sfdph.iderplan.10-2007

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San Francisco Department of Publ ic Health Infectious Disease Emergency Response Plan

– DRAFT –OCTOBER 2007



IDER Plan: Table of Contents, Page 1/2 Draft 10/2007

TABLE OF CONTENTS

i Introduction

ii Organizational Chart

IDER CORE PLAN

1 COMMAND

2 PLANS SECTION

3 Situation Status Unit

4 Resource Status Unit

5 Documentation Unit

6 Technical Specialties Unit

7 Demobilization Unit

8 OPERATIONS SECTION

9 Epidemiology and Surveillance Branch

10 Investigation Group

Case Investigation Team

Contact Investigation Team

Laboratory Liaison Team

Field Investigation Team(s)

11 Surveillance Group

Surveillance Team

Syndromic Surveillance Team

- Syndromic Surveillance Field Unit(s)

12 Laboratory Branch Lab Testing Group

- Sample Prep Team

- PCR Team

- Conventional Testing Team

- Lab Data Entry Team

Lab Resources Management Group

- Specimen Receiving Documentation Team

- Surge Capacity Team

13 Disease Containment Branch

14 Infection Control Group

15 Restriction, Exclusion, and Clearance Group16 Mass Prophylaxis Group

POD Area Teams

- POD Unit(s)

Push Distribution Teams

POD Staging Area

17 Isolation and Quarantine Group

Home-Based Isolation & Quarantine Team

Facility Based Isolation & Quarantine Team

18 Communicable Disease Information Branch

19 Information Triage Group20 Information Content Creation Group

Treatment and Prophylaxis Guidance Team

Document Development Team

Clinician Consultation Team

21 Information Dissemination Group

Electronic Dissemination Team

Alternative Dissemination Team

Telephone Dissemination Team

- Phone Bank Unit

22 Data Branch

23 Data Analysis Group

Epidemiology and Surveillance Data Team

Syndromic Surveillance Data Unit

Restriction, Exclusion, Clearance Data

Team

Mass Prophylaxis Data Team

Isolation and Quarantine Data Team

24 Application Support Group

Application Support Team

25 Continuity of Operations Branch

26 LOGISTICS SECTION

27 Personnel Unit

Staff Staging Area

28 Supplies Unit

29 ▪ Pharmaceutical and Medical Supplies

- Local Pharmaceutical Caches

Facility Cache

Homeland Security Local Cache

- Outside Pharmaceutical and Medical

SuppliesReceipt, Store, and Stage Warehouses

30 Communication Equipment Unit

31 Information Technology Unit

Application Support

32 FINANCE SECTION

33 Procurement Unit

34 Cost Unit

35 Personnel Time Tracking Unit



IDER Plan: Table of Contents, Page 2/2 Draft 10/2007

ANNEXES

1 Respiratory Aerosol Transmissible Diseases

2 Bioterrorism Event

3 Biological Agent Detection in the Environment

a. Indoor Sampling Detection

b. Outdoor Sampling Detection

c. Evaluation and Testing of Suspicious Substances or Packages4 Waterborne Diseases

APPENDIX

A ICS Forms

B Activation and Notification

C Plans

D Communicable Disease Information

E Epidemiology and Surveillance

F Isolation and Quarantine

G Infection ControlH Mass Prophylaxis

I Restriction, Exclusion, and Clearance

J Laboratory

K Data

L Continuity of Operations

M Logistics

N Finance

O Job Action Sheets

P Pharmaceuticals and Medical Supplies

Q Reference Materials



IDER Plan: Introduction Page i/vi Draft 10/07

INTRODUCTION

A BACKGROUND

Infectious disease emergencies are circumstances caused by biological agents, including organisms such

as bacteria, viruses or toxins with the potential for significant illness or death in the population.

Infectious disease emergencies may include naturally occurring outbreaks (e.g., measles, mumps,meningococcal disease), emerging infectious diseases (e.g., SARS, avian influenza), and bioterrorism.

The circumstances of infectious disease emergencies may vary by multiple factors, including type of

biological agent, scale of exposure, mode of transmission and intentionality (bioterrorism), and many

others. Public health measures to contain such outbreaks are especially important for diseases with high

morbidity or mortality and limited medical prophylaxis and/or treatment

B PURPOSE

The purpose of the Infectious Disease Emergency Response (IDER) Plan is to contain an outbreak of

disease caused by an infectious agent or biological toxin, or respond to other infectious disease

emergencies as defined above (e.g., a detection of a potential bioterrorism agent in the environment or one case of smallpox). This is consistent with the San Francisco Department of Public Health’s (DPH)

mission to protect the public from illness and/or death.

Activities that may be implemented during an Infectious Disease Emergency Response include:

• Epidemiological surveillance and investigation activities such as case surveillance and investigation,

and contact tracing, monitoring, and management.

• Public health disease containment measures such as infection control, mass prophylaxis, isolation and

quarantine, or restriction and clearance,.

• Laboratory testing and confirmation of threat agents.

• Communicable disease information dissemination to the medical community, responders, and the

public.

• Coordination with other city, regional, state and federal agencies and other organizations responding

to a large public health emergency.

• Coordination with city, regional, state, and federal law enforcement agencies conducting an incident

criminal investigation.

C SCOPE

An infectious disease emergency (IDE) occurs when urgent and possibly extensive public health and

medical interventions are needed to respond to and contain an infectious disease outbreak or biological

threat that has the potential for significant morbidity and mortality in San Francisco.

The Communicable Disease Control Unit (CDCU) within the Communicable Disease Control and

Prevention (CDCP) Section of the DPH routinely receives reports of cases of infectious disease (with the

exception of tuberculosis, HIV/AIDS, and sexually transmitted diseases), conducts investigations and

implements disease containment measures. The IDER Plan is intended to be used for any infectious

disease emergency that requires a response that exceeds the CDCU’s normal disease control capacity.

This may include outbreaks with significant morbidity and/or mortality of naturally occurring diseases,

emerging or unknown diseases, waterborne outbreaks, and bioterrorism situations. Some outbreaks or



IDER Plan: Introduction Page ii/vi Draft 10/07

situations will require limited response activities; other situations will require large-scale response efforts

that involve many sections within the DPH and/or many city agencies.

The IDER Plan is a functional response guide for the IDER Incident Commander and other responders.

The IDER Plan includes a Core Plan, four scenario-based Annexes, and Appendices. The Core Plan is

modular and provides overall guidance for infectious disease emergencies. Depending on the situation

parts of the plan can be activated and deactivated as necessary. The Annexes include specificrecommendations for the following situations:

• Respiratory Aerosol Transmissible Diseases

• Bioterrorism Events

• Biological Agent Detection in the Environment

• Waterborne Outbreaks or Threats.

The Appendices contain detailed instruction and tools to be used during a response and include protocols,

forms, guidelines, Memorandums of Understanding (MOUs), and other documents.

This Plan does not apply to medical or other public health emergencies not caused by an infectious or

biological agent. The IDER Plan also does not cover other health concerns such as direct medical care,alternate standards of care, medical surge, and mental health; however, the IDER Plan does include plans

for providing guidance and consultation regarding infectious disease emergencies to the medical

community.

The IDER Plan is to be utilized in concert with the DPH Emergency Operations Plan (or any future DPH

Emergency Plan), which delineates the supporting and coordinating functions that will be handled at the

Department level. The IDER Plan is also designed to be used in conjunction with the City and County of

San Francisco’s Operational Area Emergency Operations Plan (EOP) when DPH resources are exhausted

and/or when multiple City Departments or Agencies are involved in the response. These additional plans

further describe the roles and responsibilities of the DPH and other local agencies, state agencies, and

federal agencies in responding to an infectious disease emergency.

The Communicable Disease Control and Prevention (CDCP) Section will supply key staff to lead the IDE

response, to represent the disease control function at the DPH Departmental Operations Center (DOC)

and to represent the Health Department at the City and County Emergency Operations Center (EOC).

D ASSUMPTIONS

The Plan integrates the key elements of communicable disease control and prevention with emergency

management concepts. A National Incident Management System (NIMS) compliant Incident Command

System (ICS) organizational structure will be utilized to scale the response as needed to effectively

manage and meet the incident objectives the infectious disease emergency response. California also

requires use of the Standardized Emergency Management System (SEMS) by Government Code §8607(a)for managing response to multi-agency and multi-jurisdiction emergencies in California. This plan

assumes that SEMS is NIMS compliant and also conforms to SEMS guidelines and communications.

The IDER Plan assumes that individuals occupying leadership positions have achieved high level ICS

training. The IDER Plan further acknowledges that there are a limited number of personnel within the San

Francisco Department of Public Health with the knowledge and training in infectious diseases,

epidemiology, public health, and emergency preparedness. The CDCP Section has prepared a functional

plan that can be used to guide disaster service workers called in to respond to the infectious disease

emergency. The IDER Plan maximizes the use of expert personnel within CDCP and/or the Laboratory



IDER Plan: Introduction Page iii/vi Draft 10/07

to appropriate leadership positions in the response and as representatives to the DOC, EOC, and/or the

Mayor’s Health Policy Group.

The IDER Plan is intended to guide IDE responders. The Plan is modular and assumes each IDE incident

will require tailored activation and utilization of the IDER Plan. The IDER Plan can be adjusted to

address scenarios varying by infectious disease agent, size and/or overall severity. The modular format

allows those in leadership positions to quickly access pertinent information. This plan outlines key

functions and roles, but depending on the scale of the event and the response, one individual responder may fulfill more than one role or position.

The IDER Plan also assumes that all confidential data regarding individual cases will not be shared

outside of those who need to know in order to fulfill our legally mandated public health functions.

E PLAN ACTIVATION

Only authorized staff may direct the activation/deactivation of the IDER Plan. The IDER Activation and

Notification Protocol should be utilized (see Appendix B1). DPH staff authorized to initiate

activation/deactivation include the:

• Director, San Francisco Department of Public Health

• Director, Communicable Disease Control and Prevention Section

• Director, Bioterrorism and Infectious Disease Emergency Unit

• Director, Communicable Disease Control Unit (CDCU)

• Director, Communicable Disease Prevention Unit

• Disease Control Team Leader, (CDCU)

• Communicable Disease Control and Prevention On-Call Physicians

• City & County of San Francisco Health Officers

One or more of the following criteria for an IDE must be met for activation:

• Large outbreak requiring more than routine CDCU resources;

• Possible or confirmed bioterrorism as defined in the Bioterrorism Event Annex;

• Positive signal from an acknowledged environmental detector;

• First or initial case(s) of an emerging infectious disease with potential for significant illness or death

in the population

• High profile situation involving an infectious disease

• Waterborne outbreak or threat

• Activation of the DPH DOC and/or Citywide EOC for an IDE response or other emergency with

potential need for an IDE response.

An activation triggers implementation of the Infectious Disease Response Plan and notification of the

Infectious Disease Emergency Response (IDER) responders. The following modules should be activated for every response:

5 Incident Command5 Plans Section5 5 5 5 5 5

Operations Section

• Epidemiology and Surveillance Branch

o Surveillance Group

o Investigation Group

• Disease Containment Branch



IDER Plan: Introduction Page iv/vi Draft 10/07

5 5

• Communicable Disease Information Branch

• Continuity of Operations Branch 5 Logistics Section

Other modules may be activated as needed depending on the scope and magnitude of the incident. See

the situation specific Annexes for guidance.

F NOTIFICATION

The following leaders must be notified when the IDER Plan is activated:

• Health Officer/Director, Department of Public Health

• Deputy Director, Department of Public Health Office of Policy and Planning

• Public Information Officer, Department of Public Health

• California Department of Public Health DCDC Duty Officer

• Emergency Medical Services (EMS) Duty Officer

The need to notify other internal and external partners of the activation of the IDER Plan will be

determined by the circumstances of the event including: the suspected biological agent, the anticipated

scope of the response, the size of the impacted populations, whether bioterrorism is suspected, and

whether there is a waterborne component to the incident. See the situation specific Annexes for guidance.

Internal partners potentially receiving notification include: Emergency Medical Services Section (EMS)

Public Health Laboratory, Environmental Health (e.g., Section Director, Haz-Mat Duty Officer, on-call

Environment Health Inspector), Personnel, DOC Activation Group, Medical Health Operational Area

Coordinator (MHOAC).

External partners potentially receiving notification include: San Francisco Department of Emergency

Management (DEM), San Francisco City & County EOC Activation Group, Mayor’s Office, Weapons of

Mass Destruction Alert Group, Regional Disaster Medical/Health Coordinator (RDMHC), California

Department of Public Health DCDC Duty Officer, and California Emergency Medical Services Agency.

Additional external partners to be notified are addressed in the IDER Plan Annexes and Activation and

Notification Protocol in Appendix B1.

G ROLES AND RESPONSIBILITIES

Within DPH, the CDCP Section is the lead section for an Infectious Disease Emergency Response and

will supply personnel to staff the IDER Incident Command as well as other positions of leadership and

positions requiring technical expertise. The IDER Incident Commander will have final authority on all

decisions pertaining to the response.

The DPH is the lead agency for any health or medical emergency response in the City and County of San

Francisco. When activated, the DPH DOC will provide support and coordination for additional resources

for the response and fulfill other aspects of DPH functions not part of the IDER response. Consult the

DPH EOP for further details.

The San Francisco EOC provides coordination for all city departments, regional, state and federal disaster

response partners. The EOC also maintains contact and coordination with other local government EOCs,

the Governor’s Office of Emergency Services / Homeland Security Coastal Regional Emergency

Operations Center (REOC). The EOC and other city agencies’ DOCs use the NIMS/ICS/SEMS



IDER Plan: Introduction Page v/vi Draft 10/07

throughout their response operations. See the City and the County of San Francisco Emergency

Operations Plan for additional information and details. The IDER Commander will communicate with

liaisons at the DPH DOC and/or EOC as necessary in order to inform key departmental and political

leaders regarding the scope of the IDE response and the rationale for decisions with large impact to the

public.

H AUTHORITIES

In California, cities and counties have the responsibility to protect the public’s health, and these duties fall

under the responsibility and authority of the Local Health Officer. Specifically, “the Health Officer may

take any preventive measure that may be necessary to protect and preserve the public from any public

health hazard during any state of war emergency, state of emergency, or local emergency, within his or her jurisdiction” as defined by California Government Code § 8558.

“Preventive measure” means abatement, correction, removal, or any other protective step that may be

taken against any public health hazard that is caused by a disaster and affects the public health. Funds for

these measures may be allowed pursuant to Sections 29127 to 29131, inclusive, and 53021 to 53023,

inclusive, of the Government Code, and from any other money appropriated by a County Board of

Supervisors or a City governing body to carry out the purposes of Section 101040.

The Health Officer, upon consent of the County Board of Supervisors or a City governing body, may

certify any public health hazard resulting from any disaster condition if certification is required for a

Federal or State disaster relief program.

The Health Officer shall take measures to control the spread or further occurrence of any contagious,

infectious, or communicable disease of which he/she is aware. The Health Officer may inspect any place

or person when necessary to enforce health regulations.

The IDER Commander, if not a Deputy Health Officer, will serve as the Health Officer designee for decisions and implementation of authority to implement these public health interventions.

Additional authorities and codes include:

Citywide EmergencyOperations Center (EOC)

DPH Departmental

Operations Center (DOC)

Infectious Disease

Emergency Response

Incident Commander

Plans Section Operations Section Logistics Section Finance Section

Command Staff Information, Safety,

Liaison, and

Field OfficersGeneral Staff

* A dashed line indicates that this group will carry out a support and coordination role if activated.



IDER Plan: Introduction Page vi/vi Draft 10/07

• California Government Code, Title 1, Division 4, Chapter 8 , Sections 3100, 3101, and3102, and

Declaration: Public Employees as Disaster Service Workers

• San Francisco Administrative Code, Chapter 7, Sections 7.1-7.19, Disaster Council Emergency

Service Workers

• California Health and Safety Code, Section 458, Authority to Take Preventive Measures During

Emergency by the County Health Officer

• Legal authorities for isolation and quarantine (IDER Appendix Fa)

• Health Officer Guide for Communicable Disease Control in California

• California Government Code, Section 8695, Immunity of Physicians and Nurses

• Business and Professions Code, Section 2727.5, Practice of Nursing in Emergency

• Business and Professions Code, Sections 4008 and 4227.1, Pharmacy

I SUPPORTING ACTIVITIES

Depending on the scale and scope of the disease the following activities may need to be activated.

Continuity of City Services. In the event of a reduced workforce either due to an emergency requiring

large numbers of responders or widespread illness or other reasons, the EOC will activate continuity of

operations plans to ensure that critical city services continue to be provided.

Health Care Surge. High prevalence of morbidity, mortality, and the worried well may lead to an

increase in public demand for health services (e.g. hospitals, clinics).

• Hospital Surge. Hospitals anticipating or experiencing health care demands that exceed their daily

operating capabilities should activate hospital surge plans utilizing their emergency operating

procedures and request assistance via the hospital incident command system (HICS).

• Alternate Care. Alternate care sites (e.g. tents, mobile field care clinics) can be activated to provide

basic care to civilians. The DOC will activate as needed.

Community Disaster Response Hubs. Community Hubs (located in SF emergency districts) will

coordinate the work of community organizations and other groups to provide medical/mental health

support, shelter support, food and water distribution (and other relief supplies as needed), support to

vulnerable populations, and information dissemination and coordination. The DOC/EOC will activate as

needed.

Mental Health Support. An infectious disease emergency may cause anxiety among the general

population. To provide mental health services to city residents the DOC may activate this plan.

Mass Fatality. When the number of fatalities exceeds daily operating capacity, the Mass Fatality Plan

will be activated by the EOC.

J PLAN MAINTENANCE

This emergency response plan was developed by the DPH Communicable Disease Control and

Prevention (CDCP) Section in cooperation with other DPH sections. CDCP will exercise and update the

plan, or components of the plan, periodically. Changes, updates and revisions will be released aswarranted after



IDER Plan: Introduction Page vii/vi Draft 10/07

K IDER COMMUNICATIONS

The IDER Plan assumes that all communications and requests follow ICS guidelines (e.g. vertical

communication to supervisees or supervisor). During each operational period, there should be a

minimum of one briefing between supervisors and supervisees.

Exceptions for some pre-approved lateral communications are detailed in the relevant modules of the

plan. For example, groups within the Epidemiology & Surveillance Branch will need to communicatedirectly with Isolation & Quarantine and Restriction & Clearance Groups regarding individual cases.

During a response, the Information Officer may approve specific lines of lateral communication. Lateral

communications may occur when it is simply to clarify a previous communication. However, all new

decisions or new requests must be communicated vertically and approved through the ICS structure. For

example, if a Branch would like to make new information available that includes policies or guidelines

that have not yet been approved, it must be sent to the Information Officer for approval and then to the

Plans Section for internal dissemination and the Communicable Disease Info Branch for external

dissemination. In addition, any communications that change the scope of the operations, the objectives,

or strategies must be approved via the ICS chain of command.

Any lateral communications between IDER responders and the DOC or EOC must also be communicated

up the ICS chain of command. For example, when the Logistics Section follows up on resourcesrequested and previously approved by the IDER commander, the IDER Commander must also be

informed.

The Plans Section is responsible for distribution of internal IDER communications. The CD Information

Branch is responsible for distribution of external IDER communications (e.g. public, clinicians, etc.) onceapproved by the Information Officer. The Information Officer is responsible for communications with

the PIO, media, DOC, and/or EOC.

L TRAINING

The following types of training will occur at the Staff Staging Area - common responder training needs

(e.g. general orientation to situation, ICS overview, radio use, computer login, PPE). Training that will

occur at individual modules includes job specific training (e.g. how to use Epi Go Kit, blast fax).



1. COMMAND

A. ORGANIZATION CHART

Citywide Emergency

O erations Center EOC

SFDPH Departmental

O erations Center DOC

Infectious Disease

Emergency Response

Incident Commander

Plans Section Operations Section Logistics Section

Command Staff

Information, Safety,Liaison, Field

OfficersGeneral Staff

Finance Section

* A dashed line indicates that this group will carry out a support and coordination role if activated.

B. DESCRIPTION

a. Purpose & Objectives

The purpose of IDER Command is to provide overall management and to be responsible for the major

decisions of the infectious disease emergency response. Command objectives include:

• Establish the IDER Command and response modules.

• Approve and authorize the Incident Action Plan.

•

Approve and authorize any major decisions or requests that are a part of the response.• Authorize any major changes to the Incident Action Plan or to the length of the operational period.

• Maintain an appropriate response organization.

b. Methods

IDER Plan. The IDER plan, including the Annexes and Appendices, are a guide for responding to

different types of infectious disease emergencies.

Operational Period. The length of the operational period (e.g. 8 hours, 12 hours, 24 hours) isdetermined by the needs of the incident and set by the Command and General Staff. In rapidly escalating

or very complex incidents, the operational periods should be shorter to allow for rapid response to

changing events.

C. IMPLEMENTATION

a. Incident Commander

Activate the Incident Commander position immediately upon activation of IDER.

IDER Plan: 1. Command, Page 1/6 Draft 10/07



The Incident Commander is selected based on the incident type and by qualifications and experience.

The Deputy should be able to assume the position of the Incident Commander.

In multi-agency incidents a Unified Command organization may be formed to jointly determine

objectives, strategies, plans, and priorities and work together to execute integrated incident operations and

maximize the use of assigned resources.

The Incident Commander (IC) is responsible for the overall management of the incident at the IDER Command Post and any activated field sites (e.g., POD(s), Isolation and Quarantine Facilities, RSS

Warehouse, Field Command Post, etc.). The Incident Commander is directly responsible for ensuring

that all activities are directed toward accomplishment of the overall objectives. The Incident Commander,

with assistance from General and Command Staff, is responsible for setting the objectives for the

operational period. Example objectives include:

• Facilitate laboratory diagnosis/confirmatory testing

• Obtain more information about the incident (e.g. source of the outbreak, duration, who is at risk,

geographic extent, how many people are affected)

• Provide guidance to clinicians on diagnosis, treatment, and prevention

• Provide guidance to the public on prevention and when to seek health care

• Implement disease control measures (e.g. prophylactic antibiotics, PPE, isolation)

The size or complexity of an incident may prompt the Incident Commander to expand the incident

response organization (activate or de-activate modules).

Functions of the Incident Commander

• Assess the situation and/or obtain a briefing from the prior Incident Commander. Obtain and review

the Incident Briefing Form (201) if available.

• Determine Incident Objectives and strategy for the next operational period with input from General Staff

and Command Staff. Approve and authorize the implementation of an Incident Action Plan.

• Establish or maintain an IDER Command Center and a field Incident Command Post if necessary.

•

Establish or maintain an appropriate organizational structure and activate/deactivate modules as needed.• Approve requests for additional resources or for the release of resources.

• Approve the use of staff, volunteers, and auxiliary personnel.

• Coordinate activity of Command and General Staff/Section Chiefs. Ensure planning meetings with

General Staff/Section Chiefs are scheduled as required.

• Oversee functions of the Information Officer, Safety Officer, Liaison Officer, and Field Officer.

• Ensure all documents and policies developed by the response are reviewed and approved.

• Coordinate response support with activated Department Operations Centers’ (DOCs) and Emergency

Operations Centers’(EOCs) key personnel and officials as required.

• Keep agency administrator and key personnel and officials informed of incident status.

• Authorize release of information to the PIO, DOC, emergency responders, public, or clinical community

after review and approval from the Information Officer.

• Ensure that adequate safety measures are in place.• Coordinate the response with other relevant agencies.

• Order demobilization of the incident response when appropriate.

a.1. Information Officer

Activate the Information Officer position for all IDER activations.

This position will review and approve all documents that are distributed to internal and external IDER

audiences. The Incident Commander will provide final authorization, as appropriate. Once approved,




coordinate with the Plans Section for internal IDER dissemination and the CD Information Branch for

external (e.g. clinicians, general public) dissemination, and the Liaison Officer for dissemination to

partners. This position will also review and provide approval of all policies and guidelines developed by

IDER responders, then submit to the IDER Commander as appropriate for final authorization.

The Information Officer provides information to the PIO/DOC/EOC/JIC, including incident and response

information, informational materials (e.g. fact sheets, health alerts, press releases created by the

Communicable Disease Information Branch), and a designated physician media spokesperson asrequested.

The Information Officer may have an Assistant Information Officer assigned to serve as a liaison to the

PIO and/or JIC if necessary.

Functions of the Information Officer

• Review and approve all documents, policies, and guidelines developed by the IDER response.

• Track and list all approved documents including time and date of approval

• Serve as an IDER liaison to the Department of Public Health PIO, DOC PIO, and/or JIC.

• Determine from the Incident Commander if there is any sensitive or confidential information that

should not be shared outside the IDER organizational structure.

• Develop or provide material for use in media briefings (technical communicable disease pressreleases and talking points will be provided by the CD Info Branch). Designate a media spokesperson

if requested.

• Obtain media information that may be useful to incident planning and share this during

Command/General Staff/Section Chief meetings.

• Assign Assistant Information Officers as needed.

a.2. Safety Officer

The Safety Officer position should be activated when:

1. It is necessary to develop and recommend measures for assuring responder safety, OR

2. It is necessary to assess and/or anticipate hazardous and unsafe situations.

The Safety Officer is responsible for ensuring that the physical and psychological health needs of all staff

serving the IDE response are being addressed. Federal, state, and local laws, ordinances, and regulations

mandate minimum safety equipment and procedures for private and public employees and employers

alike. Contracts or contractual obligations may also be in place. An emergency does not supersede these

regulations. The ultimate responsibility for the safe conduct of incident management operations rests

with the Incident Commander (IC) and supervisors at all levels of the incident management team.

Assistant Safety Officers may be assigned to implement key functions such as implementation of personal

protective equipment (PPE) for IDER responders, surveillance of IDER responders for symptoms of the

infectious disease of concern, and to assess and provide safety recommendations for Points of

Distribution (PODs), the Receipt, Stage and Store Warehouse (RSS), and/or other sites. (Specific rolesand responsibilities for on-site Assistant Safety Officers can be found in the Mass Prophylaxis Group

module and the Pharmaceutical & Medical Supplies Sub-Unit module of the IDER Plan).

If an IDER responder requires medical evaluation or care while working during the response, the Safety

Officer will provide information and direction to ensure the responder is seen at the San Francisco

General Hospital Occupational Health clinic or other location.

Functions of the Safety Officer

• Review the Incident Action Plan for safety implications.




• Identify hazardous situations associated with the incident.

• Develop a safety message for IDER responders.

• Participate in Command and General Staff meetings.

• Recommend PPE as recommended by the Infection Control Group and develop and implementation

strategy with the Staff Staging Area. and General Staff.

• Develop a protocol and implementation strategy for provision of medical prophylaxis if necessary for

IDER responders, based on guidelines developed by the Mass Prophylaxis Group

• Exercise emergency authority to stop and prevent unsafe acts.

• Investigate accidents that have occurred within the incident area.

• Coordinate with the Compensation/Claims Unit in Finance/Administration as required.

• Assign Assistant Safety Officers as needed.

• Develop protocol to track the health and safety of IDER responders, including injuries, minor

illnesses, and surveillance for signs and/or symptoms of relevant infectious disease

a.3. Liaison Officer

Activate the Liaison Officer when the incident is multi-jurisdictional or involves several agencies.

The Liaison Officer is the contact for cooperating agencies assigned to the incident. These are personnel

other than those involved in a Unified Command. The Liaison Officer does not interact with the

DOC/EOC or the media. The Liaison Officer may need to identify the appropriate contact at key

agencies.

Functions of the Liaison Officer

• Be a contact point for partners and cooperating agencies.

• Maintain a list of assisting partners and agency representatives.

• Assist in establishing and coordinating inter-agency contacts.

• Keep agencies supporting the incident apprised of the incident status.

• Monitor incident operations to identify current or potential inter-organizational problems.

• Participate in planning meetings, providing current resource status, including limitations and

capability of assisting agency resources.

a.4. Field Officer

Activate the Field Officer when an IDER presence is required at a field command post or other field site.

When the infectious disease emergency commences at a specific location a Field Officer may be needed

to provide infectious disease specific information to agencies and partner organizations on-site. The Field

Officer and an Administrative Assistant may function as part of Unified Command at a field command

post or coordinate with a designated liaison. All field requests for information and recommendations will

be forwarded to the Incident Commander and all responses should first be authorized by the Incident

Commander. The Field Officer will provide situational status information between the IDER Command

and the partners and agencies at the field site.

Functions of the Field Officer

• Be a contact point for partners and cooperating agencies at the field command post.

• Provide information to the IDER Commander regarding the incident and response activities at the

field site.

• Coordinate actions and decisions with the IDER Incident Commander.

• Provide infectious disease information (e.g. clinical information, infection control guidance) to

agencies at the field site.

• Maintain a list of assisting partners and agency representatives at the field site.





• Safety Plan for IDER responders

• List of IDER responder health and safety incidents

G. RESOURCES

The following resources will be required to perform response operations:

a. Protocols, forms, and guidelines, and MOUs

Items Location

ICS Forms Appendix A

b. Office and Communication Supplies

ItemsUnits

Required

Location or

Request From

Telephone 1 Logistics

Fax machine access 1 Logistics

Computer with local network, internet access 1+ Logistics

Printer access 1 Logistics

800 MHz Radio/cell phone/pager 1+ Logistics

Copy machine access 1 Logistics



2. PLANS SECTION


Operations Section

Situation Status Unit

Technical Specialist

Unit

Resource Status Unit

Demobilization Unit

Documentation Unit

Logistics SectionPlans Section Finance Section

IDER Commander

B. DESCRIPTION


The purpose of the Plans Section is to succinctly provide IDER leaders with accurate and comprehensive

information that enables optimal decision making regarding on-going and future management of the IDE

response.

Plans Section objectives include:

• Collect, assess and integrate incident and response information to produce an overall assessment of

the incident which will include the status of the infectious disease emergency and of IDER

operational activities and use of resources.

• Prepare projections of the incident, response needs and response capabilities.

• Provide recommendations for decisions and/or actions that will address future response needs.

• Facilitate Command/General staff meetings and the production of Incident Action Plans for each

Operational Period.

•

Maintain documentation of the response and store original response-related documents.• Prepare for demobilization.

• Coordinate access to technical specialists as needed.

b. Methods

Planning strategies include but are not limited to:

Incident Action Plan. Incident Action Plans define the response activities and resource utilization for a

specified time period, called the operational period. The plan contains objectives reflecting the overall

IDER Plan: Plans Section, Page 1/4 Draft 10/07



incident strategy and specific actions and supporting information for the next operational period. The plan

may have attachments, including incident objectives, organization chart, communication list, medical

plan, and incident maps. See Appendix A for ICS Forms.

Incident Status Summary: A summary of collected, assessed, and incident and response information

from activated IDER modules including: status of the emergency, IDER operational activities, resource

use, anticipated future needs, and alternative solutions to address those needs. The Incident Status

Summary will be presented to Command and General Staff for use in decision-making and developmentof Incident Action Plans.

Resource Tracking System. Personnel and material resources must be entered in the electronic

Resource Tracking System each time they are issued or re-assigned to different positions. The Resource

Tracking System records the current location and status of all assigned resources. The Logistics Section

will have primary responsibility for checking in and updating the status of resources. However, the

Resources Unit will also have administrative access to the system in order to summarize overall resource

status, utilization, needs and fulfillment. Other IDER responders will be able to request resources but will

not be able to update the status of resources using the electronic system. Instructions for how to use this

system are in Appendix M2.

Demobilization Plan. A Demobilization Plan will describe how personnel and activities of the infectiousdisease emergency event are to be reduced and/or closed out as the event abates. Demobilization

planning early on ensures a more orderly and appropriately phased conclusion of response activities. It

also identifies items requiring follow-up and the parties responsible.

Documentation. Documentation of the response and maintenance of records ensures crucial informationis available to staff during a response and after a response. The availability of information will key for the

preparation of After Action Reports and provide a historical and legal record of the response.

Technical Specialists. Coordination of technical specialist expertise will assist in providing information

and guidance to response staff. Technical specialists are individuals who have specialized knowledge and expertise and whose role in the response has not been previously planned for. There are no pre-

determined qualifications for technical specialists, rather they should be experts in their field of work.Examples include plume modelers, vector control specialists, veterinarians, toxic substance specialists.

Consult the Plans Section Unit modules in the following pages of the IDER plan for additional details of

the strategies listed above.

C. IMPLEMENTATION

a. Plans Section

Activate the Plans Section for all IDER activations. Activation of the Situation Status Unit, Resource

Status Unit, and Documentation Unit should be considered.

Upon activation, the Plans Section Chief will be briefed by the Incident Commander on the situation and

current operational objectives. The Plans Section Chief will make recommendations about which Plans

Section Units are needed for the response and will activate approved Units.

Functions of the Plans Section

• Collect and assess information on the current situation, response activities, and available resources

(e.g. Situation Status Updates from IDER modules, Resource Tracking System, and Collaborative

Fusion).

IDER Plan: Plans Section, Page 2/4 Draft 10/07



4. RESOURCE STATUS UNIT


Plans Section

Situation Status

Unit

Demobilization

UnitResource Status

Unit

Documentation

Unit

Technical

Specialist Unit

IDER Commander

B. DESCRIPTION


The purpose of the Resource Status unit is to track all resources (personnel and material) once they have

been deployed for the response. The Unit objectives include:

• Track the status and location of assigned resources following deployment from the Logistics Section.

• Maintain a master list of all resources committed to the response.

• Track staff assigned to the response using the personnel tracking system, Collaborative Fusion, or

other method.

• Anticipate and identify resources that may be needed in the next operational period.

• Determine the best manner to deploy anticipated resources.

• Provide resource status information to the response.

b. Methods

Methods used by the Resource Status Unit to manage supplies and personnel include:

Resource Categorization. Resources include personnel and material goods and must be categorized by

capability and capacity across disciplines and tracked throughout the response. Information on resource

location and condition is necessary for maintaining an up-to-date and accurate picture of resource

utilization. Resources deployed for a response can have one of three status conditions:

• Assigned resources are personnel, teams, equipment, or facilities that have been checked-in and are

supporting incident operations.

• Available resources are personnel, teams, equipment, or facilities that have not yet been assigned to

an incident and are ready for a specific work detail or function.

• Out-of-service resources are personnel, teams, equipment, or facilities that have been assigned but are

unable to function for mechanical servicing, rest, personal reasons, cost reasons (e.g. the cost of usingthe resource is prohibitive), sterilization is required before re-use, or other reasons.

• In-use items have been assigned to responders and can be re-called if needed. The Logistics Section

and Operations Section Chief should provide guidance.

Resource Tracking System. Personnel and material resources must be entered in the electronic

Resource Tracking System each time they are issued or re-assigned to different positions. The Resource

Tracking System records the current location and status of all assigned resources. The Logistics Section

will have primary responsibility for checking in and updating the status of resources. However, the

Resources Unit will also have administrative access to the system in order to summarize overall resource

IDER Plan: Plans Section/Resource Status Unit, Page 1/3 Draft 10/07



status, utilization, needs and fulfillment. Other IDER responders will be able to request resources but will

not be able to update the status of resources using the electronic system. Instructions for how to use this

system are in Appendix M2.

Incident Organization Chart. A schematic depiction of the response organization used to indicate what

ICS modules are activated and the names and locations of personnel staffing each module. The Incident

Organization Chart is prepared by the Resources Status Unit in collaboration with the Personnel Unit and

is posted with other displays at the Incident Command Post and other areas as needed.

C. IMPLEMENTATION

a. Resource Status Unit

Activate the Resource Status Unit when it is necessary to track and summarize the status of resources

(personnel or material) or to plan for anticipated future resource needs.

The Resource Status Unit is responsible for analyzing responder requests and the status of resources in

order to anticipate the need for future resources and to maximize resource use, reduce communications

load, provide accountability, consolidate control of single resources, and minimize waste and inefficiency.The resource request and tracking process includes:

1. Responder requests a resource utilizing the Resource Tracking System or the General Message Form

(ICS Form 213) and it is approved by their supervisor.

2. The Logistics Section receives the request and determines if the request can be filled or if the request

must be forwarded to the DOC. The Logistics Section updates the Resource Tracking System with

the status of the request.

3. Once the resource is available the item or person is deployed to the appropriate location. The

Resource Tracking System or a log is updated by the Logistics Section.

4. When the resource is no longer needed it is returned to the Logistics Section for future deployment.

The Logistics Section updates the Resource Tracking System or log.

The Resource Status Unit will post a summary of resources (personnel and material supplies) on a

briefing board for Command and General Staff.

Functions of Resource Status Unit

• Coordinate resource tracking and status with Logistics Branch.

• Each operational period prepare a list of responders working in the operational period and

disseminate to all staff working in the response and as part of continuity operations (e.g., CDCP,

Lab).

• Prepare and maintain the resource components of the Command Post display, including the

organizational chart and resource allocation and deployment.

• Maintain and post the current status and location of all resources.

• Provide personnel and material resource status (utilization and needs) to Plans Section Chief.• Anticipate future resource needs.

D. STAFF POSITIONS

The following positions are required for minimum staffing levels.





Staff Position Roster

Job Title Task OverviewJob

ClassificationNo. of

Employees Location

Resource Status Unit Leader Manage Resources Status Unit Staff and ensure that Unit objectives are metfor the operational period.

1 IDER

Command

Resource Status Unit Member Assist the Resource Status Unit Leaderto track resources and to anticipate and

manage resource needs.

IDER

Command

E. REPORTING

The Resources Status Unit reports directly to the Plans Section Chief.

F. DELIVERABLES

The Resource Status Unit is responsible for producing the following:

• Resource Report (developed from the Resource Tracking System or a log)• Resource Utilization Forecasting Plan

• IDER Organization Chart/Operational Period Personnel List

• Situation Status Update, ICS Form 209b (for each Operational Period)

• Module Objectives, ICS Form 202b (for each Operational Period)

• Module Log, ICS Form 214 (for each Operational Period)

G. RESOURCES



Items Location


IDER Organization Wall Chart Appendix C1

Resource Tracking System Database Appendix M1

Resource Tracking System Instructions Appendix M2

Collaborative Fusion Instructions Appendix M11

CDCP Inventory Appendix M3

DPH Inventory Appendix M4


ItemsUnits

Required

Location or

Request From

1. Telephone 1 Logistics

2. Fax machine 1 Logistics

3. Computer with local network, internet access 1 Logistics



6. TECHNICAL SPECIALIST UNIT


Plans Section

Situation Status

Unit

Demobilization

Unit

Resource Status

Unit

Documentation

UnitTechnical

S ecialist Unit

IDER Commander

B. DESCRIPTION


The purpose of the Technical Specialist Unit is to provide or obtain technical expertise for the infectiousdisease emergency response. Unit objectives include:

• Collect technical information (e.g. environmental, toxics) to support planning and operations

activities as needed.

• Identify additional technical expertise needed for the response to provide planning and operations

guidance and support.

