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Overview of COH 440 Project Elements

Components:

1. Hazard & Vulnerability Analysis (HVA)

2. Signature Assignment Paper

3. Signature Assignment Presentation

Scenario:

You are applying for an internship within the Emergency Preparedness and Response department at your local county health department. The application process requires that you submit a public health disaster management plan for a natural or man-made event in the community. The plan should adapt best practices and lessons learned from a recent event in a similar community to prepare your local community. The most comprehensive, evidence-based and realistic plans will be selected for in-person interviews which will include a presentation of the proposal. The plans should also be mindful of an all-hazards approach. Earning an internship will provide you opportunities to network with experts that can help improve your skills and provide you a competitive advantage when applying for employment and/or graduate school.

Step 1: Pick an area with hazards that are interesting to you (e.g., San Diego)

HVA:

To write and present a disaster management plan for your chosen local jurisdiction, it is necessary to know what hazards are present. A HVA is a way to determine top hazards for an area. Choose the area on which you want to do your project, and complete the HVA worksheet for your chosen jurisdiction.

Step 2: Identify the top threats to the jurisdiction based on results of your HVA and chose a high-ranking hazard on which you would like to focus (e.g., wildfires in San Diego)

Step 3: Complete the paper and presentation, following the rubric.

Paper:

Following the scenario above, write your paper as if you were creating a public health disaster management plan for your chosen jurisdiction, using the hazard you chose from the HVA and acknowledging the HVA process for your paper (e.g., write a plan for public health management of wildfires in San Diego).

Running Head: Oklahoma County Tornado Disaster Management Plan 1

Oklahoma County Tornado Disaster Management Plan 2

Sample Paper

Oklahoma County Tornado Disaster Management Plan

University

Title

Oklahoma County has the largest population in Oklahoma. According to the U.S. Census Bureau there were 776,864 individuals residing in this county in 2015. Oklahoma County consists of 708.82 square miles, with a population of 1,013.8 per mile (U.S. Census Bureau, n.d.). The racial/ethnic majorities are broken down as: White (57.9%) followed by Hispanic (16.1%) and Black (14.6%); the median age is 34.2 and 2015 median income was $47,437, with 18.2% of residents below the poverty line (Oklahoma Demographics, 2017).

In order to implement a disaster management plan with all residents of this County in mind, an all hazards approach will be used. In order to assess the probability of a disaster and the impact on the community, a Hazard and Vulnerability Analysis will be conducted.

Hazard and Vulnerability Analysis

A collaborative Public Health Hazard and Vulnerability Analysis was conducted for Oklahoma County using the Kaiser HVA template. Information to conduct the HVA was gathered from historical weather data and Oklahoma County Emergency Management office. The results of the HVA identified the top four natural hazards to Oklahoma County were tornados 67%, thunderstorms 61%, floods 59%, and fires 56%. Based on this HVA tornados will be the focus for the public health disaster management plan.

According to the National Severe Storms Laboratory, a tornado is “a narrow, violently rotating column or air that extends from the base of a thunderstorm to the ground (NSSL, n.d. para. 1).” Tornadoes are formed from thunderstorms and are generated when cool air overrides a layer of warm air, forcing the warm air to quickly rise (Oklahoma County, 2013). There are two types of winds associated with tornadoes, rotating vortex and straight line (FEMA, 2013). Vortex winds are the extreme winds typically associated with tornadoes. These winds can tear structures apart, life vehicles off the ground, and uproot trees. Straight line winds, also known as damaging winds, are high velocity winds that exert significant pressure. These winds can break windows, damage siding, tear off roofs, and cause a structure to collapse. Tornadoes are classified based on the Enhanced Fujita scale. This scale measures the intensity of tornadoes and classifies them into 6 categories, EF 0- EF5. An EF 0 has wind speeds of 40-72 mph; EF1 has wind speeds of 73-112 mph; an EF 2 has wind speeds of 113-157 mph; an EF3 has wind speeds of 158-207 mph, an EF4 has wind speeds of 208-260 mph and an EF5 has wind speeds of 261-318 mph (Storm Prediction Center, n.d.).

