH
meetings.
0 Fiscal reporting Fiscal Analyst
-
0 Program Tracking/Reporting Assessment Coordinator I
CHS Supervisor
EH Supervisor
HP Manager
93
Attachment A: KCPHD Organizational Chart
_________ 2_0_1_7_K_itt_itas County Public Health De p artment Qr[anization _C_h_a1_·t _______ _
h ,.,..,., ... ,.
~:.trM':11
" --
tJm,...,,,..u.191.,.1w --....ityMuhl, ~ .. ..hti!Jt~ AIT.~t,iil i-(',M1111 1'~'U .....
.... !-~~ ---~"1n1 m11
~111.l-u1~ ~l....iu. ....... ~"·
t
6io..-µt, l-lHUI'\ f1 , ... ~ ... ,a111t W, I ~'9uhlt
""'4c-Art l 5.n...:.t.im • Sf'e~hu !!M"" ~· ,~!"''
~i Hul1P'! I f,M~;:.'.!i';, ••llh -· ffj_~t#p1"1.I J ,1111fjft1£t,~11o,1 L ~~~"' "'1><1 'I . ~bi,•l
.....,:::t: u..ni, ~l!!riJ H•V ~~nk<I
lo.O ~-(-
94
Attachment B: Essential Services
Identified Essential Services to Sustain LHJ Mission and Operations
FOUNDATIONAV I REQUIRED BY
DE ,· IR.lPTION ESSENTIAL LAW?
Birth certificates are available for births in Washington after Program RCW 70.58 .020
July 1907 . Death certificates are available for deaths that were WAC
electronically filed after August 2013. 246-490-010
---FOUNDA 1!/0N,ifI,/Ji REQU/REDBY
.DMCIUPTION SSENI'IAL LAW?
The communicable disease program is responsible for Capability/ RCW 70.05.070
preventing and investigating outbreaks and controlling the Program WAC
spread of communicable diseases in the community. ES#l ,2 ,3,4,5 ,6, 7 246-100-036
The tuberculosis program provides referrals for tuberculosis Program 70 .28.005
treatment and monitoring of tuberculosis cases. ES#l, 2, 7 70.28.031
WAC 246-170
11 FOUNDATIONAVE REQUIREDBY
'l!J~$CfiQ'TION SSENTIAL _LAW?
All retail food , catering and temporary food events are licensed Program RCW 70.05.070
and inspected through the food safety program. Food handler's ES#l ,2,3,6 69 .07
permits are also issued . WAC 246-215
County Code
Operating the county owned water bank and metering program, No County Code
enforcement for county code related to water mitigation for
residences.
The drinking water program works to ensure safe drinking water Program RCW 70.05 .070
for all residents of Kittitas County through inspections and ES#l, 5, 6 43.20 .05070
permitting of individual wells and public water systems. 70 .119
KCPHD also serves as a collection site for a water testing WAC
laboratory. 246-291-030
County Code
An environmental health specialist permits and inspects all Program RCW 43.20.050
county septic systems and licenses septic system installers and ES#l, 2, 5, 6 WAC
septic tank pumpers . 246-272A
County Code
The vector program monitors and controls vector borne diseases Program RCW 43.20 .080
such as West Nile Virus (WNV) and rabies . Specimens are sent ES#l, 2, 3 70.24
95
I -F Or!NDArf1(-)NAUE 'HE0.[J]RED JJY .p I
f>/3$J;:.lfifoi'JQN ~/AL ,, UW? .
to the state lab for testing as appropriate. We also collect WAC
mosquito samples during WNV season and provide public 246-100-036
education about WNV.
Public water recreation facilities are licensed and inspected to Program RCW 70.90.140
meet state standards of public safety. ES#l,3,5,6 (JPR)
Solid waste facilities are permitted and inspected to ensure Program RCW 70.95.160
proper handling of waste to prevent potential pollution, vector ES#l,2,3,5,6
problems, and public nuisances . We are also involved in
education and prevention activities around unsecured loads, and
complaint investigation.
Public campgrounds and parks are inspected annually for health Program RCW 43.20.050
and safety issues. ES#l,3,5,6 WAC 246-376
An environmental health specialist conducts annual inspections Program RCW 43.20.050
of public and private schools and playgrounds to ensure a safe ES#l, 3, 5, 6 WAC
and healthy environment for children. 246-366A-20
96
I.
II.
III.
IV.