• Determine if the technical expertise resides with assigned response personnel.

• Recruit technical specialists from outside the response.

• Orient Technical Specialists assigned to the Unit or joining other modules of the response.

b. Methods

The Technical Specialist Unit will utilize the following methods to achieve objectives:

Health Alert Notification Database (HAND): The HAND is a database of clinicians in San

Francisco (stratified by specialty) and other stakeholders that can be used to identify medical specialists.

The database contains approximately 3,000 names, phone numbers, fax numbers, addresses, and other

contact information.

Collaborative Fusion. This software facilitates the recruitment, skill assessment, assignment, training

and tracking of City and County of San Francisco workers and volunteers during an emergency response.

This software may be used to identify local technical specialists.

Technical Expert Recruitment. When technical experts can not be identified by the TechnicalSpecialists Unit, requests for assistance from state and federal agencies will occur via the Departmental

Operations Center (DOC) or the City and County of SF Emergency Operations Center (EOC).

C. IMPLEMENTATION

a. Technical Specialists Unit

IDER Plan: Plans Section/Technical Specialist Unit, Page 1/4 Draft10/07



IDER Plan: Operations Section/Epidemiology and Surveillance Branch, Page 3/3 Draft 10/07

Epi & SurveillanceBranch Deputy

Assist Epi & SurveillanceBranch Director; assumeE&S Branch director

position if necessary

2230, 2804, 2591 Supervisory experience;training and/or experiencein epidemiological field investigations;

IDER Command

Epi & Surveillance

Branch AdministrativeAssistant

Assist with administrative

duties

1424, 1426 Knowledge of office

methods and procedures;the operations of commonoffice machines and

equipment.

1 IDER

Command

E. REPORTING

The Epidemiology & Surveillance Branch reports directly to the Operations Section Chief. Incident

specific information will be provided to other Operations Section Branch Directors.

F. DELIVERABLES

The Epidemiology and Surveillance Branch is responsible for producing the following:




• Documents assigned to Epidemiology and Surveillance Groups, Teams, and Units

G. RESOURCES



Items Location

ICS Forms Appendix X


ItemNo.

Required

Location or

Request From





800 MHz Radio/cell phone/pager 1 LogisticsCopy machine access 1 Logistics



IDER Plan: Epidemiology and Surveillance Branch/Surveillance Group, Page 6/7 Draft 10/07

Staff Position Roster: Syndromic Surveillance Team


ClassificationCritical Skills No. of

Employees Location

SyndromicSurveillance Team

Leader

Coordinates and manages theSyndromic Surveillance

Group

2589, 2591,2802, 2803

Experience conductingsyndromic surveillance

and/or syndromicsurveillance data

analysis; supervisory or project coordinator

experience

1 IDER Command

SyndromicSurveillance Field Unit Leader

Coordinates and managesSyndromic SurveillanceField Unit activities

2588, 2589,2591,2806

Education or experienceconducting syndromicsurveillance;

supervisory or projectcoordinator experience

TBD

SyndromicSurveillance Field Unit Epidemiologist

Collects syndromicsurveillance data

Depends on typeof data

collection

Experience collectingsurveillance or epidemiological data;

experience extractingdata from medicalcharts

TBD

E. REPORTING

The Surveillance Group reports directly to the E&S Branch Director. Incident specific information will

be provided to the Investigation Group and the Data Branch (E&S Data Team and the Syndromic

Surveillance Data Team).

F. DELIVERABLES

The Surveillance Group is responsible for producing the following:




• Surveillance case definition

• Surveillance case report forms

• Chart abstraction forms (if necessary)

• Active surveillance protocols/guidance documents

• Syndromic Surveillance data analysis plan (produced with the Syndromic Surveillance Data Team in

the Data Branch)

• Syndromic surveillance data collection tools and investigation protocols (produced with the

Syndromic Surveillance Data Team in the Data Branch)

• Syndromic surveillance alert thresholds (produced with the Syndromic Surveillance Data Team in theData Branch)

• Syndromic surveillance data analysis report (produced with the Syndromic Surveillance Data Team in

the Data Branch)

G. RESOURCES

The following resources will be required to perform minimum response operations:



C. IMPLEMENTATION

a. Investigation Group

Activate the Investigation Group when:

1. Case investigation is required, OR

2. Contact investigation is required, OR 3. An epidemiologic study is needed, OR

4. Symptom monitoring is needed.

The Investigation Group will usually be activated at the beginning of an IDE response.

The Investigation Group Supervisor will receive preliminary situational information from the

Epidemiology and Surveillance Branch Director, including but not limited to, person, time, place, disease

information, severity of illness (hospitalization and mortality), need for laboratory confirmation of

diagnosis, and mode of transmission - particularly whether the disease is transmitted from person-to-

person.

The Investigation Group will work with the Surveillance Group and Data Branch to develop theinvestigation strategy and forms, surveys, and questionnaires required for investigation. They will also

provide guidance to the component modules regarding the use of these documents.

Considerations for Conducting an Investigation

When a point source exposure is suspected

To generate a hypothesis about possible exposures:

• Review cases’ residence, work addresses, and travel history for common location or exposure.

• During exploratory interviews, consider activities or sites where exposures may occur (e.g., health

care settings, animal processing, animal fecal aerosolization, outdoor venues, community events,

large social events).

To test a hypothesis about possible exposures:

• Conduct an analytic study to identify the source or vehicle of the pathogen to control or eliminate the

source of disease to prevent further primary cases.

• Conduct an environmental study and/or collect environmental samples (request assistance from

Environmental Health via the DOC). Feasibility depends on the persistence of the pathogen in the

environment and the suspected setting/source. It may be useful to define the population at risk from

the initial point source exposure.

When the disease is naturally-occurring and spread person-to-person

• Once the pathogen is characterized and the number of cases increase, case investigation and lab

confirmation may not be necessary or can be scaled back (e.g., pandemic influenza – as the pandemic

reaches mid to later stages).• When widespread community transmission is occurring, contact investigation activities may be scaled

back due to lack of resources (e.g., extensive smallpox, pneumonic plague, SARS).

• If surveillance suggests a change in clinical presentation (e.g., the fatality rate increases dramatically)

or the epidemiology of disease (e.g., certain populations are more severely affected), then more

thorough or different case investigation strategy may be necessary.

Functions of Investigation Group

• Determine the scope of investigation activities and which component teams and units should be

activated or deactivated.

IDER Plan: Epidemiology and Surveillance Branch/Investigation Group, Page 3/11 Draft 10/07



• Decide if an epidemiologic study is needed; if needed, the Investigational Epidemiologist in the

Investigation Group will determine the study design and design the survey instruments in

coordination with the E&S Data Team in the Data Branch.

• Approve, monitor, evaluate, and modify Investigation Group products and processes.

• Coordinate Investigation Group activities with Surveillance Group Leader.

a.1. Case Invest igat ion Team

The Case Investigation Team will be activated when:

1. Case investigation is required (case investigation may already be in process prior to activation of the

IDER Plan); OR

2. An epidemiologic study is needed.

The main objective is to interview suspect cases or their proxies (e.g., family member, guardian) and

healthcare personnel for case demographics, clinical information, exposure information, and contact

identification.

Key steps for Case Investigation

1. Receive information from the Investigation Group Supervisor regarding the event, investigation

strategy, and cases to interview.2. Refine the case definition for investigation purposes.

3. Receive case information. A list of cases will initially be provided by the CDCP Communicable

Disease Control Unit (which functions during normal operations). During the emergency response

potential cases may be provided by the following modules (if activated):

• The Surveillance Group may identify cases as they receive provider reports.

• The Contact Investigation Team may identify symptomatic contacts or contacts that know of

other suspect cases.

• The Field Investigation Team(s) may identify cases through their possible activities: active

surveillance, case investigation and contact investigation.

• The Laboratory Liaison Team may identify new cases through laboratory test reports.

• The Continuity of Operations Branch may receive case reports related to the emergency event.

• The Isolation and Quarantine Group may identify individuals in quarantine who develop

symptoms.

• The Mass Prophylaxis Group may identify cases during screening activities at the PODs.

• The IDER Phone Bank may identify cases through phone calls with the general public. 4. Interview cases and fill out any forms, surveys, or questionnaires provided by the Investigation Group

Supervisor or the Case Investigation Team Leader.

5. If potential contacts are identified during the investigation, forward information to the Contact

Investigation Team.

6. If cases work in sensitive occupations or work/live in sensitive situations, forward information to the

Restriction, Exclusion, and Clearance Group.

7. If cases should be isolated, forward information to the Isolation & Quarantine Group.

8. Provide all case data and forms to the E&S Data Team in the Data Branch.

Functions of Case Investigation Team

• Interview cases and complete CCD and CDPH Case Report Forms and submit to the E&S Data Team

in the Data Branch.

• Develop method, timeline, and protocols for contacting and interviewing cases.

• Identify possible contacts to cases if the disease is transmitted from person-to-person. Refer potential

contacts to the Contact Investigation Team.




Key steps for Contact Investigation

1. Receive information from the Investigation Group Supervisor regarding the event, investigation

strategy, and contacts to interview.

2. Refine the contact definition for investigation purposes.

3. Receive contact information. A list of cases may initially be provided by the CDCP Communicable

Disease Control Unit (which functions during normal operations). During the emergency response

potential contacts may be provided by the following modules (if activated):• The Case Investigation Team will be the primary source contacts to investigate.

• The Surveillance Group will identify cases and may also identify contacts as they receive

provider reports.

• The Field Investigation Team(s) may identify contacts through their possible activities: active

surveillance, case investigation and contact investigation.

• The Isolation and Quarantine Group may identify individuals who have come into contact with

cases.

• The IDER Phone Bank may identify contacts through phone calls with the general public.

• The Safety Officer may provide information about responders who have been in contact with

cases.

4. Prioritize which contacts are investigated and monitored.

• First priority should be on identifying:

o Contacts that were exposed to the infectious disease event/cases and

o Contacts who are at highest risk for developing the infectious disease (Disease

morbidity/mortality is higher in certain groups of contacts, e.g., children, pregnant women,

immunocompromised).

• Other factors to help prioritize contacts include:

o Whether the case was suspected or confirmed

o Case symptom onset date and the infectious period

o Type of contact/exposure

o Length of exposure in hours

o Dates of first and last exposure

5. Interview contacts and fill out any forms, surveys, or questionnaires provided by the Investigation

Group Supervisor and/or the Contact Investigation Team Leader.

6. If potential cases are identified during the investigation, forward information to the Case Investigation

Team.

7. If contacts work in sensitive occupations or work/live in sensitive situations, forward information to

the Restriction, Exclusion, and Clearance Group.

8. If contacts should be quarantined, forward information to the Isolation & Quarantine Group.9. Provide all contact data and forms to the E&S Data Team in the Data Branch.

Functions of the Contact Investigation Team

• Develop method, time-line, and protocol for monitoring contacts (e.g., how frequently contacts are

monitored, duration of contact surveillance). Reference, refine, or develop protocols.

• Identify and interview contacts.

• Conduct contact symptom monitoring. If contact is quarantined and the Isolation and Quarantine

Group has been activated, then the Isolation and Quarantine Group will perform symptom

monitoring.

• Educate contacts about symptoms and home care/infection control if appropriate.

• If appropriate refer contacts for post-exposure prophylaxis.

• Refer contacts to the Case Investigation Team, Field Investigation Team, the Isolation and Quarantine

Group, or the Restriction, Exclusion and Clearance Group as appropriate.

• Refer ill contacts for medical care.

• Transmit data to the E&S Data Team in the Data Branch.




Staff Position Roster: Contact Investigation Team



Employees LocationContact

Investigation TeamLeader

Manage and coordinate

Contact Investigation Teamactivities

2588, 2589,

2806

Supervisory or project

coordinationexperience; someexperience or knowledge of

epidemiologicalinvestigations

1 IDER

Command

Contact Investigator Conduct contactinvestigation

2587, 2806 Interviewer skills for health/medicalinterview

1 IDER Command

Staff Position Roster: Laboratory Liaison Team



Employees Location

Laboratory LiaisonTeam Leader

Manage and coordinateLaboratory Liaison Team

activities

2588, 2589,2806

Ability to understand lab test results;

familiarity with lab procedures; experienceusing MLAB.

1 IDER Command

Laboratory LiaisonTeam Member

Liaises with laboratories 2587, 2806 Ability to understand lab test results;familiarity with lab

procedures; experience

using MLAB.

IDER Command

Staff Position Roster: Field Investigation Team(s)



Employees Location

Coordinating Field Investigation Team

Leader

Manage and coordinate Field Investigation Teams’

activities

Supervisory or projectcoordination experience

1 IDER Command

Field InvestigationTeam Leader

Manage and coordinate Field Investigation Team activities

Supervisory or projectcoordination experience

1 IDER Command

Field Investigator Conduct active surveillanceand field case/contactinvestigation

Depends on function of the team; may need interviewer skills,

particularly of a probingtype of health/medicalinterview; experienceconducting chart

reviews; clinical skillsfor specimen collection

1 IDER Command

E. REPORTING

The Investigation Group reports directly to the Epidemiology and Surveillance Response Branch.Incident specific information will also be provided to the Surveillance Group, Data Group, and Disease

Containment Branch (Restriction, Exclusion, and Clearance Group and Isolation and Quarantine Group).




F. DELIVERABLES

The Investigation Group is responsible for producing the following:

• Investigation questionnaires/surveys/forms

• List of Referrals to Restriction, Exclusion, & Clearance Group and the Isolation and Quarantine

Group.

• Situation Status Update, ICS Form 209b (for each Operational Period)• Module Objectives, ICS Form 202b (for each Operational Period)


G. RESOURCES


a. Protocols, forms, guidelines, and MOUs

Items LocationICS Forms Appendix A

Respiratory Aerosol Transmissible Forms Appendix Eg

BT Forms Appendix Eh

Gastroenteritis Forms Appendix Ei

Status Reports

Template Investigation Group Status Report Appendix Aa2

Template Case Investigation Team Status Report Appendix Aa3

Template Contact Investigation Team Status Report Appendix Aa4

Template Laboratory Liaison Team Status Report Appendix Aa5

Template E&S Field Team Status Report Appendix Aa6

Template E&S Field Unit(s) Status Report Appendix Aa7

E&S Branch – General Use

Language Line Instructions Appendix Ab1Instructions for Reporting to CDHS Appendix Ab2

HIPAA Exemption Letter Appendix Ab3

CDHS Other Outbreak/Other Reportable Disease or Disease of UnusualOccurrence Report

Appendix Ab4

Phone Call Template Intake Form Appendix Ab5

CDHS Confidential Morbidity Report Appendix Ab6

Go Kits and EPI Go-Kits

Overview of Go-Kits Appendix Ac1

Computer Check-out Protocol Appendix Ac2

Go-Kit Check out Protocol Appendix Ac3

List of Go-Kit Supplies Appendix Ac4

Tempa-DOT disposable paper thermometer instructions Appendix Ac5

Instructions for Disposing of Hazardous Waste Appendix Ac6

Instructions on Donning PPE Appendix Ac7

Outbreak Protocol Appendix Ac8

Steps of a Field Investigation Appendix Ac9

Process– Tools & Forms

Case Investigation Process Worksheet Template Appendix Ad1

Contact Investigation Process Worksheet Template Appendix Ad2

Laboratory Liaison Process Worksheet Template Appendix Ad3

Contact Information

Contact Information for SF hospitals Appendix Ae1





Contact Information for Laboratories Appendix Ae2

Laboratory Related Forms and Tools

Specimen Collection and Handling During Transport Appendix Af1

Specimen Receiving Information Appendix Af2

Specimen Submittal Form Appendix Af3

CDHS VRDL Viral Specimen Submittal Form Appendix Af4

CDHS Norovirus Outbreak Specimen Submittal Form Appendix Af5

SFDPH Influenza Specimen Collection Instructions Appendix Af6SFDPH Norovirus Specimen Collection Instructions Appendix Af7

SFDPH VZV Smallpox Specimen Collection Instructions Appendix Af8


ItemsUnits

Required

Location or

Request From

Telephone 1+ Logistics


Computer with local network, internet access, statistical software (1 per

position in Syndromic Surveillance Data Unit) 1+ Logistics


800 MHz Radio/cell phone/pager (1 per leader/supervisor, 1 per field unit) 1+ Logistics


Laptops (1 per Field Team) 1+ Logistics



IDER Plan: Laboratory Branch, Page 1/8 Draft 10/07

12. LABORATORY BRANCH


B. DESCRIPTION


The purposes of the Laboratory Branch is to provide testing of human, animal, and environmental

specimens/samples to aid in the identification of organisms responsible for an infectious disease

emergency. The lab can also assist in determining the responsible organism’s transmissibility,

pathogenicity, and/or antibiotic susceptibility. The Branch objectives include:

• Provide technical consultation and guidance on appropriate specimens and lab testing.

• Provide technical consultation and guidance on potential hazards (e.g. transmissibility, pathogenicity)

and specimen collection tools for IDER responders, clinicians, and other sentinel clinical laboratories.

• Perform laboratory-based analysis of specimens to detect infectious disease agents.

• Manage and report on laboratory test results from the San Francisco Public Health Lab and other

reference or surge capacity labs (report results to other Operations Section Branches and enter data

into Laboratory Information Management System (LIMS).

•

Coordinate testing at other sites.• Handle and/or store specimens prior to transport to alternative testing sites.

b. Methods

The Laboratory Branch will use the following methods to achieve objectives:

PCR (Polymerase Chain Reaction). PCR is a molecular biology technique for enzymatically replicating

nucleic acids (DNA/RNA) without using a living organism. The technique allows a small amount of the

DNA or RNA molecules to be amplified exponentially which can enhance speed and sensitivity of

Operations Section

Epidemiology and

Surveillance Branch

Data Branch

Laboratory Branch

Communicable Disease

Information Branch

Disease Containment

Branch

Continuity of

O erations Branch

Lab Testing Group

Specimen Receiving

Documentation Team

Surge Capacity Team

Lab Resources

Mana ement Grou

Conventional Testing

Team

Lab Data Entry Team

Sample Preparation

Team

PCR Team



laboratory analysis. PCR is commonly used in medical and biological research labs for a variety of tasks,

such as the detection of hereditary diseases, the identification of genetic fingerprints, the diagnosis of

infectious diseases, paternity testing and the cloning of genes.. During an IDE response, PCR may be

used to detect and/or identify an infectious disease agent or agents. PCR is typically preceded by

purification of nucleic acid from specimens to be tested. PCR can be accomplished on up to 30

specimens within a 3-6 hour timeframe.

Conventional Testing. Conventional testing comprises serologic techniques (the detection of antibodiesto infectious agents), antigen detection methods, culture techniques and biochemical testing. These

testing methodologies, used individually or in consort with one another serve to detect and speciate many

infectious agents. While serologic and antigen testing can be accomplished in a matter of hours, culture

techniques often take at least 24 hours, with 24-72 hours being the norm for definitive results.

Laboratory Response Network (LRN). The LRN is an integrated state, national and international

network of laboratories that are fully equipped to respond quickly to acts of chemical or biological

terrorism, emerging infectious diseases, and other public health threats and emergencies. The LRN,

accessible via the internet, provides protocols for the detection of various infectious organisms and can

arrange to test samples sent to them.

Local Lab Network for Expanded Testing. The laboratory has established relationships with other laboratories within the region. Such alliances allow the San Francisco Public Health Laboratory to obtain

support in the form of reagents, expertise or acceptance of surge specimens (specimens that cannot be

tested at the San Francisco Public Health Laboratory due to insufficient lab capacity).

C. IMPLEMENTATION

a. Laboratory Branch

The Laboratory Branch should be activated when there is a public health emergency suspected to be

caused by an infectious organism and:

1. It is necessary to test specimens at the San Francisco Department of Public Health Laboratory, OR

2. It is necessary to facilitate testing at other laboratories, OR

3. It is necessary to provide guidance on specimen collection and/or laboratory testing.

The Laboratory Branch is composed of the Laboratory Testing Group and the Laboratory Management

Group.

Functions of the Laboratory Branch

• Provide technical guidance on sample collection, laboratory testing, and transmissibility,

pathogenicity, and/or antibiotic susceptibility.

• Activate laboratory groups.

• Report individual and/or summary testing results to liaisons of the Operations Section (Lab Liaison inEpidemiology & Surveillance Branch, Disease Containment Restriction Branch, and the Restriction,

Exclusion, and Clearance Branch).

• Ensure that laboratory results are electronically reported by entering information into the Laboratory

Information Management System (LIMS) in a timely manner.

a.1. Laboratory Testing Group

Activate the Laboratory Testing Group when it is necessary to test or facilitate testing of specimens

occurring from the emergency event.


http://en.wikipedia.org/wiki/Hereditary_disease

http://en.wikipedia.org/wiki/Genetic_fingerprint

http://en.wikipedia.org/wiki/Diagnosis

http://en.wikipedia.org/wiki/Infectious_disease

http://en.wikipedia.org/wiki/Paternity_testing

http://en.wikipedia.org/wiki/Cloning

http://en.wikipedia.org/wiki/Cloning

http://en.wikipedia.org/wiki/Paternity_testing

http://en.wikipedia.org/wiki/Infectious_disease

http://en.wikipedia.org/wiki/Diagnosis

http://en.wikipedia.org/wiki/Genetic_fingerprint

http://en.wikipedia.org/wiki/Hereditary_disease



The Laboratory Testing Group is composed of the Sample Preparation Team, PCR Team, and

Conventional Testing Team.

Specimens may be provided to the Laboratory Testing Group by the Epidemiology and Surveillance

Branch, the Disease Containment Branch, and the Continuity of Operations Branch. All specimens must

be accompanied by a Laboratory Specimen Submission Form, (see Appendix J2).

Confidential Guidelines Regarding Laboratory Tests. Laboratory test data shall be considered strictly

confidential by all members of the Laboratory Branch. Individual test results and/or summaries from

multiple test subjects can be generated in the form of a single document. Such summaries shall include

testing statistics and notes regarding testing anomalies, if any. Summary or de-identified laboratory test

data can be shared with the DOC, EOC, City agencies, San Francisco Hospitals and Clinics, the

California Department of Health Services, and the Centers for Disease Control and Prevention, in addition

to other State and Federal Agencies. Individually identified lab results shall only be shared with officials

or responders with a need to know, and with other health agencies. No other agencies or individuals shall

have access to individually identified data without signed patient consent or a subpoena. Summary (de-

identified) laboratory results may be shared with other agencies.

Functions of the Laboratory Testing Group• Perform laboratory testing on relevant specimens.

• Provide updates on testing capacity.

• Report testing results to Laboratory Branch Director.

• Upon authorization of Laboratory Branch Chief, report testing results to Epidemiology and

Surveillance Branch, the Disease Containment Branch, and the Continuity of Operations Branch.

a.1.1. Sample Preparation Team

Activate the Sample Preparation Team when samples are received or are expected.

Functions of the Sample Preparation Team

• Identify type of testing that is needed.• Prepare samples for PCR or conventional testing analysis.

• Enter specimen data into Lab Information Management System (LIMS)

Ensure that Chain of Custody is properly documented and maintained upon receipt and any subsequent

release of testing specimens

a.1.2. PCR Team

Activate the PCR Team when the suspected agent is one for which the laboratory maintains analyte

(organismal) -specific reagents. A current list of agents that can be tested by PCR at the San Francisco

Department of Public Health Laboratory can be found in Appendix J15.

Functions of the PCR Team• Test specimens.

• Enter results into LIMS.

• Provide results to Laboratory Testing Group Supervisor.

a.1.3. Conventional Testing Team

Activate the Conventional Testing Team when:




1. Testing cannot be performed by PCR Testing Team, OR

2. Culture or Serology is deemed a reasonable testing method for the suspected agent, according to lab’s

expertise and LRN testing recommendations.

A list of agents that can be tested by conventional methods at the San Francisco Department of Public

Health Laboratory can be found in Appendix J15.

Functions of the Conventional Testing Team• Test specimens.

• Enter results into LIMS.

• Provide results to Laboratory Testing Group Supervisor.

a.1.4. Laboratory Data Entry Team

Activate the Laboratory Data Entry Team when the Department of Public Health Laboratory has

generated lab results that need to be reported.

Functions of the Laboratory Data Entry Team

• Enter laboratory test results into the electronic Laboratory Information Management System (LIMS)

• Prepare hardcopy backups of all data generated by Laboratory Testing Team• Provide all results to Laboratory Testing Group Supervisor for further dissemination to additional

emergency response Branches

a.2. Laboratory Resources Management Group

The Laboratory Resources Management Group should be activated when it is necessary to test or

facilitate testing of specimens occurring from the emergency event. This may involve the performance of

laboratory testing onsite at the Public Health Laboratory, or the forwarding of specimens to a State or

Regional LRN laboratory. The Laboratory Resources Management Group Supervisor will oversee the

safety of laboratory staff during an emergency and coordinate with the Safety Officer.

The Laboratory Resources Management Group is composed of the Specimen Receiving/DocumentationTeam and the Surge Capacity Team.

Functions of the Laboratory Resources Management Group

• Manage specimen receipt and documentation.

• Manage additional testing through the help of local area laboratories.

• Forecast incoming specimens

• Oversee laboratory safety

a.2.1. Specimen Receiving/Documentation Team

Activate the Specimen Receiving/Documentation Team when samples are received or are expected.

Specimens submitted with appropriate forms are processed by this team for laboratory testing, or

forwarding to other laboratories (State or local LRN) simultaneous to being entered into the LIMS for

storage and management in electronic format. (Submission of a paper form allows for redundancy in the

submission system, and secondarily allows for a hard-copy backup of all records associated with lab

testing.)

Laboratory test results shall be entered electronically into the LIMS, where they can subsequently be

printed into hard-copy form whereupon they are filed on the premises.




Functions of the Specimen Receiving/Documentation Team

• Document incoming specimens and testing results.

• Assist microbiologists as needed.

• Keep inventory of testing reagents used, and projected to be used.

• Notify Team Leader when Reagents run low.

a.2.2. Surge Capacity Team

Activate the Surge Capacity Team when the:

• The amount of testing that needs to be done exceeds the capabilities of the San Francisco Public

Health Lab, OR

• Testing can not be performed at the San Francisco Public Health lab.

The Surge Capacity Team will communicate with local laboratories and/or the regional state lab to ensure

that specimens are packaged correctly and sent for testing.

Functions of the Surge Capacity Team

• Monitor laboratory testing at the San Francisco Department of Public Health Laboratory.

• Contact alternative testing sites (see Appendix J10 for list of sites).

• Coordinate transportation to alternative testing site.

• Receive testing results from alternative testing sites, log results in LIMS and communicate those

results to the Laboratory Testing Team Supervisor

D. STAFF POSITIONS


Staff Position Roster: Lab Branch



Employees Location

Laboratory Branch Director Manage all laboratory operations 2492 1 IDER Core

Staff Position Roster: Laboratory Testing Group



Employees Location

Lab Testing Group Supervisor Manage lab testing of specimens 2464, 2466 1 IDER Core

Staff Position Roster: Sample Preparation Team



Employees Location

Lab Testing Microbiologist Perform specialized lab testing 2462, 2464,2466

1 Lab

Laboratory Testing / Data EntryAssistant

Assist Microbiologists and Supervisors; perform data entry intoLIMS

2416, 2402,2462

1 Lab




Staff Posit ion Roster: PCR Team



Employees Location


1 Lab

Staff Position Roster: Conventional Testing Team



Employees Location


1 Lab

Staff Position Roster: Lab Data Entry Team



Employees Location



2416, 2402,2462

1 Lab/IDER Core

Staff Position Roster: Lab Resources Management Group



Employees Location

Lab Resources Management Group

Supervisor

Manage inventory, specimen receiving,

documentation, and testing capacity

2464, 2466 1 IDER Core

Staff Position Roster: Specimen Receiving/Documentation Team


Classification

No. of

Employees LocationLab Resources ManagementMicrobiologist

Assess adequacy for testing of incoming specimens; preparespecimens for testing

2462, 2464 1 Lab



2416, 2402,2462

1 Lab

Staff Position Roster: Surge Capacity Team



Employees Location

Lab Resources Management

Microbiologist

Assess adequacy for testing of

incoming specimens; preparespecimens for testing

2462, 2464 1 Lab



2416, 2402,

24621 Lab

E. REPORTING




The Laboratory Branch reports directly to the Operations Section Chief. Incident specific laboratory

information may be provided directly to the Plans Section and Operations Section, Epidemiology and

Surveillance Branch and Disease Containment Branch.

F. DELIVERABLES

The Lab Branch is responsible for producing the following:

• Laboratory Test Results

• Laboratory Testing Reports

• De-identified Summary Reports

• Guidelines regarding specimen collection

• Proper storage for specimens involved in emergency events (noting that specimens may be considered

evidence in legal proceedings)




G. RESOURCES

The following resources will be required in order to perform minimum response operations:


Items Location


Service Contracts for equipment Appendix J1

Laboratory Submission Forms Appendix J2

LIMS software instruction manual Appendix J3

Laboratory Testing Protocols Appendix J4List of Laboratory Testing Surge Acceptors Appendix J5

Laboratory Detection Capabilities (Rapid (PCR) or non-rapid method format) Appendix J6

Protocol for Handling White Powders (as hazards to be tested and potential

evidence)

Appendix J7

Chain of Custody Forms Appendix J8

Lab Forwarding Procedure Appendix J9

Lab Testing Surge Acceptors Appendix J10

Lab Influenza Testing Capabilities and Supplies Appendix J11

Lab Personnel for IDER Appendix J12

MLAB Access Instructions Appendix J13

Preventive Maintenance Appendix J14

SFDPH Public Health Laboratory IDE Agent Identification Capabilities Appendix J15

SFDPH Public Health Laboratory Capabilities Appendix J16


ItemsUnits

Required

Location or

Request From

Telephone 1+ Logistics


Computer with local network, internet access, LIMS Software 1+ Logistics






800 MHz Radio 1 Logistics

Computer Screen Projector 1 Logistics


c. Material Resources

General categories of the resources required for the Lab Branch are listed below.

ItemsLocation or Request From

Thermal Cycler (for Polymerase Chain Reaction) 101 Grove (4th floor) / Logistics

Agent-specific antisera / testing kits 101 Grove (4th floor) / Logistics

Polymerase Chain Reaction Master Mix kits for DNA 101 Grove (4th

floor) / Logistics

Plasticware for serology and cell culture 101 Grove (4th floor) / Logistics

Plasticware for bacterial culture and testing 101 Grove (4th floor) / Logistics

Glass and plastic pipettes for measuring 101 Grove (4th floor) / Logistics

Water Purification system 101 Grove (4th floor) / Logistics

Polymerase Chain Reaction Master Mix kits for RNA 101 Grove (4th floor) / Logistics

Specimen collection plasticware 101 Grove (4th floor) / Logistics

Safety supplies (disinfectants, goggles, gloves, lab coats, splash guards, gowns) 101 Grove (4th

floor) / Logistics

Biological Safety Cabinets 101 Grove (4

th

floor) / LogisticsChemicals 101 Grove (4th floor) / Logistics

Freezers and Refrigerators 101 Grove (4th floor) / Logistics

Incubators 101 Grove (4th floor) / Logistics

Temperature-controlled water baths 101 Grove (4th floor) / Logistics

Autoclaves 101 Grove (4th floor) / Logistics

Dishwashers 101 Grove (4th floor) / Logistics

Balances and Scales 101 Grove (4th floor) / Logistics

pH meter 101 Grove (4th floor) / Logistics

Centrifuges 101 Grove (4th floor) / Logistics



13. DISEASE CONTAINMENT BRANCH


Epidemiology and

Surveillance Branch

Data Branch

Laboratory Branch


Information Branch

Disease Containment

Branch

Continuity of

O erations Branch

Restriction Exclusion

and Clearance Group

Infection Control

Group

Home-Based Isolation

and Quarantine Group

Facility-Based Isolation

and Quarantine Team

Mass Prophylaxis

Group

Isolation and

Quarantine Group

Push Distribution

Teams

POD Staging Area

POD Area Teams

POD Unit(s)

Staging Area

Operations Section

B. DESCRIPTION


The purpose of the Disease Containment Branch is to implement measures to minimize the spread of

infectious disease. The Branch objectives include:

• Utilize available information to determine which containment strategies will be most effective for the

disease and scope of the incident.

• Recommend and/or implement disease containment strategies.

• Provide guidance on disease containment measures that can be implemented by the larger medical

community and the public.

b. Methods

Disease containment methods include but are not limited to:

Infection Control. Infection Control encompasses a set of strategies that are intended to either prevent or limit transmission of an infectious disease from one person to another, or from an environment or object

to a person. The Infection Control Group will provide expertise on modes of transmission of diseases and

infection control strategies (e.g., PPE, disinfection, sterilization, social distancing) to prevent or decrease

transmission in both healthcare and non-healthcare settings. The Infection Control Group can offer

guidance and consultation to the Safety Officer the Isolation and Quarantine Group, and hospitals, the

medical community, policymakers, and the public.

Isolation and Quarantine. Isolation is the separation of infected persons from others for the period of

communicability in order to prevent the transmission of the agent. Quarantine is the limitation of

IDER Plan: Operations Section/Disease Containment Branch, Page 1/4 Draft 10/07



D. STAFF POSITIONS





Employees Location

Disease Containment BranchDirector

Supervise Disease Containmentactivities, assign responsibilities, orientstaff and serve as a resource for allstaff in the Disease ContainmentBranch

Clinician or Disease ControlCoordinator

1 IDER Command

Disease Containment BranchDeputy

Assist Branch Director withsupervision of disease containmentactivities, assigning responsibilities,

orienting staff, and serving as aresource for all staff in the Branch

Clinician or Disease ControlCoordinator

IDER Command

Administrative Assistant Perform administrative duties to assistin the production of the DiseaseContainment Situation Status Report,documenting actions, taking notes at

meetings, and other duties as assigned.

1 IDER Command

E. REPORTING

The Disease Containment Branch Director will report to the Operations Section Chief.

F. DELIVERABLES

The Disease Containment Branch is responsible for producing the following:



• Response documents and/or products assigned to active modules within the Branch.

G. RESOURCES

The following resources will be required to perform minimum response operations. See Disease

Containment Group sections for resources required by each group.

a. Protocols, forms, and guidelines, and Memoranda Of Understanding

Items Location

1. ICS Forms Appendix A


ItemsUnits

Required

Location or

Request From









800 MHz Radio/cell phone/pager 1 Logistics




14. INFECTION CONTROL GROUP


Disease Containment

Branch

Mass Prophylaxis

Grou

Restriction, Exclusion,

& Clearance Grou

Push Distribution

Teams

POD Staging Area

POD Area Teams

POD Unit(s)




and Quarantine Team

Isolation and Quarantine

GroupInfection Control Group

B. DESCRIPTION


The purpose of the Infection Control Group is to make recommendations on infection control strategies to

minimize the spread of infectious disease. The Group’s objectives are to:

•

Identify appropriate infection control strategies to prevent or reduce the spread of infectious disease.• Advise healthcare providers, emergency responders, congregate residential setting workers, and the

public on measures that they can use to protect themselves, their patients, their families, and others.

b. Methods

The Infection Control Group will be responsible for identifying the best combination of infection control

strategies for any particular disease, situation, or setting. Strategies for infection control include but are

not limited to:

Standard Precautions. Standard Precautions are designed to limit the spread of infections from blood or

body fluids and consist mainly of hand washing after contact with blood or body fluids, the use of

protective equipment to prevent contact with blood or body fluids, and the cleaning of equipment, linensand the environment that has been contaminated with blood or body fluids.

Contact Precautions. Contact Precautions are designed to limit the spread of infections transmitted by

touching contaminated inanimate objects or by touching intact skin. Contact Precautions consist mainly

of Standard Precautions in addition to placing an infected individual in a private room and the use of

gloves and gowns when entering the room.

IDER Plan: Disease Containment Branch/Infection Control Group, Page 1/5 Draft 10/07



Droplet Precautions. Droplet Precautions are designed to limit the spread of infections that can be

transmitted by large-particle droplets (>5 µm diameter) that can be generated by the infected person

during coughing, sneezing, talking, or the performance of procedures. Droplet Precautions consist mainly

of Standard Precautions in addition to placing an infected individual in a private room and the use of a

mask when within 3 feet of an infected person.

Airborne Precautions. Airborne Precautions are designed to limit the spread of infections that can betransmitted by very small particles (≤ 5 µm diameter) that can remain suspended in the air. Airborne

Precautions consist mainly of Standard Precautions in addition to placing an infected individual in an

airborne infection isolation room (AIIR) and the use of a respirator with respiratory protection at least as

protective as an N95. An AIIR is a private room with monitored negative air pressure, 6-12 air exchanges

per hour with outside exhaust, or through HEPA filtration if air has to be re-circulated..

Hand Hygiene. Hand Hygiene means washing hands or the use of hand sanitizer to reduce the number of

organisms on the hands to decrease the chance of transmitting infection. Hand sanitizer may be used

when hands are not visibly soiled otherwise wash hands with soap and water (see Hand Hygiene

Instructions in Appendix G7). Hand sanitizer must have at least 60% alcohol content.

Respiratory Hygiene. Respiratory Hygiene is designed to decrease the spread of infections that aretransmitted by aerosols by having an infected person cover their cough, cover their mouth and nose in

certain settings, and performing Hand Hygiene whenever there is contact with respiratory secretions.

Personal Protective Equipment (PPE). PPE is the use of gloves, gowns, masks or any other equipment

that is designed to protect the wearer from becoming infected when contact with ill or exposed persons is

necessary.

Decontamination. The process of removing infectious particles from individuals who have become

contaminated.

Cleaning. To remove dirt prior to disinfection or sterilization. Dirt can interfere with the disinfection or

sterilization process.

Disinfection and Sterilization. Methods of destroying or removing infectious organisms from

contaminated objects or environments.

See Appendix G for detailed descriptions.

C. IMPLEMENTATION

a. Infection Control Group

Activate the Infection Control Group when it is determined that the emergency event is caused by aninfectious agent to assist in providing infection control recommendations, guidance, and consultation.

If an infection control professional is not assigned to this Group, one should be requested from the

Technical Specialist Unit in the following situations:

• When the disease is unknown, or

• When the disease is transmitted via the respiratory route and is not responsive to available

antimicrobials or vaccines, or




• When there are multiple or unusual modes of transmission, or

• When there are shortages of single bedded rooms or infection control supplies/equipment.

An infection control professional can help with cohort planning, evaluating the need for group Isolation or

Quarantine, re-use of PPE during shortages, planning alternate PPE, and altered infection control

standards during shortages or in unusual situations.

Decisions about infection control recommendations will be based on available data including the case

definition, incubation period, mode of transmission, infectious period, and availability of effective

prophylaxis or treatment (to be provided by the Epidemiology and Surveillance Branch, Disease

Containment Branch, and Logistics Branch). The Infection Control Group will assess the advantages,

disadvantages, costs, and practical limitations of the various strategies as part of the process of generating

infection control recommendations.