There are two regions in the U.S. where tornadoes occur at higher frequencies, these include Florida and the south-central parts of the U.S. known as “Tornado Alley.” The states that make up Tornado Alley include Texas, Oklahoma, New Mexico, Kansas, Colorado, Missouri, Nebraska, South Dakota, and Iowa. “Tornado season” in the Southern Plains typically occurs between the months of May and June, although tornadoes can occur at any time of the year. (NSSL, n.d.). The geographic location of Oklahoma, makes it an optimal spot for convection weather to occur (Oklahoma County, 2013). The Rocky Mountains, which are located north-west of Oklahoma, provide cool air masses; the Gulf of Mexico provides a source of moisture; and the northeast provides dry-hot conditions.

Data collected from 1950-2010 shows that Oklahoma has averaged 54 tornadoes per year (The State of Oklahoma, n.d). During this period, there were 3,466 tornadoes. These tornadoes caused 281 deaths and injured 4,353 individuals. The most recent and deadliest tornado in Oklahoma occurred on May 20, 2013 at 2:56 p.m. CDT. This EF-5 tornado touched down southwest of Moore OK, part of Oklahoma County. The tornado was on the ground for 39 minutes, traveling a distance of 14 miles, with a diameter of 1.1 miles (FEMA, 2014). The tornado claimed the lives of 24 individuals, 7 of which were children, injured 324, and caused $2 billion in damages.

Goal Statement

The purpose of this public health disaster management plan is to ensure the welfare and safety of all citizens of Oklahoma County during a tornado by providing a comprehensive overview of preparedness, mitigation, response, and recovery plans that have been carefully selected and researched.

Objectives

1) By Six months after the plan is revealed, 90% of residents living in Oklahoma county will have a plan in place in case of a tornado; this includes plans for when at home, work, school, or out in the community.

2) Three months after the plan is revealed 95% of residents will be aware of weather alert systems such as, the Accessible Hazard Alert System which sends out an automated text, email, or phone call to alert the public of weather hazards and 85% of residents will be registered to one of these systems.

3) After a tornado occurs in the county, response efforts will be deployed and all units will be working in their designated areas by 30 minutes after the tornado has subsided. Ensure the safety of all personnel working on recovery and response efforts after a disaster.

Ecological Strategy and Emergency Planning Model

An effective emergency planning model consists of developing an all hazards emergency operation plan (EOP) that covers all phases of a disaster (preparedness, mitigation, response and recovery). A comprehensive EOP will assign responsibilities to specific individuals and organizations to carry out during an emergency; determine authority and organizational relationships, and show how actions will be coordinated; describe how individuals and property will be protected during a disaster or emergency; identify personnel, equipment, supplies, facilities and other resources that will be used during response and recovery; and identifies what steps will be used to mitigate response and recovery activities (Mississippi State University, n.d.).

FEMA defines mitigation as the effort to reduce loss of life and property by lessening the impact of disasters (FEMA, 2016). Mitigation efforts occur during all phases of a disaster. Mitigation efforts for tornadoes include warning systems, alerts, safe rooms, stand-alone shelters, reinforced buildings and community storm shelters. A tornado watch will be issued when there is a higher than normal chance of a tornado forming. A tornado warning will be initiated when a tornado is indicated on radar or has been spotted. Each town in Oklahoma county will be equipped with multiple tornado warning sirens. These sirens will be tested on a weekly basis to ensure they are working properly. Sirens will go off as soon as a tornado warning is issued in a particular area. Residents will be encouraged to register for weather alerts that will either send a text message, email or call individuals and alert them of weather hazards in their area. Having safe rooms, stand-alone shelters, and reinforcing buildings are essential for providing coverage and protection from tornadoes. New building codes will require all buildings to be reinforced and will require homes to be equipped with safe rooms. Community shelters will be located throughout the county in order to provide protection for individuals who do not live in homes that cannot provide protection and for those who are caught out in the storm when the warning sounds.

Preparedness efforts for all disasters include public education, planning, training, and exercises. It’s important for each member of the community to be prepared for a tornado. Every individual should create a plan for themselves, their family members, and pets/animals to include where they will take shelter in the event of a tornado and how they will get there. Plans should include when at home, work, school, and areas that are spent during leisurely time. If family members are not together, their plan should also include a place to meet up at after authorities have declared that it is safe to move about. Individuals should also have an emergency preparedness kit in their homes and vehicles that have essential items such as a radio, flashlight, batteries, first aid kit, and enough food and water to last two days.

