County Community Disease Containment
Standard Operating Guide
AUTHORITIES
Primary Agency· X County Health Department
§ / Supporting Agencies
§ Emergency Medical Services (EMS)
§ Local hospital(s)
§ X County Emergency Management
§ Behavioral/Mental Health Agency
§ Local Funeral Directors
§ County/District Coroner
§ X County Sheriff
§ Local Elected Officials
§
I. MISSION
The Community Disease Containment Standard Operating Guide (CC SOG) provides X County with step-by-step instructions for reducing or minimizing person-to-person spread of disease by separating individuals with disease or at an increased risk for developing disease from individuals at lower risk.I.a. PURPOSE
The CC SOG is used during infectious or contagious disease outbreaks to assist decision makers in implementing community containment measures, which require individuals to be separated from the general population. This SOG and the core attachment the “Kansas Community Containment Isolation/Quarantine Tool Box” (Attachment 1) contains information and tools needed to implement a range of measures necessary in the case of an outbreak of infectious or contagious disease. The tools include flow charts, statutes, regulations, sample forms, and protocols for performing the tasks associated with community disease containment. This SOG is interdependent with other SOG’s. The related SOG’s are referenced in this SOG and must be referred to when dealing with community disease containment issues. The Kansas Isolation and Quarantine statute K.S.A. 65-129 (Attachment 1, Section V.) provides the template for control efforts in the case of large-scale outbreaks of naturally occurring diseases like pandemic influenza or SARS or artificially introduced biological agents in connection with bioterrorism.There are many other alternatives that will be utilized beyond individual isolation and quarantine. These alternatives are addressed within this SOG. The effectiveness of these measures will rely upon the understanding, comprehension and active cooperation of the public, business and clinical care infrastructures within communities. These measures are discussed in Attachment 1/Section II.
I.b. SCOPE
The X County Health Department will maintain and update this SOG and will provide all involved community partners with a copy. A copy of this guide will be maintained at the X County Health Department as well as X County Emergency Management. A copy or appropriate excerpts/sections will be provided to local legal and or law enforcement authorities in the event of their involvement. The following is a link to the online version of the Tool Box (Attachment 1) that can be used or be sent to partners in a community containment activity (state link will be provided when developed or local link can be created).In accordance with CDC and KDHE requirements, this guide will be reviewed quarterly to ensure accurate and updated information. Changes will be posted on the “Record of Review and Update” found at the front of the SOG.
II. SUMMARY
X County has formed a HEALTH AND MEDICAL TASK FORCE as a part of the county Biological Incident Annex that will ensure a multi-disciplinary approach to planning for and response to incidents requiring a major medical or public health response including Community Containment measures, in accordance with state law, regulations and pertinent CDC guidance. The Health and Medical Task Force will meet program requirements as set forth in the preparedness checklist for community containment measures in (Attachment 1/Section II [preparedness checklist]).
A HEALTH AND MEDICAL TASK FORCE may be expanded (depending upon scope and magnitude of the situation) to include:
· State Health Officer
· State Epidemiologist
· State legal counsel
· State program (pertinent to diseases associated with event) staff· Local County or District Attorney
· Local and/or County Law Enforcement
· Local and State Emergency Management
· Regional or surrounding jurisdiction local health officers
These positions and their back-up point-of-contact information can be found in the X County Mass Dispensing SOG.
The following provides guidance on the range of approaches that will be used in relation to various levels of threat represented by different infectious and contagious diseases. In addition, specific guidance documents and templates are provided for use by local health departments in conjunction with Kansas’s statutes associated with Isolation, Quarantine and other community containment measures (Attachment 1/Section II).
Command and Control (Decision Making):
Implementation of community disease containment measures will require cooperation between local, state, and possibly federal authorities. K.S.A. 65-129 provides the local county health officer or the state health officer with the authority to declare necessary containment measures (Attachment 1/section V). X County is required to use the county specific Incident Command System (ICS) in accordance with National Incident Management System (NIMS) requirements.
A copy of the incident command structure for community disease containment in X County can be found in the attachment 2. The emergency call-down roster for community disease containment in X County is located in Attachment 3.
These positions and their back-up point-of-contact information can be found in Attachment 4. Job action sheets for the command staff are found in Attachment 5.
