EMERGENCY SUPPORT FUNCTION #8

HEALTH, MEDICAL, AND MORTUARY SERVICES


LEAD:

Fire Agencies

Medic One

Public Health

Coroner's Office

SUPPORT:

Emergency Management

I. INTRODUCTION

A. Purpose

To coordinate the organization and mobilization of medical, health, ministerial, and mortuary services within Thurston County during an emergency/disaster.

B. Scope

This ESF involves assistance to Thurston County in identifying and meeting the health, medical, and mortuary needs of victims of a major emergency or disaster. This assistance includes the following:

1. Assessment of medical/health needs

2. Health surveillance

3. Medical care personnel

4. Medical/health equipment and supplies

5. Patient evacuation

6. In-hospital care

7. Mental health

8. Public health information

9. Vector control (Rats, Pests, etc.)

10. Potable water

11. Wastewater and sanitation

12. Solid waste disposal

13. Ministerial Services

14. Mortuary services and victim identification

II. RELATED POLICIES

A. Fire Agencies will provide Basic Life Support (BLS) and Medic One will provide Advanced Life Support (ALS).

B. All Thurston County mutual-aid emergency medical responders who provide emergency medical assistance in Thurston County will operate under Thurston County procedures and protocols.

C. Thurston County Public Health will provide guidance to the County, agencies, and individuals on basic public health principles involving safe drinking water, food sanitation, personal hygiene, and proper disposal of human waste, garbage, and infectious or hazardous waste.

III. PLANNING ASSUMPTIONS

A. A significant natural or technological disaster could overwhelm Thurston County medical facilities and services requiring emergency coordination of casualties.

B. The Thurston County hospitals, clinics, nursing homes, pharmacies, and other medical and health care facilities may be severely structurally damaged, destroyed, or rendered unusable.

C. A disaster can pose public health threats to food, water, and personal health.

D. Damage to manufacturing facilities, waste processing and disposal facilities, sewer lines, and water distribution systems and secondary hazards such as fires could result in toxic environmental and public health hazards to the surviving population and response personnel.

E. The damage and destruction of a catastrophic natural disaster will produce urgent needs for mental health crisis counseling for disaster victims and response personnel.

F. Disruption of sanitation services and facilities, loss of power, and massing of people in shelters may increase the potential for disease and injury.

IV. CONCEPT OF OPERATIONS

A. Emergency Medical Services

1. The primary objective of Emergency Medical Services in an emergency/disaster is to insure that basic and advanced life support systems are organized and coordinated to provide prompt, adequate, and continuous emergency care to disaster victims. These will include, but are not limited to:

a. Identification and coordination of medical resources.

b. Identification of potential sites and support staff for temporary emergency clinics.

c. Emergency care at shelters and congregate care facilities.

d. Coordination of medical transportation resources.

2. Local Mass Casualty plans will detail operational concepts and responsibilities so that the Emergency Medical Services System existing in the area will be capable of providing mass casualty emergency medical services during an emergency/disaster.

3. The provision of basic and advanced life support services shall be provided per local plans for Fire Agencies and Medic One. Mutual aid between and among emergency medical service providers shall be utilized to make maximum efficient use of existing local, regional, or inter-regional assets, resources and services. Response requirements may exceed the capabilities of the local Emergency Medical Services System and can be augmented by services and assets provided under mutual aid if available.

4. A Public Health and Medic One, and/or Coroner's Office representative will jointly perform the EOC function of coordinating medical, health, and mortuary resources.

5. Hospitals will respond according to their established emergency response plans.

B. Public Health and Social Services

1. Public Health provides or coordinates health and sanitation services within the community, including:

a. Identification of health hazards.

b. Identification and control of communicable disease.

c. Vector control.

d. Examination of food and water supplies for contamination.

e. Ensure compliance of emergency sanitation standards for disposal of garbage, sewage, and debris.

f. Assessment of environmental contamination and public health risk from hazardous materials spills.

g. Mental health services, including stress management services for emergency responders.

h. Keep the County Commissioners, Emergency Management, and the public informed regarding health conditions, warnings, and advisement.