V.
Topic
Purpose
Kittitas County Public Health Department
Environmental Health
Table of Contents
Planning Assumptions
Policies
Responsibilities
Concept of Operations
I. Purpose
Page
97
97-98
98
98
98-99
Environmental Health (EH) refers to the ability to reduce the risk of human contact with
environmental public health hazards in the event of an emergency. Reducing exposure risk pertains
to hazards such as contaminated food, air, water, solid waste, hazardous materials, and vectors
associated with exposure to infectious diseases, bacteria and pathogens.
II. Planning Assumptions
Based on the Kittitas County Hazard Identification and Vulnerability Assessment (HIV A), EH
response will most frequently address incidents involving flooding and wildfires. However,
97
historically, KCPHD has also responded to incidents involving solid waste, extended power outages,
and contaminated properties.
III. Policies
Incidents that require issued health orders, will follow the KCPHD Health Order policy
IV. Responsibilities
KCPHD will be responsible for the following activities:
Inspect the extent of damage to water and onsite sewage systems on properties within Kittitas County
resulting from natural or manmade disasters. Provide a subject matter expert for the Kittitas County
Emergency Operation Center.
Provide public information on safety precautions to reduce environmental exposure via press releases,
and media outreach.
Inform partner agencies as well as the general public of dangers associated with the emergency.
Ensure that all facilities regulated by the EH programs are not operational until facilities comply with
Kittitas County Code.
Coordinate with partner agencies to ensure environmental hazards are not accessible to the public.
Regardless of the agency lead, KCPHD will assess the severity of hazard and overall health and
safety of the situation and ensure mitigation of the environmental hazard.
V. Concept of Operations
Agencies that KCPHD may coordinate with include Department of Ecology, Kittitas County
Community Development Services, fire response agencies, local law enforcement, Red Cross, solid
waste, City of Ellensburg, pest control, Washington State Department of Fish and Wildlife, Unites
States Forest Service, Washington State Department of Natural Resources and the Washington State
Department of Health.
KCPHD staff may become aware of an incident in the following manner:
A. Environmental Health Staff discover the incident
B. Information is received via the emergency, twenty four hour, phone line
C. Law enforcement contacts the department
D. Local owner/operator notifies KCPHD of the incident.
E. A member of the public relays the information.
F. Partner agencies inform KCPHD of the situation.
KCPHD may provide the following in response to an emergency:
A. Work with emergency management to identify existing or potential environmental hazards
during emergency incidents.
98
B. Provide emergency messaging to reduce environmental hazard exposure to Kittitas County
residents as well as emergency responders.
C. Provide prophylaxis to emergency responders
D. Provide safety recommendations to responders.
E. Coordinate with disaster relief agencies to prevent the spread of disease with
recommendations or inspections for drinking water systems, food service centers, waste
disposal, and sanitary provisions.
99
Kittitas County Public Health Department
Communicable Disease
Table of Contents
Topic
VI. Purpose
VII. Planning Assumptions
VIII. Policies
IX. Responsibilities
X. Concept of Operations
Page
101
101
101
101
101-102
100
VI. Purpose
Communicable disease refers to diseases that can spread from one person to another, or are spread
through food, water, or other vectors that are contaminated or infected. A communicable disease
outbreak may present challenges that require an emergency response. In addition, emergencies and
disasters may create conditions that foster outbreaks of communicable disease. Reducing exposure or
stopping exposure to these diseases is an important public health function.
VII. Planning Assumptions
KCPHD has responded to incidents involving Tuberculosis, E. Coli, and pertussis outbreaks.
Outbreaks of measles, salmonellosis, and a variety of other communicable diseases have been
reported recently in the state and the nation. Disasters have the potential to disrupt systems that
protect the public from communicable disease.
VIII. Policies
KCPHD staff will follow disease-specific procedures, follow up, and reporting per Washington State
Department of Health requirements. Communicable disease response will follow the Communicable
Disease Reporting and Investigation policy (attachment*). Incidents that require issued health
orders, will follow the KCPHD Health Order policy ( attachment *)
IX. Responsibilities
KCPHD will be responsible for the following activities:
Inform Kittitas County partner agencies and residents of 24/7 disease reporting contacts
Receive information regarding notifiable conditions or disease outbreaks.
Complete necessary disease investigations related to the notifiable condition and/or outbreak.
Enter disease investigation data into the state's online reporting system. Implement exclusions within
childcares and/or school settings when necessary.