At any given time during the containment process, X County will activate the required level or levels of community containment measures based upon the scope of the threat represented by a particular infectious or contagious disease agent, its mode of transmission and control, and its anticipated impact on the community. Guidance and recommendations for these measures can be found in Attachment 1/Section I (flow charts) and Section II (Guidelines and Recommendations). If X County Health Officer is unable to function in their legally designated capacity or determines that the magnitude and scope of the event extends beyond their jurisdiction or available resources, the State Health officer and/or designee(s) shall serve in X County health officers place in accordance with (K.S.A. 65-129).
III. LEVELS OF ACTIVATION
X County Local Health Officer or health department designee(s) in conjunction with the Health and Medical Task Force will assess the impact of a particular infectious and contagious disease and determine the scope and magnitude of the community containment measures in conjunction with the local or state epidemiologist and pertinent program staff. The X County Local Health Officer in conjunction with the Health and Medical Task Force will determine the levels of activation needed based upon the guidance provided in the X County Biological Incident Annex and will direct their actions through the use of the tools provided in The Kansas Community Containment Isolation/Quarantine Toolbox found in Attachment 1 (toolbox) and involve other members of the HEALTH AND MEDICAL TASK FORCE as indicated.
X County Local Health Officer and/or designees in conjunction with the HEALTH AND MEDICAL TASK FORCE will assess the need to involve community partners at levels indicated by the determinations of the HEALTH AND MEDICAL TASK FORCE and draft orders for the enforcement of various community containment measures as warranted by events (Attachment 1/Section III [sample orders]). During a response requiring activation of this SOG, X County Health Officer and/or health department designees will coordinate with community partners to:
(A) General (refer to X County Biological Incident Annex)
· X County Health Department Administrator/Designee will activate the HEALTH AND MEDICAL TASK FORCE and establish an incident command structure in accordance with the Local Emergency Operation Plan.
· Activate established legal preparedness plan (refer to Attachment I/Section III).
· Notify community partners, such as law enforcement, first responders, healthcare facilities, mental health professionals, local businesses, and the legal community using the X County emergency personnel call-down roster (Attachment 3).
· Monitor and assess factors that will determine the types and levels of response, including the epidemiologic profile of the outbreak, available local resources, and level of public acceptance and participation.
· Activate the Crisis Risk Communications SOG for the X County Public Health department
(B) Temporary emergency facilities for patient isolation, quarantine, and assessment of patients (Attachment 1/Section IV [appendix 3])
· Activate appropriate community-based facilities for isolation of patients who have no substantial healthcare requirements.
· Activate facilities that will be used for individuals who do not have access to an appropriate home setting (e.g. travelers and homeless populations) when home isolation is indicated
· Activate quarantine facilities and plans for staffing and equipping them.
· Utilizing the MASS DISPENSING SOG activate clinic sites and plans for staffing and equipping them, including the ability to dispense antiviral drugs to identified cases in the priority groups.
(C) Community containment measures (Att. 1/Section I/Section II/Section IV)
· Activate procedures and legal authorities to restrict movement within the community as necessary.
· Activate procedures for medical evaluation and isolation of quarantined persons who exhibit signs of illness.
· Provide Just in time training for volunteers, first responders and healthcare workers, as necessary, in the use of personal protective equipment
· Provide appropriate prophylaxis or vaccination for law enforcement, first responders or those individuals or groups having at-risk contact with individuals in isolation or quarantine based on the priority prophylaxis list (Attachment 6).
· Activate the local health department Crisis Risk Communications SOG and the local Mental Health Plan (in development) in order to prevent stigmatization and provide mental health services to persons in isolation or quarantine.