2. If the threat to public health is of such magnitude that supplemental assistance is necessary, the State and Federal Government may provide such assistance. Requests may be made through normal Emergency Management channels. Local health officers may also obtain supplemental State/Federal assistance by direct request to the Secretary, Washington State Department of Health.

3. Public Health provides limited medical support and sanitation services (identifying health hazards and making recommendations) to mass care facilities when activated. The Health Department maintains limited supplies that may be used at mass shelters including:

4. Public Health provides the medical support and mechanism for inoculating the public and emergency personnel if warranted by threat of disease. The Health Department typically maintains on-hand several hundred doses of Tetanus/Diphtheria vaccine and Immune Serum Globulin. Various other vaccines may also be available in limited quantities.

5. Public Health provides oversight of potable water supplies. Thurston County residents obtain their drinking water from either individual water sources or connection to one of 852 public water supplies. These public supplies range in size from two connections to several thousand connections and may be either publicly or privately owned and operated. A water-testing laboratory is located in the courthouse and has the capacity to analyze several hundred water samples per day for bacterial contamination. (Laboratory results will normally take 24 hours to complete.) In addition, the Health Department has three chlorine test kits which can be used to determine the level of chlorine disinfectant in drinking water.

6. Solid waste disposal permitting is a function of Public Health. There is one solid waste disposal site at the Hawks Prairie landfill; three transfer stations are located at Rainier, Rochester, and Summit Lake. Limited hazardous waste storage exists at the Hazo House facility at the landfill (household hazardous waste only).

7. Sewage treatment plants are located at: LOTT, Boston Harbor, Tamoshan, Seashore Villa Mobile Home Park, Carlyon Beach, and Beverly Beach. The majority of rural areas are serviced by on-site systems, either individual or community. Power outages may disrupt services.

8. In coordinating public health services and establishing priorities, administrative details shall be accomplished by the director of Thurston County's Public Health and Social Services Department. Decisions involving medical and technical expertise shall be the responsibility of the Public Health Officer.

9. Determination of critical priorities in the public health effort will be made in consultation with the Board of Health, local elected officials, and state and federal service agencies.

C. Mortuary Services

1. The Coroner has jurisdiction over bodies of all deceased (RCW 68.08.010). (Procedures may vary if an incident falls under the jurisdiction of the FAA, State, or the military.)

2. The Coroner's Office will coordinate support to local mortuary services as needed. Local funeral directors may assist in the processing of human remains at the discretion of the Coroner.

3. If local resources for proper handling and disposition of the dead are exceeded, the State and/or Federal Government may provide supplemental assistance for identification, movement, storage, and disposition of the dead. The County Coroner may make a request for such assistance to Emergency Management or to the State Department of Health.

D. Emergency Vital Statistics

1. The Sheriff's Department compiles information regarding missing persons in unincorporated Thurston County.

2. The Coroner identifies deceased persons in all of Thurston County.

3. Deaths are registered at the Public Health and Social Services Vital Records Office.

E. Mental Health

Mental Health services and/or critical incident stress debriefing will be provided as needed through Public Health and Social Services.

V. RESPONSIBILITIES

A. Emergency Medical Services

1. Local

a. Emergency Management

Provides logistical and other support to emergency medical service providers upon request from the incident commander or medical services representative.

b. Fire Agencies

1) The first Fire Agency at the scene evaluates the situation and makes the decision whether to request additional assistance (Incident Command System).

2) When the decision is made to activate the Mass Casualty Incident Plan (Reference C.), the first agency on the scene will serve as the on-scene commander until the fire department arrives.

3) Other agencies responding to the incident will report to the designated staging area.

4) Establish field communications between appropriate agencies.

5) All Thurston County Fire Agencies provide Basic Life Support.

c. Medic One

1) Provides Advanced Life Support services.

2) Assist in coordinating private ambulance and EMS resources.

3) Under the Incident Commander, coordinates Mass Casualty response.

4) Coordinate storage and distribution of donated medical supplies.

5) Coordinate use of the City of Tumwater's Disaster Trailer with emergency medical supplies and equipment.

6) Provide a representative to the EOC to coordinate the EMS response, if requested.

7) Provide casualty and damage assessment information to the EOC.

