1. Virginia Department of Health
Emergency Support Function(ESF)-8 Public Health and Medical Services
Overview
Dr. S. Hughes Melton
Jeffery Walker
Andrew Slater

2. Virginia ESF-8 Overview
The ESF-8 Health and Medical Group’s mission is to coordinate the provision of critical services to protect the health of citizens and to provide medical, mental health and fatality management services as needed in disasters and large-scale emergencies.
ESF-8 provides assistance in identifying and meeting the public health and medical needs of those adversely affected by an emergency. This support is categorized in the following core functional areas:
Assessment of public health/medical needs (including behavioral health)
Public health surveillance
Medical care personnel
Medical equipment and supplies
Emergency Medical Services
Environmental health monitoring and response
Mortality management
Support to Mass Care and Public Works emergency support functions

3. Local and Regional Public Health

4. Healthcare Coalitions and Regional Healthcare Coordinating Center

5. Commissioner’s Code Authority
§§ / authority to promulgate orders to meet any emergency.
§§ Isolation/Quarantine authority.
§§ / authorizes persons not ordinarily authorized to do so to administer and dispense medications.
§§ / VAC address the provision of emergency contact information by health care providers.
§§ / / Immunization authority
§ Chief Medical Examiner authority to declare cause of death

6. Virginia Department of Health Functions
Office of Emergency Preparedness
Epidemiology
Surveillance and Investigation/Consultation
Risk Communications and Education
Emergency Medical Services
Radiological Health
Drinking Water
Environmental Health Services
Chief Medical Examiner
Family Health Services
Immunization
Health Equity
Pharmacy Services
Tuberculosis And Newcomer Health
Epidemiology
Surveillance
Track trends & patterns of illness of public health concern, generate statistics, take action on identified problems
Improve provider reporting of disease, including electronic laboratory reporting
Syndromic surveillance – over 100 facilities submit data on reasons for emergency visits
Special event (e.g., Inauguration) and special disease (e.g., influenza) surveillance
Provide statewide surveillance systems
Investigation / Consultation
Investigating disease and outbreak situations
Remove the source, protect contacts of ill persons, restrict activities, arrange for lab testing, etc.
Requires daily coordination within the agency and frequently with other state agencies and the federal government
Daily public health actions prepare staff for larger and more serious incidents of public health concern
Risk Communication
Maintain pre-scripted messages, talking points and press releases on many issues to rapidly disseminate information
Staff support to the Joint Information Center (JIC) in the state Emergency Operation Center (EOC) to coordinate information affecting the health of the public
EMS
Augment VDH VERT response to VEOC
Deploy and coordinate HMERT and other EMS resources during emergencies or disasters
Coordinate external EMS resources
Ensure continuity of internal and external EMS resource communication during response
Rad Health
Monitor event, release status
Provide staff support to VEOC ESF8 and input to Joint Information Center on risk/crisis communications
Estimate emergency worker and population dose
Estimate exposure, deposition, contamination
Provide protective action recommendations (responders, public)
Potassium Iodide (KI) administration
Advice to Evacuation Assembly Center
Monitor decontamination efforts, provide technical expertise and treatment guidance to Health Districts, health providers, etc.
Assist remainder of VDH on implementing long-term monitoring of adverse health effects
Drinking Water
Timely Identification of disruption to water supply operations and initiate timely and effective technical assistance to the waterworks
Monitor and report drinking water safety; issue appropriate emergency orders, ensure affected customers are notified; and advise consumers of appropriate protective action
Notify and coordinate with local, state, and federal agencies, and organizations to assist with the response.
Provide situational awareness of waterworks status and needed resources to decision makers
If VEOC activates ESF #3,coordinate and organize state capabilities and resources to facilitate the delivery of essential engineering services
Environmental Health
Participate in the Virginia Rapid Response Team (VDH, VDACS, DCLS) to respond to food borne illnesses.
Maintain the Food Emergency Response Plan
Provide guidance and training to local health departments for food-borne outbreaks and food-specific emergency responses.
Protect public health by quickly identifying whether restaurants and shellfish plants were affected during an emergency and determining if these facilities may continue to operate.
Provide regulatory oversight as it pertains to the destruction, seizure, and embargo of contaminated foods.
Notify and coordinate with VDACS, DCLS, State Police, and the FDA to assist with emergency food event responses.
Announce precautionary harvest area closures prior to the event as necessary. Assess impacted areas post event and issue closures as needed.
Post event follow-up by testing post-event samples of seawater and shellfish to assess bacteriological and viral contamination.
Chief Medical Examiner
Effectively manage fatality incidents resulting from either man made or natural event that may cause MASS fatalities that fall under medical examiner jurisdiction.
OCME will ensure:
Complete collection and examination of the dead
Recovery of forensic, medical and physical evidence
Identification of the fatalities using scientific means with law enforcement support
Certification of the cause and manner of death
Management, storage and reunification of remains
- Document fatalities for admissibility in criminal / civil courts.
- Ensure completion of investigations and review of daily non-event medical examiner cases of the Virginia localities.