Request voluntary isolation and/or quarantine.
Provide a subject matter expert for the Kittitas County Emergency Operation Center.
Provide public information on safety precautions to reduce exposure via press releases, and media
outreach.
Inform partner agencies as well as the general public of dangers associated with the emergency.
Inform partner agencies and responders of required prophylaxis and precautions.
Provide communicable disease treatment, as applicable or coordinate clinical management with the
appropriate lead agency.
Regardless of the agency lead, KCPHD will assess the severity of hazard and overall health and
safety of the situation.
Mitigation for disease control may include quarantine, isolation, exclusion, or a specific health order
issued to prevent the spread of disease.
X. Concept of Operations
Agencies that KCPHD may coordinate with include Washington State Department of Health, Kittitas
Valley Healthcare, local medical providers, fire response agencies, local law enforcement, and Red
Cross.
KCPHD staff may become aware of an incident in the following manner:
101
A. Information is received via a notifiable condition alert.
B. Information is received via the emergency, twenty four hour, phone line
C. Law enforcement contacts the department
E. A member of the public relays the information.
F. WA DOH informs KCPHD of an associated disease outbreak or cluster
G. Partner agencies inform KCPHD of the situation.
KCPHD may provide the following in response to an emergency:
A. Work with emergency management to identify existing or potential disease exposure
during emergency incidents.
B. Provide emergency messaging to reduce exposure to Kittitas County residents as well as
emergency responders.
C . Provide prophylaxis to emergency responders and the public.
D . Provide safety recommendations to responders.
E. Coordinate with disaster relief agencies to prevent the spread of disease.
102
Kittitas County Public Health Department
Mass Fatality
Table of Contents
Topic
XL Purpose
XII. Planning Assumptions
XIII. Policies
XIV. Responsibilities
xv. Concept of Operations
Page
104
104
104
104
104-105
103
XI. Purpose
Mass fatality refers to an incident where more deaths occur within Kittitas County than local
resources can handle. The deaths may be caused by non-public health related reasons; however, the
purpose of this annex is to serve as guidance for deputy registrars to process death certificate
information.
XII. Planning Assumptions
According to the Kittitas County Coroner, an incident resulting in five deaths would be considered a
mass fatality, which would require assistance from resources outside of Kittitas County.
XIII. Policies
Only deputy registrars may process death certificates for Kittitas County Public Health Department.
XIV. Responsibilities
KCPHD will be responsible for the following activities:
A. Receive demographic information from either receiving physician or coroner via Electronic
Death Registry System (EDRS)
B. Assess information input into the EDRS for completion
C. Assign a local file number and sign information electronically in the EDRS
D. Submit EDRS information to the Washington State Department of Health.
XV. Concept of Operations
KCPHD will work closely with the Kittitas County Coroner, Kittitas County Emergency Manager,
and Washington State Department of Health.
KCPHD staff may become aware of an incident in the following manner:
A. Notification received via the emergency, twenty four hour, phone line
B. Law enforcement contacts the department
C. Kittitas County Coroner
D. A member of the public relays the information
E. Partner agencies inform KCPHD of the situation
KCPHD may provide the following in response to an emergency:
A. Work with emergency management and Kittitas County Coroner to provide deputy
registrars
B. Work as liaison between local deputy registrars and Washington State Department of
Health's EDRS
104
C. Provide information/RCW in regard to presumed deaths and situations where remains are
found, but not identified
D. Provide deputy registrars beyond KCPHD's normal business hours, as needed
105
.
I\... D ea th Certificate Proce ss
l'sing the Electroni c Death Re gis tr y System (EDRS ;
Kittitas Couot, Public HulchDl:putmont
Deputy R.ei•= ""°" completed EDRS
1Af~tioo; ·usiga. .1 loc.1l file 11.u.mber .ui.d sign s
oloctrottic,11<".
106
I.PURPOSE:
Kittitas County Public Health Department (KCPHD)
Investigation Protocol
AnnexK
The purpose of this protocol is to establish the necessary procedures for the investigation of
suspected outbreaks and clusters of communicable diseases, and environmental public health
hazards to ensure timely investigations. The investigation protocol delineates responsibilities as
well as steps to investigate the issue along with reporting requirements.
KCPHD will follow appropriate procedures and notification practices when investigating
complaints and reports of health problems and occupational public health hazards. KCPHD will
notify and provide direction to appropriate persons/agencies throughout the investigation
process.
