1. February 7, 2017 Jefferson County Public Health Lakewood, CO
MFHCC Meeting
February 7, 2017
Jefferson County Public Health
Lakewood, CO

2. Welcome and Introductions

3. Agenda Arrive, sign in, grab lunch Welcome & Introductions – Janelle
Changes to HCCs and Healthcare Preparedness Program (HPP) – Dane Matthews, Director, CDPHE-OEPR
Agency Updates - All – Lisa
Upcoming Training and Events – Lisa and Janelle
Member Agency Spotlight – Colorado Coalition for the Homeless - Stan Eilert
Infectious Disease Update: Mumps & Measles – Carol McDonald
Health Alert Network (HAN) Overview – Lisa and Christine
Public Health Emergency Operations Plan (PHEOP) Summary - BOH Rule to have partners review the plan - Janelle and Christine
Influenza Update - Angel Anderson, JCPH and Lisa Miller, MD, MSPH, CDPHE
Inpatient Bed Tracking Discussion – Lisa and Janelle
Grant Funding - James Robinson, DHPD
Review New Action Items
Networking

4. Review previous action items
Janelle Worthington

5. Review Previous Action Items
Person responsible
Deadline
Contact Christine/Cali if interested in becoming a JCPH or Denver Closed POD.
All
On-going
Janelle or Lisa to sign up for workgroups of interest, including the PHED EX workgroup.
Member Spotlight - Janelle and Lisa if you would like to be featured on the website.
Cali will the Inventory Management System Excel form to all Denver Closed POD partners for confirmation and for POD site records.
Cali Zimmerman
TBD
Janelle

6. Healthcare Preparedness Program (HPP) and HCC Changes FY 2017 – 2022
Dane Matthew, Director CDPHE - OEPR (303)

7. Hospital Preparedness Program
ASPR’s Hospital Preparedness Program (HPP) enables the health care delivery system to save lives during emergencies and disaster events that exceed the day-to-day capacity and capability of existing health and emergency response systems.
HPP is the only source of federal funding for health care delivery system readiness, intended to improve patient outcomes, minimize the need for federal and supplemental state resources during emergencies, and enable rapid recovery.
HPP prepares the health care delivery system to save lives through the development of health care coalitions (HCCs) that incentivize diverse and often competitive health care organizations with differing priorities and objectives to work together.

8. Hospital Preparedness Program
The intended HCC participants include but not limited to:
Hospitals
EMS (including inter-facility and other non-EMS patient transport systems)
Emergency Management Organizations
Public Health Agencies
Behavioral health services and organizations
Child care providers (e.g., daycare centers)
Community Emergency Response Teams (CERT)1 and Medical Reserve Corps (MRC)2
Dialysis centers and regional Centers for Medicare & Medicaid Services (CMS)-funded end-stage renal disease (ESRD) networks3
Faith-based organizations
Federal facilities (e.g., U.S. Department of Veterans Affairs (VA) Medical Centers, Indian Health Service facilities, military treatment facilities
Home health agencies, including home and community-based services 1 “Community Emergency Response Teams.”
Infrastructure companies (e.g., utility and communication companies)
Jurisdictional partners including Cities, counties, and tribes
Local chapters of health care professional organizations (e.g., medical societies, professional societies, hospital associations)
Local public safety agencies (e.g., law enforcement and fire services)
Medical and device manufacturers and distributors
Non-governmental organizations (e.g., American Red Cross, voluntary organizations active in disasters, amateur radio operators, etc.)
Outpatient health care delivery (e.g., ambulatory care, clinics, community and tribal health centers, Federally Qualified Health Centers (FQHCs), 4 urgent care centers, freestanding emergency rooms, stand-alone surgery centers)
Primary care providers, including pediatric and women’s health care providers
Schools and universities, including academic medical centers
Skilled nursing, nursing, and long-term care facilities
Support service providers (e.g., clinical laboratories, pharmacies, radiology, blood banks, poison control centers)
Other (e.g., child care services, dental clinics, social work services, faith-based organizations)
Specialty patient referral centers (e.g., pediatric, burn, trauma, and psychiatric centers) should ideally be HCC members within their geographic boundaries.
Specialty patient referral centers may also serve as referral centers to other HCCs where that specialty care does not exist. In such cases, referral centers’ support of HCC planning, exercises, and response activities can be mutually beneficial.