7. VDH Service Areas Scholarships
Financial Assistance for Non Profit EMS organizations and Localities
State Office of EMS
Anatomical Services
Medical Examiner Services
Health Statistics
Vital Records
Immunization Program
Tuberculosis Prevention and Control
Sexually Transmitted Disease Prevention and Control
Disease Investigation and Control Services
HIV/AIDS Prevention and Treatment Services
Pharmacy Services
Health Research, Planning and Coordination
Regulation of Health Care Facilities
Certificate of Public Need
Child and Adolescent Health Services
Women's and Infant's Health Services
Chronic Disease Prevention, Health Promotion, and Oral Heath
Injury and Violence Prevention
Women, Infants, and Children (WIC) and Community Nutrition Services
Local Dental Services
Restaurant and Food Safety, Well and Septic Permitting and Other Environmental Health Services
Local Family Planning Services
Support for Local Management, Business, and Facilities
Local Maternal and Child Health Services
Local Immunization Services
Local Communicable Disease Investigation, Treatment, and Control
Local Personal Care Services
Local Chronic Disease and Prevention Control
Local Nutrition Services
Payments to Human Services Organizations
Administrative and Support Services
Drinking Water Regulation
Drinking Water Construction Financing
Public Health Toxicology
State Office of Environmental Health Services
Shellfish Sanitation
Bedding and Upholstery Inspection
Radiological Health and Safety Regulation
Emergency Preparedness and Response

8. Office of Emergency Preparedness Program Structure and Funding
Funds awarded through the United States Department of Health and Human Services through two cooperative agreements:
Public Health Emergency Preparedness Program (PHEP): Center for Disease Control and Prevention (CDC)
Hospital Preparedness Program (HPP): Office of HHS Assistance Secretary for Preparedness and Response (ASPR)
PHEP -  CDC's Office of Public Health Preparedness and Response funds preparedness activities to state and local public health systems through the Public Health Emergency Preparedness (PHEP) cooperative agreement and other funding. Through these resources, CDC helps public health departments improve their ability to respond to a range of public health incidents and build better prepared communities.
HPP - The Hospital Preparedness Program (HPP) enables health care systems to save lives during emergencies that exceed day-to-day capacity of health and emergency response systems. As the only source of federal funding that supports regional health care system preparedness, HPP promotes a sustained national focus to improve patient outcomes, minimize the need for supplemental state and federal resources during emergencies, and enable rapid recovery. HPP prepares the health care system to save lives through the development of regional health care coalitions (HCCs) that incentivize diverse and often competitive health care organizations with differing priorities and objectives to work together.

9. HPP & PHEP Structure

10. Public Health & Healthcare Preparedness Funding Trend

11. Current Supplemental Funding
Hospital Preparedness Program (HPP) Ebola Funding
Public Health Emergency Preparedness Program (PHEP) Ebola Funding
PHEP Supplemental Zika Funding

12. Public Health Emergency Preparedness (PHEP) Capabilities
1. Community Preparedness
2. Community Recovery
3. Emergency Operations Coordination
4. Emergency Public Information / Warning
5. Fatality Management
6. Information Sharing
7. Mass Care
8. Medical Countermeasure Dispensing
9. Medical Materiel Management / Distribution
10. Medical Surge
11. Non-Pharmaceutical Interventions
12. Public Health Laboratory Testing
13. Public Health Surveillance and Epidemiologic Investigation
14. Responder Safety and Health
15. Volunteer Management
These 15 capabilities are what we plan, organize, train and equip to address at the local, regional, and state levels. To assist state and local public health departments in their strategic planning, CDC developed 15 capabilities to serve as national public health preparedness standards.
CDC applied a systematic approach to developing the public health preparedness capabilities. The content is based on evidence-informed documents, relevant preparedness literature, and subject matter expertise gathered from across the federal government and the state and local practice community.

