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

2. Welcome and Introductions

3. 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

4. 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.
Janelle or Lisa to sign up for workgroups of interest, including the full-scale exercise workgroup.
Member Spotlight - 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 the Inventory Management System Excel form to all Denver Closed POD partners for confirmation and for POD site records.
Cali Zimmerman
TBD

5. Upcoming Meetings and Trainings
Lisa Filipczak

6. 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 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

7. Four-wheel Emergency Assistance Team (FEAT)
Michael Hirschman

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

9. 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 ).
Effective on November 14, 2015

10. Effective: October 15, 2014

12. 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.

13. 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.

14. 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.

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

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

17. 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.

18. 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.

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

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

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

22. 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.

23. Questions? CDPHE Guidance
Communicable and non-communicable disease conditions reportable by health care providers and laboratories.

24. Full Scale Exercise (FSE) Overview & Discussion

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

26. 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.

27. 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

28. 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

29. 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.

30. 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

31. 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

32. 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

33. 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

34. 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 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.).

35. 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

36. 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

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

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

39. 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

40. 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.).

41. Review New Action Items
Janelle Worthington

42. Thank you! Networking