9. Urban and rural HCCs
Urban and rural HCCs may have different membership compositions based on population characteristics, geography, and types of hazards. For example, in rural and frontier areas—where the distance between hospitals may exceed 50 miles and where the next closest hospitals are also critical access hospitals with limited services—tribal health centers, referral centers, or support services may play a more prominent role in the HCC.

10. Hospital Preparedness Program
The Health Care Preparedness and Response Capabilities
Draft came out in October…Identified significant HCC roles
Guidance describes what the health care delivery system, including HCCs, hospitals, and emergency medical services (EMS), have to do to effectively prepare for and respond to emergencies that impact the public’s health.
Capabilities may not be achieved solely with the funding provided by the HPP
Funding for required to be directed to HCCs
Exceptions: Centrally procured services by state (ie. EMSystems, CHA, CCHN)
State administrative oversight capped at 18% for BP1 – down to 15% by BP5
Goal, more HPP funding pushed to the regional/local level HCC to determine localized comprehensive health care preparedness priorities

11. HPP Capabilities
Capability 1: Foundation for Health Care and Medical Readiness
Goal of Capability 1: The community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.
Capability 2: Health Care and Medical Response Coordination
Goal of Capability 2: Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.
Capability 3: Continuity of Health Care Service Delivery
Goal of Capability 3: Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.
Capability 4: Medical Surge
Goal of Capability 4: Health care organizations—including hospitals, EMS, and out-of-hospital providers—deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

12. Colorado Specific HCC Challenges
OEPR sent letter to ASPR in November requesting concessions…denied.
We must submit a detailed plan with our grant application in March for how Colorado will comply with restructuring and funding HCCs.
Colorado currently has 34 HCCs…many single county entities
Many current HCCs do not meet core membership requirements
Many HCCs do not have members with multiple “like” organizations
Most HCCs are planning organizations only and have no operational roles identified to support ESF8 lead during response
Most HCCs do not have an identified fiscal agent able to receive funds from the state

13. Next Steps
HCC districts established; Goal is 9-15 total for the state (in progress)
Each district may have multiple sub-coalitions—preferably not geographically oriented but functionally oriented coalitions
Existing HCCs to align with one of the districts (not all HCCs will need to change) and adopt a governance structure
HCCs identify fiscal agents:
Fiscal agents may be:
HCC itself as a non-profit entity
A governmental agency
A non-profit agent (such as CHA, Colorado Rural Health Center, etc.)
When selecting a fiscal agent, HCCs should consider:
Cost of fiscal agent services
Agent’s policies for procurement, hiring, and spending
HCC’s Personnel costs to manage funds internally as a non-profit entity to ensure proper accounting, procurement, and tracking requirements
Provide Colorado Plan for implementation to ASPR

14. FIRST DRAFT of Proposed HCC Layout based upon existing HCCs, RETACs, and All Hazard Regions7 1 5 12 8 9 2 10 3 13 6 11 4

15. OEPR Focus 2017 - 2022 Slogan: Prepared for when someday…is today
VISION:
Ensure Colorado’s communities are completely prepared to respond to and recover from, incidents adversely impacting health and our environment
MISSION:
Protect the health of Colorado’s people by collaborating with our community partners to provide preparedness support, skilled incident response, and expert recovery guidance whenever needed
Priority Goals:
Countermeasure Mitigation
Information Management
Recovery Management
Training and Exercise
HCC Establishment
Response Support