8) Submits appropriate forms to recover disaster funds and damages.

d. Medical Disaster Preparedness Advisory Committee

Provide input into plans, tests, and exercises to assure that the Emergency Medical Services System will be able to provide emergency medical services in the systems service area during mass casualties, disasters, or national emergencies.

e. Hospitals, Nursing Homes, Health Care Facilities

Maintain procedures and protocols for reducing patient population for events that may require evacuation, and procedures for continuing medical care for those who cannot be evacuated.

2. State Emergency Management

Coordinate supplemental emergency medical and logistics support as requested by local political subdivisions.

3. Federal

a. Federal Emergency Management Agency (FEMA)

When local, state, and volunteer agencies' capabilities to provide mass care or essential needs are exceeded, FEMA may assign Federal agencies under mission assignment to supplement state and local emergency medical efforts.

4. American Red Cross

Under its charter, provides supplementary medical, emergency aid, and other health services upon request and within capabilities.

B. Public Health Services

1. Local

a. Emergency Management

1) Provides overall coordination of local resources to support local public health activities.

2) Serves as liaison between local agencies and State Emergency Management.

b. Public Health and Social Services

Provide or coordinate the provision of health and sanitation services including:

1) Provide preventive medical and health services.

2) Control communicable diseases.

3) Detect and identify possible sources of contamination dangerous to the general public health of the community.

4) Staff the EOC for coordination of medical and health services.

5) Provide for the coordination of health and sanitation services at mass care facilities.

2. State Emergency Management

Alert State and federal agencies of possible need for emergency medical, health, and mortuary services.

3. Federal

a. Federal Emergency Management Agency (FEMA)

When local, state, and volunteer agencies' capabilities to provide public health services are exceeded, FEMA may assign Federal agencies under mission assignment to supplement state and local public health efforts.

b. Department of Health and Human Services

Has the prime responsibility for Federal activities associated with health hazards resulting from emergencies.

1) Assists state and local communities in taking protective and remedial measures for ensuring sanitary food and potable water supplies; adequate sanitary systems; rodent, insect and pest control; care of the sick and injured; and control of communicable diseases.

2) Assigns professional and technical personnel to augment state and local forces.

c. Department of Agriculture

Under guidelines of the Food and Drug Administration, works with state and local governments in establishing public health controls for the proper disposal of contaminated food and drugs.

C. Mortuary Services

1. Local

a. Coroner

1) Assumes overall responsibility for the care, identification, and disposition of the dead and notification of next-of-kin during and after disasters.

2) Determines the manner and cause of death and provides information to Public Health and Social Services Vital Records Office for issuance of the death certificate.

3) Maintains a current list of mortuaries, morgues, and other facilities for the care of the dead. Coordinates with these services.

4) Selects suitable facilities for emergency morgues and ensures that qualified personnel operate them.

5) Keeps all necessary records and furnishes the Public Information Coordinator with a periodically updated casualty list.

6) Provides a representative from the Coroner's Office to the EOC upon request and if available.

7) Establishes and maintains Standard Operating Procedures for disaster responsibilities.

8) Obtains additional supplies, as needed. Includes: body bags, tags, special manpower, etc. Additional requests should be made through normal emergency management channels.

9) Originates requests for state and federal assistance.

b. Emergency Management

1) Coordinates local support for mortuary services.

2) Serves as liaison between the local agencies and State Emergency Management.

c. Other Local Agencies and Facilities

Provide support to the Coroner in the identification, movement, storage, security, and disposition of the dead as requested.

2. State

a. State Emergency Management

In conjunction with the Department of Health, coordinates supplemental assistance to support local mortuary services.

b. Department of Health

Provides for the recording and preservation of death certificates.

3. Federal

a. Federal Emergency Management Agency (FEMA)

Coordinates Federal assistance to supplement local emergency mortuary services.

b. Federal Bureau of Investigation

Provides victim identification services.

c. Military

Provides manpower, equipment, and facilities to support local processing, handling, and disposition of the dead.

4. Funeral Directors Associations (County, State, and Federal)

Provides support to the local coroner when requested.

VI. REFERENCES

A. The Federal Response Plan, ESF #8 Health and Medical

B. Washington State Comprehensive Emergency Management Plan

C. Mass Casualty Incident Plan