The Annexes should be consulted for overall infection control response recommendations for respiratory

aerosol transmissible diseases, bioterrorism agents, biological agent detection situations and water-bornediseases. If the infectious agent is known consult Appendix G for disease specific infection control

recommendations and protocols. When the disease is unknown the most precautionary measures should

be used until the mode of transmission and other important characteristics of the disease are confirmed.

Recommendations made by this group will primarily be disseminated to the public, emergencyresponders, hospitals and clinicians through the Disease Control Branch and the Communicable Disease

Information Branch following approval from the Information Officer.

Functions of the Infection Control Group

• Make infection control recommendations for healthcare and non-healthcare settings to prevent the

spread of the infectious disease and/or the spread of any diseases resulting from the response.

• Provide infection control guidance to the Isolation and Quarantine Group for use in isolation and

quarantine settings.

• Provide technical consultation regarding approved infection control recommendations to emergency

event responders (e.g. Isolation and Quarantine Group, Information Content Creation Group,Restriction, Exclusion and Clearance Group, Safety Officer, law enforcement, ambulance providers).

• Provide consultation to the Epi & Surveillance Branch on information needed to create surveillance

tools (e.g. Appendix Gb3, Healthcare Workers’ Self-Monitoring Log).

• Provide consultation to the Safety Officer on Personal Protective Equipment (PPE) recommendations

and other infection control recommendations related to responder safety.

• Provide guidance regarding decontamination, if appropriate, in coordination with environmental

health specialists.

D. STAFF POSITIONS



Job Title Task Overview Job Classification(Critical Skill)

No. of Employees Location

Infection Control Group Supervisor Assign responsibilities, orient staff,and serve as a resource for all the staff in and outside of the group.

Clinician (Physicianor Nurse) with

Epidemiology or Infection Control or

1 IDER Command




Infectious Diseaseexperience, InfectionControl Professional

Infection Control Member Assist with research,recommendations, preparation of guidance, and educational information

Clinical andcomputer skills,

disease controlexperience

IDER Command

E. REPORTING

The Infection Control Group Supervisor reports directly to the Disease Containment Branch Director.

F. DELIVERABLES

The Infection Control Group is responsible for producing the following:

• Infection control recommendations for clinical and public settings, including PPE recommendations.

• Infection control guidelines for isolation in healthcare, home, group facility, and other settings, if necessary.

• Infection control guidelines for quarantine in home and group settings, if necessary.

• Decontamination guidelines for biological agents, if relevant

• Infection Control Check-List Evaluation tools for Isolation & Quarantine Facilities, if necessary




G. RESOURCES



Items Location


Biological Respiratory Protection Program Grid Appendix G1

High Hazard Procedure Respiratory Protection Recommendations Appendix G2 SFDPH Interim Infection Control Recommendations for Healthcare Settings

during an Infectious Disease Emergency or Bioterrorism Event

Appendix G3

Environmental cleaning checklist Appendix G4 Infection Control and Social Distancing Strategies Overview Appendix G5 CDC Educational instructions on how to don and remove PPE Appendix G6 Instructions on Hand Hygiene Appendix G7 Guide for Developing Infection Control Recommendations Appendix G8 Instructions on Home Cleaning & Disinfecting Appendix G9 Evaluation for Home Suitability for Isolation Appendix G10 Infection Control for BDS Appendix G11 Decontamination

BDS Decontamination Procedure Appendix Ga1

Information about BDS Alert, Anthrax, & Decontamination (post and read to Appendix Ga2





USPS Employees at ECP)

USPS Status Form (USPS Employees complete after Decontamination Appendix Ga3 Guidelines on Decontamination for Biological Agents Appendix Ga4 Respiratory Aerosol Transmissible Diseases

Pandemic Influenza- Phase 6 Infection Control Recommendations Appendix Gb1

Pandemic Influenza- Phase 4 & 5 Infection Control Recommendations Appendix Gb2

Self-Monitoring Log for Exposed Workers to Known Respiratory Disease Appendix Gb3 Personal and Family Preparedness Kit Contents for Pandemic Influenza Appendix Gb5 Worksheet on Health Officer's Considerations for Pandemic Flu Non-

pharmaceutical interventions - Extended Dismissal of Students for School

Appendix Gb6

Severe Pandemic Influenza Public Health Response Matrix Appendix Gb7 High Hazard Procedure Respiratory Protection Recommendations Appendix Gb8 Books & Manuals

Control of Communicable Disease Manual 101 Grove

Hospital Epidemiology and Infection Control 101 Grove

Practical Handbook for Healthcare Epidemiologists 101 Grove

Principles and Practice of Infectious Diseases/Mandell, et.al 101 Grove

Red Book Report of the Committee on Infectious Diseases, AAP 101 Grove

SFDPH Infectious Disease Emergencies Guide Appendix Dd

Control of Communicable Disease Manual 101 GroveHospital Epidemiology and Infection Control 101 Grove

Practical Handbook for Healthcare Epidemiologists 101 Grove

Principles and Practice of Infectious Diseases/Mandell, et.al 101 Grove

Red Book Report of the Committee on Infectious Diseases, AAP 101 Grove


Items UnitsRequired

Location or Request From









15. RESTRICTION, EXCLUSION, AND CLEARANCE GROUP


Disease Containment

Branch

Mass Prophylaxis

GrouRestriction, Exclusion, &

Clearance Grou

Push Distribution

Teams

POD Staging Area

POD Area Teams

POD Unit(s)




and Quarantine Team


GroupField Investigation

Grou

B. DESCRIPTION

A. Purpose & Object ives

The purpose of the Restriction, Exclusion, & Clearance (REC) Group is to reduce the spread of infectious

disease to susceptible populations and comply with California Code of Regulations (CCR) Title 17. The

Group objectives include:

•

Follow up on cases and contacts who may be infectious and who work or are in sensitive occupationsor situations (SOS). Sensitive situations or occupations are determined based on transmission of

identified etiology.

• Compliance with CCR Title 17 which legally mandates exclusion/restriction of persons with certain

diseases from sensitive occupations or situations.

• Limit the transmission of the agent to populations who are more likely to be infected, or may have

more serious outcomes, by limiting contact with cases and contacts in an SOS.

• Provide incident specific infection control information to cases, contacts, and/or employers.

B. Methods

Strategies for the Restriction, Exclusion, & Clearance Group include:

Case/Contact follow-up investigation. Make contact with cases and/or contacts who have been

identified as working in a sensitive occupation or to be in a sensitive situation by the Epi & Surveillance

Branch. This includes individuals who are 1) epidemiologically linked to the initial case during either the

infectious period (contacts or secondary cases) or the exposure period (co-primary cases) and, 2) who

work in an occupation or are in a situation in which activities of cases or contacts could enhance or

continue transmission of the agent. Interview cases and contacts regarding specific work activities/or

situations to determine if they should require restriction or exclusion in order to protect the public’s

health.

IDER Plan: Disease Containment Branch/Restriction, Exclusion & Clearance Group, Page 1/6 Draft 10/07



Restriction. Prevent an exposed or infected person from performing specific work activities in order to

prevent the transmission of an infection to susceptible populations. Maintain this restriction for a time

period based on what is known about the infectious period until effective treatment or prophylaxis (if

indicated) has been completed, or until the case has been determined to be free of the infection by

laboratory testing in a Public Health Laboratory.

Exclusion. Prevent an exposed or infected person from entering a workplace or group setting in order to

prevent the transmission of an infection to susceptible populations. Maintain this exclusion for a time period based on what is known about the infectious period, until effective treatment or prophylaxis (if

indicated) has been completed, or until the case has been determined to be free of the infection by

laboratory testing in a Public Health Laboratory.

Clearance. Clearance is the final step in the restriction or exclusion process to allow persons who have

been restricted or excluded from an occupation or situation to return to their regular work duties or

situation after they are no longer considered to be infectious, or are no longer at risk of becoming

infectious, based on current clinical/epidemiological information. Clearance is either based on negative

laboratory test result(s), completion of treatment(if indicated), or end of known infectious period. Once a

case is determined to no longer be infectious, or a contact is determined not to be infectious, written and

verbal notification to the workplace or facility is necessary to complete the process and allow the person

to return to their occupation or situation.

Information, Education, Communication. Provide educational materials developed by the

Communicable Disease Information Branch to the case or contact and the supervisor, administrator, or

manager in the workplace or group setting to help identify additional cases, or potentially exposed

contacts, and to promote incident specific infection control practices and disease containmentinterventions.

Sensitive Occupation or Situation (SOS). Sensitive occupations may include but are not limited to:

workers who prepare or handle food, healthcare workers, and caretakers for children, the elderly, or the

disabled. Sensitive situations may include but are not limited to: residential facilities, daycare centers,schools, jails or other group settings where there may be a high number of susceptible individuals or a

highly vulnerable population.

C. IMPLEMENTATION

a. Restrict ion, Exclus ion, and Clearance (REC) Group

Consider activation when it is determined that the infectious disease emergency is caused by an agent that

is transmissible from person to person (Note once the REC group is activated, Continuity of Operations

group will be responsible for restriction, exclusion & clearance activities for those emergency conditions

reported in persons in sensitive occupations and settings (SOS).)

The Data Branch, Epidemiology and Surveillance Data Team will supply the Restriction, Exclusion, &Clearance Group with the name, address, phone numbers, and/or other locating information for all cases

and contacts who are known or suspected to be in a Sensitive Occupation or Situation.

Decisions about when and for what duration restriction or exclusion, and clearance should be applied, will

be based on current knowledge and available surveillance and epidemiologic data, including disease

transmission characteristics of the outbreak. The following criteria should be utilized for identifying

restriction, exclusion, and clearance requirements:




• Restriction. Restriction should be utilized when there are specific occupational or situation-related

activities that allow transmission of the disease to susceptible persons. If the only activities that can

be performed in an SOS are those that allow transmission of the disease, then the case or contact may

not be able to work or participate in those situations and may be excluded. Employers should be

notified of the estimated duration of restriction, if known, and what specific jobs/activities are

disallowed. See Appendix Id18 for a list of specific disease in which restriction may be indicated. In

some instances when there are limited essential personnel (e.g. healthcare workers) during a large

outbreak, restriction may involve cohorting of exposed workers with exposed or ill patients/clients.(The activity that is being restricted in this instance is working with or being in a group of unexposed

susceptible individuals.) The Restriction, Exclusion, and Clearance Group should request technical

consultation from the Infection Control Group about necessary personal protective equipment (PPE).

See Appendix ID17, The Use of Cohorting when Restricting Workers in an SOS.

• Exclusion. Exclusion should be utilized when there may be transmission of the disease in a

workplace or group setting regardless of specific duties performed.

• Clearance. Clearance should occur when restriction or exclusion should be rescinded. Clearance is

based on negative laboratory test result(s), completion of treatment (if indicated), or the end of the

known infectious period, depending on the infectious agent. See Appendix Ia and Ib for guidance.The interaction with the client will be managed by the REC team members who will be providing

specimen collection kits and instruction to clients. Once clients have returned specimens to the lab,

the tracking and testing prioritization will be managed by the Lab Liaison located in the Epi and Surveillance Branch.

Information including date restricted/excluded, locating information for case or contact, employer, date

kits provided/ date counseled, laboratory results (provided by the Laboratory Liaison) will be collected by

REC Group and relayed to the Data Branch for data entry. The Restriction, Exclusion, & Clearance

Group will provide to the Investigation Group of the Epidemiology & Surveillance Branch the locating

information for any new cases or exposed contacts newly identified during its investigations.

The Restriction, Exclusion, & Clearance Group may require technical consultation from other IDER

operational elements including the 1) Laboratory Liaison Team, to facilitate appropriate handling and

tracking of clearance specimens; 2) Infection Control Group for infection control consultation; and 3) the

Communicable Disease Information Branch for development of informational materials.

Functions of the Restriction, Exclusion, & Clearance Group

• Identify appropriate strategy to prevent disease transmission in SOS.

• Follow up investigation of cases and contacts who are identified to be in an SOS.

• Notify cases and contacts in an SOS when they are restricted or excluded.

• Notify employers or administrators that cases or contacts are restricted or excluded.

• Provide information on the disease, mode of transmission, prophylaxis, treatment, and preventive

measures to the workplace or group site for distribution to all potential contacts and a method for

those people who subsequently become symptomatic to report themselves.

• Develop an appropriate clearance strategy depending on the disease. Coordinate clearance testing

with the case/contact, if indicated.

• Coordinate with the Laboratory Liaison Team to prioritize and track specimens and review lab

results.

• Review and follow-up on the daily report which includes the list of names of persons under REC,

date of receipt of collection kits, date of specimen submission, and lab results and clearance status.

• Notify cases, contacts, and employers when clearance is completed and when the case/contact may

return to regular work duties or to a sensitive situation.

• Restriction or exclusion of health care workers may be more effectively managed on-site in

collaboration with employee infection control providers.




D. STAFF POSITIONS




Classification

No. of

Employees Location

Restriction, Exclusion, &Clearance Group Supervisor

Assigns responsibilities, orients staff,and will serve as a resource for all thestaff within and outside the Group

2588, 2589,2806

1 IDER Command

Restriction, Exclusion, &Clearance Group Member

Assist with investigation, restriction,exclusion, and clearance of potentialSOS exposed or ill persons

2806, 2587 IDER Command

E. REPORTING

The Restriction, Exclusion, & Clearance Group Supervisor reports directly to the Disease Containment

Branch Director.

F. DELIVERABLES

The Restriction, Exclusion, & Clearance Group is responsible for producing the following:




• Case exclusion letter for case including specimen collection guidance if indicated

• Case restriction letter for case including specimen collection guidance if indicated

• Case exclusion letter for employer or manager

•

Case restriction letter for employer or manager • Case clearance letter for case

• Case clearance letter for employer or manager

• Contact Exclusion letter for contact

• Contact Restriction letter for contact

• Contact restriction letter for employer or manager

• Contact exclusion letter for employer or manager

• Contact Clearance letter for contact

• Contact Clearance letter for employer or manager

G. RESOURCES



Items Location


Clearance Documents

Clearance specimen (stool) collection directions in multiple languages Appendix Ia1




Clearance specimen (respiratory) collection guidelines for clinicians Appendix Ia2

Clearance specimen laboratory test request form, SF Public Health Laboratory Appendix Ia3

Case clearance letter for case -- template Appendix Ia4

Case clearance letter for employer or manager--template Appendix Ia5

Case clearance memo for Environmental Health Services (EHS)--template Appendix Ia6

Contact clearance letter for contact--template Appendix Ia7

Contact clearance letter for employer or manager--template Appendix Ia8

Contact clearance memo for EHS--template Appendix Ia9Clearance disease-specific recommendations

Amebiasis protocol Appendix Ib1

Avian influenza (H5N1) protocol Appendix Ib2

Chickenpox protocol Appendix Ib3

E. coli O157:H7 and STEC protocol Appendix Ib4

Hepatitis A protocol Appendix Ib5

Measles quicksheet Appendix Ib6

Mumps quicksheet Appendix Ib7

Pertussis quicksheet Appendix Ib8

Rubella quicksheet Appendix Ib9

Salmonellosis protocol Appendix Ib10

SARS protocol Appendix Ib11

Shigellosis protocol Appendix Ib12Typhoid fever--California Code of Regulations, Title 17, Section 2628 Appendix Ib13

Exclusion Documents

Case exclusion letter for case--no clearance specimens required--template Appendix Ic1

Case exclusion letter for case with specimen collection guidance--template Appendix Ic2

Case exclusion letter for employer or manager--template Appendix Ic3

Case exclusion memo for EHS--template Appendix Ic4

Contact exclusion letter for contact--no clearance specimens required--template Appendix Ic5

Contact exclusion letter for contact with specimen collection guidance--template Appendix Ic6

Contact exclusion letter for employer or manager--template Appendix Ic7

Contact exclusion memo for EHS--template Appendix Ic8

List of specific diseases for which exclusion may be indicated Appendix Ic9

Restriction Documents

Case restriction letter-GI--for case--no clearance specimens required--template Appendix Id1Case restriction letter--GI--for case with specimen collection guidance--template Appendix Id2

Case restriction letter-NonGI--for case--no clearance specimens required--template

Appendix Id3

Case restriction letter--NonGI--for case with specimen collection guidance--

template

Appendix Id4

Case restriction letter--GI--for employer or manager--template Appendix Id5

Case restriction letter--NonGI--for employer or manager--template Appendix Id6

Case restriction memo--GI--for EHS--template Appendix Id7

Case restriction memo--NonGI--for EHS--template Appendix Id8

Contact restriction letter-GI--for contact--no clearance specimens required--template

Appendix Id9

Contact restriction letter--GI--for contact with specimen collection guidance--

template

Appendix Id10

Contact restriction letter-NonGI--for contact--no clearance specimens required--

template

Appendix Id11

Contact restriction letter--NonGI--for contact with specimen collection guidance-

-template

Appendix Id12

Contact restriction letter--GI--for employer or manager--template Appendix Id13

Contact restriction letter--NonGI--for employer or manager--template Appendix Id14

Contact restriction memo--GI--for EHS--template Appendix Id15

Contact restriction memo--NonGI--for EHS--template Appendix Id16

The Use of Cohorting when Restricting Workers in an SOS Appendix Id17





List of specific disease in which restriction may be indicated Appendix Id18

Linelist/spreadsheet with clearance specimen submission dates & testing results--

template

Appendix Id19

Linelist for excluded/restricted health care workers--template Appendix Id20


Items UnitsRequired

Location orRequest From






C. Material Resources

ItemsUnits

Required

Location or

Request From

Go Kit 1+ Logistics (101

Grove, # 406)Enteric Kit 1+ Logistics (101

Grove, # 406)

Rash/Respiratory Kit 1+ Logistics (101

Grove, # 406)



IDER Plan: Disease Containment Branch/Mass Prophylaxis Group, Page 1/17 Draft 10/07

16. MASS PROPHYLAXIS GROUP


B. DESCRIPTION


The purpose of the Mass Prophylaxis Group is to provide mass dispensing of preventive vaccines and/or

antimicrobials. This is highly scalable, meaning it could be activated for as little as 200 people or go up

to serving 1.2 million people. The objectives of the Group are to:

•

Set up and operate the Point of Dispensing (POD) and Staff Assignment and Training (SAT) site.• Operate POD sites in a scalable fashion to serve the appropriate number of clients (200 vs. 1.2

million) in a timely manner.

• Dispense antibiotics to pre-identified groups unable or unwilling to use PODs, and to those whose

self-dispensing capacity can reduce the demand on PODs (community-based organizations, such as

those serving homebound people, large employers, or building managers, emergency responders, and

hospitals).

b. Methods

The Mass Prophylaxis Group will use the following strategies to dispense mass prophylaxis:

Point-of-Dispensing (POD). The POD - the concept of pulling people into one central location - is thefoundation of mass prophylaxis operations and is an efficient way to reach large numbers of people (200

to 1.2 million) quickly. San Francisco has the ability to establish 1 to 20 PODs with the number activated

dependent on the needs of the response. PODs where antibiotics will be dispensed will also have the

capability of giving extra medication for family and neighborhood members. Individuals coming to a

POD have the ability to pick up antibiotics for up to ten others. PODs where vaccinations are dispensed

will only be able to give vaccinations to the individual patients who come to the POD. All PODs will be

able to serve unaccompanied minors who are age 13 or older. Any child age 12 or younger needs to be

accompanied by their adult guardian to receive services. POD Playbooks have been developed for each

of the identified sites that entail setup, operations and takedown instructions. PODs will remain open

Disease Containment

Branch

Mass Prophylaxis GroupRestriction, Exclusion,

& Clearance Grou

Infection Control

Grou

Push Distribution

Teams

POD Staff Assignment and

Trainin Area

POD Area Teams

POD Unit(s)


Group




and Quarantine Team



until the overall prophylaxis needs have been met. Playbooks for each of the identified POD sites are

located at 1) the POD site, 2) IDER Group, 3) SFDPH DOC and 4) the Fire Station closest to each

identified POD (see Appendix Ha1 for playbook legend). It is built into POD plans to have epidemiology

and surveillance teams available on site if contact tracing or client interviews are necessary to gain more

information about the disease exposure patterns. For diseases that are especially communicable from

person to person, triage recommendations will be provided by the CD Information Branch, to keep

particularly infectious people out of the POD and referred and/or transported for medical care instead.

Each POD will have an ambulance with basic life support capabilities parked outside. Public messageswill also be heavily broadcast, giving directions on who should come to a POD and what the internal

POD process will be like for all patients. Depending on the scale of the event, prophylactic antibiotics or

vaccines will come from either a local cache or the Strategic National Stockpile (SNS). In any emergency

requiring that PODs be set up, the goal is to do so in the period of time that we are waiting for materiel to

arrive from the SNS or in the time that it takes to break down bulk pharmaceuticals from the local cache.

See module 29, Pharmaceuticals and Medical Supplies, for more information.

Push Dispensing. The basic concept of Push is to provide pre-identified organizations and/or businesses

with instructions and antibiotics so that they can dispense to groups unable or unwilling to use PODs, and

to those whose dispensing capacity can reduce the demand on PODs. Pre-identified organizations include

those who serve people in their homes, or people who are isolated, large employers (with > 500

employees), emergency responders, and hospitals. The Push dispensing strategy can only be used for antibiotics and will not be available for vaccinations. Push strategies will only be activated when the

response demands exceed what can be easily provided by City and County personnel (e.g. a citywide

response wherein over 100,000 clients need antibiotics) and after PODs have been set up and are running.

SFDPH has created PushKits with background information and relevant attachments for businesses and

organizations to complete self-dispensing plans. Related self-dispensing templates have been created for Emergency Responder organizations (see Appendix Hc). Organizations will either have antibiotics

delivered to them (through agreements with the Department of Public Works) or they may pick them up

from a site that would be determined at the time of the disaster. Antibiotics will not be deployed in

advance, since all of the antibiotics will come from the Strategic National Stockpile. A Push Spreadsheet

has been created for all organizations that have completed self-dispensing templates and is located in theMass Prophy/Push/Push Partner Spreadsheet folder on the S/AllStaff drive. The templates ask how

many antibiotics are necessary to prophylax all employees, their family members and their clients (if applicable) such that the approximate overall needed number of antibiotics for push will be known in

advance. That allotment will be set aside at the RSS site for Push purposes. If Push is being activated, the

Push Distribution Team will send electronic messages to all push registrants to confirm their

participation. See Appendix Hc for protocol to send electronic messages and activate pre-designated

phone number for receiving messages from Push Partners. See Appendix Hc1 for the Push Playbook.

Emergency Responder and critical infrastructure agencies will receive a three-day supply of antibiotics

from a local cache. There are three different ways that Emergency Responder/Critical Infrastructure

agencies can receive antibiotics: 1) Through self-dispensing (agencies are responsible for dispensing to

their own employees and providing enough for family members), 2) Dispensing in buildings (creation of

a POD within a building) to dispense to the agencies employed in or surrounding that building (e.g. City

Hall and Hall of Justice), and 3) By working in a POD and receiving prophylaxis as part of the PODoperations training at the Staff Assignment and Training Area (see below). A self-dispensing/screening

form with dispensing instructions has been created and technical assistance is being provided by SFDPH

for buildings that will dispense as well as agencies that will self dispense. This work is ongoing.

POD SAT. The POD Staff Assignment and Training (SAT) Area is a site for City & County Disaster

Service Workers and/or registered volunteers to report, check-in, be assigned, be trained for mass

prophylaxis jobs, receive prophylaxis themselves (as well as for their family members if applicable) then

be deployed to their assigned POD work sites. The POD SAT Area is an adjunct to the IDER Staging




Area and performs all of the functions of the IDER Staging Area in addition to mass prophylaxis specific

procedures.

Screening. Screening is utilized to identify what type of prophylaxis an individual should be given.

Three screening models can be utilized at PODs and Push Dispensing Sites: Paperless, Form, and

Maximum (a Form/Verbal combination). The Paperless Model utilizes signs to direct individuals to the

appropriate prophylaxis table. The Form Model requires individuals to fill out a questionnaire with their

medical history to identify the appropriate prophylaxis. The Maximum Model depends on a trained interviewer confirming written responses to determine what type of prophylaxis the person should

receive.

Personnel Management. The staff requirements for full-scale POD/Push activation (for citywide

emergencies) are intense (e.g. greater than 6,000 needed staff for PODs only for three shifts in a 24-hour

period if all 20 PODs are activated). In that regard, a personnel management system called Collaborative

Fusion or the CORES System has been purchased to properly assign staff to needed jobs and track their

number of hours worked. Administrative privileges for this web-based software, available at

www.helpbayarea.org,will be available in multiple locations (e.g. EOC, DOC, IDER, POD Staging Area

and individual POD sites) to track the overall personnel needs/status at any given time. The first wave of

requested staff will be those needed to set up and staff the Staff Assignment and Training (SAT) area.

POD staff will be requested next and told to report to the SAT. All return shifts will be advised to go tothe respective work site where staff had worked their previous shift. For ongoing POD operations, there

will be three nine-hour shifts. The ninth-hour provides overlap for shift changes at all of the POD sites.

The overall recruitment pool of San Francisco City and County staff (excluding public safety agencies) is

about 18,000 employees who are also registered disaster service workers. All of their information should,

at the time of an emergency, be in the Collaborative Fusion system. For any non-City and Countyemployees who are interested in volunteering, they will be instructed to first go to an emergency

volunteer center (EVC) for swearing in and credentialing. From the EVC, staff will be directed to the

POD SAT area for position assignment and training.

C. IMPLEMENTATION

a. Mass Prophylaxis Group

Activate the Mass Prophylaxis Group when:

1. At least 200 people need prophylaxis in a timely manner, AND

2. When it is known what types of prophylaxis should be provided, AND

3. When prophylaxis is available to be distributed. (See the Pharmaceuticals and Medical Supplies Sub-

Unit module for details on prophylaxis available through the local cache, hospital cache, and Strategic

National Stockpile)

The Mass Prophylaxis Group at IDER consists of the Point of Dispensing (POD) Area Management

Team, Push Distribution Team, and POD SAT Area. The operational concept of mass prophylaxis is to provide the right prophylactic measure to each person needing it, in a timely manner. The following steps

should be taken when activating mass prophylaxis.

• Determine the number of prophylaxis recipients. Depending on the situation it may or may not be

necessary to provide prophylaxis the entire San Francisco day-time population. The Incident

Commander (with input from the Epidemiology and Surveillance Branch and Treatment and

Prophylaxis Guidance Team) should provide a case definition and guidance on who should receive

prophylaxis (this guidance may be modified by the Policy Group at the EOC). It should be




remembered that “unexposed” members of the public may desire prophylaxis to ease concerns and

fears.

• Determine prophylaxis type and dosing guidelines. The type and quantity of treatment and

prophylaxis to distribute should be provided by the Incident Commander with input from the

Treatment and Prophylaxis Unit. See Appendix Dd for disease specific post-exposure prophylaxis

recommendations.

• Request prophylaxis. Antibiotics/antivirals/vaccines should be requested from the Logistics Branch.

(For most large-scale emergencies, prophylaxes will need to be obtained via a request to DOClogistics for resources available from the Strategic National Stockpile (SNS) and will be distributed

by the Logistics Section from the Receipt Stage & Store (RSS) Warehouse to the appropriate

dispensing venues.) Local pharmaceutical caches can be delivered in 2-6 hours and those requested

from the SNS via the State can be available in 12-18 hours of the request. The process for requesting

the local cache is located in the Pharmaceuticals and Medicals Supplies Sub-Unit

• Select screening method. Decide what type of medical screening to utilize:

• Paper-less screening (screening signs): Utilize when it is necessary to screen > 20,000 people to

accomplish prophylaxis distribution in 48 hours. This is the most efficient form of screening

because it requires the least amount of face-to-face time with patients. Even in a paper-less

model, however, a form will still be required for approximately 20% of patients (they representthe minority of patients for whom there may be a contraindication to the dominant drug being

dispensed at the POD).• Screening-form: Utilize when time allows, it is necessary to keep a record of individuals and the

specific prophylaxis dispensed to them, and/or the group requiring prophylaxis is small.

• Maximum screening: Utilize predominantly for vaccination dispensing sites, when a

screener/interviewer verbally goes over written responses to questions to solicit a confirmatory

response. Utilize when the prophylactic measure being offered has the potential to cause asignificant number of serious adverse events or reactions (i.e. smallpox vaccine).

• Determine venue(s) for dispensing. The Mass Prophylaxis Group Supervisor, in consultation with

the Disease Containment Branch Director, will recommend how many PODs and/or Push sites to

activate for mass prophylaxis dispensing. At a minimum, at least one licensed MD should always be

on staff at a POD, to assess relative or absolute contraindications to offered prophylaxis and

refer/counsel/prescribe accordingly. Consider the number of recipients, screening method, and

dispensing time frame to identify the number of sites to operate. Activate the POD Area ManagementTeam per the instructions below.

• Set up POD(s) and POD SAT Area. POD(s) and the POD Staff Assignment and Training Area

should be operational within the time frame recommended by the Communicable Disease Information

Branch Treatment and Prophylaxis Unit. The soonest mass prophylaxis POD(s) can be operational is

2 to 24 hours following the decision to activate. Assistance for POD set up should be requested viathe EOC to the Fire Department.

• Staff Training. Almost all training of personnel who will be deployed to individual PODs will be

done in a “just-in-time” format at the SAT area. The overall training methodology after staff are

registered and receive their assignments is to attend a general orientation followed by a more specific

training that is catered to the function of that assigned position. Every staff person will receive a job

action sheet. After functional training, all staff go through an actual training POD that is set up at the

SAT. It is in this training POD that staff receive prophylaxis for themselves and, if appropriate, their family members as well. Staff will experience the training POD from both the perspectives of a

patient and as staff. After the training POD, staff attend a final debriefing or hot wash to clarify

questions/concerns in a group format. Staff are then deployed. This method of training has been

tested and has proven to be effective and efficient. The only individuals who should receive pre-

training for mass prophylaxis include trainers of trainers, those responsible for setting up and running

the SAT area, and those responsible for tracking personnel at the individual PODs using the

Collaborative Fusion system. Everyone else follows a just-in-time format. Training materials as they

are developed, however, can easily be posted on the SFDPH website and linked with other regional




websites to help explain POD operations and job descriptions in advance for anyone who is interested

in reading about them.

• Mental Health. Through work with Community Behavioral Health Services (CBHS), different

mental health strategies have been devised depending on the disease scenario and what level of

throughput is required to prophylax the intended audience in a timely manner. If it is a scenario

where extremely rapid throughput of patients is necessary, opportunities for any conversations within

a POD will be minimized and, therefore, no mental health staff will be present. Patients will, instead,

hear through public messaging and notices posted at PODs the locations of the nearest mental healthclinics to PODs where both individual and group assistance will be available. In situations where

throughput requirements are much slower, mental health counselors will be available on site. Trained

mental health professionals will also be available at the POD SAT area and if it necessary to deploy

more professionals for staff at individual POD sites, that will be arranged through the DOC.

• Infection Control. Infection control guidelines for POD staff (e.g. PPE) should be requested from

the Infection Control Group.

• Prophylaxis delivery and distribution. Prophylaxis will require sorting, labeling and packaging by

the Logistics Section at the Receipt, Store, and Stage (RSS) Warehouse. The Department of Public

Works (DPW) has agreed to transport the cache of antibiotics to the POD/Push site(s). DPW trucksfrom the RSS will require SFPD or SFSD escorts. SFPD has already agreed to provide such escorts

and requests should be made via the Logistics Section of the EOC. All distributed materiel will also

have to be entered into an inventory tracking management system that is yet undetermined.Collaborative Fusion has a product that is a possibility that includes hand-held devices with bar-

coding capabilities.

• Notify the public. Public messages must be specific and clear about who is eligible to visit a POD,

what specifically takes place at a POD and where they are located. Public messages should be created

and disseminated by the Communicable Disease Information Branch and Information Officer in

coordination with the DOC PIO and/or JIC if activated.

• Triage. Special triaging activities may be necessary (e.g. respiratory aerosol transmissible diseases)

to keep infectious people out of the POD. Resources and attention should be directed to the front

door of a POD to ensure that disease does not enter and spread within. Triage activities may includetaking temperatures of anyone who feels they may have a fever. Triage guidelines, questions and

instructions should be sought from the Communicable Disease Information Branch.

• Dispense antibiotics to persons potentially exposed. A general course is a 10-day supply.Depending on the scenario, an additional 50-days worth of antibiotics may have to be dispensed. In

terms of vaccines, it is usually one or two doses (separated by one month) depending on the disease

scenario. In some instances, it may be necessary to dispense both antibiotics and vaccines.

• Provide antibiotic medicine fact sheets. Pre-written antibiotic prophylaxis fact sheets in multiple

languages are located in Appendix Hd - Hp and should be printed and distributed to individuals

attending the POD and/or distributed to the media via the Information Officer, DOC, EOC, or JIC.

• Contact Tracing. Emphasis may be placed on activation of certain surveillance stations at a POD

such as the Contact Tracing Station.

• Data Collection. The Mass Prophylaxis Data Team will be responsible for collecting and analyzing

POD data (see module 23 for details).

• Vaccine Actions and Adverse Reactions. For vaccines (i.e. flu), instructions for what to do in the

rare instance of an adverse reaction or event will be posted at each POD and may also be distributed

to each vaccine recipient. The Vaccine Adverse Event Reporting System (VAERS) will be utilized

and recipients will be instructed go to their personal medical provider with the vaccination card they

received at a POD to seek treatment/care. Individual physicians will then be able to complete the

VAERS form and submit it to the VAERS office. For patients who visit their personal clinician

without a vaccination record, the Communicable Disease Information Branch will set up a live phone

bank or telephone line to help provide more specific information (lot number, i.e.) to health care

providers whose patients are experiencing adverse reactions. See Appendix H10 for details on

tracking adverse events.




• Disseminate public information. Fact sheets (see Appendix Hd - Hp), guidance on what to do if

feeling ill, how to provide self-care and/or other messages should be created and disseminated via the

website, newspapers, and other media by the Communicable Disease Information Branch

Dissemination Team.

• Transport Staff. All first shifts will report to the SAT for registration, assignment to jobs and just in

time training, then be deployed to POD sites. Muni and/or school busses for transporting POD staff

should be requested via the EOC Logistics Section. Any return shifts should report directly to the

POD site to which an employee is assigned and transportation may not necessarily be provided. • Care and Feeding of POD Staff: At each designated POD and the POD SAT, rooms have been set

aside in which POD staff will take mandatory breaks. Unit leads at individual PODs and Personnel

coordinators have it written into their job action sheets that they are responsible that staff take breaks

on a rotating schedule. For the very first shift, because it involves registration, assignment, training

and deployment, staff will be notified that they should anticipate a 12 hour shift. All return shifts,

however, will be 9 hours. There is a POD staff safety section of the overall general

orientation/training curriculum at the POD SAT as well so all staff hear of the importance of staying

well-rested. Food for staff will be arranged through the EOC. In general, the City and County has an

arrangement with the Salvation Army for food but it is anticipated that many private businesses willalso contribute if a call for assistance is put out through the EOC.

Depending on the evolving circumstances, lab confirmation results, evidence, and guidance from theCDC, further prophylaxis actions in the following days may include: discontinuing the antibiotics;

dispensing another 50 days of antibiotics to complete a 60 day course, subsequent vaccinations; or avaccination series.

Functions of the Mass Prophylaxis Group

• Oversee overall mass prophylaxis (i.e. POD operations, Push distribution operations) and POD Staff

Assignment and Training (SAT) Area operations. (See Appendix H for POD playbooks, push

playbook and staff staging are playbook)

• Make logistical requests to CD Containment Branch Director.

• Determine prophylaxis strategies to be utilized (i.e. POD, Push).

• Determine screening strategy to be utilized (i.e. paper-less, form, or maximum)

• Identify number of PODS needed and locations.

• Oversee dispensing to Emergency Responder and Critical Infrastructure agencies

• Identify which Push Partners to activate.

• Oversee take down of POD SAT Area and POD sites as their use for emergency mass prophylaxis is

finished and return the sites to their regular managers in pre-emergency condition.

• Report any suspected cases or contacts to the Epi Investigation Group.

a.1. POD Area Management Team

The POD Area Management Team is required when the number of active PODs is too great for the Mass

Prophylaxis Group Supervisor to oversee alone. (When four or five POD locations have been activated a

POD Area Manager should be assigned to oversee operations of a set of PODs located geographically

near one another.)

The POD Area Manager will coordinate closely with other POD Area Managers, the Mass Prophylaxis

SAT Area, and the Pharmaceutical and Medical Supplies Sub-Unit within the Logistics Section Supplies

Group.

Function of the POD Area

• Provide guidance, and serve as a resource to POD Units and to Mass Prophylaxis Group Supervisor.

• Coordinate logistics requests.




• Coordinate situation status reports with Mass Prophylaxis Group Supervisor

a.1.1. Point of Dispensing (POD) Unit(s)

Activate a POD when it is necessary to provide prophylaxis or vaccinations to at least 200 people quickly

(minimum of 36-48 hours).

To serve San Francisco’s daytime population estimated at 1.2 million people, close to 40 facilities instrategic locations in San Francisco have been identified (see Appendix Ha for locations) to serve as

possible POD sites. 20 of those identified sites are large enough to accommodate a throughput of 2,000

people per hour. All identified sites have the ability to accommodate a throughput of at least 500 people

per hour (in disease scenarios where more time is available to dispense prophylaxis, in one week for

example, a smaller throughput is acceptable). For a small event, only one POD may need to be opened.

General tenets of POD operations include:

• Keep clients moving through the POD at all times (avoid bottlenecks).

• Minimize paperwork for clients so as to maintain adequate throughput at a POD site.

• Have enough trained staff available to effectively manage the POD and respond to client needs.

Providing mass prophylaxis is staff-intensive and logistically complex. Setup, operations and takedown

instructions for all identified POD facilities are contained in individual site-specific POD Playbooks. For

a timeline of how to coordinate POD setup see Appendix Ha. For a list of essential job functions at aPOD, see Staff Positions below.

The POD Manager is co-located with representatives from other agencies who are present at the POD

site, including security personnel, parking and traffic personnel, and administrative staff for improved

communications. The POD Manager will have a walkie talkie to communicate with on-site staff and theCommunications Center). All communication in and out of a POD will be through one central

communication station, which will have an 800 Mhz radio. All PODs will also have active telephone

lines located at the communication station. See Appendix Ha for POD organizational chart and

communication flow explanation.

Situation Status Updates. The POD Unit provides updates to the POD Area Manager (or Mass

Prophylaxis Group Supervisor if no Area Manager has been activated). Updates should include estimated

throughput and waiting times, doses dispensed, numbers of patients served, breakdown of prophylaxis by

type (if applicable), pharmaceutical supply status, personnel needs, public safety issues, supply needs,

information about changes to protocols or procedures, information about special situations (such as

mental health distress among POD workers), and how the staffing distribution is working (particularly

early in POD operations). It is written into the job action sheet of the POD Manager to conduct regular

briefings with specified POD unit staff, including Security Liaison, the Operations Chief, the Assistant

Clinic Manager, the Logistics Chief, the Medical Director and the Personnel Coordinator.

