MFHCC Meeting November 1, 2016 Jefferson County Public Health, Parfet Building Lakewood, CO

Welcome and Introductions

Agenda Welcome & Introductions - Janelle Review Previous Action Items - Janelle Upcoming Trainings – Lisa Four-wheel Emergency Assistance Team (FEAT) – Michael Hirschman Updated List of Reportable Conditions in Colorado – Christine Billings Full Scale Exercise (FSE) Overview & Discussion Overview of FSE by CDPHE Office of Emergency Preparedness & Response – Michael Bean & Greg Stasinos MFHCC Role in FSE – Janelle and Lisa Update of MFHCC Jurisdictions and Agencies – Janelle and Lisa Expect/complete the MFHCC member survey by November 18th– Lisa Agency Updates - All Review New Action Items - Janelle FSE Planning Workgroup meets today 1:30-2:30pm Networking

Review Previous Action Items Person responsible Deadline Contact Christine/Cali if interested in becoming a JCPH or Denver Closed POD. All On-going Call your local non-emergency dispatch, introduce yourself and ask what situations they would like you to use this number instead of 911. Prepare to report back at the next meeting. There is a statewide need for blood donors so please spread the word. Email Janelle or Lisa to sign up for workgroups of interest, including the full-scale exercise workgroup. Member Spotlight - email Janelle and Lisa if you would like to be featured on the website. Distribute survey to gather feedback about the healthcare coalition merger and to identify training opportunities for 2017. Lisa & Janelle 11/18/16 Cali will e-mail the Inventory Management System Excel form to all Denver Closed POD partners for confirmation and for POD site records. Cali Zimmerman TBD

Upcoming Meetings and Trainings Lisa Filipczak

Upcoming Trainings – Lisa Thanks to those that attended the MFHCC Networking Social Event at Steuben’s in Arvada! Thanks to those that participated in the JCPH & Arvada Fire “Operation Bubble Blast”Full Scale POD Exercise on Oct 21st! Nov. 3, 9:30 am - 2:30 pm – Ebola Tabletop Exercise – West Metro Fire Rescue Training Facility, Lakewood Nov. 30th, 9:00 – 10:30 am – Community Inclusion in Colorado (CICO) Maps Training @ Tri-County Health Department Sign-up for Full Scale Exercise Workgroup - workgroup will meet after today’s meeting Note that December 6th MFHCC meeting cancelled

Four-wheel Emergency Assistance Team (FEAT) Michael Hirschman

Changes to Rules and Regulations Pertaining to Epidemic and Communicable Disease Control Christine Billings, MPH Emergency Preparedness and Response Coordinator Jefferson County Public Health

Update from CDPHE Board of Health accepted the proposed changes on September 16, 2015 for the Rules and Regulations Pertaining to Epidemic and Communicable Disease Control (6 CCR 1009-1). Effective on November 14, 2015

Effective: October 15, 2014

Changes To better explain who must report conditions (Labs and/or individuals) and the required timing (24hrs vs 7 days): Regulations 1-3 were combined to create a single table.

Changes Accession number is required on all reported diseases with supporting laboratory results to comply with CDC reporting requirements and be able to link multiple tests performed on the same specimen.

Changes Clinical and reference laboratories are required to submit cultures or original clinical material for specific reportable conditions as listed in the reportable disease table. Laboratories will submit bacterial culture isolates or patient clinical material that yields positive findings to the CDPHE Laboratory Services Division.

Changes Methicillin-resistant Staphylococcus aureus (MRSA) was deleted from the “Conditions Reportable by all Laboratories.”

Changes The definition of carbapenem-resistant Enterobacteriaceae (CRE) was changed. See regulations for new definition. CRE remains a 7 day reportable condition CDC 2013

Changes Carbapenem-resistant Pseudomonas aeruginosa (CRPA) was added as a 7 day reportable condition by laboratories. Image Left: CDC staff show 2 plates growing bacteria in the presence of discs containing various antibiotics. The isolate on the left plate is susceptible to the antibiotics on the discs and unable to grow around the discs. The disc on the right has a CRE that is resistant to all the antibiotics tested and is able to grow near the discs. Image Right: This is a plate that demonstrates the modified Hodge Test which identifies resistance in Enterobacteriaceae. Bacteria that are resist to Carbapenems, which are typically “last resort” antibiotics, produce distinctive clover-leaf shape.

Changes Viral hemorrhagic fever was added as a 24 hour reportable condition by individuals AND laboratories. Includes: Ebola virus disease, Crimean-Congo hemorrhagic fever, Lassa fever, Marburg fever, and more.

Changes Severe or Novel Coronavirus was added as a 24 hour reportable condition by individuals AND Laboratories. Includes: SARS and MERS-CoV

Changes Tularemia was changed from a 7 day reportable to a 24 hour reportable disease.

Changes Acute flaccid myelitis (AFM) was added as a 7 day reportable condition. Definition can be found on CDPHE website

Changes When a laboratory performs a culture that is positive for Mycobacterium tuberculosis, the lab shall store the isolate until it receives a request from the state or local health department for the isolate OR the lab may fulfill this requirement by submitting the isolate to the state public health lab. Once the isolate is received by the state public health laboratory it will be submitted to a CDC-contracted laboratory for genotype testing.

Questions? CDPHE Guidance Communicable and non-communicable disease conditions reportable by health care providers and laboratories. https://www.colorado.gov/pacific/sites/default/files/DC_ComDis_Reportable-Conditions.pdf

Full Scale Exercise (FSE) Overview & Discussion

Overview of FSE by CDPHE Office of Emergency Preparedness & Response - Michael Bean & Greg Stasinos

PHED EX - Objectives Capability: Information Sharing Objective: Demonstrate the ability to effectively collect, synthesize, and share information with local and state partners throughout the duration of the incident. Capability: Emergency Operations Coordination Objective: Demonstrate the ability to activate an operations center, develop a coordinated response strategy, and manage and sustain response to a public health incident. Capability: Medical Countermeasures Dispensing/Medical Material Management and Distribution Objective: Demonstrate the ability to support and participate in Colorado’s medical supply chain procedures.