The Oklahoma County’s Emergency Management Department is responsible for providing educational information to community members on appropriate sheltering methods during a tornado, including locations of storm shelters in the area. Information will be provided to the community via bi-annual meetings, information packets that are updated and mailed out annually to each resident, the County’s website and through public service announcements. Low-income residents who are unable to afford an emergency kit, can pick one up at their town-halls.

It’s important for the community to be involved in preparing for tornadoes. All schools and hospitals will be required to participate in at least two tornado drills per year, and all businesses will be required to have at least one tornado drill per year. All businesses will be required to post the location of emergency shelters to the nearest entry way of their facilities. When a tornado watch is an effect business will be required to make announcements every 30 minutes over the stores PA system. During a tornado warning, businesses will be required to announce this over the PA and provide information to the nearest storm shelter, if the facility is not a safe means of providing cover.

Oklahoma County will participate in regional preparedness efforts with other counties in their region. These preparedness efforts will include collaboration on grants, exercises, training, and resources.

A response plan is necessary to help coordinated time sensitive actions that are necessary to help save lives and reduce injury, protect property, stabilize the situation, and provide for basic human needs directly before and after an incident (Mississippi State University, n.d.). Response efforts include providing emergency services, search and rescue teams, transportation, having utility crews available, ensuring communications, opening up shelters, and dispersing volunteers. After the tornado has subsided, emergency response personnel will be activated to start rendering services and perform a rapid assessment of the area in order to prioritize response activities, allocate resources, and request additional assistance from mutual aid partners and the state.

Directly after the storm, a rapid assessment should be conducted to obtain critical information on lifesaving needs, critical infrastructure, critical facilities, damage risk, and displaced individuals (FEMA, n.d.). Response teams need to be ready to move after it is declared safe. Roads may be damaged or blocked by debris, having a response team dedicated to removing the debris and clearing pathways will be critical for emergency medical services, firefighters, police officers, and search and rescuers to reach their intended destinations. A utility crew will need to be readily available in order to respond to hazards such as downed power lines, electrical systems, or broken gas lines.

Plans should be implemented before a disaster to insure emergency responders and rescue workers are informed about potential hazards they may encounter and are equipped with personal protective equipment (PPE). Personnel may encounter blood or bodily fluids, pathogens from sewer system breaks, damaged utility services, scattered debris, smoke and dust, fall hazards, materials with sharp or jagged edges, and unstable buildings with the potential of collapse. PPE should include gloves, sturdy footwear, respiratory protection, protective eyewear, and hearing protection.

Volunteers and volunteer organizations are an essential asset to the response and recovery of disaster areas. Volunteers need to be well organized and coordinate with the Incident Command System in order to effectively respond to a disaster. Volunteer organizations such as the Red Cross, the Salvation army, and AmeriCorps will be needed to assist with setting up shelters, providing food and water to those displaced, and providing response and disaster relief efforts.

The recovery phase includes the short and long term efforts needed to restore a community’s systems and activities back to normal (FEMA, n.d.). Recovery efforts start as soon as the incident has occurred; recovery efforts may be coinciding with response efforts. Recovery efforts include returning economic and business activity to a positive state, restoring and improving health and social services, stabilizing critical infrastructure and implementing housing solutions.

Emergency Management

The international Association of Emergency Managers defines emergency management as “the managerial function charged with creating the framework within which communities reduce vulnerability to threats/hazards and cope with disasters (FEMA, 2007, p. 4).” Emergency management involves the coordination and integration of actions from individuals and households, private and nonprofit sectors, community entities and all levels of government necessary to build, sustain, and improve the capability to mitigate against, prepare for, respond to, and recover from disasters (FEMA, 2007). Emergency management seeks to improve the outcome of disasters and can be measured in lives saved, fewer injuries, reduced damages, and shorter recovery time.