Functions: POD Operations• Ensure that POD support personnel have received prophylaxis and Personal Protective Equipment (if

required).

• Ensure that POD throughput is safe and adequate.

• Provide assistance to special needs patients.

• Carry out triage, prophylaxis screening, and medical consultation for individuals with complex

medical histories that may impact the type of prophylaxis provided.

• Carry out contact tracing and surveillance activities where applicable.

• Provide information sheets and guidance on where to obtain additional information.




• Coordinate forms distribution, data collection, and record keeping where applicable

• Request and receive prophylaxis supplies from the Logistics Section.

• Re-package, label, reconstitute, and inventory pharmaceuticals according to pre-determined protocols

as needed.

Functions: POD Logistics

• Receive and fill POD Unit logistics requests

• Maintain up-to-date inventory of supplies

• Maintain financial records of supplies.

• Ensure the collection and re-packaging of POD supplies for demobilization.

• Track staff hours and assignments through Collaborative Fusion staffing software (see Appendix M11

for instructions)

• Identify staffing gaps and communicate as appropriate to SAT.

• Provide just-in time training for on-site position changes

• Monitor and maintain record of all communication requests

• Provide healthy working environment for POD Unit staff (e.g. rest breaks, food, drink)

a.2. Push Dispensing Team

Activate the Push Distribution Teams when prophylaxis must be dispensed and:

1. It is necessary to decrease the burden of visitors to the PODs, OR

2. It is necessary to reach those who are unable (because they are homebound) or unlikely (those who

are culturally or linguistically isolated) to come to a POD.

It is more complicated to administer vaccines via Push strategies than antibiotics. In some limited

capacity, however, vaccines may be available for those organizations who have the medical staff and

knowledge to administer vaccines (e.g. nursing homes, home health services). The list of Push Partners

provides a rough estimate of the number of people that will require prophylaxis through Push dispensing.

These numbers can be used for requesting prophylaxis. PushKits or dispensing instructions (see

Appendix Hc) have been distributed to organizations that are in the registry.

The Push Distribution Team will be responsible for contacting organizations that have registered in the

Push registry (this is currently a spreadsheet located at Appendix Hc2), coordinating antibiotic delivery or

pick-up, and providing additional instructions for participating organizations. Emergency responder and critical infrastructure agencies will also be in the registry, to properly divide and deploy the local cache.

Functions of the Push Dispensing Team

• Alert Push Partner organizations to activate dispensing plans (see Appendix Hc1 for Push Playbook

and alerting procedure)

• Process requests for pharmaceuticals from Push Partner organizations.

• Provide ongoing guidance via telephone and e-mail to support Push Partner organizations.

•

Coordinate deliveries to Push Partners.• Audit Push organizations’ dispensing procedures to ensure adherence to dispensing protocols.

• Track Push Partner shipments and compile data regarding number of people being served

(individually and overall), and the type (if more than one type) of prophylaxis being dispensed.

a.3. POD Staging Area Team

Activate the POD Staff Assignment and Training Area when 1 or more POD sites have been activated.




Because mass prophylaxis operations are logistically intricate and staff-intensive, a separate or designated

POD Staff Assignment and Training (SAT) Area is necessary. Approximately 100 people will be needed

per shift to staff each POD. Disaster Service Workers and spontaneous volunteers will be solicited via

electronic and telephone messages through Collaborative Fusion and public messages. The instructions

for POD staff will be to check in at a designated time to the POD SAT area for relevant registration,

assignment and job training. Prophylaxis will also be available at the POD SAT for all staff. While

spontaneous volunteer will be encouraged to register and credential themselves at an Emergency

Volunteer Center (EVC), the POD SAT will have the capability to produce temporary disaster serviceworker ID cards on site that are the same as City and County DSW cards. Equipment to produce such

cards is housed with the Personnel Unit at 101 Grove St.

A POD Staging Area takes approximately 1-3 hours to set up and is essential for:

• check-in and registration,

• credentialing,

• assignment of specific job functions,

• providing prophylaxis to staff,

• training in overall POD operations as well as individual job functions, and

• deployment of staff to their respective work locations throughout the City.

For a small-scale event, staff can be checked-in, assigned and trained in as little as two hours. For larger-

scale event involving thousands of staff, staging will take longer.

The POD SAT Team is led by a POD SAT Manager, who coordinates and oversees all operations and

communicates objectives and work strategies to the POD Staging Management Team (Safety Officer,

Operations Chief, Logistics Chief) at the beginning of each shift. The POD Staging Management Team

will need to request transportation to transport POD staff to activated PODS and security assistance for

each POD (agreements are already in place with Muni and SFPD) through the EOC. Depending on

whether there is an identified threat to staff themselves, or if streets are not safe for unaccompanied travel,

security escorts of busses to POD sites may be necessary. This will also be arranged through the EOC

and requested by the POD Staging Management Team. POD setup/takedown, layout, operations, job

functions, and other guidance is located in Appendix Ha5, POD SAT Playbook.

Functions of the POD SAT Area Team

• Check-in individuals reporting for work.

• Assign positions to individuals.

• Train new staff for POD roles.

• Deploy staff to POD locations.

• Receive, manage, dispense, and track POD SAT Area supplies.

• Ensure working communication mechanisms for SAT Area.

• Ensure working communication mechanisms between SAT Area, Staging Management Team and

individual PODs.

•

Coordinate facility management at POD SAT Area.

D. STAFF POSITIONS





Staff Position Roster: Mass Prophylaxis Group

Job Title Task OverviewCritical Skills No. of

Employees Location1

Mass Prophylaxis GroupSupervisor

Oversee mass prophylaxis response Projectmanagement,

supervisory

1 IDER Command

Staff Position Roster: POD Area Team


Employees Location1

POD Area Manager Oversee operation of up to 5 PODs inan area

High levelProjectmanagement,,

communication

1-5 IDER Command

Staff Position Roster: POD Unit(s)

Job Title Task Overview Job

Classification

No. of

Employees LocationPOD Manager Oversee all activities of one POD High level

projectmanagement,

supervisory,communication

1 POD

POD Assistant POD Manager Assist with management of one POD communication 1 POD

POD Assistant Safety Officer Ensure the safety of all persons in thePOD at any given time, including staff

and the public

1 POD

POD Assistant Operations Chief Oversee site dispensing operations: therunning of the patient and pharmacy

areas of the POD clinic

Projectmanagement,supervisory,

communication

1 POD

POD In/Out/Flow Lead Ensure patients move smoothlythrough the POD, without excessive

bottlenecks

Communication, projectmanagement

1 POD

POD Entry Staff Person Direct patients to initial line; screen

out those with special needs for additional assistance

- 1-10 POD

POD Exit Staff Person Ensure patients leave with thenecessary medication and information

- 1 POD

POD Line Monitor Answer questions; direct patients to

correct line or next available station

- 6-20 POD

POD Medical Lead Oversee and make decisions on clinicaloperations; answer clinical questions

MD or Pharm D 1 POD

POD Screening Lead Oversee all aspects of triage and

prophylaxis screening, including

medical consultation

MD or PharmD 1 POD

POD Triage Staff Person Triage persons to allow into the PODonly those meeting the approved criteria

Possibly RN,LVN,

1-10 POD

POD Prophylaxis Screener Screen patients to determine theappropriate prophylaxis for them

Possibly RN, or MD (depends onscenario)

2-12 POD

POD Medical Consultant Choose correct medication for patient by protocol; consult further if needed (for more complex cases)

MD or PharmD 1-2 POD

POD Dispensing Lead Oversee dispensing; ensure patients Possibly 1 POD




receive the correct medication and anyinformation/interaction sheets that may

be available

PharmD or MD

POD Dispenser Dispense medication according toscreening form, or other protocol

Possibly RN

(depends onscenario)

8-30 POD

POD Re-stocker Re-supply dispensing stations whenthey become low on stock of

prophylaxis medication or druginformation/interaction sheets

- 1 POD

POD Pharmacy/Drug PreparationLead

Oversee pharmaceutical operations,including ordering, receipt, storage,handling, labeling and repackaging (if

necessary)

- 1 POD

POD Drug Preparation Staff Person Handle drugs; repackage if needed;

keep inventory; label as needed

Possibly MA,depends onscenario

2 POD

POD Mental Health Lead Oversee all mental health services inthe POD

Possibly LCSW,

MFT, or MD,Psychologist,supervisory,

project

management

1 POD

POD Mental Health Provider Provide mental health services in thePOD to POD staff and/or the public

Possibly LCSW,

MFT, or MD,Psychologist(depends on

scenario)

1-4 POD

POD Data Collection Lead Oversee data collection, quality,security, storage and transport of data

forms and/or files; summarize data for ongoing clinic and mass prophylaxisoperations

Possiblydatabasemanagement,

(depends onscenario)

1 POD

POD Forms Distribution Lead Oversee distribution of any forms communication 1 POD

POD Forms Distributor Distribute any forms to patients as theyenter the POD

- 2 POD

POD Forms Collection Lead Oversee collection of any forms communication 1 POD

POD Forms Collector Collect any forms as patients leave;check form against medication and

drug information/interaction sheet toensure patient has correct drug and info sheet based on screening form

- 2 POD

POD Data Collector Collect data on drugs dispensed, patients served, wait times, etc.

Communication,

data entry1 POD

POD Public Information/EducationLead

Oversee dissemination of approved public information/education about

disease and/or prophylaxis

Supervisory,

communication, projectmanagement

1 POD

POD Educator Provide education about disease and/or prophylaxis

Health

Education1-4 POD

POD Operations Runner Run errands or convey information asneeded; assist restockers and datacollectors

- 4 POD

POD Logistics Chief Oversee all logistics activities in thePOD including the management of supplies, personnel, communications

and facilities

Communication,

supervisory, projectmanagement,

disasterhelp.net

1 POD

POD Supplies Lead Maintain inventory of supplies and distribute as needed to stations, viarunners; track rate of supply use; order

additional supplies

Communication,supervisory,

projectmanagement

1 POD




POD Receiving/Unloading Staff Person

Unload supplies from deliveries and take to supplies area or drug

preparation if pharmaceuticals

- 2 POD

POD Inventory Staff Person Keep up-to-date inventory of suppliesusing provided forms; assist with

filling supply orders

- 1 POD

POD Personnel Lead Oversee any on-site training and

deployment of staff, including

appropriate staffing over breaks; track staff hours and breaks


projectmanagement,disasterhelp.net

1 POD

POD Communications Lead Maintain needed communicationswithin POD and between POD and external entities; send, receive, and convey messages


projectmanagement

1 POD

POD Communications Monitor Monitor 800 MHz radio and other communications devices; transmitmessages in and out of the POD; log

messages on easels

Communication,high levelorganizationalskills

1 POD

POD Facilities Lead Oversee all activities related to

facilities including maintenance, wastedisposal, and provision of food and

drink for staff

supervisory 1 POD

POD Maintenance Staff Person Provide site maintenance - 1 POD

POD Waste Disposal Liaison Liaise with outside personnel to ensurewaste is picked up for disposal;includes medical and non-medicalwaste

Possiblycertification in

disposal of biohazardousmaterials(depends on

scenario)

1 POD

POD Food and Drink Staff Person Replenish food and drink supplies;keep area clean; part-time job

- 1 POD

POD Logistics Runners Run errands and convey messages; act

as scribe for staff in area; conveymessages between POD staff and

communications staff

- 4 POD

POD Float Staff Person Fill in for other staff, on breaks, in caseof bottlenecks, etc.

Communication, possibly RN,

MA

3 POD

POD Security (provided by SFPD) Provide security, per security plan, for clinic site, staff, public and

pharmaceuticals

SFPD 10 POD

POD EMT (provided by outside

agency)

Care for people needing emergency

attention

EMT,Paramedic

2 POD

Staff Position Roster: Push Distribution Team


Employees Location 1 Push Distribution Manager Oversee Push distribution High level

Projectmanagement,,communication

1 101 Grove




Staff Position Roster: POD Staff Ass ignment and Training (SAT) Team

Job Title Task Overview JobClassification


POD SAT Manager Oversee POD SAT Area operations High levelProjectmanagement,

supervisory

1 POD SAT

POD SAT Assistant Safety Officer Ensure safety of persons at SAT Area High level


1 POD SAT

POD SAT Assistant OperationsChief

Oversee all Staff SAT Area operationsactivities including check-in/registration, assignment, training

and deployment

High level


1 POD SAT

POD SAT Check-In/RegistrationLead

Oversee check-in/registration activitiesat Staff Staging Area

CollaborativeFusion, project

management,supervisory

1 POD SAT

POD SAT Intake/Registration Staff Person

Check-in/register staff persons and volunteers at Staff Staging Area using

Collaborative Fusion

CollaborativeFusion,

2 POD SAT

POD SAT Assignment Lead Oversee assignment of staff personsand volunteers to POD locations

CollaborativeFusion, , projectmanagement,

supervisory

1 POD SAT

POD SAT Assignment Staff Person Assign staff persons and volunteers to positions and POD locations using

Collaborative Fusion,

CollaborativeFusion,

2 POD SAT

POD SAT Training Lead Oversee all general and position-

specific training at Staff Staging Area

Training,supervisory,health education

1 POD SAT

POD SAT Response Trainer Provide overall POD response training Training, health

education1-2 POD SAT

POD SAT Station Trainer Provide station-specific training Training, healtheducation,

possibly clinicalknowledge

4-10 POD SAT

POD SAT DeploymentCoordinator

Oversee deployment of assigned staff persons and volunteers to appropriatePOD locations

Communication, project

management

1-2 POD SAT

POD SAT Runner Assist with all operations activities atthe SAT Area

Without physicallimitations

4-8 POD SAT

POD SAT Assistant LogisticsChief

Oversee all SAT Area logisticsfunctions including management of supplies, personnel, communications,and facilities

Communication, project

management,supervisory

1 POD SAT

POD SAT Supplies Lead Oversee all activities related tosupplies

Inventory

control, project

management

1 POD SAT

POD SAT Supplies Staff Person Fill supply orders, keep up-to-date

inventory of supplies

- 1 POD SAT

POD SAT Personnel Lead Oversee all activities related to personnel staffing at POD Staging.

- 1 POD SAT

POD SAT Communications Lead Oversee all communications activities

within the POD and between the PODand external entities

Communication, projectmanagement,

supervisory

1 POD SAT

POD SAT Communications Staff Person

Assist with monitoringcommunications, conveying messages,and keeping records of

- 1-2 POD SAT




communications

POD SAT Facilities Lead Oversee all aspects of facilities

maintenance

- 1 POD SAT

POD SAT Facilities Staff Person Provide facility maintenance - 1-2 POD SAT

E. REPORTING

The Mass Prophylaxis Group Supervisor reports to the Disease Containment Branch Director. The POD

Area Managers or POD Manager (if only one POD is activated), the SAT Area Manager, and the Push

Distribution Manager report directly to the Mass Prophylaxis Group Supervisor.

Ongoing mass prophylaxis incident specific information will be provided to the Logistics Section,

Communicable Disease Information Branch, Epidemiology and Surveillance Branch, and Infection

Control Group.

F. DELIVERABLES

The Mass Prophylaxis Group is responsible for producing the following:




• POD Pharmaceutical Tracking Log

• POD Supply Inventory Tracking Log

G. RESOURCES



Items Location


POD Operation Materials

POD Playbooks Appendix Ha1

Directional Signs Appendix Ha2

POD Go-Kit Trailer Content List Appendix Ha3

POD Go-Kit Trailer Locations Appendix Ha4

POD Staff Assignment and Training (SAT) Appendix Ha5

Triage Guidelines Appendix Ha6

Communications Plan within a POD and outside of a POD Appendix Ha7Transportation plan to a POD and around PODs Appendix Ha8

Overall sequence of actions/events around POD activation and setup Appendix Ha9

Handling adverse reactions/events after POD dispensing Appendix Ha10

POD Site List Appendix Ha11

Emergency Responder Antibiotic Dispensing Template Appendix Ha12

Instructions for Handling Media at the PODs Appendix Ha13

Antibiotic Inventory Control Form Appendix Ha14

Reporting form for POD Manager to POD Area Manager (at IDER) Appendix Ha15

POD Patient Tracking Appendix Ha16




Google Maps of where each POD is located Appendix Ha17

PPE Recommendations for POD staff Appendix Ha18

POD Staffing Flow Model Appendix Ha19

Screening Forms

Doxy Dominant Antibiotic Screening Form Appendix Hb1

Individual Screening Form for use in Push (push) Appendix Hb2

Multi-person Abx Screening Form & Dispensing Instructions (for public PODS

where at least one person has Doxy contraindications)

Appendix Hb3

Antibiotic Dispensing Clinic Screening Form for BDS Alert Appendix Hb4

Push Operation Materials

Push Kit Appendix Hc1

Push Partner List Appendix Hc2

Public Information Fact Sheets

Instructions on what to do if you leave a POD without prophylaxis Appendix Hd1

What happens in a POD Public Fact Sheet Appendix Hd2

USPS Information about Mass Prophylaxis POD (directions POD given after

Decontamination)

Appendix Hd3

Arabic Drug Information Sheets Appendix He

Chinese Drug Information Sheets Appendix Hf

Farsi Drug Information Sheets Appendix Hg

Hmong Drug Information Sheets Appendix HhItalian Drug Information Sheets Appendix Hi

Japanese Drug Information Sheets Appendix Hj

Korean Drug Information Sheets Appendix Hk

Russian Drug Information Sheets Appendix Hl

Spanish Drug Information Sheets Appendix Hm

Tagalog Drug Information Sheets Appendix Hn

Thai Drug Information Sheets Appendix Ho

Vietnamese Drug Information Sheets Appendix Hp

General

BDS Mass Prophylaxis: Anthrax Appendix Hq1

b. Mass Prophylaxis Group Office and Communication Supplies

ItemsUnits

Required

Location or

Request From

White board 2 Logistics







c. POD Supplies

The following items are required for each POD.

ItemsUnits

Required

Location or

Request From

Directional signs POD Kits,

Appendix

Disease information sheets Playbooks,

Appendix

Prophylaxis and follow-up informational sheets Playbooks,

Appendix




Dispensing protocols 5 Playbooks,

Appendix

POD playbook 1 Each POD,

District Police

Station, Nearest

Fire Station,Operations

POD Go-Kit 1 DPW, For

current location

see Appendix

Collaborative Fusion License 1 Logistics

Card Reader (magnetic strip reader) 1 Logistics

Fire extinguisher 1 POD Site,

Logistics

Folding/Portable tables Varies by

site

POD Site,

Logistics

Folding/Stacking chairs Varies bysite

POD Site,Logistics

POD forms POD Playbook,Appendix

Triage guidelines Infection Control

Group

Telephone 1 POD SAT,

Logistics

Fax machine access 1 POD SAT,

Logistics

Computer with local network, internet access 1+ POD SAT,

Logistics

Printer access 1 POD SAT,Logistics

800 MHz Radio/cell phone/pager 1 POD SAT,

Logistics

Copy machine access 1 POD SAT,Logistics

d. Staff SAT Supplies

ItemsNo.

Required

Location or

Request From

SAT Area Go-Kit 1 Logistics (DPWwill deliver)

Collaborative Fusion license 2 Logistics

Identification Card reader 2 Logistics

Telephone 1 POD SAT,

Logistics

Fax machine access 1 POD SAT,

LogisticsComputer with internet access 1 POD SAT,Logistics

Printer access 1 POD SAT,

Logistics

800 MHz Radio/cell phone/pager 1 POD SAT,

Logistics

Copy machine access 1 POD SAT,

Logistics

Badge software, camera, printer 1 Logistics

LCD Projector 1 Logistics





VCR/DVD player with projection screen 1-2 Logistics

SAT Area playbook 1 POD SAT,

District Police

Station, Nearest

Fire Station,Operations

POD number card set for personnel deployment station 2 Playbook,

Appendix

Training materials

e. PUSH Supplies

ItemsNo.

Required

Location or

Request From

Push Kit Push Playbook

List of push partners and contact info Push Playbook

Push outreach plan Push Playbook

Emergency responder plans and contacts 1 Push Playbook

Push playbook 1 Appendix

Telephone 1 LogisticsFax machine access 1 Logistics







IDER Plan: Disease Containment Branch/Isolation and Quarantine Group, Page 1/8 Draft 10/07

17. ISOLATION AND QUARANTINE GROUP


B. DESCRIPTION


The purpose of the Isolation and Quarantine (I & Q) Group is to implement containment measures to prevent the secondary spread of an infectious disease by decreasing contacts between the infected and

uninfected. The Group’s objectives include:

• Implement isolation measures to limit the spread of infection from persons who are infected with

disease (cases) to uninfected persons for the duration of the infectious period.

• Implement quarantine measures to limit the spread of infection from asymptomatic persons exposed

to a communicable disease (contacts) who may be infected but not yet have symptoms to uninfected

or unexposed persons for a period of time equal to the longest usual incubation period.

b. Methods

The Isolation and Quarantine Group will use the following methods to achieve objectives:

Isolation. Isolation is a strategy used to prevent the spread of disease from person-to-person. Isolationis the separation of infected persons from other persons for the period of communicability in such places

and under such conditions as will prevent the transmission of the infectious agent. Isolation can occur in

a home and/or designated non-healthcare facility. Recommendations on isolation for healthcare facilities

will be provided by the Infection Control Group.

Quarantine. Quarantine is a strategy used to prevent the spread of disease from person-to-person.

Quarantine is the limitation of freedom of movement of persons or animals that have been exposed to a

communicable disease for a period of time equal to the longest usual incubation period of the disease, in

Disease ContainmentBranch

Mass Prophylaxis

Grou


& Clearance Grou

Infection Control

Grou

Push DistributionTeams

POD Staging Area

POD Area Teams

POD Unit(s)


Grou


and uarantine Team


and uarantine Team



such manner as to prevent effective contact with those not exposed. Quarantine can occur in a home or

designated non-healthcare facility or healthcare facility. A contact may be quarantined in a healthcare

facility for medical necessity unrelated to the infectious disease emergency.

C. IMPLEMENTATION

a. Isolation and Quarantine Group

Activate the Isolation and Quarantine Group when the disease is person-to-person transmissible

(primarily for respiratory aerosol transmissible diseases) and under the following considerations:

• Characteristics and clinical presentation of the disease. Characteristics such as mode of

transmission (e.g. airborne vs. droplet) and viability of the infectious microbes in the environment

will impact the effectiveness of isolation and quarantine strategies.

• Pathogenicity or infectious dose of the disease. Early identification, isolation of cases, and

quarantine of contacts may be critical to slow or stop the spread of disease if the agent is highly

pathogenic and/or the infectious dose is low.

• Onset and duration of disease communicability. Effective disease containment through isolation or quarantine may be more difficult if infectivity precedes symptoms, or if the disease has a short

incubation period and long infectivity period.

• Available prophylaxis and/or treatment. When prophylaxis and/or treatment for a communicable

disease is less available, isolation and quarantine may be a more important disease containment

strategy.

• Available resources. Isolation and quarantine strategy is labor intensive and requires resources and

support from other agencies (e.g. Sheriff, Police) for it to work effectively.

• Timing and presence of disease in the community. Once a disease is widespread in the

community, and most of the population has likely already been exposed, isolation and/or quarantine

may not be as useful.

The Isolation and Quarantine Group will require information and guidelines from the Infection Control

Group. The Isolation and Quarantine Supervisor will receive referrals of cases to be isolated and contacts

to be quarantined from the Epidemiology and Surveillance Branch. The Group Supervisor will confer

with the Infection Control Group and Safety Officer to establish and implement a plan for limiting direct

contact with isolated or quarantined persons and for monitoring IDER response staff for signs and

symptoms of disease, particularly those with direct contact with cases and contacts under quarantine or

isolation in the home or non-healthcare facility settings,.

Site of Isolation/Quarantine. Isolation and quarantine can be applied at the individual or group level.

Whenever possible, cases and contacts will be isolated or quarantined at home. Those who do not meet

home isolation or quarantine criteria, or those who require shelter or are unable to stay in their usual place

of domicile, will be isolated or quarantined in pre-identified facilities for the duration of the isolation or

quarantine period as long as their medical status permits.

Isolation/Quarantine Order. Depending on the situation, cases and contacts may be served with a

health officer order initiating isolation or quarantine. Individuals who refuse to comply with the order

will face legal sanctions (See Appendix Fa6, Protocol for Legal Enforcement of Isolation and Quarantine).

Services for Individuals in Isolation/Quarantine. Services provided by other agencies such as legal

expertise, law enforcement support, care and shelter services, and mental health counseling will be




coordinated by the DOC/EOC to ensure the success of isolation and quarantine strategies (See Appendix

Fa8, Protocol on Isolation and Quarantine Logistics). In some circumstances (e.g. during a pandemic)

voluntary isolation and/or quarantine may be recommended without issuance of legal orders if adequate

resources are not available or for other reasons. Coordination with agencies providing support services to

cases, contacts, or their dependents will be managed by the Home Based and Facilities Based Isolation

and Quarantine Team Leaders. Team Leaders will act as liaisons with respective agencies to facilitate

law enforcement, legal services, mental health, care and shelter, and other support services.

Functions of the Isolation and Quarantine Group

• Provide updates to Disease Containment Branch Director.

• Coordinate with the Safety Officer and Infection Control Group.

• Forward lab specimens to the Laboratory Liaison.

• Receive and review referrals from Epidemiology and Surveillance Branch.

• Disseminate and monitor the use of infection control guidelines to Isolation and Quarantine staff.

• Resolve, track and escalate issues and problems related to isolation and quarantine.

• Coordinate clinical monitoring data submission to the Data Branch.

a.1. Home-Based Isolation & Quarantine Team

Activate the Home Based Isolation and Quarantine Team when cases or contacts have been or will be placed in home-based isolation or quarantine.

This Team will expand or contract depending on the number of referrals received, and the resources

available. The optimal number of members per Field Team is 2, and a Field Team Leader should be

assigned to every 4-6 teams. A Field Team will monitor signs and symptoms of disease, obtain

specimens as needed, educate patients and families, and deliver and administer post-exposure prophylaxis

if indicated and available. Three types of Field Teams requiring varied skills include:.

• Office Based Team. Monitors cases and contact remotely via telephone, fax machine, or other

identified modality.

• Field Team A. Visits the residence to monitor cases and any contacts living in the same household.

• Field Team B. Visits the residence to monitor contacts only in a household without cases.

• Field Team C. Visits the residence to monitor cases only.

For Field Teams A and C, at least one member on each of the teams will be a clinician (e.g. RN, NP, PA),

in order to address the higher clinical complexity involved in evaluating cases for disease progression and

additional medical needs. For Field Teams A and B, a member of the team may be clinical support staff

(e.g. health worker or disease control investigator) to conduct routine simple monitoring of contacts for

emerging signs and symptoms of the disease based on protocols established by Epidemiology and

Surveillance Branch in consultation with the Infection Control Group. Team C staffing will depend on

available personnel and their skills. See Appendix Fb for isolation and quarantine forms and protocols.

The DOC will identify city agencies and community-based organizations to provide auxiliary services to

support home-based isolation and/or quarantine. The Home-based Isolation and Quarantine Team will be

responsible for making referrals for auxiliary services such as food delivery, mental health counseling,

medical care, spiritual counseling, dependent care and pet care (See Appendix Fa8, Protocol on Isolation

and Quarantine Logistics).

Functions of the Home Based Isolation & Quarantine Team




• Receive criteria for home based isolation and quarantine from the Isolation and Quarantine Group

Supervisor.

• Receive referrals from Isolation and Quarantine Group Leader.

• Ensure completeness of clinical monitoring data and submit data to the Data Branch.

• Provide regular reports to Isolation and Quarantine Group Leader.

• Instruct cases, contacts, and their household members on isolation and quarantine protocols and

infection control recommendations.

• Identify disease progression in cases and/or development of symptoms in contacts.

• Identify need for medical evaluation and arrange for either a referral to Shelter Medical Clinic (a city-

run clinic for homeless people requiring shelter beds) or transport to an acute care facility.

• Determine need for, coordinate, and submit requests for mental health services, support services (e.g.,

food and water, care and shelter, dependent care, prescription medication delivery, pet care, spiritual

needs), law enforcement and security, legal services, and additional resources.

• As recommended by the Safety Officer and Infection Control Group enforce personal protective

equipment and infection control recommendations to limit staff exposures to infectious persons.

a.2. Facility-Based Isolation & Quarantine Team

Activate the Facility-Based Isolation and Quarantine Team when non-healthcare facilities are designated

for isolation or quarantine of cases and/or contacts. Facilities should be utilized for:

• Cases and/or contacts that do not meet home eligibility criteria (see Appendix Fb3).

• Cases and/or contacts that are unable to remain in home isolation or quarantine.

• Cases and/or contacts that do not have acute medical care needs.

Isolation Facility. Isolation facilities will house cases only, and these facilities will be staffed with both

clinical staff and support staff based on the clinical needs of the cases. Basic care including activities of

daily living such as assistance with feeding and hygiene, maintenance of prescribed medication for

chronic illness, and education regarding isolation will be provided. When cases develop acute illness,

they will be transferred to an acute care or sub-acute care medical facility for management.

Quarantine Facility. Quarantine facilities will house contacts only, and these facilities will be staffed

with more support staff than clinical staff. The clinical staff will be responsible for evaluation of disease

development, including signs and symptoms. The support staff will be responsible for specimen

collection, patient education, and other duties as assigned. Post-exposure prophylaxis will be

administered by the clinical staff as indicated and if available. When contacts develop symptoms, they

will be evaluated, referred, and transported to either an acute or sub-acute care medical facility or to an

isolation facility.

Both the Isolation and Quarantine facilities will be managed by a Facilities Management Team. The

Facility Management Team will coordinate the non-clinical functions of the facilities including, but not

limited to, maintenance and custodian duties, request and receive deliveries of supplies and equipment,coordinate all support services, and overall operation of the facilities. It is optimal to have one Facility

Management Team Member per facility, and have a Facilities Management Team Leader for every 3-5

facilities.

The DOC or EOC will identify city agencies and community-based organizations to provide auxiliary

services to support facility-based isolation and/or quarantine. The Facility-Based Isolation and

Quarantine Team will be responsible for receiving and coordinating auxiliary services such as food

delivery, designated I & Q shelter sites, mental health counseling, medical care, spiritual counseling,




dependent care and pet care (See Appendix Fa8, Protocol on Isolation and Quarantine Logistics). See

Appendix Fc for facility isolation and quarantine forms and protocols.

Functions of the Facility Isolation & Quarantine Team

• Receive referrals from Isolation and Quarantine Group Supervisor.

• Oversee and coordinate the functions and operations of the Isolation and Quarantine facilities.

• Ensure thoroughness of data documentation and submit to the Data Branch.

• Provide reports to Isolation and Quarantine Group Supervisor including resource needs.

• Determine need for and coordinate medical services and submit request to Shelter Medical Clinic as

needed.

• Determine need for, coordinate, and submit requests for mental health services, support services, law

enforcement and security, legal services, and additional resources.

D. STAFF POSITIONS


Staff Position Roster: Isolation & Quarantine Group

Job Title Task OverviewJob Classification

(Critical Skills)No. of

Employees Location

Isolation and Quarantine GroupSupervisor

Oversees implementation of isolationand quarantine strategies

Organizational and management skills

1 IDER Command

Staff Position Roster: Home Based Isolation & Quarantine Team



Employees Location

Home Based Isolation and

Quarantine Team Leader

Coordinates home isolation and

quarantine functions with city and non-city agencies. Distributes workload,assigns specific functions to office and field team members.

Management skills 1 IDER

Command

Home Based Isolation and

Quarantine Team Member

Monitors cases/contacts remotely via

telephone, fax or other identified modality.

Communicationskills

1 per 30-40clients

IDER Command

Isolation and Quarantine Field Team Leader

Assigns and oversees functions of theField Teams.

Clinical skillsManagement skills

1 per 5 Field Teams

IDER Command

Isolation and Quarantine Field

Team Clinician

Conducts home visits and clinical

evaluations.

Clinician 1 per 8-12

cases

Field

Isolation and Quarantine Field Team Member

Conducts home visits and monitorscases/contacts for signs and symptoms

based on established protocols.

Health Worker 1 per 8-12cases or 12-15

contacts

Field

Staff Position Roster: Facility Based Isolation & Quarantine Team



Employees Location

Facility Isolation and QuarantineTeam Leader

Coordinates non-healthcare facilities based isolation and quarantinefunctions with city & non-city

agencies. Distributes workload,

Management skills

1 IDER Command &

Facilities




assigns specific functions to staff.

Isolation and Quarantine Facility

Clinical Team Clinician

Performs clinical functions, monitors

clients for disease progression.

Clinician 1 per 20-25

cases, or 30-40 contacts

Designated Facility

Isolation and Quarantine FacilityClinical Team Member

Monitors clients for disease progression, assist Clinical TeamClinician Responder as needed

Health Worker 1 per 10-12cases, or 15-20 contacts

Designated

Facility

Facility Management Team Leader Oversees the operation of non-healthcare facilities, ensures problemsare addressed or resolved, supervises

Facility Management Team Members

Facilitiesmanagement

1 per 3-5facilities

Designated Facility

Facility Management TeamMember

Coordinates daily operation of thefacility

Facilitiesmaintenance

1 per facility Designated Facility

E. REPORTING

The Isolation and Quarantine Group Supervisor reports directly to the Disease Containment Branch

Director.

F. DELIVERABLES

The Isolation and Quarantine Group is responsible for producing the following:




• Data for the Data Branch

G. RESOURCES



Items Location


Documents for Both Home and Facility Isolation and Quarantine

Isolation Order Packet (cover letter, order, termination) Appendix Fa1

Quarantine Order Packet (cover letter, order, termination) Appendix Fa2

Frequently Asked Questions about Isolation and Quarantine Appendix Fa3

Fact Sheet on Isolation and Quarantine Legal Authority Appendix Fa4Summary of State and Local Laws related to Isolation & Quarantine Appendix Fa5

Protocol on Legal Enforcement of Isolation and Quarantine Appendix Fa6

Protocol for Appeals Conference on Health Officer's Orders for Isolation and

Quarantine

Appendix Fa7

Protocol on Isolation and Quarantine Logistics Appendix Fa8

Legal and Logistical Data Tracking Appendix Fa9

Isolation and Quarantine Alert from SFDPH to SF Law Enforcement Agencies Appendix Fa10

MOU/MOA with ambulance/ EMS/ service to transport patient from isolation and Appendix Fa11




quarantine facilities

Instructions for using language line (translation services) Appendix Fa12

Instructions on Hand Hygiene Appendix Fa13

Instructions on Respiratory Etiquette Appendix Fa14

Instructions on Enviromental Cleaning and Disinfection Appendix Fa15

Instructions on Handling of Eating Utensils, laundry, and wash Appendix Fa16

Protocols on submitting support/assistance requests to Legal, Law Enforcement, Care &Shelter, and Mental Health

Appendix Fa17

Status Report Template to DC Branch Director Appendix Fa18

Specimen Collection and Transportation Guidelines Appendix Fa19

Transportation of clients from Home or Non-Healthcare Facilites to Health CareFacilities for medical necessity

Appendix Fa20

Transportation of clients from Home to other Facilities Appendix Fa21

Support Services Referral Form Appendix Fa22

Protocol for Post Exposure Prophylaxis delivery and sign-off from clients Appendix Fa23

Protocol for HCW Self-Monitoring and Log for Disease Symptoms Appendix Fa24

Re-assessment/checklists for cessation of Isolation and Quarantine Appendix Fa25

Medical/Mental Health Referral Form Appendix Fa26

Home Based Isolation and Quarantine Documents

Status Report Template to I&Q Group Supervisor- Home Isolation Appendix Fb1Status Report Template to I&Q Group Supervisor- Home Quarantine Appendix Fb2

Evaluation for Home Suitability for Isolation and Quarantine Appendix Fb3

Instructions for Home Isolation Appendix Fb4

Instructions for Home Quarantine Appendix Fb5

Monitoring Log for Persons on Home Isolation Appendix Fb6

Monitoring Log for Persons on Home Quarantine Appendix Fb7

Transportation Protocol for Health Worker Appendix Fb8

I&Q Go-Kit Appendix Fb9

Protocol for PPE and Infection Control Guidelines for IDER staff on Home Visits Appendix Fb10

Facility Isolation and Quarantine Documents

Status Report Template to I&Q Group Supervisor- Non-HC Isolation Appendix Fc1

Status Report Template to I&Q Group Supervisor- Non-HC Quarantine Appendix Fc2

Criteria for Non-Healthcare Facility Based Isolation or Quarantine Appendix Fc3Instructions for Non-Healthcare Facilities Based Isolation Appendix Fc4

Instructions for Non-healthcare Facilities Based Quarantine Appendix Fc5

Initial Medical Admission Evaluation for Persons on Isolation Facility Appendix Fc6

Initial Medical Admission Evaluation for Persons on Isolation Quarantine Appendix Fc7

Monitoring Log for Persons on Non-Healthcare Facility Based Isolation Appendix Fc8

Monitoring Log for Persons on Non-Healthcare Facility Based Quarantine Appendix Fc9


ItemsUnits

Required

Location or

Request From










C. Material Resources (for Field and Non-Healthcare I & Q Facilities)

ItemsNo.

Required

Location or

Request From

N95 masks 1+ LogisticsGloves 1+ Logistics

Hand Sanitizer 1+ Logistics

Goggles or eye protectors 1+ Logistics

Gown or plastic aprons 1+ Logistics

Alcohol pads 1+ Logistics

Alcohol hand wipes 1+ Logistics

Clip boards/writing pads 1+ Logistics

Pens 1+ Logistics

Thermometers 1+ Logistics

Stethoscopes 1+ Logistics

Surgical masks 1+ Logistics

Backpacks/utility bags 1+ Logistics

City vehicles 1+ LogisticsRadios/cell phones 1+ Logistics

Specimen kits & forms 1+ Logistics

Plastic bags 1+ Logistics

Specimens storage/transport cooler 1+ Logistics

Specimens collection kit (“Go Kit”) 1+ Logistics

Trash bags 1+ Logistics

City Maps 1+ Logistics



18. COMMUNICABLE DISEASE INFORMATION BRANCH


Epidemiology and

Surveillance Branch

Data Branch

Laboratory Branch


Information Branch

Disease Containment

Branch

Continuity of

O erations Branch

Information Triage

Group

Treatment & Prophylaxis

Guidance Team

Document Development

Team

Information Content

Creation Group

Information

Dissemination Group

Electronic

Dissemination Team

Alternative

Dissemination Team

Telephone

Dissemination Team

Phone Bank Unit

Clinician Consultation

Team

Operations Section

B. DESCRIPTION


The purpose of the Communicable Disease (CD) Information Branch is to provide accurate and timely

communicable disease information to clinicians, emergency leaders and responders, the public, and other

stakeholders. The Branch objectives include:

• Develop accurate and timely communicable disease information documents, protocols, fact sheets,

and other information for various audiences.