16. Roll-up to Domains and PHEP/HPP Capabilities
OEPR Focus
Roll-up to Domains and PHEP/HPP Capabilities
Community
Resilience
Incident
Management
Information
Countermeasure &
Mitigation
Surge Management
Recovery Management
Response
Support
Countermeasure
Training and Exercise
HCC Establishment
Community Recovery
Fatality Management
Community Preparedness
Responder Safety and Health
Information Sharing
Medical Countermeasure Dispensing
Medical Material Management and Distribution
EOC Activation
Public Information
Responder Health & Safety
Volunteer
Foundations for Health Care & Medical Readiness
Health Care & Medical Response & Recovery Coordination
Medical Surge
Continuity of Health Care Service Delivery
Emergency Operations Coordination
Emergency Public Information and Warning
Bio
Surveillance
Emergency Operations Coordination

17. Solutions?

18. Agency updates
We are taking the suggestion to move Agency Updates to the first part of the meeting to ensure we have enough time for everyone to report out about current events. Also, in an effort to save time, we are not going to call out various disciplines so people can respond at any time.
Lisa

19. Agency Updates
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

20. Agency Updates Epidemiology 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.).
Do we want to keep this slide?

21. Upcoming Trainings and Events
Lisa and Janelle

22. Upcoming Events & Trainings
Networking Activity - Full Moon Snowshoe Event, February 11th
Idaho Springs area – Echo Lake or Bakerville to Loveland Trail (BLT)
6pm food and drinks in Idaho Springs
Sign-in sheet – provide and cell phone that we can contact on the weekend
Discuss need for PPE/Decontamination/HazMat trainings

23. MFHCC Website - 2017 Training and Exercise Opportunities in our Community
Throughout the year - Mental Health First Aid Trainings
Jan - June - Bridging The Gap Medical Interpreter Training by Asian Pacific Development Center
Feb 8 & 15 - ICS 100 & 700 In-Person Trainings, Clear Creek
March 1 & May 8 - Trauma Informed Care Workshops, Jefferson Center for Mental Health. July Public Information in an All-Hazards Incident
Sept Pediatric Disaster Response and Emergency Preparedness
Visit the MFHCC website for details about all of the events listed.
Mention the Trauma Informed Care Workshop since we took a poll of interest in that last month.

24. PHED EX
Public Health Emergency Dispensing Exercise (PHED EX) – June 2017
Workgroup divided into two groups:
1. Denver PHED EX Workgroup
2. Jefferson/Clear Creek/Gilpin PHED EX Workgroup
Communications workgroup
Will meet to review draft plan and eventually test it
-Thank you to members who completed the PHED EX spreadsheet. We submitted details about resource requests to CDPHE.
- PHED EX next steps – We will reach out to people that signed up for PHED EX workgroup. If you would like to be involved with the communications workgroup, please us.

25. Member agency spotlight – Colorado Coalition for the homeless
Janelle Intro
Stan Eilert

26. Public Health Emergency Operations Plan (PHEOP) Review
Janelle Worthington, JCPH

27. JCPH PHEOP
Board of Health Rule – PHEOP reviewed & updated at least every 3 years:
Submitted to CDPHE/OEPR
Submitted to local Board of Health
Copy made available to: OEM, Hospital(s), Rural Health Clinics, FQHC’s, RETAC’s
JCPH’s PHEOP Summary will be sent out with the meeting minutes
If you would like to review the full PHEOP or any of the Plan Annexes, please Janelle at
Please send feedback and questions to Janelle about either the PHEOP Summary or the full plan

28. JCPH PHEOP – Concept of Operations
Purpose: Describe the basic strategies and mechanisms by which JCPH will prepare, prevent, protect against, quickly respond to, and recover from all-hazard emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine activities:
Infectious disease outbreaks, environmental public health hazards, natural disasters, and other threats that threaten the public’s health.
PHEOP is divided into two parts:
Concept of Operations, provides guidance based on the three operation phases:
Prepare, Prevent, Protect
Respond
Recover
Plan Annexes, consists of several support annexes that provide specific guidance for specific situations, such as mass care and public information communications.