II. SCOPE
This protocol applies to any incident in Kittitas County that requires investigation of suspected or
identified public health hazards. These hazards include environmental health incidents as well as
disease reports. Investigations may range from investigating a suspected case patient, to a cluster
(3 patients), or potential outbreak (5 patients). A cluster evaluation may be differentiated from
an outbreak in that a single case of some infectious disease may trigger the use of outbreak
protocol.
III. PLANNING ASSUMPTIONS
KCPHD does not have the capacity, beyond initial response and assessment, to conduct
additional studies or etiological investigations.
KCPHD cannot conduct multiple, simultaneous in-person investigations due to limited
personnel. KCPHD Administrator, Health Officer, or Supervisory staff may assign employees to
investigate incidents, even if the nature of said incidents are outside the normal purview of the
responding staff. For example, non-medical staff may conduct phone interviews in regard to
infectious disease exposure.
Depending on the nature of the investigation, KCPHD may involve KSCO or Code Enforcement
to assist with compliance issues .
III. RESPONSIBIL TIES:
A. KCPHD will be responsible for the following activities as the lead investigative agency for
public health hazards or diseases:
107
1. For all complaints and reports of communicable disease and/or occupational health
hazards received by KCPHD, KCPHD will document pertinent information of any
potential or verified health issue or incident.
2. Diseases that are communicable will be assigned to the Community Health Supervisor.
Environmental Health issues will be assigned to the Environmental Health Supervisor.
Supervisors may choose to investigate or delegate the investigation to an employee,
preferably within that program.
a. Depending on the breadth and urgency of the investigation, outside agencies, such
as DOH or Ecology, may be involved.
b. Food Borne Illness investigations will be led by KCPHD staff with Food
Inspector training and will follow established DOH protocols.
3. KCPHD will conduct interviews with reporting party.
a. If the original complaint or report does not warrant an investigation, interviews
may not be conducted.
4. KCPHD investigating staff will refer to DOH guidelines regarding reporting procedures,
if required.
5. KCPHD will be responsible for contacting and updating all regulatory agencies if
necessary.
6. KCPHD will provide education to partners and providers, as necessary, specific to the
hazard or identified disease.
7. Investigating staff will notify Health Officer, Administrator, and CH/EH Supervisors of
health issues or incidents that require Health Orders, or subsequent compliance checks.
8. KCPHD will compile information on health issues or incidents and provide updates to
public/agencies as needed. An After Action Report may be required if an investigation
resulted in an Order.
9. Determination of follow-up that is necessary will be discussed and implemented by
Investigating Staff, CH/EH Supervisors, Public Health Administrator, and Public Health
Officer.
IV. CONCEPT OF OPERATIONS:
Protocol for disease investigation may include disease specific procedures outlined by the
Washington State Department of Health, contact management, clinical management, mitigation,
use of prophylaxis, laboratory coordination, and/or the use of legal authorities for public health
hazards or disease control. KCPHD will follow the procedural steps below:
108
i«;ftto "h" •~c~
«>tnptointbf r,!~ot KCPHDWII! nod!'/
no1l!~'!'lllfll odf KCPH DAdmlnt:ou,r, •Pp1o i,r 1Mo"11cncyof h I sd°'cnn l'll!<lth-i
e v101!.!1on~wnnes:.c:t1 _11..,llh,Ot( , ,u,p,u..ioi,t t:n,lill$~lllJ oddll ,<Wlli 1 ro<',ot,.:,o:
<11lrl11,1 1,q,en1on. COmm.u~l\ lfei, h ll,:Cst11atlon ~OIJI>-b<ev,mo Tor•! ~•!I are
X!'J> iOm~VO•o~Cil lC> <111/o-e1,.irOM1,no1 ~c~,.., 1e:sc,r n,o,,g_ r~11l1ed ror.onllel<'l~c
con<1ltknsm111 lllfnot tteolhH11fml'(fc,;sl llke~!ODc,OOt l <e!pOl'tle, tbefmerc,!ocy
•no,l,!iotrf but~••~& lm1..ulp11on i;.>mmuni\llblcO~ O~etllll>:l~toltwlllbe
ln~<l...,ll) EpldemlOkla\'or loltowed"'n~
<>11\1>reol<11<>lffll Oepanm,nt of Ecoqy.
