Orange County (CA) Emergency Management Organization

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					           Orange County (CA) Emergency Management
                                    SEPTEMBER 2009

       To increase the overall awareness of staff regarding the potential impact a pandemic could have
        on Federal operations.
       To begin development of policies related to management of personnel during a local pandemic
       To create an action list of items that need to be resolved as well as assignment of each item to
        specific personnel for completion, and designation of a timeline for completion.

Ground Rules & Assumptions

       Your experience and perspective within the organization will be specific to you. By asking
        questions and challenging each other regarding answers and/or assumptions, we can better
        understand the complexities and interwoven nature of how we, as an organization, operate. That
        being said, challenge and question with respect for the other individuals in the group.
       There are no “stupid” questions except those that are not asked.
       Concern for yourself and your family when discussing this scenario is expected, real and
        appropriate. Use this concern to dig deep into defining real and workable solutions as well as
        defining areas that need resolution to ensure the well-being of those who work here, including
       Understand that there are many aspects of this situation still unresolved by the medical
        community. We should be creative in our analysis to accommodate potentially yet unknown
       Local government is generally not “in charge” during a pandemic incident. This responsibility
        lies with the health officer. Primary concern should be focused on development of policies and
        procedures for management of our own personnel and resources based upon the direction
        received from the public health authorities.


In late March and early April 2009, cases of human infection with the H1N1 virus were first reported in
Southern California and near San Antonio, Texas. All U.S. states have since reported cases of H1N1 flu
infection in humans. As part of the federal government response to the H1N1 virus, the Department of
Health and Human Services issued a nationwide public health emergency declaration on April 26, 2009
(Press Release). On July 23, 2009, Secretary Sebelius signed a renewal of the determination that a public
health emergency exists.

On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of novel
influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6. This action
was a reflection of the spread of the new H1N1 virus, not the severity of illness caused by the virus. At

the time, more than 70 countries had reported cases of novel influenza A (H1N1) infection and there were
ongoing community level outbreaks of novel H1N1 in multiple parts of the world.

Since the WHO declaration of a pandemic, the new H1N1 virus has continued to spread, with the number
of countries reporting cases of novel H1N1 nearly doubling. The Southern Hemisphere’s regular
influenza season has begun and countries there are reporting that the new H1N1 virus is spreading and
causing illness along with regular seasonal influenza viruses. In the United States, significant novel H1N1
illness has continued into the summer, with localized and in some cases intense outbreaks occurring. At
this point, the virus is considered to be widespread among the population and testing for the virus is
focused on those who become hospitalized or who are at extreme risk due to underlying medical

As children return to school in the fall, cases are expected to continue to increase. It is also possible that
the virus will mutate, making it more deadly or more resistant to anti-viral medications. The H1N1 virus
fatalities are in significantly different age groups than seasonal influenza. Forty-one % of the H1N1
fatalities have been in the 25-49 age group. This is a very different pattern from what is seen in seasonal
influenza, where an estimated 90% of influenza-related deaths occur in people 65 years of age and older.
The most susceptible among the population seem to be children and women, especially pregnant women.
The United States continues to report the largest number of novel H1N1 cases of any country worldwide,
however, most people who have become ill have recovered without requiring medical treatment.
According to health officials, a pandemic may come and go in waves, each of which can last for six to
eight weeks. This cycle is expected to last between 18 months and two years until general immunity
develops in the population.

While the development and testing of a vaccine is nearing completion, it is clear that the need for vaccine
is going to outstrip supply and the supply of antiviral drugs is also likely to be inadequate during these
early months of the pandemic. Difficult decisions will need to be made regarding who gets antiviral drugs
and vaccines. Current CDC recommendations for vaccinations focus on the following five groups:
     Pregnant Women
     Health care workers and emergency medical responders
     People caring for infants under 6 months of age
     Children and young adults from 6 months to 24 years
     People aged 25-64 with underlying medical conditions (asthma, diabetes, etc.)

These five groups comprise a total of 159 million people in the United States. What is more important to
note is who is NOT included in these recommendations (law enforcement, general emergency workers,
etc.) as we work through the pandemic planning process.

As we move through this exercise, it is also important to keep in mind that death rates are determined by
four factors: the number of people who become infected, the virulence of the virus, the underlying
characteristics and vulnerability of affected populations, and the availability and effectiveness of
preventive measures.

                            MANAGEMENT SECTION
Business continuity planning issues:
     Sick leave usage policies (personal illness vs. family member illness vs. fear of exposure)
           o Discuss limits outlined in MOU’s – are these adequate and/or appropriate?
     Legal authority to force people to go home
           o Paid or not paid? Vacation or sick or both? In what order?
     Identification of essential services
           o If offices are open
           o If offices are closed
     Work from home policies (Who? How do you monitor work? Who pays for equipment?)
     Labor issues – what authority do we, as Management, have to change policy? How does this need
       to happen – what is the process?