13. Hospital Preparedness (HPP) Capabilities
Foundation for Healthcare and Medical Readiness
Healthcare and Medical Response Coordination
Continuity of Health Care Service Delivery
Medical Surge
HPP capabilities outline the high-level objectives that the nation’s health care delivery system, including health care coalitions (HCCs) and individual health care organizations, should undertake to prepare for, respond to, and recover from emergencies. These capabilities illustrate the range of preparedness and response activities that, if conducted, represent the ideal state of readiness in the United States.

14. ESF-8 Support Agencies Secretary, Agriculture and Forestry
Department of Agriculture and Consumer Services
Secretary, Natural Resources
Department of Environmental Quality
Secretary, Administration
Department of General Services
Division of Consolidated Laboratory Services
Secretary, Public Safety and Homeland Security
Department of Emergency Management
Virginia State Police
Virginia National Guard
Secretary, Veterans’ and Defense Affairs
Secretary, Health and Human Resources
Department of Behavioral Health & Developmental Services
Department of Social Services
Virginia Hospital and Healthcare Association
VACO / VML
City, Town and County Governments

15. VDH Response To Addiction Epidemic
Completed
Primary: Declaration of a Public Health Emergency
Secondary: Addiction Disease Management Sessions
Tertiary: Naloxone Standing Order
In Progress
Establishment of VDH Incident Management Team
Develop Response Concept of Operations
Cross Agency Coordination
Surveillance of adverse health impacts of opioid addiction: Death, Injury due to Overdose, Hepatitis B and C infections, HIV
Identification of regional champions
Approved legislation establishing Syringe Services Programs as part of comprehensive harm reduction
Board of Medicine approved new emergency regulations that will give it authority to specifically regulate the prescribing of opioids for pain

16. VDH Addiction IMT Incident Commander Dr. Marissa Levine
Liaison Officer Joe Hilbert
PIO
Maribeth Brewster
Administration/Logistics/Finance Chief
Richard Corrigan
Planning Chief
Bob Mauskapf
Operations Chief
Dr. Hughes Melton
Procurement/ General Services
Steve VonCanon
Exercise Branch
Suzi Silverstein
Tertiary Prevention Branch
Lead: OEPI (TBD)
Hospital/Medical Community
Kelly Parker
CHS Branch
Bob Hicks IT
Debbie Condrey
Finance
Beth Franklin
35 Local Health District Directors
Data and Intelligence Branch
Dr. Laurie Forlano
Disease/ED Data HR
Rebecca Bynum
Liaison – External Partners
VSP, VDEM, DBHDS, VDSS
DDP (Diana Jordan, RN)
National Abstinence/ PMP Data
OFHS
Regional Response Branch
Lead: CHS/OEP
Secondary Prevention Branch
Lead: EMS (Gary Brown)
Education
Carole Pratt
Training
Lisa Wooten
Primary Prevention Branch
Lead: OFHS (Dr. Vanessa Walker Harris)
EMS/Naloxone Data
OEMS
Death Data
OCME
Access/Functional Needs Planning
Of of Health Equity
(Dr. Adrienne McFadden)

18. Virginia's Public Health Emergency Preparedness
Regional and Local Discussion
Jeffery Walker

19. How VDH Works
VDH Has worked in a regional construct since 2003 with Regional teams, similar to Regional VDEM current structure
We also work in a “Health District” format
Unlike local OEM because it may not represent a one to one county/political jurisdiction
So how does VDH work to support ESF8 activities
Regions- similar to VDEM/VSP/VDOT -discuss personnel make-up, roles/responsibilities (Coordinator, Epi, PIO)
Districts-similar to your local OEM but may encompass more counties within a district-may make it tough to coordinate-Personnel and roles and responsibilities (HD, Local Health Emergency Coordinator, EPI, Nursing, Environmental Health…)
We all understand the roles of Emergency Coordinators and the PIO function, but we as I mentioned within the roles and responsibilities at the State/Regional/Local level include Epidemiology, which Dr. Melton briefed out on that role and function earlier
Now going back to the map Dr. Melton showed…your touchpoint to PH may be…