Sta ffwillrererto OOH When the upon compia11oo 01
Gu ldelheslor Publ t lnve~a>~ lnvestlgatloo, DOH
ClearOiilllJlosi5ls He• Ith I nvestlgations source of i nfection as and other partners
avaUable. and use environmental~ fiefd Wlllbenotified.
corresponding OOH investigations will KCPHDwill
Reportl1111 Form(s). occur. cene,ateAfter
Action Report.
KCPH D staff recad
i ncident and as:slln
lead in~ator. The A<tnfnlsttm
lnitialevaluationwill EHstaffwllleducate Health Offlc<1. IWf determine
npp1 oi:, tc rdl)Clli.e applicable porties on Pullltw«matlcn the publt: health
concern andcontinue Office-will d«lde
to monitor for BM and When 10
outbreak potential. notlly ""' ~
No clear dla(nosisis ..... ~andthe
available. p.t,I~ N<Xlllrallcn
mll'f lnclllde a<>lldo'
CH sta ffwillusethe e~ via emllff « fllll,
ICCPI-ID Ccmmunl<tlol<, medlar..._cr 01s ..... lnilal Report
Form and contlnueto Clherm!lhodsas
monitorforoutbreak ~
potential.
109
Topic
XVI. Purpose
Kittitas County Public Health Department
Substandard Air Quality Response
Table of Contents
XVII. Planning Assumptions
XVIII. Policies
XIX. Responsibilities
XX. Concept of Operations
XVI. Purpose
Page
The Substandard Air Quality Response refers to the ability to coordinate with agency
partners to notify the public of air quality issues as a result of wildfires or any smoke related
emergency or disaster, to provide resources and recommendations, and in the case of
hazardous air quality implement health orders ceasing activities . In addition, the purpose
includes the ability to assess indoor air quality, specific to public places, which may request
assistance in gauging the risk of poor indoor air quality caused by smoke.
XVII. Planning Assumptions
Kittitas County has responded to wildfires in previous years caused by lightning strikes,
arson, and other human and natural factors. Multiple counties within the region may
experience wildfires simultaneously. Hazardous levels of outdoor air quality may constitute
the declaration of emergency, regardless of the wildfire location.
A. The Washington State Department of Ecology (Ecology) will be the lead agency
in determining the outdoor ambient air quality and Kittitas County will follow the
Washington Air Quality Advisory {WAQA).
B. Monitoring may become unavailable via Ecology. If monitoring becomes
unavailable, KCPHD may coordinate with Ecology to utilize other monitoring
resources.
C. The region may not have the resources or expertise, locally, to assess indoor air
quality during wildfire emergencies or smoke related incidents. State and federal
resources to assist with indoor air monitoring may not be available.
D. Indoor air quality monitoring via KCPHD may not be available for all requesting
agencies.
E. Private locations and public places may use private environmental consulting
agencies for indoor air monitoring.
F. Indoor air monitors, E-samplers, are not adequate for outdoor monitoring.
110
XVIII. Policies
G. Kittitas County will coordinate with the Washington State Department of Health
(DOH) and Ecology regarding air quality.
H. KCPHD will distribute masks, as available, to the public during incidents with air
quality alerts issued by Ecology and periods of air quality conditions that range
from "unhealthy to sensitive populations" to "hazardous."
I. If KCPHD is unable to provide indoor air monitoring to all public places
locations, the Health Officer will prioritize monitoring based on sensitive
populations receiving priority.
J. Air quality conditions that reach "unhealthy" within a school building will result
in a recommendation from the Health Officer to close school until indoor air
quality can be mitigated to "unhealthy for sensitive populations."
K. Outdoor activities should be moved indoors when the air quality moves beyond
the threshold of"unhealthy for sensitive populations (150 index/35.4 WAQA)"
and cancelled or moved to and area with acceptable air during "unhealthy" or
worse.
L. Hazardous air quality will result in the closure of outdoor events via an enforced
Health Order. Events will be occasions permitted through the county or local
municipalities, openly advertised as an event to the public, or charge admission.
M. For large scale, annual events, such as Kittitas County Fair or Rodeo, KCPHD
will work with agency partners to update plans and response in the event of
hazardous air quality.
XIX. Responsibilities
KCPHD will be responsible for the following:
• Provide public information regarding air quality conditions and resulting activity
recommendations.
• Provide N95 masks to the public, as available.
• Provide indoor air monitoring of locations determined to provide respite from outdoor
air.