· Utilizing community partners as supporting agencies, implement movement restrictions (including quarantine, and the provision of essential services and supplies). Examples of supporting agencies are as follows:
o Law enforcement
o Emergency Medical Services
o Local Elected Officials
o First responders
o Other government service workers
o Utilities
o Transportation industry
o Local businesses
o Schools and school boards
o Clergy and other NGO’s
(D) Utilizing tools provided in the X County Biological Incident Annex and Attachment 1/Section IV, coordinate delivering medical care, food, and services to persons in isolation or quarantine. Examples of services that will require the help of non-traditional partners include:
· Coordinate with the county Emergency Operations Center to activate the infrastructure to deliver essential goods and services to persons in isolation and quarantine. Plans or delivering essential goods and services can be found in the X County LEOP:
o Food, water, electricity, garbage collection, heating or air conditioning
o Medications, medical supplies, and medical consultation
o Mental health services
o Faith based services
o Other supportive services (day care, laundry, banking, essential shopping, etc.)
o Social diversion (television, radio, internet access, reading material)
o Transportation for medical evaluation and/or treatment
o Communication resources (phone, internet, etc)
IV. LEVELS OF CONTAINMENT(Attachment 1/Section II)
No single strategy for limiting the spread of contagious disease is possible or appropriate for all types of disease outbreaks. Because each outbreak will be situational, specific strategies need to be flexible, adaptable and developed for a “case-by-case” basis. The five primary tools of infection control, isolation, quarantine, community restrictions and sheltering can be used separately or in combination to limit the spread of disease. Decision makers will employ the least restrictive means necessary to limit exposure and/or disrupt transmission of the disease. See Attachment 1 Section I (Community Containment Flowchart) and Section II for levels of containment. The “Key Considerations” noted in Section II must be met for implementation of the more extreme measures.
V. OPERATIONAL IMPLEMENTATION
X County Health Officer and/or health department designees working with the HEALTH AND MEDICAL TASK FORCE shall implement the various Community Containment measures as indicated by the nature of the infectious or contagious disease agent and the scope and magnitude of the anticipated impact on the community as determined by the following:
(a) Protocol for Rapid Response and Containment (Adapted from the WHO Pandemic Influenza Protocol for Rapid Response and Containment):http://www.who.int/csr/disease/avian_influenza/guidelines/pandemicfluprotocol_17.03a.pdf.Recognize the event: The X County health department infectious disease nurse/administrator/designee will receive a report of a confirmed, probable or suspect case of an infectious or contagious disease from the Kansas Department of Health and Environment’s Health Alert Network or their local hospital laboratory. X County health officer and/or their designee will activate the HEALTH AND MEDICAL TASK FORCE. The HEALTH AND MEDICAL TASK FORCE will ascertain the nature of the threat according to the flow charts and decision trees found in Attachment 1/Section I utilizing the X County Biological Incidence Annex for guidance.
Responsibilities of the HEALTH AND MEDICAL TASK FORCE:
Verify the event: During an outbreak situation, after the causative agent has been identified, laboratory confirmation of cases may not be required for a jurisdiction to initiate community containment measures. However, when X County receives notification of case/cases (see BIA or, http://www.kdheks.gov/labs/downloads/Lab_table_revised_K_8_3_05_draft_revised.xls) with a disease condition that is considered a threat to the community, X County Health Officer and/or designated health department staff and the HEALTH AND MEDICAL TASK FORCE will carry out an initial risk assessment to determine the control measures warranted by the nature of the infectious or contagious disease agent.
Individual Containment Measures: In certain circumstances individuals who are infected or exposed to contagious disease agents will be separated from persons who are well.
Isolation is used when a person who is believed to be ill as a result of infection with a communicable disease agent or who is believed to be shedding the infectious or contagious disease agent is kept separated from healthy persons to prevent the spread of the disease. A decision tree for individual isolation can be found in Attachment 1/Section I.
Quarantine is used when a healthy individual is believed to have been exposed to a communicable disease agent and are kept apart from other healthy persons to prevent spread of the disease. A decision tree for individual quarantine can be found in Attachment 1/Section I
Community Disease Containment Measures are used if disease transmission is significant and sustained, local public health authorities will consider implementing community-based containment measures (Attachment 1/Section I [Community Containment Decision Tree]).
Public education and communication will be a critical element of any plan, particularly when oversight is logistically difficult or impossible. Posting of signs in public places and community gathering spots (e.g., billboards, on major thorough-fares, in newspapers, in grocery stores, in offices buildings, community centers, places of worship, and throughout public transportation systems) can reinforce public messages. The media will be enlisted to help provide information in this effort. The X County Health Department Risk Communications SOG shall be initiated in accordance with various levels of activation.