20. VDH Regions/Districts
We can see the boundaries of the regions and the encompassing districts. Described geographically rather than numerically like you all (Northern/NW etc.)
For example in Northern region-Rappahannock Area Health District encompasses five political jurisdictions
Alexandria just one
That way across the Commonwealth
As a result-your touchpoint to local public health as a local OEM may be located in a neighboring county or maybe initially through Regional Coordinator.
We as Regional Coordinators/teams, should be coordinating with your VDEM Regional teams to ensure we are properly aligned locally/regionally
Your ESF 8 lead at the local level will be your district Health Director with activities coordinated by the local health emergency coordinator

21. Dr. Melton also discussed the Capabilities that define Public Health Emergency Preparedness-
Some of these will look familiar as they cross over to FEMA Core Capabilities
The next slide is an attempt to crosswalk the FEMA Core Capabilities to relevant PHEP capabilities
This may not be 100% inclusive but it’s an example representing how we interconnect
For instance-we just looked at the Epi role of surveillance/detection-may correlate to Screening, Search and Detection
There are more obvious one to one capabilities ( Operational Coordination, Mass Care, Info Sharing, Fatality Mgt., etc.)
Looking at potential PH impacts from a disaster…

22. Potential Public Health Impacts from Disasters
Public Concern for Safety
Increased Pests & Vector
Damage to Healthcare Systems
Worsening of Chronic Illnesses
Toxic / Hazardous Exposure
Loss of Food/Med Supply(supply chain mgt)
Behavioral Health Impact
Death
Injuries
Loss of Clean Water
Loss of Shelter
Loss of Personal Property
Major Population Movements
Loss of Sanitation
Loss of Routine Hygiene
Loss of Electricity
Standing Surface Water
Disruption of Solid Waste Management

23. VDH Planning Initiatives
Situational Awareness (VHASS)
Continuity Plans (COOP)
Medical Countermeasure Distribution
CHEMPACK
Strategic National Stockpile (SNS) / Cities Readiness Initiative (CRI)
State and Local Operational Readiness Reviews (ORRs)
Annual Mass Vaccination Clinics (flu)
Surge Planning
Statewide Exercises
Bio-Watch, Guardian, +++
USPS Bio Hazard Detection System (BDS)
Suspicious Substance Protocol
VDH Emergency Coordination Center (ECC) / ESF-8)
Medical Reserve Corps (MRCs)
All Needs Populations Planning
Shelters
Opioid
NACCHO Project Public Health Ready (PPHR)
To address and plan for these eventualities, some of our planning efforts include…These occur at the State, Regional, and local levels
VHASS-essentially our webeoc
CHEMPACK-ongoing updates/planning
ZIKA-time to discuss that again-early spring/summer lead to longer mosquito season
OPIOD addiction efforts-PH Emergency Declaration
Shelters-on statewide working groups with VDEM right now
PPHR which I’ll discuss a bit more in a few moments

24. Strategic National Stockpile (SNS)
“…maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a disaster in order to reduce morbidity and mortality...”
CHEMPACK:
“Forward placement of nerve agent antidotes, providing state and local governments a sustainable resource that increases their capability to respond quickly to a nerve agent event.”

25. Project Public Health Ready (PPHR)
Project Public Health Ready (PPHR) is a collaborative program between the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC).
Vision
Local health departments (LHDs) will be fully integrated into the response community and prepared to respond to any emergency.
Mission
To protect the public’s health and increase the public health infrastructure by building local health department preparedness capacity and capability. With assistance from state health departments, LHDs will use sustainable tools to plan, train, and exercise using a continuous quality improvement model.

26. PPHR Criteria
The PPHR Criteria are nationally-recognized standards for local public health preparedness. The Criteria are divided into three goals: all-hazards preparedness planning, workforce capacity development, and demonstration of readiness through exercises and real-events. The Criteria are updated annually to incorporate the most recent federal preparedness initiatives, including CDC Public Health Emergency Preparedness (PHEP) Capabilities and the ASPR Hospital Preparedness Program (HPP) metrics

27. Goal I: All-Hazards Response Plan
Local health departments must provide their all-hazards response plan as evidence for this goal. The plan must meet a number of standards, including describing the specific roles and responsibilities department or regional staff will have in a response. Sub-measures for this goal include Communications, Epidemiology, Mass Prophylaxis and Immunization, and Environmental Health.