• Provide indoor air monitoring, as available, to public places within Kittitas County.
• Conduct monthly equipment testing of air quality monitors and ensure monitors are
recalibrated and certified, as necessary.
• Annually, monitors will be compared to outside readings via Ecology prior to wildfire
season to ensure accuracy.
• The Health Officer will determine the final recommendations and implementations of
health orders.
• Notifying Emergency Management of forecasted "hazardous" air conditions.
KCSO will be responsible for the following:
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• Assist in the enforcement of health orders related to hazardous air and outdoor events.
• Coordinate with KCPHD to provide notification of hazardous air quality conditions.
Red Cross will be responsible for the following:
• Provide shelters in Kittitas County for respite in response to outdoor air quality via
request from Emergency Management.
• Coordinate with KCPHD to allow indoor air monitoring and complete mitigation as
needed to maintain an indoor air quality of at least "unhealthy for sensitive
populations."
XX. Concept of Operations
Agencies that KCPHD may coordinate with include DOH, Ecology, fire response agencies,
local law enforcement, Red Cross, Emergency Management, and Emergency Operation
Center personnel.
Mass notification of Kittitas County residents regarding air quality:
A. KCPHD will send out press releases to local media when we become aware of air
quality alerts or air conditions that are "unhealthy to sensitive populations" or
worse, using the Kittitas County press release system.
B. KCPHD will send media releases along with corresponding air quality
recommendations to schools, sports leagues, and upon request.
C. Education will be provided via partner agency social media and the Kittitas
County Website .
D. Prior to forecasted "hazardous" air quality conditions or if air quality conditions
reach hazardous via Ecology monitors, KCPHD will notify the county,
municipalities, and the Chamber of Commerce, in addition to regular mass
notification recipients.
N95 mask distribution:
A. KCPHD will provide N95 masks, as available, free of charge, to the public during
air quality alerts and air quality conditions of "unhealthy to sensitive populations"
or worse.
B. KCPHD will post a Waiver and Release for Respirators when providing N95
masks.
C. KCPHD will provide DOH mask information along with fitting guides per request.
D. Anyone receiving a mask will receive the message that KCPHD prefers that
exposure is limited and masks are considered a "last resort" measure.
E. Typically, requesters will receive l mask per person, per household.
F. Masks will not be provided for requesters disclosing private, outdoor events, such
as weddings, barbecues, reunions, et cetera. KCPHD will refer requester to private
vendor to purchase masks.
G. KCPHD may partner with agencies within the county to provide N95 masks and
those agencies will follow the same concept of operations.
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H. KCPHD will track mask distribution numbers and request additional supplies via
emergency management or regional partners, as needed.
Indoor Air Quality Testing of Schools:
A. Upon request, KCPHD will provide indoor air monitoring of schools.
B. Two KCPHD staff will be present for on-site testing.
C. During indoor air testing, KCPHD will provide air testing information, air quality
charts, and indoor air quality readings.
D. KCPHD will provide educational materials as available from DOH and Ecology.
E. Documentation of readings will be kept on the shared county drive.
F. Readings will be forward to the Health Officer or Administrator for
recommendations.
G. Recommendations will be issued to the school on the same day of monitoring.
Response specific to hazardous air quality conditions and outdoor events:
A. KCPHD will notify emergency management as soon as "hazardous" air quality
conditions are predicted via Air Resource Advisors assigned from the United
States Forest Service or when air quality has reached "hazardous" via Ecology's
monitor.
B. KCPHD will utilize mass notification when "hazardous" air quality is forecasted
or reached within the county.
C. Events permitted through the county or local municipalities, openly advertised as
an event to the public, or charge admission for outdoor events will be issued a
health order by KCPHD.
a. Health Orders will be issued prior to the event, with specific language that
the event is to be cancelled, if and when the "hazardous" air quality
condition is reached (301 index/W AQA 250.5) determined by Ecology's
monitor.
b. For events with an audience that exceeds local capabilities, KCPHD will
request emergency management to open an Emergency Operation Center
to respond, as needed.
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W AIYER AND RELEASE FOR RESPIRATORS
Please be aware that by accepting a respirator, provided free of
charge by Kittitas County, you assume all risks of injury to your
person and hereby waive and release any and all rights and
claims for damages against Kittitas County.
Consult your doctor with any medically related questions or
concerns regarding proper use and fit.
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