An effective emergency management plan should adopt best practices from other plans. The emergency preparedness plan created utilized strengths and weaknesses that occurred during the response and recovery efforts for the tornado that occurred on May 22, 2011 in Joplin Missouri. This tornado was the deadliest tornado in the U.S. since 1947 (FEMA, 2011). The tornado caused 161fatalities and injured 1,371 individuals. The tornado damaged thousands of buildings, including the St. John’s Regional Medical Center, and caused approximately $2.8 billion in damages.

Two areas of strength that were recognized from the Joplin tornado were the regional capabilities and the use of traditional and social communications (FEMA, 2011). Joplin had participated in a number of regional preparedness initiates with 18 counties and other jurisdictions that were located in their sector. Preparedness efforts included collaboration on grants, exercises, training, and other preparedness activities. After the tornado, city officials used press conferences, press releases, email, the City’s web page, and Facebook to disseminate important emergency information to the public and response partners. Using both traditional and social media communications in a complimentary manner allowed for target audiences to receive important and necessary information about response and recovery efforts.

Two areas of weakness that the Oklahoma County plan recognized and improved upon from the Joplin tornadoes were the management of volunteers and the planning for mortuary services. In addition to the regional mutual aid, personnel from over 400 public safety organizations deployed to the area. The first challenge was when self-dispatched responders arrived in Joplin, they began performing tasks without coordinating with the local incident command. Second, many responders lack the equipment and training needed to conduct operations, such as search and rescue. As a result, improper search markings were used, instead of standard search markings. This lead to some structures that were searched multiple times, which waisted valuable time and could pose potential harm in unstable structures. Due to the large amount of fatalities, the local corners office was over whelmed. Two days after the tornado, the Disaster Mortuary Operational Response Team (DMORT) was called in. The complications came when processing the bodies and identifying victims. Initially, even with the DMORT team only 2-3 bodies were being processed per day. Coroners were allowing victim families to identify bodies, but stopped after a family member misidentified someone.

There are many roles and responsibilities involved during a natural disaster, focused on life safety, incident stabilization and preservation of property and the environment. The local emergency manager is responsible for conducting key components of emergency management such as coordinating the planning process and working with organizations and governmental agencies, conducting a hazard and vulnerability and risk assessment, and coordinating reviews of all local emergency responders; managing resources before, during and after a disaster; coordinating with all partners involved in the emergency management process, including fire services, law enforcement, emergency medical programs, public works, volunteers and voluntary organizations, private and nonprofit sector organizations, and citizens (FEMA, n.d.). The emergency manager should also be current on related legal and accreditation issues and have input into the budgeting process and consider potential fiscal issues related to disaster.

Forming a collaborative planning team is necessary to develop and maintain an EOP. This team is responsible for overseeing the implementation, review, and updating of the plan. Planning members may consist of emergency managers, fire, law enforcement, emergency medical services, public utilities, public health, health care, child welfare, animal control and care, community organizations, local businesses, social services and transportation services (FEMA, n.d.). Planning efforts need to include all phases of the disaster and should be developed in accordance with the DMA 2000, FEMA regulations, the Oklahoma Management guidance (Oklahoma County, 2014). Exercising these plans is a critical means of testing their effectiveness prior to an actual incident.

An incident command system (ICS) is a standardized organizational structure used to command, coordinate, and control personnel and resources when responding to a disaster (FEMA, n.d.). The incident commander (IC) has the authority of coordinating the use of resources and personnel at the scene of an emergency. Other important elements of the ICS include Operations, Planning. Logistics, and finance/Administration.

Surge

During any disaster, it’s important for hospitals to plan for medical surge capacity. Medical surge capacity refers to “a significant event or circumstances that impact the healthcare delivery system resulting in excess demand over capacity and/or capability in hospitals, community care clinics, public health departments, other primary and secondary care providers, resources, and/or emergency medical services (California Hospital, 2013, p. 1).” Both communities and regions need to be involved in the development of surge capacity plans that reflect local hazards and other variables (Hick, 2004). Plans must incorporate additional space requirements, the organizational structure, staffing needs, supplies, equipment, pharmaceuticals, information systems, and other necessary resources needed to support public health and patient care efforts.