29. JCPH PHEOP – Concept of Operations
Prepare, Prevent, Protect
Begins when a potential threat to public health has been identified
Hazard and Vulnerability Assessment (HVA): JCPH, JCSO EM, FHCC (2014)
Community Health Assessment (CHA)
On-going epidemiologic surveillance
Plans, vaccinations of public and JCPH staff
Caches - antibiotics, personal protective equipment (PPE) and communication equipment
Respond
21 Steps: starting with incident identification, and ending with implementing the demobilization plan
Public Health Led Incident vs. Public Health Supported Incident
Recover
Identify recovery lead; conduct a community needs assessment (includes epidemiological surveillance); restore public health services; debrief and compile the After Action Report & Improvement Plan (AAR/IP); and mitigation

30. JCPH PHEOP – Roles & Responsibilities
Jefferson County Public Health
ESF#8b Lead
Advise the BCC and BoH
Conduct epidemiological surveillance and outbreak investigations
Etc.
Jefferson County Emergency Management
Emergency Operations Center (EOC) will provide resource support
Jefferson County Type III Incident Management Team (IMT)
May fill the Command and General Staff roles if the management of the incident exceeds the capacity of JCPH
Metro Foothills Healthcare Coalition Members
May utilize the members of the MFHCC for support of a public health incident
Participate in preparedness planning, represent their ESF in the County EOC, provide staff surge capacity for JCPH, and participate in information sharing

31. JCPH PHEOP – Plan Annexes
Community Containment Annex
Continuity of Operations Annex
Epidemiological Investigation Annex
Health Alert Network Annex
Internal and External Emergency Contact Annex
Internal Information and Communications Annex
Mass Dispensing & Distribution Annex
Medical Surge Annex
Public Information and Communications Annex
Training and Exercise Annex
Volunteer Annex

32. Influenza Update Lisa Miller, MD, MSPH, CDPHE and Angel Anderson, JCPH
Janelle Intro
Lisa Miller, MD, MSPH, CDPHE and Angel Anderson, JCPH

33. Influenza Update CDPHE online influenza report:

34. Reported Outbreaks by Etiology in Jefferson County, CO
in Healthcare and Residential Facility Settings,
October 1, 2016 – February 3, 2017
Month of Report
Influenza
Confirmed Noro
Suspect Noro
Grand Total
October 2016 1
November 2016 3
December 2016
January 2017 8 2 10
February 2017 11 4 17

35. Influenza outbreak in a long-term care facility
Suspected influenza outbreak: Two cases of Influenza Like Illness (ILI) within a 1-week period without a positive test for influenza. During the time when influenza is circulating locally, the occurrence of acute febrile respiratory illness in several residents within a short time frame should be considered highly suspect for influenza until proven otherwise, regardless of whether the affected residents have been vaccinated.
Confirmed influenza outbreak: at least one resident with a positive test for influenza among two or more residents with ILI.
Please report all suspected and confirmed influenza outbreaks to your local health department. Outbreaks are reportable conditions in Colorado.
Angel Anderson, MPH, REHS
Regional Epidemiologist
Jefferson County Public Health
800 Jefferson County Parkway, Golden, CO 80401
office, fax

36. Grant funding opportunities
Lisa
James Robinson, DHPD

37. Grant Funding Opportunities
We do not currently have a regional capability to treat multiple patients from MCI in a climate controlled environment
MCI in inclement weather present significant challenges
Hypothermia has demonstrated negative impacts on trauma survival and morbidity
Buses can serve as mobile treatment areas for MCI
We do not currently have a regional capability for transporting multiple supine patients
Unlikely that this would be an MCI transport resource from a scene
More likely a multiple patient transport resource for other contingencies
Evacuations- hospital, SNF, assisted living
Moving multiple patients to a climate controlled environment (i.e. apartment fire with AFN people, inclement weather MCI)
Regional plans to have EMS perform evacuations may conflict with incident management priorities
EMS capacity to perform evacuations may be limited by day-to-day capacity and the availability of resources at the time of need
This resource can be used as incident response support for fire and HazMat rehab

38. Grant Funding Opportunities
North Central All-Hazards Region/UASI Grant Applications is:
State of Colorado Emergency Medical and Trauma Section grants is:

39. Review New Action Items
Lisa

40. Thank you! Networking