28. Goal II: Workforce Capacity Development
Local Health Departments or regions must provide evidence of a training needs assessment and training plan based on this assessment. This training plan shall reflect the workforce capacity building goals within the department.

29. Goal III: Exercise/Real-Event
Local health departments or regions must provide evidence of an exercise they have conducted or a response to a real event they have participated in. This evidence is provided through either an after action report or an incident action plan.

30. This is a sample page from the application
This is a sample page from the application. As you can see, every criteria element must have a corresponding hyperlink to a section of their plans to provide evidence of completion/inclusion. The National Review Teams who assess the applications score each criteria with a met/partially met/or not met. Met obviously indicates they are good, but partial and not mets are returned to the applicants after the review period and must be remedied bt providing additional evidence or clarification of a question from the review team. For an application to earn recognition status, there are no “not mets” permitted to pass.

31. PPHR
PPHR is a year + long application submission and national review process beginning in October (2017) and notification of successful recognition occurring January (2019).
Every single Health District in Virginia has received PPHR recognition and undergoes a re-recognition application process on a 5 year basis.

32. Conclusion
We have covered briefly how we (VDH) operate and are constructed at the regional and local level
We have covered some of our potential impacts to Public Health
We have covered some of our planning initiatives
And we have covered one way we use to assess our preparedness progress and ensure a baseline level across the Commonwealth to an established and recognized set of national criteria
Next, Andrew will come up and give you a more in depth look at the Healthcare Coalitions that we coordinate with.
Thank you for the opportunity to come here today and speak with you all
We have a common mission and skillset and it’s an honor to be able to work with so many talented and passionate emergency management professionals

34. Partners in preparedness Andrew Slater
Virginia’s Healthcare Coalitions & RHCCs
Partners in preparedness Andrew Slater

35. Healthcare Coalitions
Six Regional Coalitions

36. About the Coalition…. Central Virginia Healthcare Coalition
Healthcare Emergency Management Alliance
17 Acute Care Hospitals
4 Free-standing Emergency Departments
Long Term Care Facilities
Fire/EMS/Emergency Management Stakeholders
Exists to organize a regional healthcare preparedness program
Response
Recovery

37. Central Region

38. Other Regional Coalitions

39. RHCC Model Overview
All six healthcare coalitions operate a primary & backup Regional Healthcare Coordination Center (RHCC)
Written into the COV EOP
Statewide Hospital Emergency Operations Plan
Statewide Health & Medical Surge Plan (Annex J)
Multi-agency coordination center.
Centralized POC for emergency coordination of healthcare facility assets in the region.
Responsible for activation of the Regional Hospital Emergency Operations Plan.
Hospital ICS is used for congruency with external partners.

40. RHCC Model Overview, cont.
RHCC facilitates emergency response, communication, and resource allocation for coalition members.
RHCC accomplishes this as the primary regional contact among:
Regional healthcare facilities (Hospitals and Long Term Care)
Other five RHCCs
State EOC through the ESF 8 (Public Health) annex.
Provide coalition stakeholders with:
Healthcare Intelligence
Incident coordination
Disaster resource management

41. What Responsibilities
Providing a single point of contact between Hospitals and the VDH Emergency Communications Center (ECC) & State.
Collection and dissemination of ongoing situational awareness updates and warnings, including the management of the current bed availability in Hospitals.
Establishing and managing the communication systems for the duration of the incident.
Serve as the single point of contact and collaboration point for Virginia Fire/EMS agencies for the purposes of hospital MCI management and movement of patients from an incident scene to receiving hospitals.
Secondary resource management to hospitals for fuel, food, and water.
Collection and dissemination of initial event notification to hospitals and public safety partners.
Establishing and managing the internet-based Virginia Healthcare Alerting and Status System (VHASS) for duration of incident.
Serve as the single point of contact and collaboration point for Virginia Fire/EMS agencies for the purposes of hospital MCI management and movement of patients from an incident scene to receiving hospitals.
Coordinating inter-hospital patient movement, transfers and tracking

42. Primary Central Virginia RHCC

43. RHCC Communications Capabilities
Telephone
IP based phone system
Hard Line
Satellite Phone
Cell Phone
Internet
Broadband
HotSpot
Satellite Internet
Virginia Hospital Alerting & Status System (VHASS)
WebEOC
Text Message Alerting System
Phone/Video Conferencing
PolyComm
WebEx
Radio
STARS Radio
Amateur Radio
Statewide Interoperability
CRISiS Radio
3 site VHF & UHF repeater system
HEAR Radio
Hospital VHF System
COMLINC/RIOS
CVHC Primary & Backup Gateways