Increasing hospital space for the incoming flux of patients is a crucial element of managing hospital surge (Riley, 2011). Emergency management plans should include rapid patient discharge, canceling elective surgeries, focusing on strategies to increase bed capacity and identifying locations for alternative care facilities. The plan needs to specify how they are going to accommodate the rapid discharge of stable patients and who will be responsible for canceling elective surgeries. To increase bed capacity, the plan should include increasing beds per room and listing nontraditional spaces that can be converted for patient care. In the event that the hospital facility is damaged and unable to receive patients or full capacity is reached, pre-identified locations for alternative care facilities should be noted in the plan.

To accommodate incoming patient’s hospital staff personnel and supplemental staff support from other organization should be called upon. Other organizations that may be called upon to provide staff include Emergency Systems for Advance Registration of Volunteer Health Professionals (ESAR VHP), Medical Reserve Corps (MRC), the American Red Cross, public health departments, and/or schools (Adams, 2009). Protocols should be in place to revise staff schedules, call in off duty personnel, assign volunteers to appropriate areas and implement nonclinical staff when appropriate. Altered standards of care may be enacted to increase the capacity of existing staff.

During disasters, additional equipment, supplies, and pharmaceuticals are needed. Policies should be an enacted to optimize resources. These policies should include substitution, conservation, use of less-resource-intensive therapies, and in the worst-case scenario, reuse or reallocation of resources (Einav, 2014). Hospitals should have a stock pile of these resources, but in the event that they run out, the Oklahoma County Emergency Medical Services has an additional reserve of supplies that hospitals in the area can request upon need. It may be necessary to collaborate with the local public health department and public health laboratory in times of crisis, and consider safety issues as well.

Special Planning Considerations

During any disaster, planning members should take into account special considerations that may need to be in place before, during, and after a disaster and accounted for during the planning and response. Special considerations to consider when implementing plans include ensuring those with special needs and vulnerable populations are provided for and having plans in effect for pets and other animals.

Individuals who have special needs and vulnerabilities need to be considered in the planning process before, during, and after a disaster. Vulnerable populations include individuals with acute medical conditions, chronic diseases, people with disabilities, elderly and youth, low income, immigrants, individuals with limited English proficiency, and homeless individuals (Riley, 2011). In order to help emergency managers plan for individuals with special needs and vulnerabilities, individuals should register with the county. This register will help identify those with special circumstances so planners can adopt best practices for mitigation, preparedness, and recovery efforts.

Plans should educate the public about creating a plan for not only their families, but their pets and animals. Plans need to include identifying shelters in the area where pets are accepted. Families should ensure all pets have tags secured to their collar with their name and your phone number and address. Families should also have an emergency kit for their pets that have food, water, medications, veterinary records, food dishes, first aid kit, and a photo for identification purposes. Additionally, communities need to plan for shelters that have the ability to house, and care for pets.

In the event of a mass casualty special considerations need to be made. Triage may need to occur and in the unfortunate case of a mass fatality event, mortuary services must be expanded in addition to hospital surge for the living. The trauma system may be greatly impacted, causing reliance on mutual aid and ability to accommodate these extra resources; it is very important that all members of the work force have needed resources including food and housing, and have proper personal protective equipment (PPE) to include protection for the head, eyes, feet, and ears. and also the tools needed to do heavy lifting. In the event of a tornado the aftermath still has significant risks involved. Special planning needs to be done regarding debris removal from the roads since this will create an issue for people that are trying to seek medical care or evacuate for any reason. Another special consideration that needs to be addressed is infrastructure damage such as downed power lines.

Evaluation

Any successful program needs to be evaluated. Process, outcome, and impact evaluations will help determine if program activities have been implemented as intended, determine to what degree program objectives have been achieved, and measures the effectiveness of the program (CDC, n.d.). Process evaluations for this program will include questions such as: how many residents attended informational meetings? What information did residents receive? And What barriers were encountered when implementing training, drills and exercises? Outcome evaluations will ask questions such as: were educational programs for the public effective at helping residents from a plan to find shelter before a tornado occurred? Did practicing drills and exercises effectively prepare responders for the actual incident? Impact evaluations will ask questions such as: Did mitigation efforts help reduce fatalities, injuries, and property damage? Did the program help improve preparedness, mitigation, response, and recovery efforts? The evaluation design of this study is a non-experimental design.