MFHCC Role in FSE – Janelle & Lisa Testing Capability Information Sharing Objective: “Demonstrate the ability to effectively collect, synthesize, and share information with local and state partners throughout the duration of the incident.” Developing MFHCC Communication Plan that will be tested prior to and used during FSE Resource ordering will be done through your jurisdiction representative/liaison

Hospital – Expected Player Actions All HPP funded hospitals are expected to open their operations centers to test Objectives 1 and 2 regarding Information Sharing and Emergency Operations Coordination. Expected hospital actions during the exercise include, but are not limited to: Receive and synthesize exercise information (injects) from the exercise SimCell Work with LPHAs to ensure patient information, volume, and bed availability is communicated Work with LPHAs to identify resources and resource needs Work with LPHAs to ensure needed resources are requested utilizing local resource ordering processes. Other actions that would be taken on an organizational/local level during an incident

Behavioral Health – Expected Player Actions Behavioral Health agencies receiving funding through CDPHE are expected to complete the following actions: Work within regional exercise planning efforts to identify three activities to be tested and measured during the exercise Evaluate and provide lessons learned regarding the tested activities.

LPHA – Expected Player Actions ALL LPHAs, independent of whether they are opening a POD or RTP/LTP, are expected to open their operations centers to test Objectives 1 and 2 regarding Information Sharing and Emergency Operations Coordination. Expected LPHA actions during the exercise include, but are not limited to: Communicate with hospitals to gather patient information, resource levels, resource needs, etc. Communicate with other LPHAs within the region through regional staff and local response infrastructure to communicate situational information and resource needs Communicate with regional staff to communicate local information and needs Going through local processes to complete and send resource requests (all resource requests will be processed as part of the exercise, but MCM materials will be the only resource actually delivered.) Complete other actions that would be taken on a local level during an incident

LPHA – POD – Expected Player Actions LPHAs opening a POD will be expected to complete the following in addition to those described in the preceding section: Identify needed resources in relation to POD activities Work with regional partners and CDPHE to complete and send resource request for MCM materials Work with regional staff to coordinate transfer of SNS material from the RTP/LTP receiving the material from CDPHE to the local POD location Utilize local processed to distribute empty medicine bottles (whether that be to volunteers, staff, etc.) Coordinate with regional staff to return SNS exercise materials Demobilization of POD

LPHA – RTP/LTP – Expected Player Actions All Regional Staff LPHAs opening an RTP/LTP will be expected to complete the following in addition to those described in the previous section: Stand up, manage, and demobilize RTP/LTP as per local plans Work with CDPHE to coordinate receipt of MCM materials at RTP/LTP Work with local POD sites to coordinate pick up and transfer of MCM materials to local POD site Coordinate with CDPHE to recover MCM materials from POD to RTP sites

Other Agencies – Expected Player Actions Other regional partners are encouraged to participate in the 2017 Full Scale Exercise, though they will not be required by or receive exercise guidance from CDPHE for the exercise. These partners include, but are not limited to: Emergency Management Emergency Medical Services Law Enforcement Epidemiologists Coroners

Update of MFHCC Jurisdictions and Agencies Are you planning on participating in the FSE? If so, which days? If yes, have you started planning?  Is there anything you would like to share from those discussions? What do you want to test? Will you open a point of dispensing (POD)? Will you open a department operations center (DOC)?  (Note that all HPP funded hospitals are expected to open a hospital command center.) Please list your agency plans on the sign up sheet which is being distributed or email Lisa and Janelle with your plans if you are remote today. By Discipline Public/Environmental Health Hospitals Mental/ Behavioral Health EMS Provider Emergency Management Long Term Care Outpatient Medical Services (Example: community health center, clinic, dialysis, etc.) Other HCC Partner (Example: education, private, federal entity, coroner, etc.).

JCPH Update JCPH will only be opening their RTP JCPH will not open a POD JCPH will play on Thursday and Friday RTP POD 1 POD 2 POD 3 POD 4 POD 5 POD 6 POD 7 POD 8 POD 9 POD 10 Broomfield Clear Creek Gilpin Closed PODs

Denver Update Denver’s Draft FSE Plan: Day 1: DOC Day DEH and DPH will open a DOC to develop an IAP DPH will contact participating PODs and Hospitals for activation and/or resource requests Denver EOC open with limited staff for resource request processing, and information sharing and situational awareness coordination Day 2: Distribution Day DEH will distribute SNS assets to PODs and Hospitals DEH/DPH DOC will operate 2nd operational period to manage resource requests Day 3: Dispensing Day DPH will operate one Open POD site So far 1 Closed POD is playing

Clear Creek Update Receiving SNS from Jeffco RTP Opening 3 POD’s

Please complete the MFHCC member survey – coming soon! Also review MFHCC Charter and MFHCC Operational Structure Lisa Filipczak

Agency Updates - Janelle Please mention brief updates you would like to share with the entire group Include your name and agency name High level reports applicable to various agencies Updates requiring in depth discussions may transition into workgroups

Agency Updates Epi Update Hospitals Public/Environmental Health EMS Provider Emergency Management Long Term Care Mental/ Behavioral Health Outpatient Medical Services (Example: community health center, clinic, dialysis, etc.) Other HCC Partner (Example: education, private, federal entity, coroner, etc.).

Review New Action Items Janelle Worthington

Thank you! Networking