Issues regarding contractors to the organization (i.e. cleaning service, building inspectors, etc.):
     What guarantees do we have that they can provide service?
     If WE cancel service temporarily, do we still have to pay?
     What if they claim they were exposed?

Emergency support issues:
    Should we ever proclaim a State of Emergency?
    What are the triggers?
    What about activation of the EOC? To what level? Who should staff it?

Event Cancellations
    Who has authority?
    Time frame to issue order
    Public notification

PPE and Hygiene
    Workplace sanitization – by whom? How?
    Self-Sanitization – will we provide the resources for this? Who will control it?

Budget impact
    See Finance Section below.

     What organizations and businesses need to be brought on as partners?
     Who will we need to reach out to in order to provide assistance?

Public information and education for employees and their families – Who? How? When? What comes
from our agency and what needs to come from other agencies (identify who/when).

What about public meetings (City/County/State partners, etc.)? When must they be held, legal
requirements, screening of attendees, etc. Are there legal alternative ways to conduct business?

                               OPERATIONS SECTION
Discuss policy development and implementation for the following issues:

   PPE & Fit Testing – who, when, what type, disposal, funding, central coordination vs. departmental

   Hygiene – hand sanitizing stations, work station cleanliness especially in shared work stations,
    cleanliness of equipment

   Sick leave enforcement

   911 Responses – issues regarding exposures, PPE protocols, dispatch screening

   Vaccinations and Tamiflu – How do we prioritize? What if an employee refuses to participate? Shots
    provided on-duty? Who pays for vaccinations and/or anti-virals? What about reactions to the vaccine
    or anti-viral – are these Worker’s Comp?

   Role of industrial health in managing workplace wellness

   Cancellation of events or facility closures (will employees be paid if events or programs are
    cancelled? Is there other work for them to do? Who can/should work from home or alternate

   Who is the medical authority for employees while at work? Away from work? After being sick and
    wanting to return to work? When will a note/clearance from a doctor be required?

   Closure of government facilities to the public (trigger points, levels of staffing, etc.)

   Would we want to consider staggered staffing to ensure some employees stay well (send some
    employees home to ensure they stay healthy)

   Training & Education (employees, their families, the community, cleaning crews and other
    contractors in City facilities). Create a list of those who might need to be educated/informed.

                        PLANNING & INTELLIGENCE
   What should be considered in the development of staffing schedules?

   Which EOC staff positions are most critical? Should action be taken to ensure at least one person is
    available at all times for each of these positions?

   How will we track the illness among employees? How much information needs to be tracked and
    documented? Will this be an EOC function, a departmental function, or a combination?

   What are the legal implications of tracking illness?

   How will we communicate with employees who are not here either due to illness or facility closures?

   Is special consideration needed for employees who travel?

   What kinds of documentation might be necessary for an incident such as a pandemic? By who?

   Discuss contingency plans for the occurrence of another emergency/disaster event during the height
    of the outbreak. What can/should be done to protect remaining staff? Develop a list of critical
    functions that MUST be performed and identify possible resources outside the organization to
    accomplish these tasks (retirees, outside aid, private sector, remote access, etc.)

   What special education and/or procedures need to be implemented for education of employees and
    their families?

   How will we handle recovery issues to get “back to business as usual”? Start a list of what will need
    to be considered.

Discuss the purchase of necessary equipment:
     What will be needed?
            o N95 masks
            o Hand Sanitizers
            o Face Shields
            o Gloves
            o Paper gowns
            o Anti-bacterial wipes
            o Regular cleaning supplies
            o Other? Identify

Work from Home and Social Distancing issues:
    Computer Band Width
    Identification of essential services
    Conference call capabilities
    Who pays for home use of electronic equipment (internet service, use of home equipment, phone,
    Other? Identify

Discuss Business Continuity issues that would arise during this scenario. Discuss staff availability for
critical functions, contract fulfillment, etc.

Discuss what time keeping issues might arise:
     If work-at-home policies are implemented.
     If facility closures occur.
     For first responders held over for evaluation due to exposure.
     For sick leave taken that is out of conformance with current policies and procedures and/or

Discuss the overall budget impact this pandemic occurrence might have and how to minimize the impact
on the organization generally and the current budget specifically.

Discuss the possible budget impact in the general economy i.e. other systems that might be impacted that
could create delivery and management issues, as well as revenue loss to us.

Discuss payroll procedures needed to track impact of the illness on the organization. Are special pay
codes needed? If so, what are the triggers? Who will lead this effort?