Qualitative and quantitative data will be collected. Qualitative data will be collected through direct observations, interviews, and focus groups. Observational data will collect information on property damage, buildings that were not damaged, and on how response and recovery efforts were conducted. Key personnel such as the emergency manager, the incident commander, and first responders will be interviewed to gain an understanding of the event through their experience. A focus group will be conducted using community members, emergency responders, planning members, members of volunteer organizations, and members of the ICS command to determine what went well during the event and what areas need improvement. Quantitative data will be collected by using surveys. Surveys will be sent to individuals, those who volunteered, individuals working for volunteer organizations, emergency responders, and emergency managers. After qualitative and quantitative information is analyzed, an After-Action Report and Improvement Plan will be drafted and key findings will be presented to key stakeholders.

Conclusion

Oklahoma county has the largest population in Oklahoma. Due to the geographical location of Oklahoma tornadoes are an imminent threat to those who live there. Having a disaster management plan that extensively covers preparedness, mitigation, response, and recovery is essential to minimizing the loss of life, stabilizing the incident, and protecting property. This plan involves a whole community approach that seeks to improve the welfare and safety of its citizens through the implementation emergency management.

References

Adams, L. M. (2009). Exploring the Concept of Surge Capacity. OJIN: The Online Journal of Issues in Nursing; Vol. 14 No.2 . Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/ OJIN/TableofContents/Vol142009/No2May09/Articles-Previous-Topics/Surge- Capacity.html

Centers for Disease Control and Prevention. (n.d.). Capability 10: medical surge. Retrieved from https://www.cdc.gov/phpr/capabilities/capability10.pdf

FEMA. (2011). The Response to the 2011 Joplin, Missouri, tornado lessons learned study. Retrieved from http://kyem.ky.gov/Who%20We%20Are/Documents/J oplin%20Tornado%20Response,%20Lessons%20Learned%20Report,% 20FEMA,%20December%2020,%202011.pdf

FEMA. (2014). Tornado: Moore, Oklahoma, May 20,2013 safe room performance, observations, and conclusions. Retrieved from https://www.fema.gov/media-library- data/1418307179636-a018b8744801f8a770e6ea5c65eb5a4d/FEMA_P- 1020_Moore_Tornado_Report_508.pdf

FEMA. (2016). What is Mitigation? Retrieved from https://www.fema.gov/what-mitigation

FEMA. (2013). Welcome to IS-319 Tornado Mitigation Basics for Mitigation Staff. Retrieved from https://emilms.fema.gov/IS319/indexMenu.htm

FEMA. (n.d.). IS-0230.d Fundamentals of Emergency Management. Retrieved from https://emilms.fema.gov/IS0230d/indexMenu.htm

Hick, J. L., Hanfling, D., Burstein, J. L., DeAtley, C., Barbisch, D., et al. (2004). Health care facility and community strategies for patient care and surge capacity. American Journal of Emergency Physicians. Retrieved from http://www.aha.org/content/00-10/Hick.pdf

Mississippi State University. (n.d.). Preliminary Considerations. Retrieved from http://cra20.humansci.msstate.edu/Definition%20of%20an%20Emergency%20Operation s%20Plan.pdf

The National Severe Storms Laboratory. (n.d.). Sever weather 101-tornadoes. Retrieved from http://www.nssl.noaa.gov/education/svrwx101/tornadoes/

Oklahoma County. (2013). Oklahoma County Hazard Mitigation Plan 2013 update. Retrieved from https://www.oklahomacounty.org/emergencymanagement/documents /HMP2013WOappendixE.pdf

The State of Oklahoma. (n.d. a). Oklahoma tornado information. Retrieved from https://www.ok.gov/oid/Oklahoma_Tornado_Information.html

The State of Oklahoma. (n.d. b.) State of Oklahoma emergency operations plan. Retrieved from https://www.ok.gov/OEM/documents/State%20EOP%20Aug%202006.pdf

Storm Prediction Center. (n.d.). Enhanced F scale for tornado damage. Retrieved from http://www.spc.noaa.gov/faq/tornado/ef-scale.html

United States Census Bureau. (n.d.). Quick Facts: Oaklahoma County, Oklahoma. Retrieved from http://www.census.gov/quickfacts/table/PST045215/40109

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