• Respond to new questions and requests for communicable disease information.

• Disseminate communicable disease information to external stakeholders through electronic,

telephone, and alternative methods.

• Request approval of documents, protocols, and fact sheets from the Information Officer.

b. Methods

Methods to achieve objectives include:

Information Triage. Information triage involves: 1) establishing methods to guide clinicians, emergency

leaders and responders, the public and other stakeholders to documents and information already

developed and available; 2) receiving new unanswered questions about the communicable disease; 3)

triaging unanswered questions by logging questions, referring questions to the appropriate module for

IDER Plan: Operations Section/Communicable Disease Information Branch,Page 1/4 Draft 10/07



information development; and 4) monitoring and tracking information requests, status of information

content development and dissemination of information. Multiple channels to receive requests for

information can be established and include ICS communication channels, direct phone calls, voicemail

and email. A triage categorization system will be used to identify urgent, important, low priority, and

already addressed requests for information.

Information Content Creation. The CD Info Branch will develop communicable disease-specific

information. Within the CD Info Branch, technical experts with knowledge about communicable diseases,the ability to search scientific literature, and/or contact experts will develop informational and guidance

documents. The Plans Section can provide situational updates on the overall emergency and response

which may be used in informational documents. Communicable disease information content will be

provided in appropriate formats and languages and may include Health Alerts, Fact Sheets, Telephone

Information Line scripts, phone-bank scripts, talking points for press releases, disease news updates,

website text, position papers, treatment and/or prophylaxis guidelines, and other information. The IDER

Information Officer will provide approval of all content prior to dissemination.

Information Dissemination. Communicable disease-specific information may be disseminated to

external parties. (The Plans Section will disseminate internally to IDER responders.) The Information

Officer will share information with emergency leaders and responders external to the IDER response

(e.g., DOC, EOC). To provide information to external audiences, the following different strategies can beutilized:

• Electronic Dissemination. Website posting (e.g. DPH website, CDCP website), EMSystem posting

for San Francisco emergency departments, e-mail, and/or internal networks.

• Telephone Dissemination. Blast Fax, Telephone Information Line(s) messages, messages sent to

DPH Voice Mail Boxes, Teleconferences, Phone Bank with live operators, and/or 311 and 911.

• Alternative Dissemination. Mass mailings, paycheck mailings, leafleting, posting billboards.

The Information Officer will work with the DPH Public Information Officer (PIO), DOC, EOC, and/or

the Joint Information Center to disseminate information to, and receive information requests from the

media, including television, radio, and newspaper press.

C. IMPLEMENTATION

a. Communicable Disease Information Branch

Activate the Communicable Disease Information Branch for all IDER activations.

The Communicable Disease Information Branch will implement strategies to efficiently receive requests

for communicable disease information, develop technical communicable disease information, and

distribute this information to external stakeholders. This may include:

• communicable disease guidance to SF clinicians (e.g. Health Alert)

• treatment and/or prophylaxis advice to SF clinicians and/or responders• consultation to SF clinicians

• communicable disease-specific information to the public or responders

Functions of the Communicable Disease Information Branch

• Anticipate the needs of various audiences for communicable disease information.

• Identify the best strategies to receive information requests and to develop and distribute

communicable disease information.

• Convene meetings with Group Supervisors to provide updates and resolve issues.




• Provide oversight and guidance to Group Supervisors (e.g. answer questions, address problems, make

decisions per the Branch operational objectives, and determine which problems, requests or questions

need to be forwarded up the chain of command).

• Attend Operations/Branch meetings.

• Prepare the Communicable Disease Information Branch Situation Status Report.

D. STAFF POSITIONS





Employees Location

Communicable DiseaseInformation Branch Director

Supervise CD Info activities, assignresponsibilities, orient Group

Supervisors and serve as a resource for all staff in the CD Info Branch

1 IDER Command

Communicable DiseaseInformation Branch Deputy

Assist in the supervision of the Branchand the production of the CD InfoBranch Situation Status Update,

document Branch actions, troubleshoot as needed

IDER Command

Administrative Assistant Assist with administrative tasks of CDInfo Branch: take notes at meetings,

prepare CD Info Branch Sit StatUpdate and other tasks as needed

1 IDER Command

E. REPORTING

The Communicable Disease Information Branch Director will report to the Operations Section Chief.

F. DELIVERABLES

The Communicable Disease Information Branch is responsible for producing the following:




• Response documents and/or products assigned to active Groups within the Branch. Examples include:

o CD Info Log of Requests, Assignments and Disseminations

o Health Alerts

o

Fact Sheetso Telephone line scripts

o Phone bank scripts

o Talking points for press releases

o Disease news updates

o Website text

o Position papers

o Guidelines





G. RESOURCES

The following resources will be required to perform minimum response operations. See CD Information

Group sections for resources required by each group.


Items Location



ItemsUnits

Required

Location or

Request From









19. INFORMATION TRIAGE GROUP19. INFORMATION TRIAGE GROUP

A. ORGANIZATION CHART A. ORGANIZATION CHART


Information Branch

Information

Dissemination Grou

Information Content

Creation Grou


Guidance Team


Team


Team

Electronic

Dissemination Team

Alternative

Dissemination Team

Telephone

Dissemination Team

Phone Bank Unit

Information Triage

Grou

B. DESCRIPTIONB. DESCRIPTION

a. Purpose & Objectivesa. Purpose & Objectives

The purpose of the Information Triage Group is to guide individuals to documents and information

already developed and approved, to receive new questions or requests for communicable disease

information, and to forward requests to appropriate modules for document development. Group objectives

include:

The purpose of the Information Triage Group is to guide individuals to documents and information

already developed and approved, to receive new questions or requests for communicable disease

information, and to forward requests to appropriate modules for document development. Group objectives

include:

• Establish methods to guide clinicians, responders, the public, and other stakeholders to documents

and information already developed and available.

• Establish methods to guide clinicians, responders, the public, and other stakeholders to documents

and information already developed and available.

• Receive communicable disease questions.• Receive communicable disease questions.

• Prioritize new questions or requests for information according to importance.• Prioritize new questions or requests for information according to importance.

• Pass questions and requests for information to the Information Content Creation Group and other

appropriate modules.

• Pass questions and requests for information to the Information Content Creation Group and other

appropriate modules.

• Monitor and track status of information requests, follow-up, and creation of response documents.• Monitor and track status of information requests, follow-up, and creation of response documents.

b. Methodsb. Methods

The Information Triage Group will utilize the following methods:The Information Triage Group will utilize the following methods:

Existing information: A variety of existing information is posted to the DPH and CDCP websites and isincluded under IDER Appendix D.Existing information: A variety of existing information is posted to the DPH and CDCP websites and isincluded under IDER Appendix D.

Triage: The Information Triage Group will receive requests for information, provide information and

documents that have been approved, prioritize new requests for information according to importance, and

forward queries to technical experts in the Info Content Creation Group. The Info Triage Group will

establish multiple channels to receive requests for information including ICS communication channels,

phone calls to the Info Triage Group, phone calls to a routinely used DPH Communicable Disease

Reporting phone number, voicemail, and email. A triage categorization system will be used: 1) Urgent –

Triage: The Information Triage Group will receive requests for information, provide information and

documents that have been approved, prioritize new requests for information according to importance, and

forward queries to technical experts in the Info Content Creation Group. The Info Triage Group will

establish multiple channels to receive requests for information including ICS communication channels,

phone calls to the Info Triage Group, phone calls to a routinely used DPH Communicable Disease

Reporting phone number, voicemail, and email. A triage categorization system will be used: 1) Urgent –

IDER Plan: Communicable Disease Information Branch/Information Triage Group, Page 1/4 Draft 10/07



Highest Priority: information on urgently needed public health interventions, some VIP requests, some

Information Officer requests; 2) Important: information on non-urgent public health interventions, some

VIP requests, some Information Officer requests; 3) Low Priority: interesting information that does not

impact incident; 4) Already Addressed: information that has already been approved and disseminated.

CD Information Log of Requests, Assignments and Disseminations: An electronic log, stored in a

centrally accessible site, will be used to record information requests, priority, assignment, status of

development, name of document, location and distribution history.

C. IMPLEMENTATION

a. Information Triage Group

Activate the Information Triage Group when multiple new communicable disease information requests

are anticipated or are occurring.

Situations that will likely require Info Triage Group activation include moderate or large incidents

impacting multiple populations and/or response partners, a new or unfamiliar disease or situation, a

prolonged response, or a situation generating high public interest.

The Info Triage Group will establish methods to guide individuals to established documents and

information. This can include adding information to the Strategic Telephone Automatic Response System

(STARS) message, a message on Telephone Informational Line, and website messages. The CD Info

Triage Group will establish methods to receive requests for information, which can include:

IDER Responders

• Direct phone call to Information Triage Group (phone number will be established at the time of the

incident and made available by the Information Dissemination Unit),

• Email (IDER email address).

Non-IDER Emergency Leaders and Responders• ICS channels to the IDER Information Officer who may forward the request or refer the caller to Info

Triage Group.

• Phone call to (415) 554-2830 or other line. STARS may be set up to automatically distribute calls and

the Info Triage Group may receive calls from one of these channels.

• 311 and/or 911 Emergency Communications Department (ECD) information requests.

Clinicians

• Direct phone call to (415) 554-2830; this is the established phone number for clinicians to report

cases to the DPH Communicable Disease Control Unit. The Info Triage group may receive calls

distributed by STARS.

• Email (incident specific email address)

• Voicemail attached to disease or incident specific Telephone Information Line

Public

• General public:

o The Phone Bank, can support up to 20 call agents simultaneously answering questions from the

public. Unanswered questions will be logged and forwarded to the Info Triage Group.

o San Francisco 311 system, an established 24/7 San Francisco city system that provides

information on city and county services

o 911 Emergency Communications Department.




• Individuals who are, or are suspected to be a case, and individuals who are, or are suspected to be a

contact of a case may be directed to call to (415) 554-2830.

An intake form (the CD Information Request & Assignment Form located in Appendix De1) will be used

by Info Triage personnel to receive requests for new communicable disease information. Requests will be

logged and tracked in the Log of Requests, Assignments and Disseminations, Appendix De2.

Functions of the CD Information Triage Group• Establish and update methods to guide stakeholders to documents and information already developed

and approved.

• Establish, update, and monitor points of contact for communicable disease information requests (e.g.

telephone lines, voice mail, e-mail). Info Dissemination Group will assist.

• Receive requests for communicable disease information.

• Obtain enough information from requestors to appropriately triage and effectively inform content

development and distribution assignments.

• Forward requests from clinicians to the Clinician Consultation Unit.

• Refer information requests to the Information Content Development Group or appropriate module.

• Coordinate information requests and dissemination with the Information Officer.

• Maintain a log of all information available for distribution.

D. STAFF POSITIONS


Staff Position Roster: Information Triage Group

Job Title Task Overview JobClassification


Information Triage GroupSupervisor

Assign responsibilities, orient staff,and serve as a resource for all the staff

in and outside of the group. Establish

methods to receive info requests;Request IS/IT assistance for set-up and maintenance of phone, computer,server, and fax systems; Approvetriage, referral, production and distribution decisions.

Health ProgramCoordinator,computer skills

1 IDER Command

Information Triage Group Member Log and track information requests,fulfillment status, and distribution,

triage requests, determine responses,obtain approval of triage and response,

pass on content creation and distribution tasks, coordinate with

Assistant Information Officer

Health ProgramCoordinator,computer skills

IDER Command

E. REPORTING

The Info Triage Group Supervisor reports directly to the CD Info Branch Director.

F. DELIVERABLES

The Info Triage Group is responsible for producing the following:





• CD Info Log of Requests, Assignments and Disseminations

• CD Information Request & Assignment Form

• Summary of CD Info Requests

• Summary of Documents and Disseminations




. RESOURCESG

he following resources will be required to perform response operations:T

. Protocols, forms, and guidelines, and MOUsa

Items Location


CD Info Request & Assignment Form Appendix De1

Log of Requests, Assignments and Disseminations Appendix De2

. Office and Communication Suppliesb

ItemsUnits

Required

Location or

Re mquest Fro









20. INFORMATION CONTENT CREATION GROUP



Information Branch

Information

Dissemination GrouInformation Content

Creation Grou

Treatment &

Prophylaxis Guidance

Team

Document

Develo ment Team


Team

Electronic

Dissemination Team

Alternative

Dissemination Team

Telephone

Dissemination Team

Phone Bank Unit

Information Triage

Group

B. DESCRIPTION


The purpose of the Information Content Creation Group is to create information for IDER responders, the

medical community, other emergency responders, and the public. The Group objectives include:

• Develop San Francisco specific guidance and recommendations on treatment and prophylaxis of

communicable diseases.• Be the communicable disease information resource for the IDER response.

• Develop San Francisco specific communicable disease guidance documents (e.g., fact sheets, Health

Alerts) for various audiences.

• Provide consultation to clinicians.

• Recognize requests for new information and initiate triage by the CD Info Triage Group

• Store CD Info Branch developed documents and share with Plans Section Documentation Unit

b. Methods

Methods include but are not limited to the following:

Research. Established protocols, websites, medical and scientific literature databases, governmentguidance, and other sources will be searched regularly during the emergency event for new or changing

recommendations.

Pre-event Materials. Guidance documents, fact sheets, and other materials that have been developed

prior to the emergency event will be used or modified to the situation. Examples of pre-event materials

include the Infectious Disease Emergency Guide (Appendix Dd3 – Dd10), pre-written Health Alerts

(Appendix Db), and fact sheets for the public (Appendix Dc).

IDER Plan: Communicable Disease Information Branch/Information Content Creation Group, Page 1/7 Draft 10/07



Technical Specialists. Technical communicable disease guidance will be sought from various sources

including: IDER Operations Section, Plans Section Technical Specialties Unit, San Francisco infectious

disease clinicians, and/or others.

Clinician Phone Line. SF clinicians can call (415) 554-2830, the Communicable Disease Control Unit

reporting line, or other number to consult with a clinician.

C. IMPLEMENTATION

a. Information Content Creation Group

Activate the Information Content Creation Group when:

1. Treatment and/or prophylaxis recommendations are required for the emergency event, OR

2. Communicable disease guidance documents (e.g. fact sheet, health alerts) need to be developed for

San Francisco audiences, OR

3. It is necessary to answer technical medical questions from clinicians regarding the emergency event

via telephone or e-mail.

Functions of the CD Information Content Creation Group

• Provide oversight and guidance to Team Leaders.

• Assess prioritization of tasks provided by Information Triage Group.

• Oversee the development of treatment and prophylaxis guidance.

• Oversee clinician consultation.

• Oversee the development of documents for distribution.

• Forward created documents, fact sheets, and protocols to the Information Officer for approval.

• Store all finalized and approved documents on a central drive and update the CD Info Log of

Requests, Assignments and Disseminations.

• Provide the Plans Section Documentation Unit with finalized documents and request internal

dissemination as needed.

a.1. Treatment and Prophylaxis Guidance Team

Activate the Treatment and Prophylaxis Guidance Team when the emergency event may require

treatment and/or prophylaxis for exposed individuals.

Functions of the Prophylaxis Guidance Team

• Review reference material, pre-written treatment and prophylaxis guidance, and new guidance from

CDC and other sources.

• Develop clear adult and pediatric treatment and prophylaxis guidance.

• Provide technical and evidence-based information to assist with decisions about prioritization of

treatment and/or prophylaxis, if necessary.

a.2. Document Development Team

Activate the Document Development Team when it is necessary to create San Francisco specific

communicable disease documents relating to the incident, diagnosis, treatment and prophylaxis,

diagnostic testing, infection control, and other information for clinicians, emergency responders, the

public, and other stakeholders.




Incident specific documents required for the emergency event may include:

• Health Alerts (for clincians)

• Frequently Asked Questions (FAQs)

• Fact sheets

• Website text

• Telephone Information Line scripts

• Phone-bank, 311, or 911 scripts

• Recommendations or position papers for public

health decision makers

• Talking points for press releases

• Emergency event news updates

• Other documents as needed

The Document Development Team will depend on experts within the Operations Section for technical

content. Key content providers include the Disease Containment Branch, Epidemiology and Surveillance

Branch, Laboratory Branch, and the Treatment and Prophylaxis Guidance Team.

The Information Officer will approve all documents produced by the Information Content Creation Group

and manage requests for policy level decisions.

Functions of the Document Development Team

• Conduct searches of websites, medical and scientific literature, state and national guidelines, sources

for news updates, fact sheets, and regulations to stay current on technical communicable disease

information.

• Coordinate content with other modules.

• Develop Health Alerts and guidance documents for clinicians, laboratorians and other medical

stakeholders.

• Identify the need for policy level decisions and forward content to the Information Officer.

• Develop clear easy to read (e.g. 8th grade level) fact sheets, and other documents needed by response

partners and the general public.

• Obtain IDER Information Officer approval for all documents.

• Ensure that information for the public is translated into different languages as needed.

• Provide documents to the Information Dissemination Group for dissemination.

• Provide documents to the Plans Section and Info Content Creation Group for document storage.

a.3. Clinic ian Consultation Team

Activate the Clinician Consultation Team when it is necessary to answer technical medical questions from

clinicians in the San Francisco community regarding the emergency event.

This Team is responsible for responding to questions from the following communication systems, if

activated:

• Clinician Phone Line. Clinician calls to 554-2830, or other number, and are transferred to the

Clinician Consultation Team.

• Clinician E-mail account. Email questions referred from the Information Triage Group.

• Teleconferences: A conference phone call can be set up to provide stakeholders with an opportunityto hear and ask questions of IDE response leaders and/or communicable disease experts. This can be

an efficient method to identify issues and share late-breaking information.

The Clinician Consultation Team will provide approved information and advice to practicing clinicians

on diagnosis, treatment, prophylaxis, infection control, surveillance criteria, and other issues. Questions

that do not have approved answers should be referred to the Info Triage Group.




Phone consultation to clinicians may require significant staffing with highly trained personnel. However,

given the important response role of clinicians, every effort should be made to provide clinicians the

information they need.

Functions of the Clinician Consultation Team

• Provide approved answers to clinician queries that arrive via direct phone call, voicemail, or email.

• Refer clinicians to existing documents (e.g., health alert).

• Pass questions that do not have approved answers to the Info Triage Group.

D. STAFF POSITIONS


Staff Position Roster: Information Content Creation Group



Employees Location

Information Content GroupSupervisor

Assign responsibilities, orient staff,and serve as a resource. Receive

information requests from Info TriageGroup. Identify requests that may

require policy level decisions.

Health Program

Coordinator 1 IDER

Command

Information Content Group

Assistant

Maintain and update the Assignments

portion of the Log of RequestsAssignments and Dissemination, storeapproved documents, inform Plans

Section of finalized document.

Computer skills IDER Command

Staff Position Roster: Treatment & Prophylaxis Guidance Team



Employees Location

Treatment & Prophylaxis TeamLeader

Develop guidance on treatment and prophylaxis. Assign responsibilities,orient staff, and serve as a resource.

MD or NP 1 IDER Command

Treatment & Prophylaxis TeamMember

Research and provide treatment and prophylaxis guidance

MD, PharmD,ICP, PH nurse,

NP

IDER Command

Staff Position Roster: Document Development Team



Employees Location

Document Development TeamLeader

Assign responsibilities, orient staff,and serve as a resource. Obtain

Information Officer approvals for documents and policy level decisions.

MD, Med Epi,

NP1 IDER

Command

Document Creation Team Member Reads and processes data relevant toquestion or information request,develops guidance and written textexplaining guidance. Obtains TeamLead approval. If able work as

Clinician Consultant.

Health Educator 2+ IDER Command

Document Development Team

Assistant

Assist with information searches,

recording task fulfillment, passing ondocuments, etc.

Computer skills 1 IDER Command




Items Location


Log of Requests, Assignments and Disseminations (excel spreadsheet) Appendix De2

Health Alerts

Health Alert Development and Dissemination Protocol Appendix Db1

Health Alert Template Appendix Db2

Health Alert Request Form Appendix Db3

Health Alert Cover Sheet Template Appendix Db4

Memo to Clinicians Template Appendix Db5

Anthrax Pre-written BT Health Alert Appendix Db6

Botulism Pre-written BT Health Alert Appendix Db7

Brucellosis Pre-written BT Health Alert Appendix Db8

Burkholderia Pre-written BT Health Alert Appendix Db9

Plaque Pre-written BT Health Alert Appendix Db10

Smallpox Pre-written BT Health Alert Appendix Db11

Tularemia Pre-written BT Health Alert Appendix Db12

VHF Pre-written BT Health Alert Appendix Db13

Health Alert Content for BDS Appendix Db14 Fact Sheets

Anthrax FAQs Appendix Dc1

Botulism FAQs Appendix Dc2

Brucellosis FAQ's Appendix Dc3

Burkholderia FAQ's Appendix Dc4

Plague FAQ's Appendix Dc5

Smallpox FAQ's Appendix Dc6

Tularemia FAQ's Appendix Dc7

VHF FAQ's Appendix Dc8

Avian Influezna One Page FAQ. Appendix Dc9

Avian Influezna One Page FAQ. Spanish Appendix Dc10

Avian Influezna One Page FAQ. Chinese Appendix Dc11 Avain Influenza in Chickens/Animal Care and Control FAQ Appendix Dc12

Pre-incident General Information about BDS Response (Distributed to USPS

Employees before Alert)Appendix Dc13

Pandemic Flu - San Francisco City & County Preparedness FAQ Appendix Dc14

Clinician Reference Documents

Communicable Disease Resources : texts, lists of websites, etc. Appendix Dd1

Clinician Consultation guidelines Appendix Dd2

Anthrax, Infectious Disease Emergency Guide Appendix Dd3

Avian Influenza, Infectious Disease Emergency Guide Appendix Dd4

Botulism, Infectious Disease Emergency Guide Appendix Dd5

Brucellosis, Infectious Disease Emergency Guide Appendix Dd6

Plague, Infectious Disease Emergency Guide Appendix Dd7 Smallpox, Infectious Disease Emergency Guide Appendix Dd8

Tularemia, Infectious Disease Emergency Guide Appendix Dd9

Vial Hemorrhagic Fevers, Infectious Disease Emergency Guide Appendix Dd10


ItemsUnits

Required

Location or

Request From











White board 1 Logistics



21. INFORMATION DISSEMINATION GROUP



Information Branch

Information

Dissemination Grou

Information Content

Creation Grou


Guidance Team


Team


Team

Electronic

Dissemination Team

Alternative

Dissemination Team

Telephone

Dissemination Team

Phone Bank Unit

Information Triage

Group

B. DESCRIPTION


The purpose of the Information Dissemination Group is to distribute communicable disease information

to a variety of audiences in a timely fashion. The Group objectives include:

• Provide event-specific communicable disease information to the public.

•

Efficiently distribute packaged information to target audiences.• Maintain records of information dissemination.

b. Methods

Methods used by the Information Dissemination Group include, but are not limited to, the following:

DPH Websites: Instructions, informational documents, Health Alerts and other guidance can be posted

on the DPH main website (www.sfdph.org) and/or the CDCP website (www.sfdph.org/cdcp).

Health Alert Notification Database (HAND): The HAND is a database of clinicians (stratified by

specialty) and other stakeholders. The database contains over 7,000 names, phone numbers, fax numbers,

addresses, and other contact information including information on approximately 4,000 physicians. TheHAND can be used to contact individuals or send out mass faxes and mailings. One may also select up to

3 priority groups to receive faxes first.

Blast Fax. Mass communications can be sent out to clinicians and/or other groups in the HAND by fax

using the CDCP fax transmission program which includes 4 fax lines or a commercial blast fax system.

The commercial blast fax system is faster (can fax a document to 3000 clinicians in under 24 hours) but is

more expensive.

IDER Plan: Communicable Disease Information Branch/Information Dissemination Group, Page 1/6 Draft 10/07

http://www.sfdph.org/

http://www.sfdph.org/cdcp

http://www.sfdph.org/cdcp

http://www.sfdph.org/



EMSystem. EMSystem is a web-based management tool to assist with ambulance diversion, mass

casualty management, and information sharing among system users which include hospitals, the

Emergency Medical Services Section of the DPH, and other public safety agencies. All San Francisco

hospital emergency departments are required to have the EMSystem open at all times. Messages,

documents, and links can be posted on the main page.

Telephone Information Line. One or more recorded messages can be activated to provide information

to the public, emergency responders, and other audiences. The phone number(s) will be designated at thetime of the incident. Phone line scripts will be provided by the Document Development Team.

Media. Information can be released to the media by the DOC/EOC for city and region-wide

dissemination. Forward media press releases, fact sheets, and talking points to the Information Officer.

Phone bank. A group of phones staffed by operators trained to answer questions from the public or

specific target groups. An informational message can be included and live operators can answer questions

by following scripts. The phone bank will be located at 30 Van Ness. There are 20 dedicated phone lines.

(Currently there is no ability to transfer calls to other locations.)

311 Public Information Telephone Call Center. San Francisco 311 System, an established 24/7 system

with personnel that answer a broad range of questions about San Francisco services. (311 is not part of theIDER organization but may be an available asset.)

911. The Emergency Communications Department maintains the 911 system which provides information

to individuals in emergencies.

C. IMPLEMENTATION

a. Information Dissemination Group

Activate the Information Dissemination Group when dissemination to external parties outside of the

response are needed or anticipated.

Dissemination tools include

Information may be disseminated through the following mechanisms to the following audiences:

• Medical Community. Blast fax to individual and groups of clinicians in the HAND, information

posting for Emergency Departments via EMSystem, DPH or CDCP website postings, static content

provided on the Telephone Information Line.

• Public. DPH or CDCP website postings, static content provided on the Telephone Information Line,

hard copy information fliers, questions answered by the phone bank or 311.

Materials for press releases, talking points for spokespersons, and dissemination to the media will be provided by the CD Info Content Creation Group to the IDER Information Officer.

The CD Info Dissemination Group will maintain a record of information disseminated, update the CD

Information Log of Requests, Assignments and Disseminations, and provide updates using the Situation

Status Updates.

Functions of the CD Info Dissemination Group

• Receive content and/or documents for mass distribution external to the IDER response.

• Assign dissemination tasks.




• Re-configure documents and materials to correspond with the selected dissemination method.

• Monitor dissemination parameters and trouble shoot if necessary.

• Update the CD Info Log of Requests, Assignments and Distributions.

a.1. Electronic Dissemination Team

The Electronic Dissemination Team will be activated when it is necessary to distribute packaged

information to designated audiences via website, blast fax systems (i.e. CDCP system, commercialsystem), EMSystem, and/or email.

Functions of the Electronic Dissemination Team

• Work with the Applications Support Group in Data Branch or the Logistics Section to distribute

documents via e-mail and/or blast fax.

• Post information and/or documents to the DPH and/or CDCP website and/or EMSystem. (See

Appendix Da for instructions).

• Inform the Information Dissemination Group of distribution actions taken.

a.2. Alternative Dissemination Team

The Alternative Dissemination Team will be activated when it is necessary to explore and set-upalternative (not pre-established) methods of distributing information because established methods are

incapacitated or insufficient. Forms of alternative dissemination may include but are not limited to:

• Commercial newspaper facilities to print guidance

• Commercial websites to post guidance

• Guidance information included in paychecks and/or bills

• Mass mailings

Functions of the Alternative Dissemination Unit

• Identify alternative methods of distributing information.

•

Implement alternative methods of disseminating information.• Coordinate with other distribution efforts

a.3. Telephone Dissemination Team

Activate the Telephone Distribution Team when:

It is useful to provide information to the public on an information line, and/or

A larger than usual volume of calls is expected from the public, emergency responders, or other

individuals (not including clinicians).

The Telephone Dissemination Team will oversee the Phone Bank, coordinate messages with 311 and 911,

and is responsible for setting up static Telephone Information Lines. Messages and scripts will be

provided by the Document Development Team.

Functions of the Telephone Dissemination Team

• Identify telecommunication mechanism(s) to utilize.

• As needed, set up and maintain a telephone information line (script to be provided by the Document

Development Team). Assist with updating messages.

• As needed, initiate the Phone Bank Unit.

• As needed, coordinate messages with the San Francisco 311 System.

• Coordinate information inquiries and resources with the Emergency Communications Dept.




• Forward new questions for which there are no pre-approved answers from the Phone Bank Unit, 311,

or 911 to the Triage Team.

a.3.1. Phone Bank Unit

The Phone Bank Unit will be activated when it is necessary to use live operators to respond to the

public’s questions over the phone. Phone bank operation for the public requires significant staffing and

should be reserved for moderate and large scale incidents. See Appendix Da for the Phone Bank Instructions. Phone bank operators will use guidelines provided by the Content Creation Team.

Functions of the Phone Bank

• Set up the phone bank.

• Train phone bank operators.

• Respond to questions from the public.

• Provide to the Information Triage Group requests for new information from the public.

• Provide Situation Status Updates.

D. STAFF POSITIONS


Staff Position Roster: Information Dissemination Group



Employees Location

Information Dissemination GroupSupervisor

Assign responsibilities, orient staff,and serve as a resource for staff in and outside of the group. Establish

methods to distribute info requests.

Knowledge of

IS/ IT &communicationtechnologies

1 IDER

Command

Information Dissemination GroupMember

Receive distribution requests from InfoTriage Group, receive content fromInfo Content Group, and pass contentto Info Dissemination Teams. Update

the CD Info Log of Requests,Assignments and Dissemination.

Computer skills(spreadsheets

and databases,

MS Word,Adobe Acrobat)

IDER Command

Staff Position Roster: Electronic Dissemination Team



Employees Location

Electronic Dissemination TeamLeader

Lead electronic distribution of CD infocontent documents: blast fax, email,

website postings. Assignresponsibilities, orient staff, and serveas a resource for staff in and outside of

the Team. Maintain a log of electronicdistributions.

Knowledge of IS/ ITtechnologies

1 IDER Command

Web master Post to DPH/CDCP websites. Web master skills

1 IDER Command

Electronic distributor Distribute documents via blast fax,email, EMSystem. Insure documents

are formatted/configured correctly for distribution.

Knowledge of Blast fax

programs, MS

Access

1 IDER Command




Staff Position Roster: Alternative Dissemination Team



Employees Location

Alternative Dissemination Team

Leader

Identify and implement alternative

distributions strategies.

Communicationskills.

1 IDER Command

Alternative Dissemination TeamMember

Assist Team Lead. Computer skills. IDER Command

Staff Position Roster: Telephone Dissemination Team



Employees Location

Telephone Dissemination TeamLeader

Activate and oversee the Phone Bank.Coordinate with 311 and 911. Set uptelephone information line(s).

Phone skills,

Health Educator 1 IDER

Command

Telephone Dissemination TeamMember

Assist with the set up of telephoneinformation lines, coordination with311, 911, and the Phone Bank

Staff Position Roster: Phone Bank Unit



Employees Location

Phone Bank Unit Leader Provide public with incident and disease info and guidance. Assignresponsibilities, orient staff, and serveas a resource. Provide phoneconsultation as able.

Phone skills,knowledge of

communicablediseases, HealthEducator

1 30 Van Ness

Phone Bank Unit Member Provide information and communicable disease guidance to the

public over the phone. Maintain a logof calls.

Phone skills 2+ 30 Van Ness

Phone Bank Assistant Maintain a summary log of calls

(compiled from operator logs),compile separate list of unanswered

questions and after approval fromTelephone Dissemination Team Leader

present list of info requests to InfoTriage Group, assist with Situation

Status Update.

Computer skills 1 30 Van

Ness

E. REPORTING

The CD Info Dissemination Group Supervisor reports to the CD Info Branch Director. The CD InfoDissemination Team Leaders report to the CD Info Dissemination Group Supervisor.

F. DELIVERABLES

The CD Information Dissemination Group is responsible for producing the following:




• Phone Bank Call Log





• Electronic Dissemination Log

• List of new information requests

G. RESOURCES



Items Location


Information Dissemination

HAND instructions Appendix Da1

Blast Fax instructions for SFDPH system and for commercial system Appendix Da2

Web posting instructions for main SFDPH site & for CDCP site Appendix Da3

Telephone Information Line Instructions Appendix Da4

Bulk E-mail Dissemination Instructions Appendix Da5

Phone Bank Instructions Appendix Da6

Public Health Information Line Script for BDS Alert Appendix Da7


ItemsUnits

Required

Location or

Request From







Adobe Acrobat Professional Software 1 LogisticsBlast Fax Software 1 Logistics



22. DATA BRANCH


Epidemiology and

Surveillance Branch

Data Branch

Laboratory Branch


Information Branch

Disease Containment

Branch

Continuity of

O erations Branch

Application Support

Unit(s)

Epi & Surveillance Data

Team

Applications Support

Group

Data Analysis Group

Syndromic Surveillance

Data Unit


Clearance Data Team

Mass Prophylaxis Data

Team

Isolation & Quarantine

Data Team

Operations Section

B. DESCRIPTION


The purpose of the Data Branch is to manage and support software applications used in the Operations

Section and to receive, manage, and analyze information about the infectious disease emergency that can

guide the selection of strategies to contain the event. The Branch objectives include:

• Determine appropriate data analysis strategies for the infectious disease response in order to:

o Identify sources of disease and causes of disease spread.

o Monitor trends in the incidence and prevalence of disease to identify new or unrecognized

exposures or risk factors.

o Describe the epidemiological and clinical features of an event.

o Report cases to the proper agencies.

o Client management.

• Determine appropriate strategies for the creation, management, and administration of information

systems for IDER operations.

b. Methods

Primary methods for the Data Group include:

IDER Plan: 2Operations Section/Data Branch, Page 1/3 Draft 10/07



Data analysis. Data analysis is the systematic study of data so that its meaning, structure, relationships,

origins, etc. are understood. Data analysis uses statistical methods and logical techniques to describe,

summarize, and compare data.

Application Support and Information Systems. Application support and information systems include

the design, development, installation, and implementation of software applications and information

systems. Information systems architecture components include mission, functional and informationrequirements, system configurations, information flows, IT standards and business rules. This support

will be used to create the most efficient information system possible with available resources for the

needs of the IDER operation.

Consult the Data Branch modules for details regarding the above strategies.

C. IMPLEMENTATION

a. Data Branch

Activate the Data Branch when a module in the Operations Section has data analysis or applicationsupport needs.

The Data Branch Director is responsible for completion of Data Branch objectives and coordination

through the joint efforts of other branches involved in an emergency response.

Functions of the Data Branch

• Identify, communicate, and oversee strategies to accomplish objectives and design operational plans

in accordance with the Incident Action Plan.

• Order mobilization and demobilization of branch modules to meet incident response needs.

• Prioritize and assign responsibilities according to objectives and plans.

• Assure coordination with other partners/agencies providing application software and data analysis

assistance.• Ensure coordination with other branches within the Operations Section.

• Communicate with the Operations Section Chief and Branch Directors.

• Review the work output and process for the Data Analysis Group and the Application Support Group.

D. STAFF POSITIONS


Staff Position Roster: Data Branch

Job Title Task Overview JobClassification Critical Skills No. of Employees Location

Data Branch

Director

Supervise and manage

Data Branch activities

2804, 2591, 2803,

2230

Supervisory

experience; trainingand/or experience inepidemiological field investigations; basic

epidemiological or biostatistical analysisskills

1 IDER

Command

AdministrativeAssistant

Assist Data BranchDirector with

1424, 1426, 2585,1446

Perform administrativeduties to assist the

IDER Command





administrative duties; Branch. Take notes atmeetings and other duties as assigned.

E. REPORTING

The Data Branch reports directly to the Operations Section Chief. Incident specific information will be

provided to other Operations Section Branch Directors.

F. DELIVERABLES

The Data Branch is responsible for producing the following:

• Documents assigned to Data Groups, Teams, and Units




G. RESOURCES



Items Location


Templates

Database(s) Template Appendix Ka1

Analysis Plan Template Appendix Ka2 SAS coding Template Appendix Ka3

Data Entry Instructions Template Appendix Ka4

Data Report Template Appendix Ka5

Template Data Branch Status Report Appendix Ka13

Data Systems

ICOMS User Manual Appendix Kb1

Instructions on how to report Data to CDPH Appendix Kb2

Description and Location of Existing SFDPH Databases & Programs Appendix Kb3

The Basics of DCMS: User Guide and Technical Documentation Appendix Kb4


ItemNo.

Required

Location or

Request From









23. DATA ANALYSIS GROUP



Group

Epi & Surveillance

Data Team

Syndromic Surveillance

Data Unit


Clearance Data Team

Mass Prophylaxis DataTeam

Application Support

Unit(s)


Data Team

Data Analysis Group

Data Branch

B. DESCRIPTION


The purpose of the Data Analysis Group is to efficiently and accurately receive, manage, analyze, and

summarize data to determine the scope, cause, and progression of the event; to identify those persons

most at risk; to ascertain effective methods for controlling disease; and to evaluate the effectiveness of

response actions and interventions for decision-makers. The Group objectives include:

• Identify functional requirements for designing and maintaining epidemiological, surveillance, and

client management databases for the Epidemiology & Surveillance Branch and the Disease

Containment Branch as needed.

• Receive data from the Epidemiology and Surveillance Branch and the Disease Containment Branch.

• Organize and clean client management, surveillance, investigation, outbreak, and analytic study data

in preparation for analysis.

• Analyze, manage, and share client management, surveillance, investigation, outbreak, and analytic

study data.

b. Methods

The Data Analysis Group will use the following methods to achieve objectives:

Infectious disease epidemiological methods. Infectious disease epidemiological methods include

epidemic curves, study of contact networks, syndromic surveillance, virologic analysis, and geographic

analysis, and will be used to analyze and summarize data about the outbreak. Data Analysis Group

members must determine the epidemiological hypotheses and purpose of the analysis, design collection

tools with this purpose in mind, and choose analytic methods appropriately. The Data Analysis Group

must work with other operational branches to ensure data collection instruments are designed to optimize

IDER Plan: Data Branch/Data Analysis Group, Page 1/11 Draft 10/07



accuracy, reduce bias, allow for efficient data analysis, and address epidemiologic hypothesis or purpose,

which can include situational awareness, individual case or contact management, source of incident, etc.

Data entry. Data entry is transcribing information from the original source into a computer and can

occur through keyboard entry, scanners, speech recognition and automatic device-to-system technology.

For an IDE response, manual data entry will be minimized. When possible, electronic data sources or

automated data entry will be used.

Software and Applications. Whenever possible, software and application already in use at DPH will be

used to store, manage, and analyze data (e.g. DCMS, SAS, Access).

Transfer of information. Determining what information needs to be shared and how it will be shared

are integral issues in a response. The Data Analysis Group will actively manage and assume

responsibility for the flow of information to and from the Data Branch and will effectively prioritize data

information processing .

Client management analysis. Client management analysis includes descriptive statistics, line lists, and

work process completion and will be used to provide quantitative feedback to IDER groups to help them

manage the processes used in the IDE response and to continuously improve the functioning of their

response.

See Appendix Kb for details on software and database resources.

C. IMPLEMENTATION

a. Data Analys is Group

Activate the Data Analysis Group when data collection, storage and analysis are needed by the

Epidemiology and Surveillance Branch and/or the Disease Containment Branch.

The Data Analysis Group includes the Epidemiology & Surveillance (E&S) Data Team, the Isolation and Quarantine (I&Q) Data Team, the Restriction, Exclusion, and Clearance (REC) Data Team and the Mass

Prophylaxis Data Team. The teams will work closely with the corresponding Branches (i.e.

Epidemiology and Surveillance Branch, Disease Containment Branch) and modules to carry out

functions. Assistance with data applications can be requested from the Applications Support Group.

The Data Analysis Group Leader will receive information from the Data Branch Director on:

• What is known of the characteristics of the disease

• The progression of the event

• Disease containment strategies have been implemented

• Epidemiology and surveillance strategies that have been implemented

• Data needs of the Epidemiology and Surveillance Branch and the Disease Containment Branch

• Available information technology resources• Other pertinent information.

The Data Analysis Group will communicate this information to group members and create an analysis

plan for the Disease Containment Branch and the Epidemiology and Surveillance Branch. They willassist the branches to create analyzable questionnaires, surveys, and forms with database design and

outcome measurements in mind.




The Data Analysis Group Support Personnel Epidemiologist will be responsible for aiding the receipt of

data , tracking data information flow, and reporting information electronically and by paper to the State

and other sources.

Key Steps During an Outbreak:

1. Determine who is a case by creating a working case definition for analysis

2. Create/rewrite/refine any needed questionnaires and forms. See Appendix Ed, epidemiology and

surveillance tools and forms and state and federal reporting requirements.3. Describe the outbreak in terms of person, place, and time:

• Create an epidemic curve immediately

• Consider plotting cases on a map (if the outbreak is confined to one location like a nursing home

or hotel obtain a map of the location). Request city and regional maps from Logistics.

• Consider creating a population pyramid of cases

4. Create/reconfigure/refine database

5. Provide reports to the Epidemiology and Surveillance Branch, the Disease Containment Branch, and

to the Data Branch Director that include, but are not limited to the following information:

• Magnitude of the outbreak

• Demographics of affected persons

• Time, location, and mode of exposure

• Vehicle of exposure

• Persons at risk for disease (from either primary exposure or secondarily through contact with a

case) who may need or who are receiving treatment, prophylaxis, and/or medical follow-up or

who are isolated, quarantined, restricted or cleared.

• Persons in sensitive occupations and settings

• Quantification of client services rendered

• Evaluation of workflow processes

6. Re-analysis and re-interpretation will occur on an ongoing basis.

The information collected and analyzed by this group will aide the E&S Branch and the DiseaseContainment Branch in streamlining client referrals, intakes and assessments for clients; increase the

understanding of the extent and scope of the IDE event, and, collect information for financial and legal

purposes.

Identified data and information collected, received, and summarized will be used only for public health purposes and will be kept confidential to the extent provided by law.

Functions of the Data Analysis Group

• Identify, communicate, and oversee strategies to perform data analysis.

• Order mobilization and demobilization of modules to meet incident response needs.

• Prioritize and assign responsibilities. Provide ongoing support to modules.

• Ensure coordination with other branches within the Operations Section.

• Review the work output and process for the Data Analysis Teams.

•

Update the Data Group Supervisor on activities and resource needs.

a.1. Epidemiology and Surveillance (E&S) Data Team

Consider activating the E&S Data Team when any team or unit within the E&S Branch is activated

The Unit receives, manages, analyzes and interprets epidemiology and surveillance data on a frequent

basis to provide information about how to control and prevent disease and to understand the nature and

scope of the disease event. Statistical and data management expertise for epidemiological and

surveillance activities are housed in this team. This team oversees the Syndromic Surveillance Data Unit.




Functions of the E&S Data Team

• Determine and implement analysis plan for the Epi & Surveillance Branch data.

• Receive clinical, exposure, and laboratory data reports for cases, contacts, and case clusters from the

Epidemiology and Surveillance Branch.

• Provide the Application Support Group with the functional requirements of any database(s) created

and/or modified.

• Work with the Applications Support Group for database design and maintenance, including ability toupload data from multiple sources, linkage of various databases.

• Identify IT support needs for data transmission, database creation or modification.

• Merge, append, and/or concatenate data transmitted electronically from various sources.

• Check accuracy and quality of the epidemiology and surveillance data. Clean and edit data.

• Train data entry staff to enter data into E&S Data Team databases.

• Manage, analyze, and/or summarize data, including case counts, line lists, case mapping, and

descriptive and analytic epidemiology of cases.

• If an analytic study is conducted, act as consultant to the E&S Branch regarding analyzable

questionnaires, study purpose, study design, including power calculations.

• Generate rosters and line lists for the Case Investigation Team, the Contact Investigation Team, the

Laboratory Liaison Team, and the E&S Field Team as needed. • Submit data reports to E&S Branch for content approval and discussion of data needs periodically.

• Complete require outbreak forms and send to the California Department of Public Health or other

appropriate health agency.

a.2. Syndromic Surveillance Data Unit

Consider activating the Syndromic Surveillance Data Unit when the Syndromic Surveillance Team (in the

E&S Branch) is activated.

The Unit receives, manages, analyzes and interprets syndromic surveillance data on a frequent basis to

improve early detection of disease outbreaks. Statistical and data management expertise for syndromic

surveillance activities are housed in this unit.

Functions of the Syndromic Surveillance Data Unit

• Develop and approve data collection tools and formats with the Syndromic Surveillance Team.

• Determine and implement syndromic surveillance data analysis plan.

• Define statistical aberration alert thresholds.

• Determine plan for follow-up investigation of statistical aberrations that exceed alert thresholds;

coordinate with assistance from Syndromic Surveillance Team.

• Collect and receive syndromic surveillance data.

• Ensure data completeness and accuracy; clean and edit data as necessary.

• Manage syndromic surveillance databases.

• Provide the Application Support Group with the functional requirements of any database(s) created

and/or modified.• Work with the Applications Support Group for database design and maintenance, including ability to

upload data from multiple sources, linkage of various databases.


• Submit data reports to Syndromic Surveillance Team in the E&S Branch for content approval and

discussion of data needs on a periodic basis.




a.3. Isolation and Quarantine (I&Q) Data Team

The Team provides data support to ensure clinical information collected by the Home-Based I&Q and

Non-Healthcare Facilities-Based I&-Q Teams are collected and entered into database(s). The information

is then analyzed and reported to the I&Q Group Supervisor to assess progress and effectiveness of

strategies. In addition, the I&Q Data Team tracks specific data related to the legal and logistical

components of an I&Q response. See Appendices K for forms and protocols that may be utilized by this

unit.

Functions of the Isolation and Quarantine Data Team

• Determine strategies to accomplish data management and analysis objectives for the Isolation and

Quarantine Group in the Disease Containment Branch.

• Coordinate entry, transfer, receipt, and exchange of data with the Home-Based I&Q Team and

Facilities-Based I&Q Team • Train data entry staff to enter data into I&Q databases

• Ensure accuracy and efficiency of data entry into I&Q databases.

• Check accuracy and quality of the I&Q data. Clean and edit data as necessary.

• Merge, append, and/or concatenate isolation and quarantine data transmitted electronically from

various sources.

• Manage, analyze, and summarize data, including line lists, evaluation of client management

processes, etc.

• Submit data reports to Isolation and Quarantine Group for content approval and discussion of data

needs on a periodic basis.

a.4. Restrict ion, Exclus ion and Clearance Data Team

Consider activating the Restriction, Exclusion, and Clearance Data Team when the Restriction, Exclusion,

and Clearance Group (in the Disease Containment Branch) is activated.

The Team receives, manages, and summarizes restriction, exclusion, and clearance data on a frequent

basis to improve client management functions.

Functions of the Restriction, Exclusion and Clearance Data Team

• Develop and approve data collection tools, formats, and reports for restriction, exclusion, and

clearance data.

• Determine and implement Restriction, Exclusion and Clearance data analysis plan.

• Collect and receive Restriction, Exclusion and Clearance Group data.

• Train data entry staff to enter data into Restriction, Exclusion and Clearance databases.

• Check accuracy, completeness, and quality of data; clean and edit data as needed.

• Manage restriction, exclusion, and clearance databases.

• Identify IT support needs for data transmission, database creation or modification. Coordinate with

the Application Support Group.

• Exchange data with the E&S Data Team and the Laboratory Liaison Team as necessary.• Summarize Restriction, Exclusion, and Clearance data, including creating line lists with clearance

specimen submission dates and testing results.

• Submit data reports to Restriction, Exclusion, and Clearance Group for content approval and

discussion of data needs on a periodic basis.

a.5. Mass Prophylaxis Data Team

Consider activating the Mass Prophylaxis Data Team when:




1. The Mass Prophylaxis Group is activated, AND

2. When it is necessary to record and track individuals and the prophylaxis dispensed to them.

The Team receives, manages, analyzes and interprets mass prophylaxis data on a frequent basis to aid in

client management, including documenting informed consent and contraindications, monitoring vaccine

take, and/or documenting adverse events. Ensure coordination and exchange of data between POD sites

and with the E&S Data Team, as needed. (The Mass Prophylaxis Data Team is not responsible for

reporting on the progress of dispensation in the PODs. This team will not collect, clean, or analyze personnel recruitment and tracking data (this will be done by the Plans Resource Status Unit).)

Data collection. The POD screening form may be used to collect desired data. Surveillance data

(information about close contacts of cases) may also be collected on-site in some situations. Guidelines

for surveillance data collection will be sought from the Surveillance Group. The decision to collect

and/or enter data on or off-site will be made at the time of the event and will depend on whether there is

sufficient space and equipment. It may be more efficient to collect paper data and send all forms to a

central repository or hub for data entry. In strict antibiotics dispensing PODs following a paperless

dispensing model, patient who receives antibiotics will not be tracked in an electronic system.

Immunization data collection. Immunization data will be entered into the web-based immunization

registry, powered by California Automated Immunization Registry or CAIR software (this software ismanaged by the CDPH). At a minimum, entered fields will include patient name and date of birth,

vaccine lot number, expiration date, id of staff that administered the vaccine, an identifier of the POD site

where vaccine was administered and whether it is a first or second dose. For surveillance, it is also

recommended to enter address and telephone information of the patient. The immunization registry is not

able to accommodate surveillance or contact tracing information, so that will have to be entered into aseparate system (see guidelines from Data Branch). There should not be more than a 24-hour lag between

the time that a vaccine is dispensed and the time it is entered into an overall tracking system (the registry).

Functions of the Mass Prophylaxis Data Team

• Determine strategies to accomplish data management and analysis objectives for the Mass

Prophylaxis Group in the Disease Containment Branch.

• Work with the Applications Support Group for database design and maintenance, including ability toupload data from multiple sources, linkage of multiple databases.

• Merge, append, and/or concatenate data transmitted electronically from various sources.

• Receive data reports from POD sites.

• Aid in coordination of data exchange between POD sites.

• Exchange data with the E&S Data Team.

• Train data entry staff to enter data into Mass Prophylaxis databases.

• Check accuracy and quality of data; clean and edit data as needed.

• Manage, analyze, and/or summarize data, including counts, line lists, etc.


• Submit data reports to Mass Prophylaxis Group for content approval and discussion of data needs on

a periodic basis.

• Coordinate with the Mass Prophylaxis Group in the Disease Containment Branch to ensure the Mass

Prophylaxis Data Team functions are incorporated into the POD layout/patient flow plans.

• Serve as a resource for meeting Mass Prophylaxis Plan data needs.

D. STAFF POSITIONS





Staff Position Roster: Data Analysis Group

Job Title Task Overview

JobClassification

Critical Skills No. of Employees Location

Data AnalysisGroup Leader

Coordinate and manageData Analysis GroupSupport Personnel,

E&S Data Team,Disease Containment

Data Team

2804, 2803 Epidemiological and/or biostatistical analysis skills;supervisory experience; training

and/or experience inepidemiological field

investigations

1 IDER Command

Epidemiologist Facilitate receipt and incorporation of data

into databases

2803 Epidemiological and/or biostatistical analysis skills;

experience designing and analyzing epidemiological studies

IDER Command

AdministrativeAssistant

Performs administrativefunctions

1424, 1426,2585, 1446

Knowledge of office methods and procedures; the operations of common office machines and

equipment.

IDER Command

Staff Position Roster: Epidemio logy & Surveillance Data Team


JobClassification


E&S DataTeam Leader

Coordinate and manageE&S Data Team and

units within the team.Decide on analysisstrategy

2804, 2803 Epidemiological and/or biostatistical analysis skills;

supervisory or project coordinator experience

1 IDER Command

E&S DataTeam

Epidemiologist

Receive, manage,analyze, and interpret

E&S Branch data,excluding syndromicsurveillance data

2802, 2803 Epidemiological and/or biostatistical analysis skills;

training and/or experience inepidemiological field investigations; familiarity with

existing SFDPH software and/or applications

1 IDER Command

E&S DataTeam Trainer

Coordinate and managedata entry of E&SBranch data; train E&S

Data Team Data EntryStaff

2802 Basic epidemiological and/or biostatistical analysis skills;experience in data entry of health-

related data and/or performinghealth-related data analyses;experience interpreting and understanding lab test results

IDER Command

E&S Data

Team DataEntry Staff

Enter E&S Branch data

into databases

1424, 1426 Experience in data entry of

health-related data

IDER

Command

Staff Position Roster: Syndromic Surveillance Data Unit


JobClassification


SyndromicSurveillanceData Unit

Leader

Coordinates and manages SyndromicSurveillance Data Unit

activities

2803 Experience conducting syndromicsurveillance and/or syndromicsurveillance data analysis;

supervisory or project coordinator experience

1 IDER Command

Syndromic

SurveillanceData UnitEpidemiologist

Receives, manages, and

analyzes syndromicsurveillance data

2802, 2803 Experience conducting

synodromic surveillance and syndromic surveillance dataanalysis; familiarity with existingDPH software and/or applications

IDER

Command

SyndromicSurveillance

Data Entry

Coordinate and managedata entry of syndromic

surveillance data; train

2802, 2803 Experience conductingsynodromic surveillance and/or

syndromic surveillance data

IDER Command




Trainer Syndromic SurveillanceData Entry Staff

analysis; experience in data entryof health-related data and/or

performing health-related dataanalyses

Syndromic

SurveillanceData EntryStaff

Enter syndromic

surveillance data intodatabases


health-related data

IDER

Command

Staff Position Roster: Restriction, Exclusion, and Clearance Data Team


JobClassification


Restriction,Exclusion,

Clearance DataTeam Leader

Coordinates data entryand report functions

Experience in performing health-related data analysis; supervisory

or project coordinator experience

1 IDER Command

Restriction,Exclusion,

Clearance DataEntry Staff

Enters data efficientlyand accurately

1424, 1426 Experience in data entry of health-related data

IDER Command

Restriction,

Exclusion,Clearance Data

Analyst

Analyzes data and

generates reports

Experience in performing health-

related data analysis

IDER

Command

Staff Position Roster: Mass Prophylaxis Data Team


JobClassification


MassProphylaxisData Team

Leader


Experience in performing health-related data analysis; supervisoryor project coordinator experience

1 IDER Command

Mass

Prophylaxis

Data EntryStaff

Enters data efficiently

and accurately

1424, 253+ Experience in data entry of

health-related data

IDER

Command

MassProphylaxis

Data Analyst

Analyzes data and generates reports

Experience in performing health-related data analysis

IDER Command

Staff Position Roster: Isolation & Quarantine Data Team


JobClassification


I&Q DataTeam Leader


Experience in performing health-related data analysis; supervisory

or project coordinator experience

1 IDER Command

I&Q Data

Entry Staff

Enters data efficiently

and accurately


health-related data

IDER

Command I&Q DataAnalyst

Analyzes data and generates reports

Experience in performing health-related data analysis

IDER Command

E. REPORTING

The Data Analysis Group reports directly to the Data Branch. Each team within the Data Analysis Group

reports to the Data Analysis Group, but they report content to the corresponding module within the

Epidemiology and Surveillance Branch and the Disease Containment Branch, as appropriate (e.g., the





E&S Data Team reports to the E&S Data Branch, the Mass Prophylaxis Data Team reports to the Mass

Prophylaxis Group).

F. DELIVERABLES

The Data Analysis Group is responsible for producing the following:




E&S Data Team:




• E&S Data Team Analysis Plan

• E&S Team Epidemic Curve

• E&S Team Spot Map, if appropriate

• E&S Team Summary and Interpretation of Descriptive Statistics

Interpretation of Analytical Statistics• E&S Team Summary and

• E&S Team Database(s)

• Linelist/rosters of cases

• Linelist/rosters of contacts

• Linelist/rosters of persons needing laboratory testing

od)

eriod)

tional Period)

ols and protocols

sis report

od)

eriod)

erational Period)

Summary statistics of persons isolated

nal Period)

Period)

ed

Line list/roster with clearance specimen submission dates and testing results

Syndromic Surveillance Data Unit

• Situation Status Update, ICS Form 209b (for each Operational Peri

• Module Objectives, ICS Form 202b (for each Operational P

• Module Log, ICS Form 214 (for each Opera

• Syndromic Surveillance data analysis plan• Syndromic surveillance data collection to

• Syndromic surveillance alert thresholds

• Syndromic surveillance data analy

• Syndromic surveillance database

Isolation and Quarantine Data Team

nal Peri• Situation Status Update, ICS Form 209b (for each Operatio

(for each Operational P• Module Objectives, ICS Form 202b

• Module Log, ICS Form 214 (for each Op

• Line list/rosters of persons isolated

• Line list/rosters of persons quarantined

•

• Summary statistics of persons quarantined

Restriction, Exclusion, and Clearance Data Team

• Situation Status Update, ICS Form 209b (for each Operatio

• Module Objectives, ICS Form 202b (for each Operational


• Summary statistics of persons excluded/restricted/clear

•




• Line list/roster for excluded/restricted persons in SOS

nal Period)

h Operational Period)

riod)

Summary statistics of persons prophylaxed

se with adverse reactions

onse operations:

rotocols , forms, guidelines, and MOUs

Location

Mass Prophylaxis Data Team

• Situation Status Update, ICS Form 209b (for each Operatio

• Module Objectives, ICS Form 202b (for eac

• Module Log, ICS Form 214 (for each Operational Pe

•

• Summary statistics for tho

G. RESOURCES

The following resources will be required to perform resp

a. P

Items


TemplatesDatabase(s) Template Appendix Ka1

Analysis Plan Template Appendix Ka2

SAS coding Template Appendix Ka3

Data Entry Instructions Template Appendix Ka4

Data Report Template Appendix Ka5

Template Syndromic Surveillance Data Unit Status Report Appendix Ka6

Template E&S Data Team Status Report Appendix Ka7

Template Restriction, Exclusion, and Clearance Data Team Status Report Appendix Ka8

Template Mass Prophylaxis Data Team Status Report Appendix Ka9

Template Isolation and Quarantine Data Team Status Report Appendix Ka10

Template Data Analysis Group Status Report Appendix Ka11

Data Systems



Description and Location of Existing SFDPH Databases & Programs Appendix Kb3

The Basics of DCMS: User Guide and Technical Documentation Appendix Kb4

Description of Active Surveillance

Active Surveillance Protocol - SFGH Appendix Kc1

SFDPH Active Surveillance Macros SAS Program Appendix Kc2

SFDPH Active Surveillance Read in SAS Program Appendix Kc3

SFDPH Active Surveillance Outpatient Read in SAS Program Appendix Kc4

SFDPH Active Surveillance Admits Read in SAS Program Appendix Kc5

SFDPH Run Active Surveillance SAS Program Appendix Kc6 Description of Active Surveillance at SFGH Appendix Kc7

Epidemiology & Surveillance Process – Tools and Forms

Case Investigation Process Worksheet Template Appendix Ed1

Contact Investigation Process Worksheet Template Appendix Ed2

Laboratory Liaison Process Worksheet Template Appendix Ed3



24. APPLICATIONS SUPPORT GROUP



Grou

Epi & Surveillance Data

Team

E&S Syndromic

Surveillance Data Team


Clearance Data Team

Mass Prophylaxis Data

Team

Application Support

Unit s


Data Team

Data Analysis Group

Data Branch

B. DESCRIPTION


The purpose of the Applications Support Group is to manage critical information systems including

hardware, software, and the underlying network infrastructure required for applications. The

Applications Support Group assists the entire IDER response (not just the Data Branch or Operations

Section). The objectives of the Applications Support Group are to:

• Ensure optimal function of specialized IDER-critical information systems via efficient handling of

technical problems.

• Manage user accounts.

• Ensure that IDER data analysts and epidemiologists have the ability to gain access to and/or generate

reports/queries for applicable database-driven systems.

• Maintain the integrity and security of field data and data transmissions from field teams.

• Create, update, and modify applications databases as needed.

The function of the Application Support Group is to support critical information systems as listed belowand is not duplicative of the Logistics Section’s Information Technology Unit objectives which include:

general network issues; computer login issues including the creation of user accounts and assignment of

user groups; e-mail, printing, standard software (e.g. MS Office, PDA software, Acrobat Reader);

administrator access issues which impact software installation including Epi-X certificates, SAS, etc; and,

maintenance and repair of IT equipment.

If the Data Branch is not activated the Application Support Group may be actived by the Information

Technology Unit in the Logistics Section.

IDER Plan: Data Branch/Applications Support Group, Page 1/6 Draft 10/07



b. Methods

The Applications Support Group will use the following methods to achieve objectives:

Technical support and triage. The Applications Support Group will provide targeted and system-

specific technical support. Users of specialized IDER-critical information systems, especially those in the

Data Branch’s Analysis Group, will rely on the Applications Support Group for troubleshooting services.

The Applications Support Group will determine whether problems can be resolved using the Group’sinternal resources or whether they need to be referred to the Information Technology Unit (e.g. hardware

and network issues not specific to IDER-critical information systems). These issues include but are not

limited to malfunction or failure of file/application servers, network devices, printers, and desktop

productivity applications such as email and word processing. The Applications Support Group will

directly resolve technical issues associated with IDER-critical information systems including software

application settings or internal links between database tables that drive the information system. The

Applications Support Group will rely on their own technical expertise and strong familiarity with the

information systems to diagnose and determine the most efficient solutions to technical problems.

Database design, creation and maintenance. The collection and analysis of infectious disease outbreak

data is integral to the response. The Applications Support Group will collaborate closely with the Data

Branch’s Analysis Group to assist in the creation, maintenance, modification of databases. Examples of databases managed by the Group include, but are not limited to, those that store epidemiology and

surveillance, disease containment, and laboratory data.

User account management. The Applications Support Group will maintain control of user accounts for

IDER-critical information systems where applicable. The Group will create, assign and/or modify accesslevels of user accounts for database-driven applications as well as those with a limited number of user

licenses. Where multiple simultaneous emergency responses rely on the same information system (e.g.,

E-Team), the DOC’s Logistics Section may assume the responsibility for user account management. The

Applications Support Group would perform a coordination function between the DOC and IDER

responders who need access to the system.

Report production. Where the output of statistical analyses performed by IDER analysts must bedisseminated to other IDER responders, the Applications Support Group will assist to automate

production of reports and queries.

See Appendix Da, M, and Kb for details on information systems resources that will be needed for various

emergencies.

C. IMPLEMENTATION

a. Applications Support Group

When at least one of the IDER-critical information systems is required for the response the Applications

Support Group should be activated by the Data Branch. If the Data Branch has not been activated then bythe IT Unit in the Logistics Section.

The Applications Support Group consists of a Group Supervisor who oversees Units dedicated to a single

information system or critical computing function such as:

Outbreak management systems. The Communicable Disease and Prevention Section relies on several

database applications to manage its disease control activities. These applications primarily include the

Disease Control Management System (DCMS) and the Emerging Infectious Disease Log (EID Log).

These systems are the precursors of the Integrated Case and Outbreak Management System (ICOMS),




which is a more robust SQL database application currently under development. Once implemented,

ICOMS will be able to support large-scale communicable disease outbreak management, public health

monitoring of cases and their contacts. Like DCMS and EID Log, ICOMS will be a key component of

CDCP’s disease control activities and be a critical part of a large infectious disease emergency. The

Applications Support Group will manage DCMS and EID Log as well as ICOMS when its rollout is

complete.

Strategic Telephone Automatic Response System (STARS). An automatic call distribution system thatsupports the operations of CDCP’s disease reporting and control activities. The system comprises

telecommunications hardware (telephones and PBX switching equipment) and software (call routing

software and statistical reporting software). The Applications Support Group will provide support with

STARS reporting software and assist with the production of utilization reports which can be used by end-

users to optimize staffing levels. The group will coordinate with the Information Technology Unit to

troubleshoot hardware issues.

Collaborative Fusion. A web-based system that enables IDER, the DOC, EOC, and/or other responders

to query a city-wide database and identify/recruit response staff for a public emergency. The system

allows emergency managers to track deployment of disaster service workers as well as civilian

volunteers.

MLAB. A laboratory information management system that is primarily utilized by DPH Laboratory for

its day-to-day operations. In an emergency, the Applications Support Group will support and coordinate

access to MLAB to ensure that laboratory testing information are properly managed and reports are

effectively distributed to the appropriate responders. See Appendix J.

Alerting, messaging, and information sharing systems. Several systems may be used to enable the

sharing of information with partner agencies involved in an IDE response:

• EMSystem. EMSystem is an alerting/notification and bed-tracking system managed by DPH EMS

section. The system facilitates the bi-directional dissemination of EMS data, including patient data

and bed availability, between DPH and hospital EDs. EMSystem may also be used to notify key

responders of critical information in the initial stages of an emergency.

• California Health Alert Network (CAHAN). CAHAN is a web-based statewide system managed by the California Department of Public Health. CAHAN allows for inter-jurisdictional sharing of

information and electronic data in large-scale emergencies that may involve multiple counties or

operational areas.

Communicable Disease Control & Prevention (CDCP) Website. The CDCP Section’s website will

become a critical tool for information dissemination to the public in an IDE response. The management

of website content is handled via a web-based template tool running on a Cold Fusion platform. The

Application Support Group will provide technical support for the posting/editing of web pages and

uploading of electronic documents. See Appendix Da3.

Health Alert Notification Database (HAND) and blast fax system. A multi-user accessible database

application that manages the dissemination of Health Alerts/Advisories/Updates to San Francisco’sclinical community including physicians, EMS providers, clinical laboratories, and allied health

professionals. This tool is a critical component of the emergency response’s public information and

communications system. DPH’s health alerts or other guidelines may be disseminated to clinicians using

HAND in conjunction with multiple fax servers. The Application Support Group will assist with the

generation of fax send lists and coordinate the dissemination via commercial blast fax services or CDCP’s

own fax server. See Appendix Da for instructions.

Resource Tracking System. A multi-user accessible database application that tracks the request,

assignment and deployment of resources by IDER responders. This system will be used primarily by the




Logistics Section and Plans Sections to manage material and human resources used in the response. This

system will likely be used to varying degrees in all IDER activations.

Field data transmission. In responses where field investigation teams are activated, the successful and

secure transmission of data collected in the field to the IDER data repository is a critical component of the

response strategy. The Applications Support Group will prepare the necessary computing resources

required by the field investigation teams to transmit data. The Group will also coordinate with the

Information Technology Unit or the appropriate DOC Logistics personnel to establish the proper transmission protocols and to ensure that the DPH network infrastructure can support the secure

transmission/receipt of field data. This may include installation of Virtual Private Network (VPN)

software and certificates on field laptops, provision of wireless data transmission equipment to field

teams, and management of the firewall and secure ftp server(s). The Group will also manage the

integration of field data into the existing core databases of the relevant information system.

Functions of the Applications Support Group

• Determine the appropriate IT/computing strategies to accomplish response objectives and deploy

information systems to support operational plans.

• Work with the Data Branch’s Analysis Group on database design and maintenance, including ability

to integrate data from multiple sources, linkage of case and contact databases.

• Provide technical assistance to merge, append, and/or concatenate data transmitted electronicallyfrom various partner agencies or from field investigation teams.

• Receive and triage technical support issues for users of IDER-critical information systems.

Coordinate support with Information Technology Unit.

a.1. Appl ications Support Units

The Applications Support Unit should be activated when at least one IDER-critical information system

(see list above) is required to support response activities.

The Applications Support Group supervisor can activate specific Applications Support Units to provide

support for each information system utilized in the response. Each Applications Support Unit comprises,

one or more individuals with technical expertise and significant familiarity with the information system

Functions of the Applications Support Group

• Provide technical assistance to modules on IDER-critical information systems.

D. STAFF POSITIONS


Staff Position Roster: Application Support Group

Job Title Task Overview JobClassification No. of Employees Location

Applications Support GroupSupervisor

Coordinate and manage theApplications Support Group and unitswithin the group. Decide on strategy

to manage computing resources.

IT administrator 1 IDER Command




Staff Position Roster: App lication Support Team



Employees LocationApplications Support Unit Staff Manage individual IDER information

systems. Assist Analysis Group and other IDER responders with

maintenance of database(s), datatransmission, manage system user

accounts and access, and respond totechnical support queries.

IT specialist,technical

expertise with

specificinformation

system

IDER Command

E. REPORTING

The Applications Support Group reports directly to the Data Branch Director or the IT Unit in the

Logistics Section if the Data Branch has not been activated. Information about the information systems

will also be provided to the Analysis Group or other IDER responders as needed.

F. DELIVERABLES

The Group is responsible for producing the following:

• IT resource utilization plans

• Creation of database(s) where they pertain to IDER-critical information systems

• User accounts and access rights for IDER-critical information systems




G. RESOURCES


a

. Protocols, forms, guidelines, and MOUs

Items Location


Template Application Support Group Status Report Appendix Ka12

Data Systems



Description and Location of Existing SFDPH Databases & Programs Appendix Kb3 The Basics of DCMS: User Guide and Technical Documentation Appendix Kb4

Information Systems

STARS Operation Manual Appendix M7

How to set-up a satellite and record a satellite broadcast Appendix M 9

Collaborative Fusion Instructions Appendix M 11

Information Dissemination Systems

HAND instructions Appendix Da1

Blast Fax instructions for SFDPH system and for commercial system Appendix Da2





H site & for CDCP siteWeb posting instructions for main SFDP Appendix Da3

Bulk E-mail Dissemination Instructions Appendix Da5

Phone Bank Instructions Appendix Da6

Lab Systems

LIMS software instruction manual Appendix J3

MLAB Access Instructions Appendix J13


Required ReItems

Units Location or

quest From









25. CONTINUITY OF OPERATIONS BRANCH


Epidemiology and

Surveillance Branch

Data Branch

Laboratory Branch

Communicable

Disease Information

Continuity of

O erations Branch

Disease Containment

Branch

Operations Section

B. DESCRIPTION


The Continuity of Operations Branch ensures that communicable disease control and prevention mission

critical activities are addressed when CDCP staff levels are minimal due to an IDER response. The

Branch objectives include:

• Investigate reports of communicable disease that cause severe morbidity or mortality or that are prone

to epidemic spread.

• Implement disease control measures for disease(s) that are easily transmitted and are likely to cause

an outbreak.

• Maintain and prioritize other CDCP activities as necessary.

b. Methods

The Continuity of Operations Branch will rely on the following methods to meet objectives.

Passive Surveillance. Passive surveillance reports will be investigated to detect cases or outbreaks of communicable disease.

Disease Control. The Continuity of Operations Section will make disease control recommendations (e.g.

treatment, prophylaxis, infection control) and implement as needed and able for preventing or containing

communicable diseases or outbreaks separate from the initial IDE event/response.

IDER Plan: Operations Section/Continuity of Operations Branch, Page 1/4 Draft 10/07



C. IMPLEMENTATION

a.1. Continuity of Operations Branch

Activate the Continuity of Operations Branch for all IDER activations.

Staffing. Depending on the scale of the response, the Continuity of Operations Branch may include 2

individuals or may include most CDCP staff. Personnel assigned to the Continuity of Operations Branchshould include CDCP staff and if possible, individuals who regularly carry out prioritized activities. A

clinician consultant (or on-call MD) should be identified to support communicable disease control

activities. Preferably this person will not be involved in the emergency response; however, personnel in

the Clinician Consultation Unit, Treatment and Prophylaxis Unit, Infection Control Unit, or other module

with disease control experience can also be assigned to support the Continuity of Operations Branch.

Priorities for the Continuity of Operations Branch will depend on the scale of the response and available

CDCP staff and may include:

• Small IDER Activations. For responses that include a minimal number of CDCP personnel, the

Continuity of Operations Branch Director will be responsible for maintaining mission critical and

many of CDCP’s daily activities. Federal, State, and Local regulation compliance should bemaintained.

• Large IDER Activations. For IDER activations requiring all, or the majority of CDCP staff, mission

critical disease control activities (see the list of mission critical diseases in Appendix L2) and other

key CDCP activities (e.g., flu vaccination clinics, grant renewals) identified during activation will be

prioritized. Passive surveillance will be maintained and utilized to identify cases or outbreaks of non-

emergency related disease. As able, the Continuity of Operations Branch will carry out non-

emergency related restriction, exclusion, and clearance procedures for persons in sensitive

occupations or situations as required by State regulation (California Code of Regulations, Title 17)

and handle specimen collection and laboratory testing prioritization issues for the cases under its

purview.

For both small and large IDER Activations the Continuity of Operations Branch Director will oversee

CDCP managers and/or unit personnel and participate in IDER Operations Section meetings and provide

updates regarding mission critical activities.

When additional material or personnel support is required to carry out mission critical activities or an

additional infectious disease emergency has been identified, the Continuity of Operations Branch should

provide a situational update and request assistance immediately. The Operations Section Chief and

Incident Commander will determine whether 1) to re-direct resources out of the response to assist with the

continuity of operations; 2) to have the IDER response assist with continuity of operations functions; or,

3) to expand the scope of the response to include an additional infectious disease emergency response.

Functions of Continuity of Operations Branch Director • Ensure that all Continuity of Operations Branch personnel have checked in at the Staff Staging Area.

• Monitor calls and faxes to the Communicable Disease Control Unit.

• Identify critical cases or outbreaks named in the list of mission critical diseases, Appendix L2.

• Obtain mission critical activities identified during the activation and notification conference call.

Continue to identify critical CDCP Unit activities throughout the response.

• Provide public health recommendations to treat or contain spread of disease. Carry out restriction,

exclusion, and clearance activities, manage lab specimens, and write Health Alerts as needed or

request assistance.




• Update the Operations Section Chief on issues, projects, and vital non-IDE response activities

requiring additional staff or resources.

• Develop a recovery plan to manage disease reports and other issues that are being deprioritized during

the acute phase of the response (e.g., tracking log, extended timelines).

D. STAFF POSITIONS





Employees Location

Continuity of Operations BranchDirector

Manage disease control activities notrelated to the emergency event.

Manage Disease Control telephone line phones, triage calls, interview cases.

Identify other high-priority

communicable disease control, prevention and preparedness activities

that must continue during the event.

Disease ControlExperience.Managementexperience.

CDCP Staff.

1 IDER Command

Communicable Disease ControlStaff

Manage Disease Control telephoneline, triage calls, interview cases.

Conduct phoneinterview of clients &

clinicians.Fill out forms.Data entry.

101 Grove

Communicable Disease Control

Medical Epidemiology Consultant

Provide medical and epidemiology

advice. Recommend public healthactions to control the disease. May beon-call.

MD with diseasecontrolexperience.

101 Grove

Administrative Assistant Provide administrative supportincluding note taking, phone messages,sending and receiving faxes,

modifying documents.

1 101 Grove

E. REPORTING

The Continuity of Operations Branch Director reports directly to the Operations Section Chief.

F. DELIVERABLES

The Continuity of Operations Branch is responsible for producing:



G. RESOURCES







Items Location


CDCU Protocols and Forms Appendix L1

CD Control Medical Epidemiologist Notification of Mission Critical Diseases Appendix L2


ItemsUnits

Required

Location or

Request From



Computer with local network, internet access, access to s:\Confidential Data 1+ Logistics






26. LOGISTICS SECTION


Personnel Unit Information

Technolo Unit

Supplies Unit Communication

E ui ment Unit

Pharmaceuticals &

Medical Supplies Sub-Unit

Outside Pharmaceutical &

Medical Supplies

Local Pharmaceutical

Caches

Facility Cache Homeland Security

Local Cache

Staff Staging Area

Operations Section Logistics Section Finance SectionPlans Section

Application Support

Receipt, Stage,

Store Warehouse

IDER Commander

B. DESCRIPTION


The purpose of the Logistics Section is to locate or request the supplies and personnel needed to support

the IDER response and IDER responders, and then to direct these resources to the appropriate staging

area. The Section will also ensure that communications and information technology infrastructure is

functioning and interoperable. Logistics Section objectives include:

• Receive and fulfill personnel requests.

• Receive and fulfill supplies.

• Track inventory of supplies and personnel.

• Set up, maintain, troubleshoot and repair communications and information technology equipment for

the response.

• Liaise with the DOC Logistics Section (or OPP if the DOC has not been activated) to obtain supply

and personnel resources that exceed CDCP and Lab capabilities.

b. Methods

Logistics methods utilized to achieve objectives include:

Supply Systems. The Supplies Unit will primarily draw upon CDCP and Lab supplies. The Supplies

Unit will refer to the appropriate protocols, plans and MOUs to fulfill large order requests such as

supplies for mass prophylaxis such as the Strategic National Stockpile. All supply requests that cannot be

filled by the IDER Logistics Section will be forwarded to the DOC Logistics Section.

IDER Plan: Logistics Section, Page 1/4 Draft 10/07



Personnel Recruitment. The Personnel Unit will confer with CDCP and Lab managers and Continuity

of Operations Branch Director to obtain assistance from CDCP/Lab staff. For activations requiring

additional personnel, the Personnel Unit will coordinate with the DOC and may utilize Collaborative

Fusion to manage the staffing needs of the response. Additional personnel may include other DPH

employees, City and County of San Francisco employees from other departments, and/or civilian

volunteers to meet the needs of the response.

Communications and Information Technology Systems. The Communications and InformationTechnology Unit will ensure that redundant communications and information technology systems are set

up and functioning as outlined in the resource needs section of each activated IDER plan module. The

Communications Equipment Unit and the Information Technology Unit will request assistance from the

DOC Logistics Section for repairs and troubleshooting which cannot be handled within the IDER

Logistics Section.

Consult the Logistics Section unit modules of the IDER plan for details regarding the above methods.

C. IMPLEMENTATION

a. Logistics Section

Activate the Logistics Section and all supporting Units immediately upon activation of IDER.

The Logistics Section oversees all response-related requests for personnel and equipment and to set-up

communications and computer equipment for the response. A CDCP set-up crew may be in process of

setting up rooms for an IDER activation. Once Logistics Section responders have been signed-in this

Section should assume set-up responsibility.

The Logistics Sections Chief oversees all Section activities and is responsible for receiving and fulfilling

logistics requests. The Logistics Section Chief determines which resources require Incident Commander,

Section Chief, or Branch Director approval and ensures that responders are made aware of requirements.

(Approval requirements can be changed during the incident if needed.)

Consider requiring Incident Commander/Section Chief/Branch Director Approval for:

• Personnel

• Non IDER Assets (e.g. items owned by DPH, other city agency)

• Large assets requiring logistical support (e.g. POD/RSS Trailers)

Consider not requiring approval for:

• Office Supplies

• Computers

• Communication Supplies

Functions of the Logistics Section• Oversee all Section activities.

• Attend Command/General Staff meetings.

• Provide logistical input to the Incident Commander and Plans Section in preparing the Incident

Action Plan.

• Brief Unit Leaders on the situation and their roles and responsibilities for the operational period.

• Provide oversight and guidance to Unit Leaders (e.g. answer questions, address problems, make

decisions in keeping with the Section’s operational objectives, and determine which problems,

requests or questions need further approval.)




• Prepare the Logistics Section Situation Status Update using information from the Logistics Unit(s)

Situation Status Updates.

• Anticipate logistics requirements.

• Request and coordinate with the DOC or OPP for additional resources.

D. STAFF POSITIONS





Employees Location

Logistics Section Chief Supervise Logistics activities, assignresponsibilities, orient staff and serve

as a resource to all staff in theLogistics Section.

Experience infacilities, IT,telecom, or HR.

1 IDER Command

Logistics Section Deputy Support the Logistics Section Chief tocarry out duties.

IDER Command

Administrative Assistant Perform administrative duties to assistthe Chief in the production of the

Logistics Section Situation Status and Resource Status Reports, documentingactions, taking notes at meetings and other duties as assigned.

1 IDER Command

E. REPORTING

The Logistics Section Chief will report to the Incident Commander.

F. DELIVERABLES

The Logistics Section is responsible for producing the following:




• Logistics Resource Status Reports.

• Any response documents and/or products assigned to active Units within the Logistics Section.

G. RESOURCES

The following resources will be required to perform minimum response operations. See Logistics Section

Unit modules for resources required by each Unit.


Items Location










Separation from Normal Work Duties Checklist Appendix M5

Copy machine instructions Appendix M6


DPH MIS department call list Appendix M8

How to set-up a satellite and record a satellite broadcast Appendix M9IDER e-mail information Appendix M10


Staff Staging Area Manual Appendix M12

800 Mhz Radio Operating Instructions Appendix M13

Radio Frequency Inventory and Talk Group Assignment Protocol Appendix M14

IDER Set Up Manual (includes phone and data ports in 101 Grove) Appendix M15

Phone Bank Manual Appendix M16


ItemsUnits

Required

Location or

Request From








27. PERSONNEL UNIT

A. ORGANIZATION CHART UPDATE CHART

Logistics Section


Technolo Unit


E ui ment Unit

Application SupportPharmaceuticals &



Medical Supplies


Caches


Local Cache

Staff Staging Area

Receipt, Stage,

Store Warehouse

IDER Commander

B. DESCRIPTION


The purpose of the Personnel Unit is to ensure that the IDER operation has adequate staffing for all

activated functions and that responders have been checked-in, oriented, deployed, and tracked. The

Personnel Unit’s objectives are to:

• Receive personnel requests.

• Recruit personnel.

• Assign personnel to open positions.

• Manage the Staff Staging Area to check-in/out personnel, provide basic orientation (e.g. overview of

emergency situation, ICS framework, who staff should report to, training for activities common to

most IDER responders), and deploy personnel to assigned areas.

• Update the Resource Status Unit and tracking databases (Resource Tracking System and

Collaborative Fusion) on the status of personnel requests.

• Track personnel recruited for and deployed to the response.

Personnel and supplies designated for Points of Dispensing sites (PODs) will have a specific POD

Staging Area and are not addressed in this section.

b. Methods

The Personnel Unit will draw upon the following resources to achieve objectives:

IDER Plan: Logistics Section/Personnel Unit, Page 1/5 Draft 10/07



Collaborative Fusion. Collaborative Fusion is a software system that facilitates the recruitment, skill

assessment, assignment, training and tracking of City and County of San Francisco workers and

volunteers during an emergency response.

Resource Tracking System. The Personnel Unit and Staff Staging Area will update assignment and

location of personnel in the Resource Tracking System. The Resources Unit in the Plans Section, and the

Supplies Unit in the Logistics Section will have administrative access to the system. Other IDER

responders may be able to view, but not update, the status of resources using the electronic system.

Staffing Sources. Personnel can be recruited from the following sources to fill IDER positions:

• CDCP/Laboratory Staff. Requests for staff to participate in the response should be made to the

Section Chiefs and then to Unit Managers or their designee in consultation with the Continuity of

Operations Branch Director in the Operations Section.

• San Francisco Department of Public Health Staff. All DPH employees are Disaster Service

Workers. If the DOC has been activated to coordinate the activities of multiple incidents, the DOC

Logistics Section is responsible for the recruitment of staff from DPH sections. In a small-scale

IDER incident without DOC activation, the IDER Personnel Unit will coordinate with DPH Office of

Policy and Planning and Human Resources to recruit DPH staff.

• City Agency Staff and Community Volunteers. All City Agency employees are Disaster Service

Workers. The EOC Logistics Section is responsible for the recruitment of City staff other than DPHemployees and community volunteers. The DOC/OPP will request assistance from the EOC on

personnel recruitment as needed.

Staff Staging Area. Responders arriving to the work in the emergency will sign-in at the Staff Staging

Area, receive key supplies, a brief orientation to the incident and response, personal protective equipment

training (if needed), and transportation to off-site locations.

Orientation. All personnel reporting to the Staff Staging Area will be provided with a orientation on the

infectious disease emergency event, response activities, incident action plan, the ICS organizational

structure, and where and to whom they will be reporting. Other training may be incorporated as needed

(e.g. PPE). Job specific training will take place at the work station.

Deployment. Personnel will be deployed by the Staff Staging Area to their assignments. The Logistics

Section may need to coordinate necessary transportation and request transportation via the DOC.

C. IMPLEMENTATION

a. Personnel Unit

Activate the Personnel Unit following activation of the IDER plan.

Personnel Requests. Personnel requests may be received throughout the Operational Period via the

Resource Tracking System, phone call, radio, in person communications, written requests, or email.Personnel needs may also be identified in update meetings. Requests should include the following

information: position name, job classification required (if known) or key job functions, job action sheet (if

available), time and date when staff is required, length of time staff is required, work location.

Recruitment. The following recruitment process should be utilized:

1. Ensure that necessary information has been provided by the original requestor.

2. First consider recruiting individuals from the CDCP and Laboratory.




a. If the Continuity of Operations Branch is activated, the Personnel Unit should consult the

Continuity of Operations Branch Director regarding reassignment of staff to work on the response

for a specified duration.

b. The Personnel Unit will ask the CDCP and Laboratory Directors to notify their section staff

regarding section project priorities and announce all work reassignments for the response.

c. The Personnel Unit will review the Separation from Normal Work Duties Checklist (Appendix

X) with the recruited staff before instructing them to report to the Staff Staging Area.

3. If staff are unavailable from the CDCP or Lab submit request to the DOC Logistics Section (or OPPand DHR if the DOC is not activated). (The DOC will request assistance from the EOC with

volunteer recruitment and/or any positions that can not be filled by the DOC.)

4. Update the Resource Tracking System regularly regarding the status of personnel recruitment.

Functions of the Personnel Unit

• Receive personnel requests.

• Fulfill personnel request either internally within CDCP/Laboratory or request personnel via the DOC.

• When personnel requests exceed available responders, prioritize staffing requests based on the

Operations Chief guidance.

• Update the Resource Tracking System and Collaborative Fusion on the status of personnel.

• Ensure that recruited personnel are given instructions on when and where to report for duty.

• Maintain a list of all personnel participating in the response each operational period and submit to the plans section.

a.1. Staff Staging Area

Activate the Staff Staging Team when:

• Numerous personnel external to CDCP will be assisting with the response, OR

• Large numbers of CDCP or Laboratory personnel will be assisting in the response.

The Staff Staging Team staff will be responsible for signing-in/out, assigning, issuing supplies, orienting,

and deploying personnel.

Sign-in. Responders will be required to sign-in at the beginning of an event and prior to a new

assignment. Responders will be checked-into Collaborative Fusion using a machine that will scan their

Disaster Service Worker ID badge or will be manually signed into the system by a staff person. For

assignments that run over multiple operational periods, personnel will initially sign-in (use ICS Form 211,

Appendix A9) at the Staff Staging Area. Subsequent sign-ins will occur at the work station via a sign-in

sheet or per the supervisors directions (the Personnel Unit will be responsible for collecting and logging

sign-in sheets).

Assignment. The program Collaborative Fusion will be utilized to assign registered personnel into

positions matched to their skills. The program will also be used to track responder assignments and the

number of hours worked.

Orientation. At the Staff Staging Area responders will receive an orientation that includes common

training themes required by all responders. This may include information on the Incident Action Plan,

safety notices, how to use information or communication technology, ICS fundamentals, how to request

supplies and staff via the Resource Tracking System or paper system, and other common needs (e.g. PPE

if needed). Job specific training will normally take place at the assigned work site. The Staff Staging

Area will include a briefing board where the Incident Action Plan, safety notices, and incident

information can be posted.




Deployment. Responders will be provided with instruction on how to get to their assigned work site. If

the work site is far away, transportation will be coordinated and provided by the Staff Staging Area.

The Staff Staging Team will be responsible for updating Collaborative Fusion utilized to track the

location and status of personnel. See Appendix M11, Collaborative Fusion Instructions.

Functions of the Staff Staging Team

• Sign-in responders.• Update Collaborative Fusion with any changes in personnel status.

• Assign personnel arriving to the Staging Area who meet qualifications for open positions.

• Provide orientation to all staff.

• Update the orientation procedure when necessary.

• Coordinate transportation for staff deployed to distant sites with Supplies Unit.

• Maintain Staging Area in an orderly condition.

D. STAFF POSITIONS


Staff Position Roster: Personnel Unit



Employees Location

Personnel Unit Leader Assign responsibilities, reviews and approves all personnel requests,

primary point of contact for PersonnelUnit at DOC regarding external staff recruitment, update Section Leaders on

request status

Experience inHR recruiting,

CollaborativeFusion

1 IDER Core

Personnel Unit Staff Compile personnel requests, clarify

skills for requested personnel, recruit personnel, liaison with Staging Area

Intake Coordinator, processcompensation forms.

HR experiencein staff recruiting

IDER Core

Staff Position Roster: Staff Staging Area



Employees Location

Staff Staging Area Manager Oversee the Staff Staging Area. 1 Staff Staging

Area

Staff Staging Area Member Work at one of the Staff Staging Areastations (e.g. sign-in and assignment,supplies, IT, communications,

orientation, deployment)

10+ Staff Staging

Area

PPE Training Staff Train responders to use PPE

recommended by the Safety Officer

Staff Staging

Area

E. REPORTING

The Personnel Unit Leader reports directly to the Logistics Section Chief.





F. DELIVERABLES

The Personnel Unit is responsible for producing the following:

• Personnel List with Assignment (for each Operational Period)

• Injury or compensation claims log

• Personnel Summary from the Resource Tracking System or Collaborative Fusion (to include requestsmade, personnel recruited, staff checked-in/out, staff deployed)




• Sign-in List, ICS Form 211

• Staff Staging Area Logs (see Staff Staging Area, Appendix M12)

G. RESOURCES



Items Location




Separation from Normal Work Duties Checklist Appendix M5

IDER e-mail information Appendix M10


Staff Staging Area Manual Appendix M12


ItemsUnits

Required

Location or

Request From








ItemsNo.

Required

Location or

Request From

Transportation (if staff must be deployed to other sites) 1 Logistics



28. SUPPLIES UNIT


Logistics Section


Technolo UnitSupplies Unit Communication

E ui ment Unit




Medical Supplies


Caches


Local Cache

Staff Staging Area

Receipt, Stage,

Store Warehouse

IDER Commander

B. DESCRIPTION


The purpose of the Supplies Unit is to ensure that there is an adequate supply of materials and equipment

to carry out necessary response activities. The Supplies Unit objectives include:

• Receive supply requests and fill them.• Procure, receive, check-in/out, and coordinate the delivery of supplies.

• Update the status of supplies in the Resource Tracking System or other log.

• Service reusable equipment (not including communications and computer equipment).

• Return reusable supplies to appropriate locations.

• Activate the Pharmaceutical and Medical Supplies Sub Unit.

b. Methods

The Supplies Unit will exhaust CDCP/Lab resources before requesting items from the DOC. Resources

used by the Supplies Unit include:

IDER Supply Cache. The IDER response will primarily make use of a core cache of supplies that have

been pre-positioned specifically for an IDER activation. See CDCP Inventory in Appendix M3. This

supply should be exhausted before new supplies are purchased or requested through the DOC or other

sources.

CDCP/Laboratory supplies. Supplies owned by CDCP and the Laboratory for an IDER response and

everyday operations will be utilized in an IDER activation and tracked. Consult the Continuity of

Operations Branch to determine what CDCP/Lab supplies may be dedicated to the incident response.

Appendix M3 contains an inventory of existing CDCP supplies.

IDER Plan: Logistics Section/Supply Unit, Page 1/4 Draft 10/07



Departmental/City supplies. Supplies purchased by DPH and other city agencies for disaster

preparedness and homeland security can supplement the CDCP/Lab cache in a response. These supplies

may be accessed by the Logistics Section Supplies Unit by making a supplies request to the DOC/EOC.

Departmental supplies include city cars, infection control supplies, communications equipment, etc. In

the event that a request for resources and supplies cannot be fulfilled by the DOC or EOC through

existing inventory, the IDER Logistics Chief should consult with the DOC Logistics Chief to determine if

supplies should be purchased. If the DOC is not activated, the Logistics Section Supplies Unit will need to request supplies from DPH or consider purchasing new supplies.

Purchase of new supplies. In the event that a supply request cannot be met by internal resources, the

DOC Logistics Section Chief and IDER Logistics Section Chief will discuss the most appropriate

procurement mechanism. If the commodities in question are likely to be required by multiple

simultaneous incidents which the DOC is coordinating, then the responsibility for purchasing rests with

the DOC Finance Section. If the IDE response is the only incident that needs to use those commodities or

the DOC has not been activated, then the IDER Finance Section’s Procurement Unit will be responsible

for purchasing them. Standard purchasing rules should be followed unless a state of emergency has been

declared and emergency procurement procedures take effect.

C. IMPLEMENTATION

a. Supplies Unit

The Supplies Unit should be activated immediately upon activation of IDER.

The Supplies Unit is responsible for obtaining existing, or requesting the purchase of additional supplies

to support response functions. Examples of supplies include:

• Office supplies

• IT/IS equipment (e.g. telephones, computers, 800 MHz radios)

• Laboratory Supplies• Pharmaceutical and medical supplies (including personal protective equipment)

• Food and sustenance

• Disease control supplies

Receiving a request. All response staff should be briefed on the process for making supply requests

during their orientation at the Staff Staging Area. Supply requests should be made via the Resource

Tracking System (Appendix M1) after approval from a Section Chief or Branch Director. Supplies Unit

staff will update the database periodically to show the status of the request fulfillment. Responders may

check on the status of the resource request by accessing this database or contacting the Supplies Unit.

Filling a supply request. Follow these steps:

1. Clarify with the requester or the approver if the necessary information is not provided. The requestshould specify the type of equipment, quantities needed, time when supplies need to be delivered,

delivery point of contact, and location.

2. Consult the CDCP Inventory (Appendices M3) to check if supplies are available. If available, consult

the Continuity of Operations Branch to ensure that mobilizing these supplies will not interfere with

routine operations.

3. If pharmaceutical and medical supplies are needed to support the response, activate the

Pharmaceutical and Medical Supplies Sub-Unit.

4. If the supplies are not available internally, the Supplies Unit leader or Logistics Chief will request the

item through the DOC (or OPP if the DOC has not been activated).




5. If requested supplies are not available through the DOC/EOC, consult with the DOC Logistics Chief

to determine whether:

a. The item(s) should be purchased using DPH DOC funds, or

b. The item(s) should be purchased through the IDER Finance Section Procurement Unit. (If

purchasing responsibility rests with the IDER Finance Section, consult with the Procurement Unit

to prepare a purchase order for the requested supplies.

6. Update the Resource Tracking System with the request disposition. If the supply could not be

procured, directly update the requesting Section Chief or Branch Director.

Distributing and tracking the deployment of supplies. The Supplies Unit will serve as the delivery

point of contact for all procured resources and will note their delivery in the Resource Tracking System

(include the type, quantity, and distribution location of the supplies). Contact the requestor to determine

the delivery location (e.g. POD, a specific room in a building). Deliver the supplies using runners or

specialized personnel (e.g. an accompanying pharmacist and security detail for pharmaceutical products),

as necessary. The Supplies Unit will update the delivery and final disposition of the supply in the

Resource Tracking System.

Collecting reusable supplies for future use. Supplies that are mobilized for the response, but no longer

needed, should be returned to the Supplies Unit.

Maintenance of supplies. With the exception of communications and computer equipment, the Supplies

Unit is responsible for restoring reusable supplies to useable condition. For example, if a “spent” Epi Go-

Kit is returned to the Supplies Unit during a response, Supplies Unit staff are responsible for

appropriately restocking the Go-Kit contents so that it is ready for redeployment.

Functions of the Supplies Unit

• Receive supplies requests.

• Identify IDER, CDCP, DOC, EOC supplies or purchase supplies if they are not available.

• Receive, sign-in/out, store, distribute, and track supplies.

• Update the IDER Resource Tracking System on the status of supply requests.

• Maintain an updated inventory list of materials and equipment assigned.

• Service reusable equipment (except communications and computer equipment).

D. STAFF POSITIONS





Employees Location

Supplies Unit Leader Assigns responsibilities, reviews and

approves all supply requests, contact

for Supplies Unit at DOC, work withFinance Section Procurement & CostUnit to purchase supplies

Materialsmanagement

experience

1 IDER Command

Supplies Unit Staff Compile and fulfill supplies requests,

clarify requests, check-in/out supplies,track items, update the ResourceTracking System or log, servicereusable equipment, coordinate

transportation of supplies to site.

Materialsmanagementexperience

IDER Command

Supplies Unit Runner Delivers supplies, note deliverydisposition

No essentialskills

1 IDER Command





E. REPORTING

The Supplies Unit Leader reports directly to the Logistics Section Chief.

F. DELIVERABLES

The Supplies Branch Director is responsible for producing the following:

• Resource Tracking System Supply Summery or Supplies Inventory List




G. RESOURCES



Items Location






How to set-up a satellite and record a satellite broadcast Appendix M9



ItemsUnits

Required

Location or

Request From








ItemsNo.

Required

Location or

Request From

Transportation (if supplies must be deployed to other sites) Logistics/DOC

Dolly for deliveries 1 Logistics



29. PHARMACEUTICALS AND MEDICAL SUPPLIES


Logistics Section


Technolo Unit


E ui ment Unit

Application SupportPharmaceuticals & Medical

Supplies Sub-Unit

Outside Pharmaceutical& Medical Su lies

Local PharmaceuticalCaches


Local Cache

Staff Staging Area

Receipt, Stage, Store

Warehouse

IDER Commander

*See Appendix P for RSS Organizational Chart.

B. DESCRIPTION


The purpose of Pharmaceuticals and Medical Supplies under the Supplies Unit is to provide

pharmaceutical and medical supplies. The objectives of the unit are to:

• Mobilize and ensure distribution of local pharmaceutical caches.

• Receive, store, and stage pharmaceutical supplies received from external resources.

• Manage pharmaceutical supplies relevant to an infectious disease emergency.

• Ready shipments for distribution to dispensing sites.

• Monitor and communicate status of pharmaceuticals and medical supplies.

• Ensure the proper storage and security of medications and supplies.

• Assist with assessment of local pharmaceutical resources.

• Request supplies when local resources are exhausted.

The deployment of pharmaceutical supplies for a non biologic event (e.g. chemical or other) is not

addressed in this plan.

b. Methods

The Pharmacy Unit manages and distributes local caches and assesses the need for and requests external

pharmaceutical and medical supplies. Supply sources include:

IDER Plan: Logistics Section/Pharmaceutical & Medical Supplies, Page 1/9 Draft 10/07



Homeland Security Cache (HLS Cache). The HLS Cache is a local San Francisco resource earmarked

for distribution to first responders and their families, and potentially to a limited number of first victims

within the first hours and days of a public health emergency event. See Appendix P for HLS Cache

Inventory. The contents are primarily packaged in bulk containers and will require repackaging into

individual dosage units. Once the contents are readied for distribution they will be provided to recipients

at specifically designated locations (see Appendix P). The deployment of pharmaceutical supplies for a

non biologic event (e.g. chemical or other) is not addressed in this plan.

Facility Cache Program. The Facility Cache Program is a local San Francisco resource and provides

participating SF hospital’s patients, staff, and their families with a cache of antibiotics sufficient to

provide post exposure prophylaxis for 72 hours for specific infectious disease emergencies (See Appendix

X for SF Hospital Participation in Facility Cache Program). See Appendix P for details regarding Facility

Cache Storage and Inventory. Patient drug information sheets are included in each cart. The cache is

stored in bulk form and will require repackaging for individual distribution. Each hospital will be

responsible for repackaging. The caches are reviewed on a regular basis by DPH staff to ensure proper

rotation to avoid expired drugs. The cache should only be opened under the direction of the Health

Officer, IDER Incident Commander, or designee.

Strategic National Stockpile (SNS) Program. The SNS is a multi-tiered national program organized for

flexible response to provide needed pharmaceuticals (including antibiotics), vaccines, antidotes, lifesupport medications, IV administration, medical/surgical supplies, and airway maintenance supplies. The

antibiotics and vaccines within the SNS are likely to be used in an infectious disease emergency requiring

distribution of post exposure prophylaxis or treatment. The SNS (in the form of the 12 Hour Push

Package or Managed Inventory) will arrive via the State at the local RSS Warehouse where it must be

received, staged and stored to ready it for distribution to Points of Dispensing (PODs), treatment centers,and other localities. Details on the SNS are included in Appendix P.

Donations. Donations by pharmaceutical and medical supply companies and other sources may be

offered in the event of a large scale emergency. In order for these resources to be useful, they may

require classification, inventory and organization, and temporary surge space.

Wholesalers. Requests for assistance may be made to drug wholesalers in the event of an emergency.(Their inventory may be reserved for use by the region, State or Federal stockpile programs, so they

should not be considered a dependable resource.)

C. IMPLEMENTATION

a. Pharmaceuticals and Medical Supplies

Activate the Pharmaceuticals and Medical Supplies when the Logistics Section receives a request for

pharmaceuticals or medical supplies and/or a request is anticipated.

The local caches should be accessed first to provide immediate prophylaxis and/or treatment to firstresponders, their family members and a limited number of initial victims. If the incident is of a larger

scale, and the local caches are inadequate to provide the necessary resources, external resources (e.g.

SNS, wholesale supplies, donations) should be requested immediately (or a minimum of 12 hours prior to

desired delivery) through the California SEMS process via the DPH DOC & EOC. Preparations at the

RSS should begin immediately to receive the requested supplies.

Functions

• Identify if local and/or external pharmaceutical resources and medical supplies are required to fill the

request.




• Initiate or forward the request for external resources.

• Provide updates to the Supplies Unit.

• Oversee the handling and distribution of supplies.

• Monitor and track inventory.

• Assess ongoing needs and potential need for additional requests

a.1. Local Caches

a.1.1. Homeland Securi ty Cache (HLS Cache)

Activate the HLS Cache as the primary source of pharmaceutical resources when:

1. The Logistics Branch’s Supplies Unit has received a request for antibiotics, AND

2. The type of requested prophylaxis or medication is available in the HLS Cache, (see Appendix P for

list of contents), AND

3. The Incident Commander approves the use of the HLS Cache.

Local Cache contents are primarily packaged in bulk and will require repackaging into individual dosage

units. Once the contents are readied for distribution they will need to be transported to specifically

designated locations. Request transportation assistance via the DOC. See Appendix P for Local CacheDeployment Protocol.

Functions

• Access the Local Cache using HLS Cache Deployment Protocol (See Appendix P)

• Repackage pharmaceuticals into individual doses

• Arrange for the safe transport of HLS Cache pharmaceuticals to designated PODs or treatmentcenters

• Load/unload pharmaceuticals

• Ensure the security and appropriate environment for the pharmaceuticals at the storage facility and

throughout deployment and transfer of materials.

• Track inventory and distribution.

a.1.2. Facili ty Cache

The Facility Cache can be utilized in the event of a biologic event when:

1. The type of requested prophylaxis is available in the Facility Cache (see Appendix P for list of

contents), AND

2. The Incident Commander approves distribution of prophylaxis to hospital staff, families, and/or

patients.

The Facility Cache is kept in one or more security carts on site at each hospital under the supervision of

the institution’s Director of Pharmacy (see a listing of participating facilities and cache contents held by

each in Appendix P, SF Hospital Participation in Facility Cache Program). Each hospital pharmacy is

responsible for repackaging their cache into individual unit of use dosing using the labeled envelopes

provided. Patient drug information sheets are included in each cart. Once the Facility Caches are

exhausted, hospital will have to request additional resources through the hospital emergency ICS process.

See Appendix P, Hospital Emergency Incident Command System Protocol.

Functions

• Communicate to hospital pharmacy directors or designees that the Facility Cache may be accessed.




• Provide treatment and/or prophylaxis guidance relevant to the IDE as developed by the CD

Information Branch, Treatment & Prophylaxis Guidance Unit.

a.2. External Pharmaceutical and Medical Supplies

External pharmaceutical and medical supplies should be requested when:

1. The Logistics Branch’s Supplies Unit has received a request for pharmaceuticals or medical supplies,AND

2. Anticipated need for supplies exceeds the Local Caches (HLS Cache, Facility Cache) and/or other

local resources, AND

3. The Incident Commander approves the request of external pharmaceutical and medical supplies

Requesting Resources. Requests for additional resources should be made immediately (or a minimum of

12 hours prior to desired delivery) and immediate preparations should begin at the RSS Warehouse to

receive shipments. Pharmaceutical and medical supplies can be requested through the DOC via the

California SEMS/NIMS process. Potential external sources include the SNS, wholesale supplies, and/or

donations.

Functions

• Initiate or forward request for pharmaceuticals and/or medical supplies.

• Activate the RSS warehouse.

a.2.1. Receipt, Store, and Stage (RSS) Warehouse

Preparations to open the RSS facility should begin immediately or 6 to 12 hours prior to expected receipt

of supplies. See Appendix P for RSS Playbook, RSS Supplies Trailer (see Appendix P for inventorylocation).

• Staging Resources The RSS Warehouse is a location (see Appendix for primary and back-up facility

sites) where large amounts of pharmaceuticals and medical supplies can be delivered, opened, broken

down into smaller amounts and/or re-packaged into individuals doses if not provided in this format,

and packaged for deployment to points of distribution (e.g. mass prophylaxis PODS, hospitals).• SNS 12 Hour Push Package. Contents include a variety of individually packaged doses of pre-

defined pharmaceuticals, antidotes, and medical supplies (See Appendix P for list of contents). 130

numbered and color coded containers will arrive and will need to be broken down for distribution

within San Francisco.

• SNS Managed Inventory. If non-formulary items are requested, re-packaging of supplies into

individual doses at the RSS may be necessary until CDC and/or State re-packaging firms engage.

• Wholesale Supplies. Wholesale goods may arrive in various forms and may need to be organized,

pre-packaged, staged and stored.

• Donations. Donations may arrive in various forms and may need to be organized, pre-packaged,

staged and stored.

Distributing Resources Transportation assistance for pharmaceutical and medical supplies should berequested via the DOC. Check with city attorney via liaison officer to see if it is required that a

pharmacist accompany pharmaceuticals to the distribution site and oversee the unloading and dispensing

of supplies during the emergency. (In an emergency, there may not be enough pharmacists to accompany

each shipment going out,)

Functions

• Prepare RSS warehouse for delivery.

• Receive pharmaceuticals and/or medical supplies.




• Ensure the integrity, proper storage, and maintenance of supplies (e.g. temperature control).

• Repackage supplies as needed.

• Ensure security for staff and supplies.

• Maintain updated inventory.

• Respond to ongoing inventory needs of PODs, treatment centers and other pharmaceutical and

medical supply distribution entities.

• Collect unused inventory for return to State.

D. STAFF POSITIONS


Staff Roster: Pharmaceutical and Medical Suppl ies Sub-Unit



Employees Location

Pharmaceutical and MedicalSupplies Leader

Oversee the request, receipt, storage,staging, and disbursement of

pharmaceuticals and medical supplies

from local and external sources

Experience withmanagement of

pharm/medical

supplies,inventory &tracking systems

1 IDER Command

Staff Roster: Local Pharmaceutical Caches



Employees Location

Local Pharmaceutical CacheLeader

Coordinates the pharmaceuticalresponse including deployment of thelocal caches and request for external

resources.

Pharm tech 1 IDER Command

Staff Roster: HLS Cache



Employees Location

Local Cache Pharmacist Coordinates the pharmaceuticalresponse including deployment of thelocal caches and request for external

resources.

1 IDER

Command,DOC, RSS,or other site

Staff Roster: Facility Cache


Classification

No. of

Employees LocationFacility/Hospital Cache Leader Coordinates the pharmaceutical

response including deployment of thefacility caches and request for additional resources.

PharmD,RPharm

1 IDER Command




Staff Roster: Outs ide Pharmaceutical and Medical Suppl ies



Employees Location

External Pharmaceutical and

Medical Supply Leader

Coordinates the pharmaceutical

response including deployment of thelocal caches and request for externalresources.

PharmD,RPharm

IDER Command

Staff Roster: RSS Warehouse



Employees Location

Site Manager (Incident

Commander)

Supervises the warehouse and assumes

responsibility for receipt, repackaging,and distribution of SNS assets and thereturn of unexpended resources.

1 RSS

Security Officer Responsible for providing site and transportation protection.

4+ RSS

Pharmacy Liaison Create pharmaceutical dispensing plan. 1 RSS

Logistics Section Chief Manages Logistical function of

warehouse.

1 RSS

Operations Section Chief Manages operational function of warehouse.

1 RSS

Inventory Control Specialist Management of SNS assets delivered to the warehouse from the state.

1 RSS

Inventory Control Supply Officer Management of assets apportioned and

returned from dispensing sites.

1 RSS

Data Entry Coordinator Assist Inventory Control Specialist and

Supply Officer in data entry of SNSassets received and apportioned todispensing sites.

2 RSS

Communications Specialist Responsible for warehouse and transportation communicationcapabilities.

1 RSS

Transportation Coordinator Ensure adequate transportation assetsare available to move SNS assets from

the warehouse to dispensing sites.

1 RSS

Vehicle Dispatch Works with TransportationCoordinator to deliver SNS assets to

dispensing sites.

1 RSS

Warehouse Team Leader Overall supervision of operational

workforce group

1 RSS

Workforce Group 4 sections: inspection,

staging/receiving, storage and distribution dock.

20+ RSS

E. REPORTING

Pharmaceuticals and Medical Supplies Sub-Unit reports directly to the Supplies Unit Leader. Inventory

information will be shared with the Disease Containment Branch and the Plans Section. The Mass

Prophylaxis Group will be in contact with Pharmaceuticals and Medical Supplies Sub-Unit to provide

updates on inventory needs and coordinate deployment




F. DELIVERABLES

Pharmaceuticals and Medical Supplies is responsible for producing the following:

• Pharmacutical and Medical Supply Inventory Report




G. RESOURCES



Item Location

Key SF DPH Pharmacist Contact Information Appendix P

List of SFGH Pharmaceutical Deployment Staff Appendix P

Homeland Security Cache (HLS Cache) Appendix P

HLS Cache Deployment Protocol Appendix P

Contents of Local Pharmaceutical Cache Appendix P

SFGH Pharmacy Disaster Phone Tree Appendix P

Physicians Authorized to Release the HS/D Local Pharmaceutical Cache Appendix P

SFGH Plant Diagram Appendix P

Concept of Operations/Capabilities of the San Francisco Homeland

Security/Disaster Pharmaceutical Cache (May 2006)

Appendix P

Facility Cache Documents

Key San Francisco County Hospital Pharmacy Contact Information Appendix P

San Francisco Hospital Participation in Facility Cache Program Appendix P

SNS/RSS Warehouse Documents

Departmental Contacts for RSS Warehouse Planning Appendix PDepartmental Emergency Contacts for RSS Warehouse Appendix P

Departmental Resources Offered for RSS Warehouse Appendix P

EOC Organizational Chart Appendix P

Hospital Emergency Incident Command System Protocol Appendix P

First Responder Distribution Sites for Local Pharmaceutical Stockpile (See Mass

Prophylaxis Plan)

Appendix P

Directory of Contacts – Local, Regional, State, Federal Appendix P

RSS Warehouse Organizational Chart Appendix P

RSS Warehouse Site Checklist Appendix P

Officials Authorized to Sign for SNS Material Including DEA Registrants Appendix P

Suggested Equipment Needs for RSS Warehouse Appendix P

SF Distribution Warehouse Logistical Needs Appendix P

List of Supplies for RSS Warehouse – Appendix PPharmaceutical and Supply Order Form Appendix P

Distribution Warehouse Personnel Resource List Appendix P

SF Distribution Warehouse Personnel and Contact Information Appendix P

Incident Command for the SF Distribution Warehouse Appendix P

DEA Form 222 Appendix P

SNS Transfer Form with Manifest that Identifies the Transferred Materiel Appendix P

Order Form for Ordering Supplies from the SNS (JEOC/State) Appendix P




Inventory Control System Appendix P

Timeline for whole process: Request to Distribution Appendix P

Chain of Custody Form for Narcotics Appendix P

Memoranda of Understanding Appendix P

List of Exercises Attended Appendix P

Draft MOU with RSS Appendix P


ItemsUnits

Required

Location or

Request From







c. RSS Warehouse Resources

Item UnitsRequired

Location orRequest From

800 MHz hand-held radios 2 Logistics

Portable generators with halogen light stand (500 to 1000 watts.) 2 Logistics

Secure lockable cabinet for controlled substances 1 Logistics

4X8 tables 6 Logistics

2X4 tables or 4X4 tables 4 Logistics

Hand trucks-multipurpose 2 Logistics

Chairs, folding or stackable 24 Logistics

Computers 3 Logistics

Printer 1 Logistics

Refrigerator(s) 20 cu. ft. Logistics

Storage racks, 18” X 4” or equivalent 6 Logistics

Situation Board for monitoring transportation and delivery of SNS materiel 1 Logistics

Inflatable air mattresses 12 Logistics

Blankets 12 Logistics

Air pillows 12 Logistics

Air compressor 1 Logistics

Air compressor hose (50 ft.) with 2, blower nozzles 1 Logistics

Osmotic water purifier with portable capability 1 Logistics

Copy machine (with extra printer cartridge) 1 Logistics

Fax/Scanner (with extra refill cartridge) 1 Logistics

Computer Cables 2 Logistics

AM/FM radio for news update 1 Logistics

First Aid Kit 1 Logistics

Rolls of 3” color tape (4colors each) for layout and traffic control 6 LogisticsPartitions for rest area 3 Logistics

55 Gallon trash cans on rollers and liners 6 Logistics

Toolbox with standard tools for emergency repairs 1 Logistics

Computer/Office Equipment Tool Kit 1 Logistics

Bullhorn (battery operated) 1 Logistics

Portable fans (36” minimum) 3 Logistics

Power Strips with circuit breakers (heavy duty) 4 Logistics

Extension Cords 2, 25 ft., 2, 50 ft., 2, 100 ft. (10 to 12 gauge copper) 6 Logistics

Portable Generators with Wheel Kits 2 Logistics

Flashlights and batteries 12 Logistics





Fatigue Mats 4 Logistics

ERB Max Lite Ear Plugs (200/box) 1 Logistics

Back Support Belts 24 Logistics

Leather Gloves ( work type) 12 pair Logistics

Clean-up equipment-brooms, dust pans Logistics

Tensa Barriers 4 Logistics

Hygiene Clean-Up Supplies Logistics

3,000 to 5,000 pound-capacity forklifts2

LogisticsPallet jacks 6 Logistics

d. HLS Cache Resources

ItemUnits

Required

Location or

Request From

Pill Counters 3 Logistics

Pharmaceutical Spatula 20 Logistics

Envelopes with Labels 150,000 Logistics

Counting Tray 20 Logistics



30. COMMUNICATIONS EQUIPMENT UNIT


Logistics Section


Technolo Unit


E ui ment Unit




Medical Supplies


Caches


Local Cache

Staff Staging Area

Receipt, Stage,

Store Warehouse

IDER Commander

B. DESCRIPTION


The purpose of the Communications Equipment Unit is to ensure that all communications equipment

deployed for the emergency response is functioning. The Unit’s objectives are to:

• Ensure that IDER operations have redundant modalities of communication.

• Coordinate the repair of malfunctioning communications equipment.

The procurement of communications equipment occurs in the Supplies Unit. The inventory of

communications equipment will be managed by the Supplies Unit but the Communications Equipment

Unit can actively update the inventory.

b. Methods

The Communications Equipment Unit will be responsible for installing and maintaining the following

telecommunication equipment and systems. See CDCP Inventory, Appendix M3, for detailed equipment

descriptions and storage locations:

• Landline telephones. CDCP owns one telephone for every CDCP staff member, plus an additional

cache of telephones that may be set up during a response.

• Cellular telephones. CDCP has issued cellular telephones to on-call duty officers and select CDCP

staff for day-to-day use. These may be reassigned to response staff if necessary.

• Conference call equipment (i.e. “Octopus”). CDCP owns one digital Conference Call telephone

and one analog Conference Call telephone.

IDER Plan: Logistics Section/Communications Equipment Unit, Page 1/4 Draft 10/07



• Pagers and smartphones (e.g. Treos, Blackberrys). CDCP has issued pagers and Treos to on-call

duty officers and select CDCP staff for day-to-day use. If necessary, consult the Continuity of

Operations Branch Director to reassign these to response staff.

• Satellite telephone. CDCP has one satellite phone which can be deployed for a field response

position to supplement an existing phone line that may be subject to network congestion.

• 800 MHz radios, associated accessories and operators. CDCP has procured a cache of 800 MHz

radios, spare batteries, belt clips and earpieces for emergency use. The DPH Emergency Medical

Services (EMS) Section has assigned a tracking number to each radio and configured them to operateon the appropriate encrypted channels. DPH has been assigned the channel A-2 for general

communication. The DOC Logistics Section will provide overall city coordination and support of

radio communications including requests for additional radios, radio operators and radio channel

assignments. The Communications Equipment Unit is responsible for ensuring that radios are

adequately charged and for sending malfunctioning radios to the DOC for service.

• Two-way radios. A cache of two way radios have been purchased for use at the PODs and are pre-

positioned in the POD go-kits (trailers). These are intended for intra-POD communication between

responders at each POD or for short range communication between members of field investigation

teams.

• Phone bank. CDCP has access to an automatic call distribution system at 30 Van Ness that may be

used in an IDER activation as a Public Information line. (The Clinician Consultation Unit and

Surveillance Team will receive calls from clinicians). This phone bank can support up to 20simultaneous call agents. See Appendix 16 for location and procedure for activating the Phone Bank.

• Strategic Telephone Automatic Response System (STARS). CDCP has access to a second

automatic call distribution system that primarily supports the section’s disease control and reporting

activities. This system is based at 101 Grove and can support up to 50 simultaneous call agents. The

system was programmed to function in semi-automatic mode in day-to-day operations and allow for a

switch to fully automatic mode in emergency operations. STARS has been configured with 5 vector

directory numbers (VDNs) or “channels” that can be dedicated to specific types of calls. See

Appendix M7 for a description of each channel in an IDER activation. The Communications

Equipment Unit will be responsible for setting up additional handsets and phone accessories if it is

necessary to increase the number of call center agents.

• Analog and digital phone line ports. CDCP offices and 101 Grove meeting rooms are equipped

with analog and digital phone line ports. Not all ports are activated under normal operations. SeeAppendix M15 for a diagram of the location of these ports and instructions for their activation. The

Communications Equipment Unit, in conjunction with 101 Grove Facilities Management, is

responsible for reassigning private branch exchange (PBX) lines to different locations within 101

Grove and reassigning voicemail boxes.

• Auto-attendant mailboxes. CDCP has established a number of topic-specific information lines with

auto-attendant voicemail boxes. These are intended to be used with pre-recorded messages that

answer commonly asked questions or inform the public with a consistent message. There are auto-

attendant mailboxes for seasonal flu, avian flu, BDS activation for United States Postal Service

employees, and mass prophylaxis community Push partners. These will be updated by the

Communicable Disease Information Branch.

• Fax Machines. CDCP and the Lab own fax machines that may be used for the response. Four

CDCP fax lines function with the Blast Fax system.

C. IMPLEMENTATION

a. Communications Equipments Unit

Activate the Communications Equipments Unit for IDER activations.




The Unit is responsible for setting up, maintaining and servicing all communications equipment used as

part of the IDE response; this may include communications equipment within 101 Grove, in the field, and

those belonging to the phone bank at 30 Van Ness. At the beginning of each operational period this Unit

will prepare an updated communications contact list (ICS Form 205, Communications List).

Refer to Appendix M3 for an inventory of all CDCP communications supplies. Instructions and protocols

for specific equipment are located in Appendix X and noted under “Resources” below. Document the

disposition of all service requests in the Resource Tracking System (Appendix M1).

If new equipment needs to be purchased to ensure ongoing communications and computer function,

requests can be made via the Resource Tracking System (Appendix M1) to the Supplies Unit following

approval from the Logistics Section Chief.

If activated, refer network or software problems associated with the Strategic Telephone Automatic

Response System (STARS), the automatic call distribution system used in an IDE response to the

Applications Support Group.

Functions of the Communications Equipment Unit

• Set up and test all communications equipment and telephone lines.

• Respond to requests and inquiries for communications equipment from response staff.• Provide updated phone/contact list for emergency response staff working throughout the response.

• Provide multiple modes of communication for response staff to ensure redundancy.

• Maintain and service all communications equipment and arrange for equipment to be sent to other

city departments for repair.

• Maintain a list of equipment service provided during the response and the disposition of each request

in the Resource Tracking System.

• Consult the DOC, if activated, or 101 Grove MIS, 101 Grove Facilities Management and DTIS, as

necessary.

• Prepare a Module Objectives form at the beginning of the operational period. Maintain a Module Log

throughout the operational period, and complete a Situation Status Update at the end of the

operational period. Submit to Plans Section.

D. STAFF POSITIONS



Job Title Task Overview Critical SkillsNo. of

Employees Location

Communications Equipment UnitLeader

Assign responsibilities, review and prioritize requests for equipment,service support. Point of contact

between IDER and DOC or DPH MIS.

Experience with

phone systems,800 MHz radios,

PBX lines

1 IDER Core

Communications Equipment staff Set-up and maintain communicationsequipment. Receive servicing requests,troubleshoot and service equipment,consult with DOC and EMS staff regarding the use of 800 Mhz radios.

Send equipment out for repairs and/or request replacements.

Experienceoperating and troubleshooting

phone systems,800 MHz radiooperations, PBXlines

IDER Core





E. REPORTING

The Communications Equipment Unit Leader reports directly to the Logistics Section Chief.

F. DELIVERABLES

The Communications and IT Unit is responsible for producing the following:

• Incident Radio Communications Plan, ICS Form 205

• Equipment Service Log

• Communications List, ICS Form 205 (for each Operational Period)




G. RESOURCES



Items Location







800 Mhz Radio Operating Instructions Appendix M13Radio Frequency Inventory and Talk Group Assignment Protocol Appendix M14


Phone Bank Manual Appendix M16


ItemsUnits

Required

Location or

Request From





800 MHz Radio 1 LogisticsCopy machine access 1 Logistics



31. INFORMATION TECHNOLOGY UNIT


Logistics Section

Personnel Unit Information Technology

Unit


E ui ment Unit




Medical Supplies


Caches


Local Cache

Staff Staging Area

Receipt, Stage,

Store Warehouse

IDER Commander

B. DESCRIPTION


The purpose of the Information Technology (IT) Unit is to ensure that computer and network-related

equipment deployed for the emergency response is functioning. The Unit’s objectives are to:

• Provide a stable IT infrastructure to facilitate response activities.

• Create a flexible IT infrastructure to allow operations to scale up and down in the number of

responders and locations of workstations.

• Maintain a secure electronic network that will facilitate the flow of information through the IDER

organization.

• Manage inventory of IT equipment and supplies used for the response.

The procurement of IT equipment occurs in the Supplies Unit.

If the Data Branch has not been activated and assistance with IDER-critical information systems are

required by the response, the IT Unit will assume the Application Support Group objectives.

b. Methods

The IT Unit is responsible for the following IT resources:

Desktop computers. CDCP has an existing inventory of desktop computers that are used on a day-to-

day basis but which can be deployed for a response. The IT Unit will ensure that these machines are

functional.

IDER Plan: Logistics Section/Information Technology Unit, Page 1/5 Draft 10/07



Laptop computers. Field and on-site laptops have been procured and pre-positioned for an emergency

event and are listed in the CDCP Inventory (Appendix M3). There are two caches of field laptops.

• IDER Field Laptops. Field investigation laptops are a component of the Epi Go-kits used by the

Epidemiology & Surveillance Branch and the Collaborative Fusion System which handles the

registration and deployment of disaster service workers and volunteers.

• IDER On-site Laptops. On-site laptops are reserved for the IDER command center and ancillary

work areas.

• CDCP Section laptops. Some CDCP staff have been assigned laptops for day-to-day use. The ITUnit will evaluate all resource needs of the response and prioritize deployment of these laptops as

needed.

Server maintenance. The IT Unit will be responsible for maintaining the functionality of file and

application servers that impact IDER operations. The majority of disease control/outbreak management

protocols are developed by and reside on CDCP servers. Similarly, application databases used for

outbreak management run on CDCP servers. In addition, IDER operations rely on fax and FTP servers

housed in the DPH data center at 1380 Howard. The ability to run outbreak management activities,

disseminate health alerts via blast fax, receive transmissions of case investigation field data and other IDER-critical tasks all depend on the functional status of CDCP’s servers. The IT Unit will coordinate

with DOC Logistics (or DPH Management Information Services (MIS) if DOC is not activated) to ensure

that all IDER-critical servers are functional at all times during the response.

LCD and overhead projectors. CDCP owns LCD projectors which may be deployed. Priority is to theIDER Command Center.

Printers and copy machines. CDCP owns printers and copy machines that may be deployed for a

response.

Software installation and configuration. While all CDCP desktop and laptops are equipped with

general productivity software such as Microsoft Office, email, web browser, and Adobe Acrobat Reader,

a subset of laptops have been configured for more specialized use. The IT Unit will oversee software

installation on computers used in the response and assist users with application configuration issues that

require Administrator privileges. Consult the CDCP Inventory in Appendix M3 to determine whichcomputers have specialized software installed (e.g. statistical analysis software, GIS software, Disease

Control Management System, etc.). The IT Unit is responsible for installing Virtual Private Network

(VPN) client software and certificates onto approved field laptops to allow responders to access the DPH

network remotely.

Digital certificate installation and maintenance. Response staff may need to access communication

networks (e.g., Epi-x, Biosense) with the California Department of Health Services, Centers for Disease

Control or the Department of Homeland Security. The IT Unit will provide guidance for accessing these

networks.

Network connection. IDER operations default is to expand into various CDCP offices and 101 Grove

conference rooms in order to meet the space requirement of the response. The IT Unit will assist withconnectivity issues by activating data ports and assigning appropriate bandwidth to computing resources

on the network that are essential to the response. See the IDER Set-up Manual, Appendix M15, for a

diagram of the location of these ports, and instructions for their activation.

User account management. The IT Unit will create, assign, modify and maintain control of user

accounts for all computers and e-mail accounts on the DPH network. The Unit will coordinate the

assignment of user accounts into groups and factor in the network path users will require in order to

perform their response role. Due to the sensitive nature of health information that is involved in all

outbreaks, the users’ baseline access pre-incident and post-incident must be taken into consideration




before group assignments are made. All application access issues associated with specialized IDER-

critical information systems will be managed by the Applications Support Group within the Data Branch

of the Operations Section.

C. IMPLEMENTATION

a. Information Techno logy Unit

Activate the Information Technology Unit when the response requires the set-up of IT and/or assistance

with IT infrastructure. However, in a small emergency the Unit’s activities may be carried out directly by

the Logistics Section Chief and/or staff.

The IT Unit is responsible for:

• Setting up and testing computer equipment, peripherals and network connections at all locations.

• Maintaining and repairing all malfunctioning IT equipment and network issues.

• Setting up, maintaining, and troubleshooting general software applications and systems used by

responders. (If the Data Branch has been activated, software and network issues related to specialized

IDER-critical information systems (e.g., STARS, MLAB, HAND) should be referred to theApplications Support Group. Otherwise Applications Support should be activated as part of the IT

Unit in the Data Branch.)

• Managing access rights and user accounts for IDER responders.

See the CDCP Inventory (Appendix M3) for detailed descriptions of IT equipment and storage locations.

See Appendix M10 for a list of IDER email accounts and passwords. If additional equipment (e.g.,

replacement parts, cables and switches) is not internally available, the IT Unit should forward the request

to the Logistics Section’s Supplies Unit.

Responder requests for IT equipment set-up or service should be made using the Resource Tracking

System, a paper-based method, or directly for urgent assistance. Document all IT requests in the

Resource Tracking System or a paper-based method.

Functions of the Information Technology Unit

• Set up and test all IT equipment and network connections.

• Inform Logistics Section Chief if there are substantial changes to available communication

mechanisms (e.g., loss of network).

• Provide updated user e-mail account list for staff throughout the response either through the Resource

Tracking System or a paper-based method.

• Respond to requests and inquiries for computer equipment from response staff.

• Maintain and service all computer equipment and computer network and/or arrange for equipment to

be sent to other city departments for repair as necessary.

• Maintain a list of services provided during the response.

• Maintain an inventory of all IT equipment deployed for the response.

a.1. Appl ications Support (Group & Units)

If the Data Branch is activated then the Applications Support Group and Units should be activated within

that Branch. Only consider activating as part of the IT Unit when:

• The Data Branch has not been activated, AND

• At least one IDER-critical information systems is required to support response activities.




Refer to the “Application Support Group” module within the Data Branch for guidance.

The Applications Support Group and Units provide technical expertise to the response in the following

IDER-critical information systems:

• Outbreak management systems

• Strategic Telephone Automatic Response System (STARS)• Collaborative Fusion

• MLAB

• Alerting, messaging, and information sharing systems (e.g., EMSytem, CAHAN).

• Communicable Disease Control & Prevention (CDCP) Website.

• Health Alert Notification Database (HAND) and blast fax system.

• Resource Tracking System.

• Field data transmission.

See the Applications Support Group module for details.

D. STAFF POSITIONS

This module can contain the following roles. The “Number of Employees” column indicates the

minimum number of roles required to activate this module.



Employees Location

Information Technology UnitLeader

Assign responsibilities, review and prioritize requests for equipmentservice support. Point of contact for

DOC IT Unit or DPH MIS.

Experience

managing 101Grove ISresources.

1 IDER

Command

IT Unit Staff Set-up and maintain computer and network equipment for responders.Receive network access servicingrequests, troubleshoot problems,

consult with DPH MIS staff regardingnetwork access, install software,

provide/revoke network access.

Experiencemanaging ISresources.

Administrativerights to DPHnetwork.

1-5 IDER Command

E. REPORTING

The Information Technology Unit Leader reports directly to the Logistics Section Chief.

F. DELIVERABLES

The Information Technology Unit is responsible for producing the following:

• IT Service Log

• IT Inventory

• Updated user account access list for computers and e-mails (for each Operational Period)








G. RESOURCES



Items Location






DPH MIS department call list Appendix M8

How to set-up a satellite and record a satellite broadcast Appendix M9

IDER e-mail information Appendix M10



ItemsUnits

Required

Location or

Request From



Computer with local network, internet access, administrative rights 1+ Logistics


800 MHz Radio, cell phone, or pager 1 Logistics


Extension cords 5+ Logistics

Broadband cables 5+ Logistics



32. FINANCE SECTION


Finance Section

Time Tracking UnitProcurement Unit

IDER Commander

Cost Unit

B. DESCRIPTION


The Purpose of the Finance Section is to facilitate the purchase and reimbursement of resources utilized inthe infectious disease emergency response. Finance Section objectives include:

• Track hours worked by response staff for local, state, and federal reimbursement.

• Purchase supplies necessary for the emergency response.

• Monitor multiple sources of funds.

• Track and report to the Incident Commander the financial cost of the IDER response.

b. Methods

The Finance Section utilizes the following methods to achieve objectives:

Procurement. All financial matters related to the purchase of supplies and services for the emergencyevent are managed by the Procurement Unit. The Unit will ensure that proper purchasing protocols are

utilized throughout the response. The Unit will generate purchase requisitions, obtain purchase order

approvals, manage vendor contracts, and conduct all financial transactions with vendors.

Cost Tracking. All financial tracking and reporting for the response are managed by the Cost Unit. The

Unit will ensure that all incident-associated costs are captured using existing standard DPH

methodologies as well as alternate response-specific mechanisms. The Unit will produce cost reports and

projects to decision-makers in the IDER organization to help inform and shape the response objectives

and strategies.

Time Tracking. The Time Unit is responsible for ensuring the accurate recording of personnel time and

compliance with agency time reporting policies. The Time Tracking Unit will maintain time records for all personnel assigned to the incident in preparation for cost-recovery reporting after the response. The

Unit will coordinate with the DPH Payroll Department to ensure that payroll processing for response staff

occurs in a timely fashion.

C. IMPLEMENTATION

a. Finance Section

IDER Plan: Finance Section, Page 1/3 Draft 10/07



Activate the Finance Section when:

1. It is necessary to purchase goods or services, and/or

2. It is necessary to track personnel time for state or federal reimbursement.

The Finance Section is responsible for managing the direct financial needs of the incident. Not all

incidents will require a Finance Section. In a large incident requiring DOC/EOC activation, some finance

functions will be performed at the DOC or EOC. Workers’ compensation and medical care issues will beforwarded to the DOC.

The Finance Section Chief will determine which Units are required for the response and will activate the

appropriate Units, after approval by the Incident Commander. If a Unit is not activated, responsibility for

that unit's duties remain with the Finance Chief. In very large incidents or circumstances where all

designated units in the Finance Section are activated, the Finance Chief may have a Deputy.

Functions

• Manage all direct financial functions in an IDER response.

• Provide financial and cost analysis information as requested.

• Gather pertinent information from briefings with responsible agencies.

• Develop an operating plan for the Finance Section.• Meet with Assisting and Cooperating Agency Representatives as needed.

• Maintain daily contact with the DOC on finance matters. This is particularly critical in proclaimed

disasters where State and Federal reimbursement is likely.

• Ensure that all personnel time records are accurately completed and transmitted to home agencies,

according to policy.

• Provide financial input to demobilization planning.

• Ensure that all obligation documents initiated at the incident are properly prepared and completed.

• Brief IDE Commander and DOC/EOC or DPH management personnel on all incident-related

financial issues needing attention or follow-up.

D. STAFF POSITIONS



Job Title Task OverviewJob Classification No. of

Employees Location

Finance Section Chief Supervise finance activities,assign responsibilities, orient staff and serve as a resource for allstaff. Carries out unit functions if they have not been activated.

Accounting or purchasing manager,

FAMIS/ADPICSaccess and experience, authority

to approve POs

1 IDER Command

Finance Section Deputy Assists the Finance Section Chief in carrying out duties.

Accounting or purchasing manager,

FAMIS/ADPICSaccess and experience, authorityto approve POs

IDER Command

Administrative Assistant Perform administrative duties.Take notes at meetings and other

duties.

IDER Command





E. REPORTING

The Finance Section Chief reports to the Incident Commander.

F. DELIVERABLES

The Finance Section is responsible for producing the following:

• Summary of Procurements

• Time Tracking Report




G. RESOURCES



Items Location


Personnel Time Tracking Materials

Personnel Time Tracking Report Template Appendix Na1

Procurement and Cost Documents

Flowchart of Procurement Mechanisms Appendix Nb1

Procurement and Cost Unit Tracking Spreadsheet Appendix Nb2

Instructions on completing blanket purchase orders and releases against term

contracts

Appendix Nb3

Blanket Purchase Order and Release Against Term Contracts Form Appendix Nb4

Instructions on completing one-time purchase orders Appendix Nb5

One-time purchase order form Appendix Nb6

Controller’s Office Chart of Accounts Appendix Nb7

References from CCSF Office of Contract Administration’s Rules & RegulationsPertaining to the SF Admin code, Chapter 21 Acquisition of Commodities &

Services

Appendix Nb8


ItemsUnits

Required

Location or

Request From








33. PROCUREMENT UNIT


Finance Section


IDER Commander

Cost Unit

B. DESCRIPTION


The purpose of the Procurement Unit is to ensure that supplies are procured through the appropriate

protocols during an IDE response. The Unit’s objectives include:

• Ensure cost accountability of the response through the preparation of appropriate purchasingdocuments for supplies and equipment.

• Ensure the quick and efficient procurement of response supplies by establishing and managing vendor contracts.

• Support ongoing response operations through acquisition of scarce supplies via commercial sources.

b. Method

Procurement Unit methods and tools for procuring supplies include:

Blanket Purchase Order. DPH has established Department blanket purchase orders, renewed everyfiscal year, with various vendors that allow the Department to purchase commodities from those vendorsaccording to the terms of the contract. Due to the front-loaded fiscal approval mechanism required tosetup blanket purchase orders, purchases made against blanket purchase orders will be a reliably efficientmeans of procuring supplies in an emergency. It is possible to establish a blanket purchase order with avendor during the incident response. The Procurement Unit will compile and maintain a listing of allknown blanket purchase orders that may be relevant to the response. The Unit will collaborate closelywith the Logistics Section’s Supplies Unit to coordinate releases against blanket purchase orders. Refer toAppendix Nb4 for DBPO form and instructions.

One-time Purchase Order. If a purchase needs to be made from a vendor with whom the City and County of San Francisco does not currently have a blanket purchase order agreement, the Procurement

Unit may requisition a one-time purchase order with the vendor, which must be approved by theappropriate DPH fiscal authority. The Procurement Unit will coordinate with the DPH Fiscal Section for expedited review and approval while ensuring compliance with CCSF’s purchasing policies. Refer toAppendix Nb for PO form and instructions.

Term Contracts. For purchases of standard commodities from established vendors, purchase orders may be released against a term contract. The Office of Contract Administration establishes term contracts withqualifying vendors, thereby front-loading the approval mechanism similar to blanket purchase orders. Aterm contract is established between a vendor and CCSF, renewed every 3 years, that allows SanFrancisco Departments to purchase any, or specified items, up to a certain dollar amount, depending on

IDER Plan: Finance Section/Procurement Unit, Page 1/5 Draft 10/07



the terms of the contract. The IDER Procurement Unit will research term contracts and maintain a listingof high-volume commodities relevant to the response.

Issuing emergency credit cards. In a large-scale emergency, the Controller’s Office may activate aseries of pre-identified credit cards (one per city agency) in the event the city’s accounting system isunable to provide timely payments to vendors. If DPH’s emergency credit card has been activated, theProcurement Unit may request to use the credit card. If the DOC has also been activated to coordinate

multiple DPH response, the Procurement Unit will coordinate with the appropriate personnel in DOCFinance Section to tap into the emergency credit line for quick purchases as needed. If appropriate,coordinate the use of the emergency credit card with the Logistics Section.

Purchasing during a declared emergency. In a large-scale emergency, the normal purchasing policiesmay be suspended following a declaration by the Mayor. The Controller’s Office will issue emergencyindex codes (usually one per city agency) and provide guidance for their use. The Procurement Unit willcoordinate with the DOC Finance Section on how to use the FEMA index code. When establishing thecriteria for making purchases using the FEMA index code, the Procurement Unit will take intoconsideration all issues that relate to post-incident reimbursement claims.

Advanced Purchasing and Inventory Control System (ADPICS). The Advanced Purchasing and

Inventory Control System is the online purchasing system for goods and services used by the City and County of San Francisco. The Procurement Unit may need to access the ADPICS system to create and track the approval path of purchase requisitions. The system also stores vendor information that will beimportant for Unit staff to utilize as part of their vendor relations responsibilities. If ADPICS becomesunavailable for any reason, the Procurement Unit must establish paper-based procedures for generating purchase orders and placing orders with vendors.

C. IMPLEMENTATION

a. Procurement Unit

Activate the Procurement Unit when it is necessary to purchase items for the response. (For small-scaleIDER activations, CDCP staff may perform the functions of the Procurement Unit.)

In medium or large-scale incidents where the DOC is not open the Unit should also be staffed with DPHFiscal employees who have authority to generate purchase requisitions and can expedite approvals.

The Procurement Unit will receive all purchase requests from the Logistics Section Supplies Unit.Purchasing procedures will vary depending on the scale of the response. Until a local emergency isdeclared by the Mayor’s office, the Procurement Unit should adhere to all normal purchasing procedures.After a local emergency declaration, the Unit may adopt emergency procurement procedures as specified in Section 21.15 of the San Francisco Administrative Code. Refer to Appendix Nb1 for a flowchart of procurement mechanisms and details below.

Steps for Filling a Procurement Request

1. Review and clarify all purchase requisitions with the Supplies Unit.2. Identify multiple vendors to determine most efficient and cost-effective source of procurement.3. Consult DPH Fiscal staff when necessary.4. Determine the appropriate funding source to be used and match the correct index and character codes

for the purchase.




5. Ensure that if grant funding is used for the purchase the guidelines of the grant allow for theexpenditures.

6. Establish, understand, and troubleshoot contracts and agreements with supply vendors.7. Issue the purchase order.8. Communicate with vendors to assess availability and cost of commodities.9. Establish blanket purchase orders during the response, if necessary.10. Update the Supplies Unit on the status of purchase orders.

11. Coordinate with the Supplies Unit to ensure that supplies are delivered to the appropriate location.12. Confirm that deliveries are accepted and invoices can be paid.13. Maintain documentation of all supplies purchased during an incident in the appropriate module of the

Resource Tracking System.

Issuing purchase orders from term contracts or blanket purchase orders

See Appendix X for instructions on completing blanket purchase orders and releases against termcontracts, respectively, and all associated forms.

One-time purchases

Instructions for making one-time supply purchases of less than $10,000 are as follows:

1. Receive a quote, in writing, from the vendor detailing the item(s), quantities and their costs.2. Create a requisition for this purchase, attaching the vendor quote, form, and appropriate funding

codes (index and character codes). (See Appendix X for associated forms)3. Obtain a minimum of three separate vendor quotes if the total cost of the purchase requisition exceeds

$2,500.4. Send completed forms to the DPH Fiscal at 1380 Howard Street.

Change of procedures during a declared local emergency

Once the incident has been declared a local emergency by the Mayor’s Office, the Procurement Unit is

responsible for switching over to emergency purchasing procedures. The Unit will confirm that purchases are charged to the appropriate emergency index codes. All documentation of purchases mademust be submitted to the Cost Unit in preparation for cost-recovery reimbursement programs.

Cost tracking

Cost-tracking during an incident is done by the Cost Unit. Determine what information or documentationmust be provided to the Cost Unit on a regular basis as the incident progresses. Submit in-progress and completed purchase orders to the Cost Unit.

Functions of the Procurement Unit

• Draft and process all supply purchase requisitions using the most appropriate procurement

procedures.• Communicate with vendors to clarify orders and coordinate delivery instructions with the Logistics

Section’s Supplies Unit.

• Work closely with the DOC Finance Section to clarify procedures and index codes.

• Update the Supplies Unit in the Logistics Section on the status of purchases.

• Ensure that supplies are received and invoices are processed for payment.

• Produce and submit to the Cost Unit all Purchase Order Summary Reports.

• Document purchases in the Resource Tracking System.




D. STAFF POSITIONS




Employees Location

Procurement Unit Leader Assign responsibilities, reviews and approves all purchase orders, primary

point of contact for Finance Sectionstaff at DOC regarding purchaseorders, update Logistics SectionSupply Unit regarding purchase order status, provide documentation for theCost Unit Leader.

Experience withDPH and CCSFFinance

protocols,authority toapprove

purchase orders,access toADPICS system

1 101 Grove

Procurement Unit staff Compile purchase order requests fromSupplies Unit, research and assignindex and character codes,communicate with vendors, execute

purchase orders, organize and document all purchase orders

Experience withDPH and CCSFFinance

protocols,familiarity withADPICS system

101 Grove

E. REPORTING

The Procurement Unit Leader reports directly to the Finance Section Chief.

F. DELIVERABLES

The Procurement Unit is responsible for producing the following:

•

Purchase Orders• Purchase Order documentation




G. RESOURCES



Items Location





Instructions on completing blanket purchase orders and releases against termcontracts

Appendix Nb3









References from CCSF Office of Contract Administration’s Rules & RegulationsPertaining to the SF Admin code, Chapter 21 Acquisition of Commodities &Services

Appendix Nb8


ItemsUnits

Required

Location or

Request From









34. COST UNIT


Finance Section


IDER Commander

Cost Unit

B. DESCRIPTION


The purpose of the Cost Unit is to track, analyze and project costs related to response operations. TheUnit’s objectives include:

• Provide cost accountability for effective management of the incident.

• Capture all financial transactions and expenditures to assist in post-incident cost-recovery efforts.

• Provide realistic and timely cost projections to inform decision-makers and shape response objectives.

• Maintain accurate financial records for incident-related compensation claims.

• Meet compliance and audit requirements of grant-funded incident response activities.

• Project financial resources needed to adequately sustain the response as well as continuity of

operations.

b. Methods

Methods and tools used by the Cost Unit to support the IDE response include:

Expense tracking and cost summary. The Cost Unit will utilize all available means to capture costs

associated with the incident. This will supplement and enhance existing city/department financial

accounting mechanisms to capture all direct and indirect costs. At all times, the Cost Unit will maintain

thorough paper-based and electronic records of accrued costs while ensuring that all regular accounting

procedures are followed. The Cost Unit may utilize information systems to help track personnel

utilization during the response. These systems include DisasterHelp.Net/e-Coordinator in a large-scale

response, or the Resource Tracking System in a small-scale response. Using personnel hours and work

assignment data from these systems, the Cost Unit will put together cost summaries of the incident.

Financial Accounting Management Information System (FAMIS). The Financial Accounting

Management Information System is the cost-accounting system used by the City and County of San

Francisco for recording and processing financial transactions. The Cost Unit will need to access FAMIS

to extract and input cost data during a response. CDCP staff will provide first-line support for querying

FAMIS for cost tracking purposes. The Cost Unit will ensure that all financial transactions are eventually

captured in FAMIS. The Unit will also be responsible for maintaining sufficient document to support the

transactions when reimbursement claims are filed in the cost-recovery phase of the response.

IDER Plan: Finance Section/Cost Unit, Page 1/4 Draft 10/07



Financial planning and projection. The Cost Unit will compile cost data from various sources and

develop financial projections for the agency director and decision-makers involved in the response. The

availability of accurate and realistic financial projects will help the Incident Commander and others in key

response roles make critical the decisions regarding resource allocation response objectives. The Cost

Unit will periodically generate forecasts and determine the financial resources needed to continue

response operations. This projection will be done in conjunction with the Plans and Logistics Sections to

inform overall resource utilization for the response.

C. IMPLEMENTATION

a. Cost Unit

Activate the Cost Unit when the cost of the response is above and beyond what is needed to support the

day-to-day operations of the CDCP section.

The Cost Unit is responsible tracking all costs and the balance on funding streams made available for the

incident response. A summary of this information should be provided to the Finance Section Chief once

during every operational period, and more often if requested. Documentation costs originate from

multiple sources, and it will be the primary activity of the Cost Unit to compile them.

Personnel Costs. CDCP and Lab staff will be the first DPH employees to be deployed into response roles

and the Cost Unit will track personnel costs to capture the full cost of the response. If an IDE response is

of limited scope, the CDCP section will absorb the costs of the response. In such cases, the Cost Unit will

review the guidelines of CDCP’s emergency preparedness grants to determine if the response was

conducted in a manner that could be re-imbursed by the grants.

Personnel expenses incidental to the response may be captured in multiple methodologies. The Cost Unit

will obtain from the Personnel Time Tracking Unit the responder names, job classifications, and time

worked and available payroll data to generate the personnel cost report.

Material Costs. Direct non-personnel expenses will be incurred primarily by the Logistics Section

Supplies Unit in conjunction with the Finance Section Procurement Unit. The Cost Unit will collaboratewith other IDER modules to collect all cost documents. Wherever applicable, paper-based records of

financial transactions (purchase requisitions, direct payment requests, reimbursement requests, etc.) will

be submitted to the Cost Unit for processing. If an emergency declaration has been made by the

appropriate CCSF governing officials, the Controller’s Office will provide guidance on the usage of

“FEMA index codes” pre-established for each city agency. In such cases, the Cost Unit will be

responsible for tracking incident-related expenses using the emergency index codes. If needed, the Cost

Unit will request additional index codes from the Controller’s Office to help track expenses. The Cost

Unit may also track expenditures incurred via DPH’s emergency pre-defined credit card activated by the

Treasurer’s Office.

If the DOC has been activated, the Cost Unit will coordinate with and refer to the DOC Finance Section

any claims issues related to the response. This may include claims against the city for damage of personal property as a result of the response or disaster service workers’ personal injury claims. If state or federal

reimbursement will be pursued by the Controller’s Office, the Cost Unit staff will provide supporting

documentation to facilitate this process.

Functions of the Cost Unit

• Maintain record of all funding sources supporting the incident, produce summary reports as needed.

• Collect and record all expenditures and financial data in a manner that allows for transparency to

support state and/or federal cost-recovery claims at the end of the response.

• Compile cost reports and generate projections for the duration of the response.




• Coordinate closely with Logistics and Plans Sections to reconcile financial and operational records.

D. STAFF POSITIONS





Employees Location

Cost Unit Leader Assign responsibilities, reviews costreports, primary point of contact for Finance Section staff at DOCregarding cost summaries and analysis

requests, update Logistics and PlansSections regarding cost projections,

provide cost documentation for theFinance Section Chief.

Experience with

DPH and CCSFFinance

protocols,experience

producing cost projections,access toFAMIS system

1 IDER

Command

Cost Unit Staff Collect, analyze and summarize costdata, consult with Plans and Logistics

Section staff on cost projections, produce reports.

Experience with

DPH and CCSF

Finance protocols,familiarity withFAMIS system

IDER

Command

E. REPORTING

The Cost Unit Leader reports directly to the Finance Section Chief.

F. DELIVERABLES

The Cost Unit is responsible for producing the following summaries during each operational period:

• Cost tracking documentation summary

• Personnel cost report

• IDER operational cost projection




G. RESOURCES



Items Location









Instructions on completing blanket purchase orders and releases against term

contracts

Appendix Nb3





References from CCSF Office of Contract Administration’s Rules & RegulationsPertaining to the SF Admin code, Chapter 21 Acquisition of Commodities &

Services

Appendix Nb8


ItemsUnits

Required

Location or

Request From









IDER Plan: Finance Section/Time Tracking Unit, Page 1/4 Draft 09/07

35. TIME TRACKING UNIT


B. DESCRIPTION


The purpose of the Time Tracking Unit is to ensure that hours worked by response staff are accounted for

in a manner that is consistent with state and federal guidelines should the event qualify for cost-recoveryreimbursement. The Unit’s objectives are to:

• Track and document hours worked by all personnel involved in the response

• Ensure that payroll is not disrupted for personnel who are deployed in a response

• Adapt existing payroll procedures to report hours worked

• Produce a personnel time tracking report for the Finance Section Chief

b. Methods

The primary responsibility of the Time Tracking Unit is to document all hours, including overtime,

worked by response staff for the duration of the response. Multiple methodologies for personnel time

tracking will be used to complement the different response activities at different sites.

Sign-in/out sheets. Sign-in/sign-out sheets should be provided to the Staging Area and all facilities

where response activities are carried out. Time Tracking Unit staff will ensure that timesheets are

available to all responders at the beginning of every operational period. At the end of each operational

period, the sign-in/sign-out sheets must be submitted to the Unit for entry into the Resource Tracking

System.

Resource Tracking System. One of the functions of the electronic Resource Tracking System will be to

store personnel check-in, work assignment, re-assignment, and check-out information. The Time

Tracking Unit will enter this information from sign-in/sign-out sheets into the Resource Tracking System.

The system will be used by the Logistics Section, Staging Area and Plans Section throughout the response

to track personnel requests, assignment and deployment status. If necessary and appropriate to thecircumstance, each section may update information in the system in real-time during each operational

period to provide accurate tracking capability.

Module Logs. All modules must keep Module Logs to document their major actions taken during each

operational period (See Appendix A). Time data may be abstracted from Modules Logs for subsequent

cost-recovery reimbursement claims filed by the city.

Collaborative Fusion. Collaborative Fusion may be utilized to track personnel time. The IDER

Command and field sites (e.g., PODs)may be equipped with laptop computers loaded with Collaborative

Finance Section

Time Tracking UnitProcurement Unit Cost Unit

IDER Commander




Fusion software. This will allow employees to sign-in and out during each operational period by swiping

their disaster service worker ID cards through custom card readers linked to the system. Time tracking

data may be extracted from this system and summarized by the Time Tracking Unit staff.

C. IMPLEMENTATION

a. Time Tracking Unit

Activate the Time Tracking Unit when:

1. The operational period requires personnel to work additional hours (e.g. over 8 hours) or days (e.g.

weekends, holidays) than a typical work shift, OR

2. Personnel from outside of the CDCP or the Laboratory participate in the response.

This Unit will work closely with the Plans Section’s Resource Status Unit and Logistics Section

Personnel Unitto ensure that all personnel time documentation is completed and collected. The Unit will

determine the most efficient method for time tracking based on the specific event and resources available.

• Small-scale incidents (fewer than 20 responders) or those limited to CDCP and Laboratorystaff . Time Tracking Unit staff should ensure that Module Logs are collected from all responders at

the end of each operational period. Time data can then be abstracted from the logs and reviewed.

• Medium-scale incidents (20 - 50 responders). In addition to Module Logs, the Time Tracking Unit

should implement sign-in/out sheets and distribute to all active response modules . These should be

submitted to the Time Tracking Unit at the end of each operational period.

• Large-scale incidents with concurrent activation of PODs. A combination of different methods

will be used depending on the work location. Collaborative Fusion may be used to capture the start

and end time of each responder via the electronic card readers and disaster service worker IDs.

• Large-scale incidents without concurrent activation of PODs (50 or more responders). CDCP’s

cache of emergency laptops and electronic card readers may be deployed to work locations. IDER

modules may be equipped with laptops and accessories to use Collaborative Fusion for responder

time tracking. Should a group of responders be assigned to field locations that cannot support theCollaborative Fusion, the paper-based Sign-in/out sheets will be the primary mechanism used to track

staff time. All time sheets will be submitted to the Time Tracking Unit at the end of each operational

period.

Time-tracking-related information to be collected, documented, and summarized including:

• Identity of all responders including their Civil Service Classification numbers and non-response DPH

section(s).

• Hours worked during the operational period.

• Assignement performed by each individual during this time.

• Breaks and meal times.

Summarized time tracking information for every operational period should be given to the Finance

Section Chief. If the response qualifies for state of federal reimbursement, all personnel time tracking

data collected during the response needs to be summarized and all supporting documentation must be

available for the cost-recovery claims submission.

Functions of the Time Tracking Unit

• Track and document hours worked by all personnel involved in the response.

• Submit a personnel time tracking report for every operational period.




• Adapt existing payroll procedures to report hours worked.

• Maintain documentation for overtime hours.

• Summarize time tracking data and prepare cost-recovery claims submission.

• Submit paperwork for reimbursement when appropriate.

D. STAFF POSITIONS





Employees Location

Time Tracking Unit Leader Assign responsibilities to Unit staff,reviews time sheets for submission to

payroll, update Plans Resource StatusUnit and Staging Area of changes to

time reporting.

Experience with

DPH payroll procedures and policies, hasacting authority

to sign timesheets

1 101 Grove

Time Tracking Unit Staff Collects and summarize time trackinginformation from multiple sources,

produce report for Finance SectionChief, submit information to payroll.

Experience withDPH payroll

procedures and

policies

101 Grove

E. REPORTING

The Personnel Time Tracking Unit Leader reports directly to the Finance Section Chief.

F. DELIVERABLES

The Personnel Time Tracking Unit is responsible for producing the following:

• Personnel Time Tracking Report




G. RESOURCES



Items Location

ICS Forms (Sign-in/out sheets, Form 211) Appendix A


Personnel Time Tracking Materials

Personnel Time Tracking Report Template Appendix Na1




ItemsUnits

Required

Location or

Request From




Printer access 1 Logistics800 MHz Radio/cell phone/pager 1 Logistics