44. Alerting Mechanisms

45. Disaster Resource Mgmt.
Stabilization Treatment In Place (STIP) Tent Systems
Stockpiles
Regional/CVHC
Statewide
Infrastructure Resiliency Projects
Emergency Generators / Facility Quick Connects
Emergency Water Supply/Wells
Emergency Chillers / Facility Quick Connects (future)
Mutual Aid Program / Resource Mgmt. Tool
Clinical Supplies
Staff
Pharmaceuticals

46. What does the RHCC mean for Hospitals?
Emerging Incident Notifications
Intelligence/Information Sharing for better decision-making
Hospital Mutual Aid
Emergency Clinical Resources – Stockpile
Evacuation Coordination / No-Notice Emergency Patient Transfers
Assistance with local EOC requests
NDMS Coordination
Patient Tracking

47. Virginia’s Patient Tracking Program
Partnership between the regional coalitions & Virginia.
During Mass Casualty Incidents, hospitals enter basic patient information into VHASS.
RHCC is responsible for requesting activation of the Patient Locator Service.
Family members can call 2-1-1, and a trained operator searches the VHASS database for a patient “match”.
If a match is found, the caller is provided the hospital’s phone #.

48. Virginia’s Patient Tracking Program

49. Case Studies from Central Virginia
Hospital Generator Failure
6/16/2016 – Severe Thunderstorms in the late evening cause widespread power outages.
Catastrophic damage to electrical grid in Richmond area.
7 hospitals are among >250,000 Dominion customers without commercial power.
8AM on 6/17/2016…
Power not expected to be restored for another 10 hours.
Failure of backup generator is impacting care for high acuity patients in ICU (on ventilators) and ED.
Summertime, no HVAC in the facility.
Locality and other hospitals have limited ability to support an evacuation

50. Non-MCI Surge Event
Historic winter storm impacted Mid-Atlantic region on January 22-23, 2016.
Record snowfall, blizzard (or near-blizzard) conditions over much of the Commonwealth.
Throughput and staffing challenges at many central region hospitals due to weather and road conditions.
Extended storm: 2 full days
Friday & Saturday;
Storm made many roads impassable.
LogistiCare & other community transport services suspended operations starting Friday.
Most community dialysis clinics closed.
The few open clinics had alarming number of missed appointments.
Discharge difficulties at hospitals due to storm.
Sunday
Record-setting Emergency Medical Services (EMS) call volume.
“Breathing Problem”, “Chest Pain” and “Sick Person” were most common 911 call types.
RHCC notifies hospitals of regional surge event; continual monitoring of facility bed capacity & ED surge indicators in VHASS.
Emergency departments across metro-Richmond become saturated with patients

51. Monday, January 25th Record-setting EMS call volume continues.
Diversion “domino” effect at hospitals.
Level 1 Trauma Center reports “inundation” of high-acuity renal failure patients to RHCC.
Request for RHCC activation:
Emergency stabilization of incident.
Enhance communication among hospitals.
Identify available bed space for EMS patients.

52. The Challenges & The RHCC Response
Situation continued to deteriorate on Tuesday
Surge operations difficult to sustain.
Only 3 out of 12 metro-Richmond hospitals have in-house dialysis capabilities.
Other 9 hospitals share single source dialysis contract with same service provider.
Dialysis service provider unable to surge staffing.
2-hour emergency treatments for patients.
9 hospitals, >50 patients, 2 roaming dialysis nurses
Response:
Coalition staff marshal physical response to primary RHCC in downtown Richmond.
Emergency regional conference calls.
3 days of coordinated EMS patient distribution based on reported capacity.
Creative VHASS reporting.
Engagement of community dialysis entities to ensure recovery from storm.

53. Questions?
Contacts:
Dr. S. Hughes Melton, MD MBA FAAFP FABAM Chief Deputy Commissioner
Virginia Department of Health
Jeffrey G. Walker, MS
Northern Region Emergency Coordinator
Virginia Department of Health
10850 Pyramid Place
Manassas, VA M:
Andrew Slater
Manager, Regional Healthcare Coordination Center
Central Virginia Healthcare Coalition M: