Overview of Application Requirements
b
2010-11 Application Guidance for
Local Health Departments and
Local Hospital Preparedness Program Entities for:
Centers for Disease Control and Prevention (CDC)
Public Health Emergency Preparedness (PHEP) Program
State General Fund (GF) Pandemic Influenza Planning Program
U.S. Department of Health and Human Services (HHS)
Assistant Secretary for Prevention and Response (ASPR)
Hospital Preparedness Program (HPP)
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July 23, 2010
California Department of Public Health
TABLE OF CONTENTS
Page
SECTION ONE:
Overview of Requirements for 2010-11 Local Public Health
Emergency Preparedness (PHEP), State General Fund (GF) Pandemic Influenza,
and Hospital Preparedness Program (HPP) Funds 3
SECTION TWO:
Guidance for Centers for Disease Control and Prevention
(CDC) Public Health Emergency Preparedness (PHEP) 12
SECTION THREE:
Guidance for State General Fund (GF) Pandemic Influenza 23
SECTION FOUR:
Guidance for U.S. Department of Health and Human Services (HHS)
Hospital Preparedness Program (HPP) 24
Index of Attachments 40
SECTION ONE:
OVERVIEW OF REQUIREMENTS
FOR 2010-11 FUNDS
This guidance describes the 2010-11 application process for local health departments (LHD) and Local Hospital Preparedness Program (HPP) Entities to apply for the 2010-11 Public Health Emergency Preparedness (PHEP), HPP and State General Fund (GF) Pandemic Influenza grants.
The funding sources and intended purposes are:
• PHEP all-hazards funds awarded to California by CDC for CDPH and LHDs to develop and maintain public health preparedness
• HPP funds awarded to California by the Assistant Secretary for Prevention and Response (ASPR) for health care facilities and emergency medical services (EMS) to develop and maintain disaster preparedness
• Local pandemic influenza planning funds appropriated from the State GF for LHDs to develop and maintain preparedness for pandemic influenza.
In order to ensure greater coordination of separate funding streams and maximize integration of funds, CDPH is issuing a single combined guidance and a Comprehensive Agreement for all funding sources available as of the date of issuance of this guidance.
However, HPP and PHEP/Pan Flu each require a separate work plan and budget. Funds from each funding source must be tracked separately.
For each funding stream, the following grant terms apply:
|FUNDING SOURCE |2010-11 FUNDING CYCLE |
| |BEGIN DATE |END DATE |
|CDC PHEP (including Reference Laboratories & Cities Readiness Initiative|August 10, 2010 |August 9, 2011 |
|(CRI)) | | |
|ASPR HPP |July 1, 2010 |June 30, 2011 |
|GF LHD Pandemic Influenza Planning |July 1, 2010 |June 30, 2011 |
Allocations for each LHD or Local HPP Entity by funding source are displayed in the CDC and HPP Allocation Table (See Attachment 1).
Local allocations are based on the following:
PHEP: Based on statute, CDPH allocated 70% of the base award, $37.5 million in Grant Year 2010-11, directly to LHDs. This includes $27.8 million in base allocations, $3.9 million earmarked for public health laboratories, an additional $483,000 for lab training and lab assistance awards. The CDC base allocation of $27.8 million is distributed to LHDs according to a funding formula of a $100,000 base plus a population based share of the remaining funds. An additional $5.9 million is allocated to LHDs identified as CRI jurisdictions.
GF Pandemic Influenza: The 2010-11 State budget includes $4.96 million for distribution to LHDs. The funds are distributed according to a funding formula of $60,000 base plus a population based share of the remaining funds.
HPP: CDPH allocated $16.01 million directly to Local HPP Entities in Grant Year 2010-11 distributing a base award of $135,000 (which includes a base of $85,000 plus $50,000 to support a Local HPP Coordinator) and a population based share of the remaining funds.
The 2010 State Budget Act has not been enacted and therefore neither State General Funds nor federal CDC PHEP and HPP funds have been appropriated. CDPH cannot disburse any funds until the State budget is passed.
2010-11 Emergency Preparedness Priorities for all Funding Sources
CDC has issued the 2010-11 PHEP grant as an extension of the 2009-10 grant, which means that there are few changes to federal requirements for this grant. CDPH encourages LHDs to complete existing priority projects rather than starting new projects that will need to continue over multiple years.
This guidance was developed in conjunction with the following:
• Recommendations made by the LHD Strategic Direction Workgroup dated May 2009, will continue to provide the Local Public Health Preparedness Strategic Direction for the 2010-11 grant year, an extension of the 2009-10 grant year. This document was used to establish the required priority projects and Work Plans identified in the guidance for each funding source. Refer to the Strategic Direction Committee Recommendations and Priorities (Attachment 2).
• CDPH Strategic Goals for 2008-2010, extended through June 30, 2011
• Federal CDC and HPP requirements for 2010-11 including CDC’s nine Goals and Capabilities and HPP Capabilities
• Results of LHD self assessments on readiness for Strategic National Stockpile (SNS) activation and CDC CRI assessments
• LHD and Local HPP Entity Work Plan priorities, progress reports, and After Action Reports (AAR)
Submission of the Comprehensive Agreement
The Comprehensive Agreement between CDPH and the LHD or Local HPP Entity contains operational information on:
• Submission of mid-year and year-end progress reports.
• The requirement to obtain pre-approval for subcontracts that exceed $5,000 before the contract is executed (if the sub-contract is not available at time of submission, please submit statement of work and budget when able to do so)
• Administrative information necessary for successful grant administration, and
• Payment provisions.
CDPH will send a customized Comprehensive Agreement by e-mail to each LHD and Local HPP Entity applicant (Local Health Executive, Local Health Officer, Local Public Health Emergency Preparedness Coordinator, Local Pandemic Influenza Coordinator, and Local HPP Coordinator). Applicants who do not receive their official Agreement within one week of receiving this guidance should contact their CDPH Regional Project Officer immediately. Regional Project Officer contact information is provided below.
|Region |Name |Phone |E-Mail |
|1 |William Porter |(916) 650-0423 |William.porter@cdph. |
|2 |Stacy Sher |(916) 346-0765 |Stacy.sher@cdph. |
|3 |Dan Nichols |(530) 589-4209 |Dan.nichols@cdph. |
|4 |Tom Hoffman |(916) 346-0771 |Tom.hoffman@cdph. |
|5 |Armando Arroyo |(916) 440-7154 |Armando.arroyo@cdph. |
|6 |Edward Soto |(916) 650-6453 |Edward.soto@cdph. |
Instructions for Counties in which Local HPP Entities are not LHDs:
In counties where the Local HPP Entity is not the LHD, the Local HPP Entity and LHD must coordinate the HPP and CDC work plans and budgets. This is particularly important for activities such as training, drills, and exercises which involve public health and the medical community.
Instructions for Los Angeles, Long Beach, and Pasadena:
Since the federal government allocates funding directly to Los Angeles, CDPH will send Los Angeles, Pasadena and Long Beach Health Departments an application package, including an agreement, for GF LHD pandemic influenza planning funds.
Technical Assistance Meetings
CDPH will host a technical assistance webinar to assist LHDs and Local HPP Entities in completing 2010-11 Work Plans and budgets for 2010-11 funds. Fiscal technical assistance will also be provided at the August 11-12, 2010, Public Health Emergency Preparedness Training Symposium.
Completing the 2010-11 Comprehensive Agreement Application
Completed applications are comprised of the Work Plan, Budget, and required Attachments, and for HPP, letters of support, as indicated in the Checklist below (pages 7 and 8) and the attachments (see chart on page 43 in the index of this guidance).
Timeline for Application Submission
|Local Guidance Release Date |July 23, 2010 |
|Application Submission Due Date |August 27 , 2010 |
|Funds Withdrawn if Application not Submitted |September 24, 2010 |
|Work Plan and Budget Approved |November 5, 2010 |
|Funds Withdrawn if Signed Agreement not Submitted |November 5, 2010 |
Application and Review Period
In order to achieve a timely application approval process, CDPH is continuing the approach utilized in 2009-10 including timeframes for 1) application submission by LHDs and Local HPP Entities and 2) review and approval by CDPH. Continuation of this approach is based on the following:
• The application process is familiar. PHEP and HPP funds have been available to LHDs/Local HPP Entities since 2003 and, although requirements change each year, the process for preparing an application remains basically the same.
• Delays in approval of applications are time consuming and divert both LHDs/Local HPP Entities and CDPH from effective implementation of emergency preparedness activities during the grant year.
This continued policy on timely grant submittal is based on the following principles:
• LHDs/Local HPP Entities will submit Work Plans, budgets, attachments and Comprehensive Agreements at the specified due dates. Work Plans and budgets will be complete and accurate, as defined in this guidance.
• CDPH will complete reviews within specified timeframes and notify LHDs/Local HPP Entities of review results.
If LHDs/Local HPP Entities do not submit timely, complete, accurate applications, and a signed agreement, funds will be reallocated to other LHDs/Local HPP Entities.
Definition of Completed Application
In order to be considered complete, LHD/Local HPP Entity applications must meet the following criteria:
• All required components of application are submitted timely by the identified due dates
o CDPH will initiate review of applications when both PHEP and HPP Work Plans, budgets and all required attachments are submitted (exceptions will be made when the Local HPP Entity is not the LHD). Incomplete applications will be returned.
• Work Plans address all required areas and are clear, specific, and responsive to requested information
• Work Plans explain the gap analysis, after action report, or other basis for priority projects and budget allocation
• Budgets support the activities in the Work Plan, balance to the allocation, are well documented and justified, and match to the requirements of each funding stream
Checklist
The following checklist shows all required documents and the corresponding deadlines.
|Checklist |Document |
| |Application for CDC PHEP Funds, State GF Pandemic Influenza Planning Funds, and HPP Funds |
| |Due: August 27, 2010 |
| |2010-11 Work Plan for CDC PHEP and GF Pandemic Influenza (Attachment 3) |
| |CDC PHEP Budget and GF Pandemic Influenza Budget (Attachment 4) |
| |Information Technology Justification (embedded in budget) |
| |HPP 2010-11 Work Plan (Attachment 14) |
| |HPP Budget (Attachment 15) |
| |Attachments |
| |Due: August 27, 2010 |
| |Participating Health Care Facilities (Attachment 17) |
| |HPP Data Elements Form (Attachment 21a for each Hospital and Attachment 21b) |
| |Letters of Support from partners (Including LHD, Hospital, Clinic, LEMSA, and Long-Term Care Facility) |
| |Training, Drills and Exercise Form for both CDC and HPP (only one copy with all exercises included needs to be submitted for |
| |each jurisdiction) (Attachment 12) |
| |Surge Bed Capacity Form (CDC and HPP) (Attachment 13) |
| |PHEP Lab Base (applicable for LRN labs) |
| |Due: August 27, 2010 |
| |California Sentinel Labs Training Record |
| |Current Select Agent Certificate of Registration |
| |Current USDA Permit for Importation and Transportation of Controlled Materials and Organisms and Vectors |
| |Public Health Microbiologist Training Stipends (if applying) |
| |Due: August 27, 2010 |
| |CDPH Laboratory Field Services (LFS) trainee approval letter for each trainee |
| |Lab trainee Training Plan |
| |Confirmation of lab trainee hire dates |
| |Laboratory Consortium Training Assistance Awards for Sentinel Public Health Laboratories |
| |Letter of support from each participating laboratory in the consortium |
| |Comprehensive Agreement |
| |Due: November 5, 2010 |
| |Signed Agreement (Exhibits A-E) |
Means of Avoiding Delayed Approval
Attention to the following items may allow LHDs/Local HPP Entities avoid delay in application approval:
|Cause of Delay |Means of Avoiding Delay |
|All funds – Application and/or budget proposes using funds for |LHDs/Local HPP Entities must ensure that funds are budgeted for allowable |
|items inconsistent with grant purposes. |activities under the grant and are tied to the activities in the submitted |
| |Work Plan. |
|CDC/HPP funds – Local Health Departments and Local HPP Entities|LHDs/Local HPP Entities must address health care surge capacity targets for |
|do not provide specific information as to how health care surge|their jurisdiction in their Work Plan. |
|capacity will be met. | |
|CDC funds – LHD’s priority projects do not address identified |LHDs must ensure Work Plans explain how previously identified gaps have been |
|gaps in Public Health Emergency Preparedness. |met if priority projects do not address these gaps. |
|CDC/HPP funds – Budgets have incomplete documentation to |LHDs/Local HPP Entities must provide sufficient detail to explain basis for |
|support travel, purchases of supplies and equipment, and |budgeted funds |
|contracts. | |
|CDC/HPP funds – Budgets appear to supplant other funding |LHDs/Local HPP Entities must ensure that budgeted funds do not supplant local |
|streams. |expenditures from other local fund sources. Stating that a staff member works|
| |only on PHEP or HPP does NOT avoid supplantation. See draft matrix for |
| |examples of allowable and unallowable staff costs (Attachment 22). |
|CDC/HPP funds –Budgeted indirect costs exceed 10% of salaries |LHDs/Local HPP Entities need to accurately calculate indirect rates based on |
|and benefits. |salaries and benefits. Budget application requires accurate computation and |
| |failure to correctly budget indirect costs will result in “Not Approved” |
| |budget status. |
|CDC/HPP base funds – Applications propose large expenditures on|All expenditures on supplies and equipment must be justified in terms of |
|purchase of supplies and equipment. |meeting specific CDC/HPP capabilities. |
| |LHDs and Local HPP Entities are held to a 40% cap for supplies and equipment |
| |utilizing CDC and HPP base funds. Exceptions to this policy may be granted for|
| |the following criteria: |
| |An applicant’s Work Plan demonstrates commitment from health care facilities |
| |to participate fully in planning, training and exercises |
| |New partners recruited into the coalition require equipment or supplies to |
| |achieve parity |
| |Outdated or expired equipment or supplies need to be replaced or updated |
| |There is no cap on the amount that can be spent on supplies and equipment for |
| |State GF Pandemic Influenza funds. |
|CDC/HPP funds – LHD/Local HPP Entities do not provide | LHDs/Local HPP Entities must submit IT Justification Forms for all IT or |
|justification or explanation of need and explanation of |communications purchases or services with detailed responses for all fields in|
|expenditures for electronic or communications equipment, |the form, and any supporting material (quotes, invoices, etc). The budget must|
|Information Technology (IT) services or IT software. IT forms |include a description of the existing IT or communications equipment, |
|are not provided or do not contain enough supporting detail. |software, or services and a statement of how the requested purchase will |
| |complement existing systems. |
|CDC/HPP funds – Budgets include incentive items. |No incentive items are allowed. |
|CDC/HPP funds – Fiscal staff have not participated in |LHDs/Local HPP Coordinators and fiscal staff need to work together in |
|preparation of budgets, resulting in fiscal errors. |development of budgets. |
Work Plans
The requirements and budget for CDC PHEP and State GF Pandemic Influenza are combined; for tracking purposes, separate totals are calculated for each funding stream. Each LHD is required to submit a single Work Plan and Budget for these two funding streams. Separate work plans and budgets are provided for HPP. Activities to meet the requirements are shown in the Work Plan template. LHDs/Local HPP Entities must address each Work Plan item. The Work Plan templates provide space below each required task for the LHD/Local HPP Entity to enter a description of the intended activities. In addition to the description of the work being completed, LHDs/Local HPP Entities must include a summary of deliverables and an estimated completion date for these deliverables. (Attachments 3 (CDC PHEP) and 14 (HPP)).
In preparation of the PHEP and HPP Work Plans, when the use of SMART Objectives is requested, please use the following criteria:
• Specific – The objectives should be very clear so every stakeholder can easily understand them.
• Measurable – Objectives need to be quantifiable in order to calculate the progress toward meeting the objective.
• Achievable – The defined objectives should be attainable. Objectives should not be easily achievable by doing nothing, nor so difficult to achieve even after expending 100% of efforts.
• Realistic – The defined objectives should be realistically achievable with the available resources (staff, infrastructure, funding, etc).
• Time – Time required to achieve the objectives should be identified.
Training and Exercise Plan
CDPH has provided an Excel spreadsheet for LHDs/Local HPP Entities to document projected trainings and exercises for the 2010-11 grant period (Attachment 12). LHDs/Local HPP Entities are required to provide the name of the training/exercise, HSEEP exercise type (use HSEEP exercise type definitions), plans and procedures being trained/exercised, participating organizations and ESF#8 capabilities tested. One Training and Exercise Plan must be submitted for both CDC and HPP training and exercise requirements. The Statewide Medical and Health Exercise and Training Program must be included in the Training and Exercise Plan. Exercises may be replaced with actual events if targeted capabilities are sufficiently tested.
Budget
LHDs/Local HPP Entities must complete a budget for each funding stream. LHDs/Local HPP Entities must ensure that allocated funds are expended in accordance with the requirements outlined in the guidance and local agreement and are consistent with the activities identified in their work plan. See Attachments 4 (CDC PHEP) and 15 (HPP) for Budget Instructions and Templates. Sample budgets have also been provided (Attachments 5 (CDC PHEP) and 16 (HPP)).
• Completed Applications including Budgets, Work Plans and Attachments must be submitted electronically to CDPH on or before August 27, 2010, as shown above. If complete application documents have not been submitted prior to September 24, 2010, funds will be withdrawn and reallocated to other LHDs/Local HPP Entities.
• In addition, completed applications must be approved by CDPH by November 5, 2010. If Work Plans and Budgets have not been approved by November 5, 2010, funds will be withdrawn and reallocated to other LHDs/Local HPP Entities. In order to meet this date, LHDs and Local HPP Entities must work expeditiously with CDPH in responding to requests for additional information.
• Local applicants may require additional time to submit the signed Agreement, Non-Lobbying Statement, and Non-Supplantation Statement. A customized agreement will be provided within one week of issuance of this guidance to each LHD/Local HPP Entity. These critical items must be submitted by November 5, 2010. Failure to meet this critical deadline will result in re-allocation of funds to other LHDs/Local HPP Entities.
Application Submission
Completed Work Plans, Budgets, HPP Letters of Support and Attachments must be submitted electronically to CDPH at LHBTPROG@cdph..
Signed Agreements and certifications must be submitted in hard copy with original signatures to the mailing address below if sent by US Postal Service or the physical address below if sent by courier. CDPH requires only one signed original. LHDs requesting that EPO return signed originals to them must submit extra copies equal to the number requested.
|Mailing Address (US Postal Service): |Overnight Mail Address (Courier): |
|California Department of Public Health |California Department of Public Health |
|Emergency Preparedness Office |Emergency Preparedness Office |
|Local Management Unit |Local Management Unit |
|Attn: CDC/HPP Application 2010/11 |Attn: CDC/HPP Application 2010/11 |
|P.O. Box 997377, Suite 73.373, MS 7002 |1615 Capitol Ave. Suite 73.373 MS 7002 |
|Sacramento, CA 95899-7377 |Sacramento, CA 95814 |
Application Approval by CDPH
Reviewing and approving the application Work Plans and Budgets is an interactive process between LHDs/Local HPP Entities and CDPH. When CDPH receives the LHD/Local HPP Entity application, it is assigned to Regional Project Officers and appropriate subject matter experts, including laboratory, epidemiology, and pharmacy experts, to review the Work Plan for completeness and the Budget for support of the Work Plan. CDPH Emergency Preparedness Office (EPO) reviews the Budget documents for computational accuracy and compliance with federal guidance documents. The timeline for CDPH review is as follows:
|Activity |Number of Days |
|CDPH will review Work Plans and Budgets and provide written comments to LHDs/Local HPP Entities within 10 |10 working days |
|working days of receipt. | |
|If additional information is needed, LHDs/Local HPP Entities will be requested to respond within 5 working|5 working days |
|days of receipt of electronic comments from CDPH. If no comments are received within 5 working days, CDPH| |
|will send a follow-up letter to the Local Health Officer and Local Health Executive. The letter will | |
|emphasize the importance of submitting the comments and restate the consequences of not having an approved| |
|Work Plan and Budget by November 5, 2010. | |
|CDPH will review additional information provided by the LHD/Local HPP Entity and provide formal written |3 working days |
|comments to the LHD/Local HPP Entity within 3 working days of receipt. | |
OTHER REPORTS
Progress Reports
Mid-year and year-end progress reports are required in 2010-11. Instructions on submission of progress reports may be found in the directions immediately preceding the work plan and budget documents.
After Action Reports
After Action Reports with Improvement Plans must be submitted within 90 days of an exercise or actual response.
Trust Fund Accounts
As stated in Exhibit B of the Comprehensive Agreement, the LHD and/or Local HPP Entity shall deposit advance federal fund payments received from CDPH into separate Trust Funds (hereafter called Federal Fund), established solely for the purposes of implementing the activities described in the LHD's and/or Local HPP Entity’s approved Work Plan and Budget and Agreement before transferring or expending the funds for any of the uses allowed. CDPH requires that the LHD and/or Local HPP Entity set up separate Federal Funds for PHEP CDC and HPP funds. A trust fund account is not required for the State GF fund.
Maintaining Documentation
The Comprehensive Agreement requires that LHDs/Local HPP Entities maintain supporting documents for the expenditure of funds for a minimum of 10 years.
SECTION TWO:
GUIDANCE FOR CDC PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP)
The purpose of the CDC PHEP Cooperative Agreement is to develop all-hazards emergency-ready public health departments by upgrading, integrating and evaluating state and local public health department preparedness for and response to public health emergencies. Examples of public health emergencies may include terrorism, infectious disease outbreaks including influenza pandemics, food-borne disease outbreaks and other food security issues, natural disasters, and biological, chemical, nuclear and radiological threats.
Given that 2010-11 is an extension of the final year of a five-year CDC project period, CDPH encourages LHDs to complete existing priority projects rather than starting new projects that will need to continue over multiple years. It is essential that LHDs use their PHEP allocation during the grant year since CDC has advised its intent to limit carry over from 2010-11 to 17 percent in 2011-12.
2010-11 LHD Required Activities:
In 2010-11, activities are structured into Overarching Requirements, Tier 1 Requirements and Tier 2 Activities. All Overarching and Tier 1 Requirements must be addressed before undertaking Tier 2 Activities.
LHDs are required to document the current status of each Overarching and Tier 1 Requirement and describe activities planned in 2010-11 to maintain the capacity of completed activities or further develop the capacity.
Priority Projects
Priority Projects are projects that are specifically selected to address a known gap or shortfall in the LHD emergency response structure. Each Priority Project must address the following:
• Description of the Project: What will be accomplished? Which capabilities or overarching requirements will be addressed?
• Participants: Who will participate in the project? List specific facilities and organizations.
• Justification: What is the identified gap or shortfall? Why was the project selected? How will the project address the identified gap?
• Project Timeline: What key activities will be completed and what are the projected completion dates.
• Deliverables: What specific products will be produced during the 2010-11 grant period?
• Evaluation of Project: How will the success of the project be evaluated? What are the quantifiable measurements that will be evaluated?
Three CDC Priority Projects are required:
• Priority Project 1: Strengthen the SNS/CRI Emergency Response Plan (under Overarching Requirements)
• Priority Project 2: Strengthen the LHD All-Hazards Emergency Response Plan (under Overarching Requirements)
• Priority Project 3: Continue Pandemic Influenza Preparedness (under Tier 1 Requirements)
Summary of Required Activities
Overarching Requirements
• Maintain lead staff members and points of contact for coordination of public health emergency preparedness and response coordination and Pandemic Influenza preparedness and response.
• Have in place a fully operational SNS Emergency Response Plan (See required Priority Project 1; Activity 2 in Work Plan)
• Have in place an Operational CHEMPACK Response Plan
• Have in place an operational PHEP LHD All Hazards Response Plan (See required Priority Project 2; Activity 3 in Work Plan)
• Ensure California Health Alert Network (CAHAN) is operational within the jurisdiction
• Ensure LHD staff are trained according to SEMS/NIMS requirements
• Maintain surveillance and epidemiological investigation capacity
• Maintain laboratory capacity appropriate to the LRN response level
• Coordinate public health emergency preparedness with Tribal entities
• Coordinate public health emergency preparedness with health care facilities
• Continue local implementation of Disaster Healthcare Volunteers (DHV)
Tier 1 Requirements
• Continue to strengthen collaborations with community partners, stakeholders, and other local government agencies in emergency planning and response activities
• In coordination with local OES, ensure a functional Medical/Health Branch is established in the Operational Area EOC and that written procedures exist to support operations
• In coordination with local OES, identify and train staff in functions of the Operational Area EOC Medical/Health Branch
• Address needs of at-risk populations in public health emergencies
• Build surge capacity for public health functions
• Maintain and test plans for Government-Authorized Alternate Care Sites and plan for mitigation of gaps in meeting overall health care surge targets
• Establish and/or maintain an ongoing training and exercise program for preparedness and response activities including training staff on California Public Health and Medical Emergency Operations Manual
• Assess current operational pandemic influenza plan using lessons learned or areas of improvement identified in the pandemic (H1N1) 2009 influenza after action report and improvement plan (AAR/IP), and develop corrective actions to address identified gaps in a timely manner
Tier 1 Requirements also include completion of Priority Project 3, requirements for LRN Reference Laboratories, and requirements for CRI funding LHDs.
Tier 2 Activities
• Have in place an operational Public Health Recovery Plan in coordination with the Operational Area Recovery Plan
• If resources permit, consider enhancing the capacity of laboratories not currently participating in the Respiratory Laboratory Network (RLN) to adopt assay for confirmatory testing for any novel influenza A
• Expand RLN to include testing of intensive care unit respiratory viruses, sentinel provider testing, and adoption of assay for confirmatory testing for novel influenza A
• Address other LHD-identified Public Health Emergency Preparedness needs
Specific Requirements for LHDs for PHEP Base Funding:
Overarching Preparedness Activities (includes two required Priority Projects)
• Maintain lead staff members and points of contact for public health emergency preparedness and response coordination and pandemic influenza preparedness and response coordination.
• Priority Project 1: Complete or improve the SNS/CRI Emergency Response Plan and procedures.
o All LHDs shall identify steps that will be taken to improve SNS/CRI Operational Plans and procedures to achieve a minimum score of 70 percent as measured by the August 2009 version of the CDC DSNS Local TAR tool.
o LHDs that have scored 70 percent or above must identify steps to address all remaining gaps to achieve a score of 100 percent.
o Actual activities to be completed should address shortfalls identified in the LHD SNS self assessment or an SNS/CRI assessment performed by CDPH or CDC.
o The “TAR Workplan” (Attachment 23) provided by CDPH should be used to identify activities designed to address the specific gaps on the TAR assessment.
o LHDs will concentrate on the following sections of the TAR if scores in these areas are not at 100%: Security, Local RSS, Dispensing, and Training/Exercise/Evaluation.
o LHDs will demonstrate involvement and participation of SNS/CRI in seasonal influenza mass vaccination clinic (s)
Cities Readiness Initiative (CRI) – Applicable to CRI funded Counties
Sixteen California LHDs outside Los Angeles County are designated as CRI entities:
|California CRI Counties/Cities |
|Alameda/City of Berkeley |Sacramento |
|Contra Costa |San Benito |
|El Dorado |San Bernardino |
|Fresno |San Diego |
|Marin |San Francisco |
|Orange |San Mateo |
|Placer |Santa Clara |
|Riverside |Yolo |
All LHDs receiving CRI funds submitted a Work Plan and budget for CRI as part of California’s application submitted to CDC on June 25, 2010. CDC has approved the budgets and Work Plans. LHDs receiving CRI funds are encouraged to use the applicable portions of the CRI Work Plan to assist them in completing the PHEP Work Plan.
RAND Drills
The RAND Corporation has developed two suites of drills to assist CDC in quantifying public health preparedness. Suite One consists of drills that address decision-making processes: 1) Decision-Making Assessment, and 2) RSS POD Supply Chain Management Tool. Suite Two consists of the five RAND Corporation Drills introduced in 2008-09: 1) SNS Staff Call Down Drill, 2) SNS Site Activation Drill, 3) SNS Facility Setup Drill, 4) Picklist Generation Drill, and 5) Timed Metrics for POD Exercises (Attachments 6-10). Standardized data collection matrices for the Suite One and Two drills are available on the DSNS Extranet at: . The site is password protected. Please contact alan.hendrickson@cdph. for the ID and password.
All non-CRI LHDs must complete three RAND drills. One drill must be a no-notice after hours SNS Staff Call-Down drill. One of the remaining two drills may be an SNS Staff Call-Down drill during normal working hours.
All LHDs receiving CRI funds must complete four RAND drills. One drill must be a no-notice after hours SNS Staff Call-Down drill. One of the remaining three drills may be an SNS Staff Call-Down drill during normal working hours.
LHDs may complete the Rand Corporation Timed Metrics for POD Exercises drill during seasonal influenza and H1N1 mass vaccination clinics if they meet the following criteria:
• Two or more clinics are operated simultaneously
• Two operational periods, including a shift change, are incorporated into the operation
• One of the clinics processes a resupply request
Real events can substitute for drills and exercises provided that target capabilities are sufficiently tested and documented.
Please contact Alan Hendrickson (alan.hendrickson@cdph.) or Anne Bybee (anne.bybee@cdph.) with any questions concerning the RAND Corporation drills.
• Priority Project 2: Strengthen the LHD All Hazards Emergency Operations Response Plan. Identify gaps in the required elements and complete the supporting plans and procedures. Address improvement activities identified in the H1N1 AAR/IP.
• Conduct Education and Training on CHEMPACK Response Plan
All LHDs shall conduct education and training on LHD CHEMPACK Plan with appropriate partners (e.g., law enforcement, fire, EMS, emergency services, emergency room departments, health care providers). Training shall include procedures for requesting, activating, deploying and receiving CHEMPACK assets. The training format is at the discretion of the LHD and may be conducted as a seminar, tabletop exercise, or other appropriate forum. For more information or assistance in please contact Dr. Dana Grau at dana.grau@cdph..
• Ensure CAHAN is operational within the jurisdiction
o Participate in the monthly statewide CAHAN All Jurisdiction Conference Call (scheduled on the second Tuesday of each month from 10-11 a.m. and posted on CAHAN).
o Describe the operational capacity of CAHAN in the jurisdiction
o Describe activities to identify, register, and retain public health partners for CAHAN. These entities should included Tribal Entities and other organizations that represent at-risk populations.
o Maintain CAHAN roles and ensure all participants within the jurisdiction are kept current and properly trained.
o Update and maintain the County Facility Report located in the county folder on CAHAN.
o Perform regular CAHAN drills and exercises
• Ensure that LHD staff are trained according to SEMS/NIMS requirements
LHDs should assess the training needs of staff related to their response efforts as written in the Interim CDHOM and ensure that they are trained in ICS 100, 200, 300, 400, 700, and 800 as appropriate including procedures involved in situational reporting and requesting resources.
• Maintain surveillance and epidemiological investigation capacity
o Conduct an annual assessment of the current plan for epidemiology and surveillance surge capacity.
o Expand epidemiology and surveillance capacity for seasonal and pandemic (H1N1) 2009 influenza:
▪ Develop and implement protocols for investigation of a cluster(s), identifying trends and issues;
▪ Develop mutual aid agreements or memoranda of understanding for regional/state collaborations for expansion of surveillance and epidemiology capacities; and/or
▪ Identify surge capacity for epidemiology response within the jurisdiction and/or geographical region.
o Identify the types of emergencies addressed by the plan, e.g. pandemic influenza, natural disasters, radiation events. Modify the plan as appropriate given the demands on epidemiology and surveillance associated with these different types of events. Use lessons learned from pandemic (H1N1) 2009 influenza response to address gaps in the plan.
o Inventory resources, including existing staff and staff brought on during the emergency. The inventory would include an assessment of the skills and knowledge of staff and the identification of gaps in knowledge and skills.
o Plan for addressing gaps in knowledge or skills. Use quantitative measures to document current status and progress in eliminating gaps.
o Develop the type of training based on a recent gap assessment, that is most appropriate, e.g. annual refresher courses, training on a core set of knowledge, “just in time” training.
o Describe how the following influenza reporting requirements are being or will be met:
▪ A mechanism exists to report (weekly) by electronic means, telephone or fax the following information during a pandemic: 1) updated numbers of influenza-associated hospitalizations and deaths due to the pandemic virus; and 2) updated numbers of laboratory-confirmed cases due to the pandemic virus identified by either the public health laboratory or by clinical and commercial laboratories (with results classified as “outpatient”, “inpatient” or “fatal”).
▪ Indicate whether the LHD is prepared to report regularly updated numbers of severe cases (ICU and fatal) of confirmed influenza (all types, including seasonal) in persons under 65 years of age in a timely manner year-round; if so, indicate the mechanism for reporting (e.g. reporting by electronic means, telephone, or fax); if not, describe the LHD’s plans for achieving this capability by September 2011, should such reporting become mandated.
• Maintain laboratory capacity appropriate to the LRN response level (Reference or Sentinel Lab)
Required of LHDs with Sentinel Laboratories:
o Maintain and update Sentinel LRN protocols which can be found on the American Society for Microbiology (AS) website at ;
o Subscribe to the CAP-LPS proficiency test sets;
o Maintain liaison with clinical/hospital laboratories in the jurisdiction or service areas;
o Provide Sentinel training updates to clinical/hospital laboratories in the jurisdiction or service area as feasible and maintain a record of trainings given and received. (contact Paul Duffey at pduffey@cdph. for a copy of the Excel spreadsheet to be used in tracking these trainings);
o Maintain a 24/7 contact list for sentinel laboratories in the jurisdiction and forward copies to the assigned LRN reference laboratory AND to CDPH with the mid-year and year-end progress reports; (contact pduffey@cdph. for an electronic copy of the spreadsheet if needed);
o If the laboratory is registered under the Select Agent Act, provide copies of the laboratory’s current registration certificate and current USDA APHIS transport permit with the 2010-11 application;
o Although LHDs with sentinel laboratories are not required to register under ACT, they nonetheless have obligations for training, safety, security; notification and reporting that must be met under this law. All public health and clinical laboratories are required to meet the ACT requirements regarding safe storage of critical materials that cannot be ruled-out as or have been forwarded to an LRN reference laboratory for confirmatory testing of possible select agents, and if confirmed, must meet reporting requirements, regardless of whether the laboratory is registered under the ACT. All local sentinel laboratories should be familiar with and contact their clinical partners to provide training materials concerning these requirements. Please contact Channing Sheets at Channing.Sheets@cdph. for materials and assistance if needed.
o Meet the following requirements for H1N1:
▪ Have plans for influenza testing including: cross-training of staff (including having adequate trained personnel available to perform influenza typing and subtyping by PCR); stockpiling of reagents and specimen collection materials, and assurance of data management capabilities to handle processing of a large number of specimens and reporting of results;
▪ Be able to identify whether specimens tested are from inpatients, outpatients, or fatal cases;
▪ Have a pre-existing plan in place for disseminating guidelines on who should be tested for influenza (e.g. hospitalized and fatal cases, outbreaks, health care workers).
Please see Attachment 11, Laboratory Training Programs for Local Health Departments, for more information regarding programs designed to assist LHDs in training laboratory staff.
Required of LRN Reference Laboratories:
o Meet all requirements for LRN sentinel laboratories above.
o Investigate feasibility and institute LRN level confirmatory testing for novel influenza A for sentinel provider testing.
o Verify that laboratory LRN protocols are up to date and comply with current CDC LRN protocols. Laboratories can obtain current protocols from the CDC LRN website. In addition to registration for participation in the CAP-LPX proficiency test sets, LRN reference laboratories must also participate in LRN-mandated proficiency test sets. Please report results of each CAP-LPX and LRN Proficiency Test set completed to the State’s MDL (attn: Dr. Paul Duffey) as they are completed. Please note: all local LRN reference laboratories should also have completed registration on the new LRN website.
o Meet ACT requirements including registration under ACT, maintenance of laboratory safety and continued training of staff. This includes:
▪ Provide data on laboratory staff training such as listing trainings attended with topics and copies of CEU certificates meeting California or Federal standards.
▪ Submit current copies of registration certificate and USDA APHIS transport permit. The certificates must be provided with submission of the 2010-11 CDC Work Plan.
• Coordinate public health emergency preparedness activities with Tribal entities
• Coordinate public health emergency preparedness activities with health care facilities
o Assist health care facilities in integrating their plans with the LHD All Hazards Response Plan
o Involve health care facilities in Government-Authorized Alternate Care Site (ACS) planning.
• Continue local implementation of Disaster Healthcare Volunteers including:
o Enroll Medical Reserve Corps members in Disaster Healthcare Volunteers,
o Develop strategies for and commitment to enrollment of medical and health volunteers into the statewide system, and
o Include notification and deployment of medical and health volunteers using Disaster Healthcare Volunteers in at least one exercise or real event in 2010-11 grant period.
Tier 1 Requirements:
• Continue to strengthen collaborations with community partners, stakeholders, and other local government agencies in emergency planning and response activities. LHDs should involve local OES, mental health, Volunteer Organizations Active in Disasters, American Red Cross, and others in planning and response activities.
• In coordination with local OES, ensure a functional Medical/Health Branch is established in the Operational Area EOC and that written procedures exist to support operations
• In coordination with local OES, identify and train staff in functions of the Operational Area EOC Medical/Health Branch
Ensure that appropriate staff are trained for Department Operations Center (DOC) and Operational Area EOC Medical/Health Branch functions including training in procedures involved in situational reporting and requesting resources.
• Build public health surge capacity across public health functions.
LHDs should ensure emergency plans address surge needs for all critical public health response functions of the LHD and any other public health agency in the jurisdiction in the event of a large scale public health emergency. The plans should include epidemiology, surveillance, and laboratory staff, supplies and equipment. LHD staff should be trained and tested (or participate in actual activations) on these plans.
• Address public health and medical needs of at-risk populations in public health emergencies
At-risk populations have needs that require specific/additional considerations in emergency plans, broadly defined in one or more of the following areas:
• Independence
• Communication
• Transportation
• Supervision
• Health care
In addition to those individuals specifically recognized as at-risk in section 2802(b)(4)(B) of the Public Health Service Act (e.g., children, senior citizens, and pregnant women), individuals who may need additional response assistance include those who have disabilities; live in institutionalized settings; are from diverse cultures; have limited English proficiency or are non-English speaking; have chronic medical disorders; and/or have pharmacological dependency. At-risk populations are those who, in addition to their medical needs, have other needs that may interfere with their ability to access or receive medical care.
These needs must be addressed and included in all planning and response activities.
Planning for the needs of at-risk populations falls into five broad categories:
• Locating and quantifying at-risk populations
• Communications with and education of at-risk populations
• Collaboration with and engagement of at-risk populations
• Provision of services including clinical care, evacuation, and sheltering
• Testing, exercising, measuring and improving preparedness for at-risk populations
In 2010-11, LHDs should build on planning started in prior grant years to meet the needs of at-risk populations and involve community-based organizations in these efforts. LHDs must articulate how they will determine the needs of at-risk populations in the jurisdiction and what activities will take place to ensure that the public health and medical needs of those individuals are addressed during emergencies. LHDs should work with community-based organizations and representatives serving at-risk populations to ensure plans are appropriate and involve the necessary partners.
• Maintain and test plans for Government-Authorized Alternate Care Sites and plan for mitigation of gaps in meeting overall health care surge targets
Continue to maintain and strengthen plans to meet surge targets at the acute level and plan Government Authorized Alternate Care Sites where targets cannot be met by expansion of the existing health care delivery system.
As in prior years, LHDs, Local HPP Entities, and health care facilities are required to develop health care surge capacity for their county in the event of a catastrophic event such as pandemic influenza. Surge plans should include movement of patients along the continuum of care from existing health care facilities to expansion of health care facilities to Government-Authorized Alternate Care Sites.
The target of 500 surge beds per million populations, or 1 bed per 2000, is preparation for a moderate event and is largely met through expansion of hospital capacity. As part of the 2006 Surge Initiative, CDPH calculated surge needs for a catastrophic event such as a pandemic influenza utilizing CDC’s FluSurge 2.0 software. Based on these calculations, it is estimated that California will need 58,728 surge beds during a catastrophic event. (See Table 1 in this guidance which displays each county’s population-based proportion of surge beds during a catastrophic event). The surge needs of a catastrophic event depend on the expansion of existing health care providers and establishment of Government-Authorized Alternate Care Sites.
In the Standards and Guidelines for Health Care Surge During Emergencies, Volume II: Government-Authorized Alternate Care Sites published in February 2008, an Alternate Care Site is defined as: “A location that is not currently providing health care services and will be converted to enable the provision of health care services to support, at a minimum, inpatient and/or outpatient care required after a declared catastrophic emergency.” CDPH adopted this operational definition distinguishing Government Authorized Alternate Care Sites from the expansion of existing health care facilities given the differing laws and regulations under which each would operate. These surge guidelines also reiterated the responsibility of local government to operate Alternate Care Sites to mitigate the impact of a catastrophic event, and for LHDs to identify sites and convene a local planning group to plan for the operation of Alternate Care Sites.
LHDs must identify sites and plan for the operation of Government-Authorized alternate care sites. Alternate Care Site plans must address issues such as activation of alternate care sites, setup of alternate care sites, supplying and resupplying of resources, and staffing plans. Surge supplies and equipment for Alternate Care Sites can be purchased with PHEP funds.
Additional information on the expansion of health care facilities and setup and operation of Government-Authorized Alternate Care Sites can be found in the Standards and Guidelines for Health Care Delivery during Surge Emergencies, Volume II, located at bepreparedcalifornia..
LHDs and Local HPP Entities must collaborate and plan for implementation of Alternate Care Site(s) during the influenza season, meeting the requirements as listed below:
▪ Number of surge beds provided by each hospital or health care facility
▪ Location of each Government-Authorized Alternate Care Site required to meet local surge bed needs
▪ Number of beds provided in each Alternate Care Site
▪ Level of care to be provided or types of patients that can be cared for; and
▪ Summary of plans for staffing, supply and re-supply of sites.
HPP funds can be used for the expansion of health care facilities and setup and operation of Government-Authorized Alternate Care Sites
• Establish and/or maintain an ongoing training and exercise program for preparedness and response activities
Each LHD must complete the Training, Drills and Exercise form, Attachment 12, in cooperation with the Local HPP Entity indicating the trainings, drills and exercises with target capabilities that are planned for 2010-11. Only one copy with all exercises included needs to be submitted for each operational area. LHDs are responsible for developing After Action Reports with Improvement Plans for each drill, exercise and/or real event. Real events may be used to meet exercise requirements provided that identified target capabilities are sufficiently tested.
LHDs, Local HPP Entities, and HPP participating health care facilities must participate in the Statewide Medical and Health Exercise on Thursday, November 18, 2010.
Required Priority Projects for Tier 1:
o CDC Priority Project 3: Continue Pandemic Influenza Preparedness related to H1N1
o Maintain Pandemic Influenza Coordinator and define the role and functions of the coordinator in pandemic influenza response.
o Assess current operational pandemic influenza plan using lessons learned or observed that were identified in your after action reports and improvement plans (AAR/IP) following the pandemic (H1N1) 2009 influenza event, and develop immediate corrective actions to address gaps (See required Priority Project 3; Activity 18 in Work Plan)
o Activate a minimum of one (1) mass vaccination clinic for seasonal influenza with a focus on vaccination of at-risk populations and priority target groups as identified by CDPH. Apply Homeland Security Exercise and Evaluation Program (HSEEP) guidelines for organization, management, and implementation of the vaccination clinic with a focus on:
▪ Tracking and reporting
▪ Adverse events identification, reporting, and follow up
▪ Implementing the ICS structure
Tier 2 Activities: (Optional)
• Develop an operational public health recovery plan
If a recovery plan exists, activate in coordination with the Operational Area recovery plan
• Consider enhancing the capacity of laboratories
Resources permitting, consider enhancing the capacity of laboratories not currently participating in RLN to adopt assay for confirmatory testing for any novel influenza A
• Expand RLN to include testing of intensive care unit respiratory viruses, sentinel provider testing, and adoption of assay for confirmatory testing for novel influenza A
• Address other LHD-identified Public Health Emergency Preparedness needs
SECTION THREE:
GUIDANCE FOR GENERAL FUND PANDEMIC INFLUENZA FUNDS
General Fund Pandemic Influenza funds shall be used for the following activities:
• CDC Priority Project 3: Continue Pandemic Influenza Preparedness
o Maintain Pandemic Influenza Coordinator and define the role and functions of the coordinator in pandemic influenza response.
o Assess current operational pandemic influenza plan using lessons learned or observed that were identified in your after action reports and improvement plans (AAR/IP) following the pandemic (H1N1) 2009 influenza event, and develop immediate corrective actions to address gaps (See required Priority Project 3; Activity 18 in Work Plan)
o Activate a minimum of one (1) mass vaccination clinic for seasonal influenza with a focus on vaccination of at-risk populations and priority target groups as identified by CDPH. Apply Homeland Security Exercise and Evaluation Program (HSEEP) guidelines for organization, management, and implementation of the vaccination clinic with a focus on:
▪ Tracking and reporting
▪ Adverse events identification, reporting, and follow up
▪ Implementation of the ICS structure
• Government-Authorized Alternate Care Sites
o Maintain, strengthen, and test operational plans in meeting surge targets at the acute level of care.
o Collaborate with Local HPP Entities, and community/regional/geographical partners for the operation of the Alternate Care Sites
o Purchase of surge supplies and equipment for Government-Authorized Alternate Care Sites.
o Develop plans for integration of Alternate Care Sites within the continuum of care from existing health care facilities to expansion of health care facilities to Government-Authorized Alternate Care Sites including details on planned patient triage, movement, and mass fatality.
SECTION FOUR:
GUIDANCE FOR HOSPITAL PREPAREDNESS PROGRAM
The purpose of the HPP Cooperative Agreement is to maintain, refine, and enhance the capabilities of health care systems to be prepared for all-hazards events. HPP funds support hospitals and other health care facilities, including clinics, skilled nursing facilities, poison control centers and emergency medical services.
Grant year 2010-11 is the second year of a three-year project period that began in 2009-10. The HPP Work Plan must describe how progress made during 2009-10 will continue in the 2010-11 and 2011-12 grant years.
The HPP Work Plan should integrate and enhance health care system preparedness activities in order to enable the systems to function in an efficient, resilient, and coordinated manner.
The Medical Surge Capacity and Capability (MSCC): (“Tiers of Resources”)
The MSCC handbook (CNA Corporation, Institute for Public Research) is a blueprint for a systematic approach to managing medical and public health response to emergencies and disasters. This guidance focuses on support of Tiers 1, 2 and 3. A Tier 2 update, MSCC: the Healthcare Coalition in Emergency Response and Recovery, was recently released, and may be found at:
Local HPP Entities are expected to develop increasingly robust capacity and capability where necessary, and work within the tiered framework to ensure integration of the health care system response from the local (Tier 3) up through the state Tier (Tier 4).
Capabilities-Based Planning (CBP) is "planning under uncertainty to provide sub-capabilities suitable for a wide range of threats and hazards, while working within an economic framework that necessitates prioritization and choice." This planning approach assists leaders at all Tiers to allocate resources systematically to close gaps, thereby enhancing the effectiveness of preparedness efforts.
The HPP Work Plan is based on the use of the latest Operational Area or community-based Hazard Vulnerability Assessment (HVA) to determine gaps in sub-capabilities. The Gap Analysis drives the rationale to fund capabilities needed by health care facilities, EMS and other HPP entities. In addition to developing capabilities for vulnerabilities identified in the HVAs, Local HPP Entities must continue to build capacity to respond to a pandemic influenza.
2010-11 HPP Activities: (presented as “Tiers of Requirements”)
In grant year 2010-11, HPP activities are structured into Overarching and Tier 1 Requirements and Tier 2 Activities. Local HPP Entities are required to document the current status of each Overarching and Tier 1 Requirement and Tier 2 Activities and describe activities planned in 2010-11. Tier 2 Activities are optional and may only be undertaken after Overarching and Tier 1 Requirements are met.
Priority Projects
Priority Projects are projects that are specifically selected to address a known gap or shortfall in the Local HPP emergency response structure. Each Priority Project must address the following:
• Participants: Who will participate in the project? List specific facilities and organizations.
• Description of the Project: What will be accomplished? Which capabilities or overarching requirements will be addressed?
• Justification: What is the identified gap or shortfall? Why was the project selected? How will the project address the identified gap?
• Project Timeline: What key activities will be completed and what are the projected completion dates.
• Deliverables/Objectives: What specific products will be produced during the 2010-11 grant period? Use the SMART Objective to identify your objectives/deliverables.
• Evaluation of Project: How will the success of the project be evaluated? What are the quantifiable measurements that will be evaluated?
Three Priority Projects are Required for Tier 1:
• Priority Project 1: Partnership/Coalition Development
• Required Priority Project 2: Medical Evacuation/Shelter in Place (SIP)
• Required Priority Project 3: Expansion of Health Care Facility Surge Capacity and Planning for Government Authorized Alternate Care Sites
Summary of Required Activities
Overarching Requirements:
• Meet the 14 required National Incident Management System (NIMS)/SEMS elements for hospitals.
• Conduct an ongoing education and preparedness training program.
• Conduct an ongoing exercise, evaluation and improvement program.
• Address the medical/health needs of at-risk populations in emergency preparedness and response activities.
Tier 1 Requirements:
• Ensure Interoperable Communications Systems.
• Expand development of Partnerships/Coalitions (required Priority Project 1).
o Expand participants and activities in HPP planning to achieve comprehensive partnerships.
o Complete plans that identify the processes partners will use to request and share assets, personnel and information during emergencies.
o Integrate local emergency medical services agencies into local partnerships.
• Ensure surge plans describe movement of patients along the continuum of care from existing health care facilities to expansion of health care facilities to Government Authorized Alternate Care Sites and should include: (Required Priority Project 3)
o Number of surge beds provided in the expansion of health care facilities.
o Level of care provided or types of patients cared for; and
o Evaluation of effectiveness for staffing, supply and re-supply of sites.
• Assure availability of supplies and equipment for Government Authorized Alternate Care Sites and Health Care Facilities (each purchase must be itemized and justified).
• Complete medical evacuation/shelter in place plans, (required Priority Project 2).
• Implement bed tracking availability including participation in statewide bed tracking drills.
• Implement Disaster Healthcare Volunteers.
• Complete health care facility fatality management plans
Tier 2 Activities: The following Tier 2 activities may be addressed after Overarching and Tier 1 Requirements are met:
• Develop/maintain pharmaceutical caches
• Purchase personal protective equipment including supplies and equipment to meet the CAL OSHA Airborne Transmission Disease Standard recommendations.
• Purchase decontamination equipment (including replacing missing or broken components) and continue development of decontamination plans
• Support the integration of Medical Reserve Corps activities
• Establish plans for integration of Mobile Medical Assets (EMSA Activity)
• Identify health care facilities that will participate in Federal Communications Commission’s (FCC) Telecommunications Service Priority Program (TSP).
Specific Requirements for Local HPP Entities for Base Funding:
Overarching Preparedness Activities:
• National Incident Management (NIMS) Elements for HPP Participating Hospitals: The Local HPP Entity will report aggregate data on participating hospitals that have adopted all NIMS elements as outlined in the NIMS Hospital Compliance Tracking Document (Attachment 18) and identify which facilities are still in the process of adopting activities. This information will be reported using Attachment 21b – Operational Area Aggregated HPP Data Elements Worksheet. Information should be provided by each HPP participating hospital using Attachment 21a – HPP Data Elements Worksheet for Individual Hospitals.
• Education and Preparedness Training:
o Local HPP Entities should support education and training opportunities for health care personnel who respond to public health emergencies. These activities should include NIMS/SEMS/HICS training, training on emergency response plans, population based care, and other training specific to individual roles during emergencies.
o Local HPP Entities and HPP participating health care facilities as well as LHDs are required to participate in the Statewide Medical and Health Training and Exercise described in Section Two of this guidance.
o Proposed trainings should include a description of how the education and training activities support capability development and are linked to health care system, community-based, and regional hazard and vulnerability analyses.
• Exercises, Evaluations and Corrective Actions: Each Local HPP Entity will coordinate with participating health care facilities in conducting exercises that test the operational capability of the following medical surge components over the period of the grant:
o Interoperable communications and Disaster Healthcare Volunteers;
o Partnerships/coalitions MOUs in place within the areas selected;
o Fatality management of health care facilities;
o Medical evacuation;
o Tracking hospital bed availability.
o Surveillance and monitoring of illness during a communicable disease public health event (e.g., pandemic [H1N1] 2009 influenza).
In addition, exercises should involve public health, local OES, emergency management, and other responders to exercise the effective public – private interaction needed during an emergency response. Exercise programs funded by HPP funds must be built on HSEEP requirements. Each Local HPP Entity must provide a list of proposed trainings, drills and exercises (See Attachment 12). LHDs and Local HPP Entities are required to submit a comprehensive training, drill and exercise plan listing all exercises in one form.
Exercises, plans and AARs should include a description of how the knowledge, skills and abilities acquired through education and training activities will be incorporated into drills and exercises. Exercise plans must demonstrate coordination with relevant entities within the local jurisdiction including partnership organizations, Metropolitan Medical Response System (MMRS entities), Medical Reserve Corps, emergency management, etc.
As a component of end-of-year reporting, Local HPP Entities shall require summaries from participating hospitals of AAR/IPs for each exercise or event, utilizing a brief form developed jointly by CDPH and the California Hospital Association. (See Attachment 19)
• Continuing Preparedness for At-Risk Populations
CDC and HPP funds require that the needs of at-risk populations must be included in planning and response activities. At-risk populations are broadly defined as those who may have needs in one or more of the following areas:
o Independence
o Communication
o Transportation
o Supervision
o Health care
These needs must be included in all planning and response activities.
Planning for the needs of at-risk populations falls into five broad categories:
o Locating and quantifying at-risk populations
o Communications with and education of at-risk populations
o Collaboration with and engagement of at-risk populations
o Provision of services including clinical care, evacuation, and sheltering
o Testing, exercising, measuring and improving preparedness for at-risk populations
Local HPP Entities must clearly articulate how the needs of at-risk populations will be determined, or if local needs have already been determined, what planning activities will take place to address the needs of those individuals. Local HPP Entities should work with community-based organizations serving these groups to ensure plans are appropriate, involve the necessary partners, and include representation from at-risk populations.
There are various definitions used to describe “at-risk populations” that a community may utilize. Local HPP Entities must continue to address the specific needs of at-risk populations in terms of communications, evacuation and sheltering and include representatives from this stakeholder community in all planning efforts.
Tier 1 Requirements
• Interoperable Communication Systems: In 2010-11, CDPH will continue enrolling hospitals, clinics and long-term care facilities in CAHAN. Local HPP Entities should participate in these CAHAN expansion efforts.
During each budget period within the three-year project period, Local Entities shall maintain and refine operational, redundant communication systems that are capable of communicating both horizontally, between health care systems, and vertically, within the OA's incident command structure, as described in the tiered response framework outlined in the MSCC Handbook.
Participating hospitals and other health care facilities, to the extent possible, should have communication devices which allow them to communicate horizontally between health care providers and vertically within the jurisdiction incident command structure with emergency medical services, fire, law enforcement, LHDs, clinics, long term care facilities, and other licensed health care facilities. During 2010-11, funds will be provided to Local HPP Entities to strengthen operational, redundant communication systems that are capable of communicating both horizontally and vertically. However, any proposed communications purchases must be supported by a clear explanation of how the purchase will augment, not duplicate, functions of CAHAN, California’s official public health emergency alerting system, and how it will interoperate under the Project 25 (P25) standards as outlined in the SAFECOM website at .
• Hospital Available Beds for Emergencies and Disasters: Local HPP Entities will ensure that all participating hospitals understand the process for collecting and reporting bed availability data. HPP participating hospitals will demonstrate the ability to report available hospital beds within 60 minutes in at least one statewide drill/exercise conducted in 2010-2011. In 2010-11 the State will not provide advance notification of the drill to Local HPP Entities.
• Medical Evacuation Planning/Sheltering in Place
See Priority Project 2
• Expansion of Health Care Facility Surge Capacity including Planning for Government Authorized Alternate Care Sites
See Priority Project 3
• Disaster Healthcare Volunteers: Local HPP Entities are expected to utilize the Disaster Healthcare Volunteers program for registration and credential verification of volunteer medical and health professionals, including Medical Reserve Corps. All Medical Reserve Corps receiving HPP funding are required to register in Disaster Healthcare Volunteers.
Local HPP Entities should continue to promote medical and health care volunteering and develop specific strategies for the enrollment of professional volunteers. Local HPP Entities should provide a brief outline of the identified strategies with proposed completion dates and indicate what efforts have begun to date, as well as the results of those efforts.
• Fatality Management: Local HPP Entities shall continue to work closely with participating hospitals, SNF’s, long term care facilities and other appropriate health care entities to ensure that fatality management plans are in place at each facility and integrated into county plans for disposition of the deceased. These plans must clearly account for the proper identification, handling and storage of remains by the health care facility. Local HPP Entities are encouraged to review the county coroner’s/medical examiner’s mass fatality management plan.
• Priority Project 1: Partnership/Coalition Development
The foundation of California’s approach to health care surge continues to be based on partnerships between health care entities and public health. Each Local HPP Entity has convened planning groups that include LHDs, hospitals, clinics, long term care facilities, local emergency medical services agencies, Tribal entities and other partners to strengthen health care emergency planning and response. This important process brings together the many entities involved in emergency response to discuss gaps and utilize available resources to address identified gaps in the most efficient manner possible.
The focus for Local HPP Entities in 2010-11 is to strengthen and expand existing partnerships and establish plans for triage of patients across the continuum of care. Additional responsibilities include development and documentation of plans for the sharing of information, staff and other resources. Integrated plans will ensure a common understanding of how health care services will be delivered during emergencies including the sharing of information and the process for requesting and sharing resources. When finalized and issued, the California Public Health and Medical Emergency Operations Manual is expected to clarify expectations in information management and resource management and roles of participants in these functions.
At a minimum, a partnership/coalition consists of:
• One or more hospitals, at least one of which shall be a designated trauma center, if applicable
• One or more clinics (including American Indian clinics), ambulatory care centers, or primary care facilities
• One or more long term care facilities
• Local Health Department
• Local Emergency Medical Services Agency
• Medical Health Operational Area Coordinator Program (function)
Local partnerships should also add the following groups to the partnership if they are not already participating:
• Home health agencies
• Hospices
• Pre-hospital care providers including dispatchers
• Local OES
• Local Welfare and Social Services Departments
• Developmental Centers
• Regional Centers
• Mental Health Facilities
• Maternal and Child Health Programs
• Community Service Agencies
• Sheriffs, Coroners and/or Medical Examiners
• Dialysis Centers
• Freestanding Surgery Centers
• Amateur Radio Operators
• Community non-profit organizations
• Additional partners as determined by the partnership/coalition
It is expected that all health care facilities and organizations receiving HPP funding from the county will participate in the local partnership.
Partnerships should focus on:
o Integrating the plans and activities of all participating partners, resulting in a common understanding of how information will be communicated, the specific roles of each partner, and the process for requesting and sharing information and resources in the Operational Area.
o Ensuring that all health care facilities within the jurisdiction are aware of procedures for information flow and requesting resources.
o Ensuring that all health care facilities understand procedures to request operating supplies when government supplied caches are available and how to obtain them.
o Increasing medical response capabilities in the county as well as in the mutual aid region;
o Preparing to meet the medical/health needs of at-risk populations in the county.
o Encouraging all health care facilities to provide training on and have Personal Preparedness programs.
The Local HPP Entity is responsible for assembling the partnership/coalition. The Local HPP Entity may serve as the lead of the partnership/coalition or another participating partner may be appointed as the lead over the partnership. As part of the planning and partnership building process, each Local HPP Entity is required to post planning meetings on its web site.
Given the required deliverables for the partnership, CDPH recognizes that additional resources may be needed to coordinate all partners in completing the deliverables. Resources may be assigned by the partnership to ensure adequate staffing to meet the requirements of the partnership priority project. Local HPP Entities in Operational Areas with more than 180 licensed health care facilities may direct an additional $50,000 to partnership staffing; Local HPP Entities in Operational Areas with 30 or more licensed health care facilities may direct an additional $25,000 to partnership staffing; and those Local HPP Entities in Operational Areas with fewer than 30 licensed health care facilities may provide justification as to how they would use up to an additional $25,000 to achieve partnership deliverables. (See Table 1)
Table 1- Number of Licensed Health Care Facilities and Number of Surge Bed Required Based on Population
|LOCAL HPP ENTITY |Population |Number of Licensed HCFs |Population Based Share of|
| | |(Hospitals, Clinics and Long-term |Surge Beds |
| |JAN 2008 |Care) |(Target of 58,723 surge |
| |DOF E-1 | |beds statewide) |
|SAN DIEGO |3,146,274 |540 |4,831 |
|ORANGE |3,121,251 |535 |4,831 |
|SAN BERNARDINO |2,055,766 |392 |3,162 |
|ALAMEDA |1,543,000 |339 |2,214 |
|RIVERSIDE |2,088,322 |330 |3,168 |
|SANTA CLARA |1,837,075 |259 |2,819 |
|SANTA CRUZ |266,519 |259 |412 |
|FRESNO |931,098 |255 |1,431 |
|VENTURA |831,587 |198 |1,287 |
|SACRAMENTO |1,424,415 |189 |2,193 |
|SAN FRANCISCO |824,525 |188 |1,427 |
|CONTRA COSTA |1,051,674 |187 |1,625 |
|KERN |817,517 |184 |1,250 |
|SAN JOAQUIN |685,660 |138 |1,060 |
|SONOMA |484,470 |132 |751 |
|TULARE |435,254 |131 |669 |
|SAN MATEO |739,469 |122 |1,144 |
|SANTA BARBARA |428,655 |94 |662 |
|STANISLAUS |525,903 |88 |813 |
|BUTTE |220,407 |87 |340 |
|SHASTA |182,236 |86 |283 |
|SOLANO |426,757 |78 |662 |
|MONTEREY |428,549 |73 |664 |
|SAN LUIS OBISPO |269,337 |71 |413 |
|MARIN |257,406 |69 |399 |
|HUMBOLDT |132,821 |62 |206 |
|MERCED |255,250 |60 |392 |
|KINGS |154,434 |42 |236 |
|MENDOCINO |90,163 |42 |141 |
|NAPA |136,704 |41 |212 |
|PLACER |333,401 |39 |506 |
|MADERA |150,887 |37 |232 |
|YOLO |199,066 |32 |302 |
|IMPERIAL |176,158 |31 |269 |
|NEVADA |99,186 |27 |156 |
|SUTTER |95,878 |25 |146 |
|SISKIYOU |45,971 |24 |72 |
|EL DORADO |179,722 |22 |279 |
|LAKE |64,059 |22 |100 |
|TUOLUMNE |56,799 |22 |89 |
|YUBA |71,929 |17 |110 |
|TEHAMA |62,419 |17 |96 |
|PLUMAS |20,917 |16 |33 |
|COLUSA |21,910 |13 |34 |
|INYO |18,152 |13 |29 |
|AMADOR |37,943 |12 |60 |
|GLENN |29,195 |10 |45 |
|MODOC |9,702 |10 |15 |
|SAN BENITO |57,784 |9 |90 |
|LASSEN |35,757 |9 |57 |
|CALAVERAS |46,127 |8 |72 |
|DEL NORTE |29,419 |8 |46 |
|MARIPOSA |18,406 |8 |28 |
|TRINITY |13,966 |6 |22 |
|SIERRA |3,380 |5 |5 |
|MONO |13,759 |2 |22 |
|ALPINE |1,222 |0 |2 |
In recognition that local emergency medical services agencies (LEMSAs) are an integral part of the local partnership, each Local HPP Entity will be allocated funds for a LEMSA Coordinator. LEMSAs representing single Operational Areas will be allocated, via the Local HPP Entity, $50,000 for a half-time position or contract to participate in the local partnership, including planning and exercising. LEMSAs representing multiple Operational Areas will receive a total of $65,000 for a part-time staff person to participate in local planning and exercising. Each Local HPP Entity within a multi-county LEMSA will receive a proportionate share of the $65,000.
The allocation formula for Local HPP Entities requires funding for LEMSA positions as part of the base. To minimize administrative processes, Local HPP Entities within a multi-county LEMSA may elect to appoint a single HPP entity to administer the partnership portion of the LEMSA contract and move the funds to that HPP entity. Upon the request of Local HPP Entities, CDPH will modify local allocations based on line-item direction to fund a single Local HPP Entity to administer the LEMSA allocation. This is the same process as used in previous years.
Specific Partnership Deliverables:
• Ensure full participation of all partners in emergency response planning efforts. Provide documentation of attendance of partners at planning sessions.
• Complete development of integrated written operational response plans that identify the processes partners will use to request and share assets, personnel and information during emergencies; including the roles and functions of all partners. Document the MHOAC role in coordinating assets and personnel.
• Develop a communications plan that addresses alerting and notification of all partners during an emergency and identify the integrated communications systems the partners will use to communicate both vertically and horizontally during a response.
• Review existing emergency response plans and procedures of each partner to identify common points of integration. This includes documentation of efforts to resolve conflicting points of integration.
• Develop Memoranda of Understanding that identify roles and responsibilities to share information, staff, and other resources. Ideally one memorandum of understanding will be signed by all partners; however, multiple agreements may be necessary to address all partner concerns. At a minimum, Local HPP Entities should ensure that a memorandum of understanding exists between the required members of the partnership.
• Train all partners in local emergency response plans.
• Ensure participation of all partnership members in one or more HSEEP exercises or drills and provide AARs with Improvement Plans. Drills and exercises must test the following:
o Sharing information across redundant communication systems
Meeting the target number of surge beds within the Operational Area including use of Government-Authorized Alternate Care Sites
o Use of Evacuation/Shelter in Place decision-making process
o Requesting and sharing of resources including use of Disaster Healthcare Volunteers
o Meeting the 14 required NIMS Compliance elements for hospitals
o Tracking and reporting available beds based on HAvBED Categories within 60 minutes
o Participating in the Statewide Medical/Health Training and Exercise program.
• Ensure completion of HSEEP-compliant AARs and Improvement Plans by all partners for drills, exercises, and events. California Hospital Association Hospital Preparedness Coordinators can provide technical assistance.
• Provide CDPH with a list of participating partners that includes the required organizations and the name of the lead participant from each partner organization.
In addition to participating in the partnership activities above, LEMSAs will need to complete the following deliverables:
• Complete a self-assessment of LEMSA disaster medical services preparedness and response capability and provide results to EMSA and the Local HPP Entity.
• Work with the local partnership to establish and manage a minimum of two EMS Field Treatment Sites in the Operational Area. As part of the LEMSA policies and procedures, adopt requirements for the establishment of EMS Field Treatment Sites and response criteria used for establishing an EMS Field Treatment Site.
• Participate in local government development of Government-Authorized Alternate Care Site plans.
• In collaboration with EMSA and the Regional Disaster Medical Health Coordinator/Specialist Program, identify sites within the Operational Area for the establishment of the State owned Mobile Field Hospitals during a disaster or emergency. Develop Memoranda of Understanding with local government or organizations to ensure availability of identified sites when needed.
• Participate in HAvBED data collection including training and exercises. Following a State sponsored exercise or activation of the HAvBED system in response to an emergency or disaster; prepare an After Action Report documenting areas identified that need improvement and a corresponding improvement plan.
• Required Priority Project 2: Medical Evacuation/Shelter in Place (SIP)
Local HPP Entities shall ensure all participating health care facilities upgrade medical evacuation plan/procedures as necessary to respond to disaster scenarios that require medical evacuation. These plans should include options to evacuate beyond the boundaries of the facility and be tested in a drill or exercise.
Not all disaster scenarios will or should require a full or partial facility evacuation. In some situations it may be safer and more medically responsible for facilities to shelter-in-place versus evacuating patients and/or facilities; Local HPP Entities shall ensure plans include shelter-in-place when evacuation is inappropriate or delayed. The decision making process for determining whether to evacuate or shelter in place should be clearly articulated in each facility’s plan.
Local HPP Entities must clearly describe the progress made in 2009-10 and activities proposed for the 2010-11 grant period to increase preparedness for medical evacuation/shelter in place.
• Required Priority Project 3: Expansion of Health Care Facility Surge Capacity and Planning for Government Authorized Alternate Care Sites
Local HPP Entities, LHDs, and health care facilities are required to develop medical surge capacity for their county in the event of a catastrophic event such as pandemic influenza. Surge plans should include movement of patients along the continuum of care from existing health care facilities to expansion of health care facilities to Government-Authorized Alternate Care Sites. The initial HPP target of 500 surge beds per million populations, or 1 bed per 2000, was in preparation for a moderate event. As part of the 2006 Surge Initiative, CDPH calculated surge needs for a catastrophic event such as a pandemic influenza utilizing CDC’s FluSurge 2.0 software. Based on these calculations, California will need 58,728 surge beds during a catastrophic event. Table 1 on page 28 displays each county’s population-based proportion of surge beds during a catastrophic event. Although the initial HPP target for surge beds was met largely through the expansion of hospital beds, the surge needs of a catastrophic event will depend on the expansion of other existing health care providers, and the establishment of Government-Authorized Alternate Care Sites.
In the Standards and Guidelines for Health Care Surge During Emergencies, Volume II: Government-Authorized Alternate Care Sites published in February 2008, an Alternate Care Site is defined as: “A location that is not currently providing health care services and will be converted to enable the provision of health care services to support, at a minimum, inpatient and/or outpatient care required after a declared catastrophic emergency.” CDPH adopted this operational definition distinguishing the Government-Authorized Alternate Care Sites from the expansion of existing health care facilities given the differing laws and regulations under which each would operate. These surge guidelines also reiterated the responsibility of local government to operate Alternate Care Sites to mitigate the impact of a catastrophic event, and for LHDs to identify sites and convene a local planning group to plan for operation of Alternate Care Sites.
Additional information on the expansion of health care facilities and setup and operation of government authorized alternate care sites can be found in the Standards and Guidelines for Health Care Delivery during Surge Emergencies, Volume II, located at bepreparedcalifornia.
LHDs and Local HPP Entities must collaborate to complete a plan for meeting the local surge bed needs during a catastrophic event. In addition, Local HPP Entities should work with health care facilities and LHDs in integrating surge plans across the continuum of care from existing health care facilities to expansion of health care facilities to Government-Authorized Alternate Care Sites, including plans for triage, patient movement, and mass fatalities. The following information shall be submitted with the application and updated at mid-year and the end-of-year progress report (See Attachment 13 – Surge Bed Capacity Form):
• Number of surge beds provided by each hospital for health care
• Location of each Government-Authorized Alternate Care Sites, required to meet local surge bed needs
• Number of beds provided in each Alternate Care Site
• Assurance that all Alternate Care Sites beds are acute care beds
• Summary of plans for staffing, supply and re-supply of Government-Authorized Alternate Care Sites
Local HPP Entities, LHDs, and health care facilities shall continue developing and improving plans and concept of operations for providing supplemental health care surge capacity to the health care system. Participating health care facilities should continue to plan for the expansion of their capacity to treat additional patients.
HPP funds can be used to continue expansion of health care facility surge capacity and for participation of health care facilities in planning for Government-Authorized Alternate Care Sites. Local HPP Entities and participating health care facilities should address communication plans and patient movement along the continuum of care from home health, to hospitals and other health care facilities, and finally to Alternate Care Sites.
General Fund Pandemic Influenza Funds and/or CDC PHEP funds can be used by LHDs to plan for site selection and the operation of Government-Authorized Alternate Care Sites.
Local HPP Entities should clearly describe the progress made in 2009-10 and activities proposed for 2010-11 to meet surge capacity needs in terms of health care facility expansion and Government-Authorized Alternate Care Sites.
Table 1, Surge Bed Requirements Based on Population, displays the surge bed requirements by county. Local HPP entities should update their current capacity numbers and report on how the capacity will be addressed.
Tier 2 Activities (Optional): The following Tier 2 activities may be addressed during 2010-2011 after Overarching and Tier 1 Requirements have been met.
• Pharmaceutical Caches: The following pharmaceutical purchases are allowable for health care providers, ancillary staff, and their families; both pediatric and adult doses shall be considered. Local HPP entities may consider a phased approach for pharmaceutical purchases in the following order of precedence:
o Antibiotics for prophylaxis and post-exposure prophylaxis to biological agents for at least three days;
o Medications (except nerve agent antidotes) and vaccines needed for exposure to other threats.
Local HPP Entities may purchase, replace and rotate pharmaceuticals only if the purchases are linked to a Hazard and Vulnerability Analysis (HVA) and identified gaps show where and why sufficient quantities do not currently exist. Caches should be placed in strategic locations based on the same HVA and stored in appropriate conditions to allow rotation of stock and maximize shelf life. Emergency contacts and contingency plans should be designated for cache access.
Health care facilities should develop procedures for storage, rotation and timely distribution of critical medications for health care providers, ancillary staff, and their families during an emergency.
• Personal Protective Equipment: Local HPP Entities may continue to acquire personal protective equipment (PPE) to protect current and additional health care personnel necessary to support events of the highest risk identified through the HVA. The amount should be tied directly to the number of health care personnel needed to support bed surge capacity during a catastrophic event that requires PPE. (See Attachment 13 – Surge Bed Capacity Form which projects surge estimate for each county.) The necessary level of PPE should be established based on the HVA and gaps in the amount of PPE needed to protect staff during events identified as the highest risks.
• Mobile Medical Assets: Local HPP Entities may continue to develop or begin to establish plans for a mobile medical capability, working with State and local partners to ensure integration of plans and sharing of resources. Mobile medical plans must address staffing, supply and re-supply, and training of associated personnel who may function interchangeably as surge augmentation or evacuation facilitators. Mobile medical asset related activities funded during the project period must be reported in the HPP end-of-year progress report.
• Decontamination: Local HPP Entities may assure adequate portable or fixed decontamination system capability exists for managing adult and pediatric patients and health care personnel who have been exposed during all hazards and health and medical disaster events. The level of capability should be in accordance with the number of required surge capacity beds expected to support the events of highest risk identified through the HVA. All decontamination assets shall be based on the number of patients/providers who can be decontaminated on an hourly basis.
• Medical Reserve Corps: Local HPP Entities may consider using HPP funds to support the integration of Medical Reserve Corps units with local and regional infrastructure. Local Entities are also encouraged to use multiple sources of funding to establish/maintain the Medical Reserve Corps program. HPP funds may be used to:
o Support Medical Reserve Corps personnel/coordinators for the primary purpose of integrating the Medical Reserve Corps structure with the Disaster Healthcare Volunteer program;
o Include Medical Reserve Corps volunteers in trainings that are integrated with that of other local, regional, and state assets, health care facilities, or volunteers through the Disaster Healthcare Volunteer program; and/or
o Include Medical Reserve Corps volunteers in exercises that integrate the volunteers with other local, regional, and state assets.
• Telecommunications Service Priority Program (TSP)
Each Local HPP Entity can identify a minimum of one hospital or health care facility to participate in the Federal Communications Commission’s (FCC) Telecommunications Service Priority Program that prioritizes facilities for re-establishing physical telecommunications lines affected by disaster. Facilities targeted for TSP must be those that the Local HPP Entity recognizes as critical medical surge responders during disaster, e.g., a designated trauma center that may be subject to interruption of communication capability.
Local HPP Entities
Local HPP Entities (or coalitions of entities) must continue to incorporate local partners in the partnership to develop and submit an application to CDPH describing proposed activities and how the Local HPP Entity plans to spend the allocated funds.
Five letters of support from the LHD, a hospital, a clinic, the LEMSA, and a long-term care facility must be submitted with the application. Counties may opt to establish a coalition and submit a single application for their pooled allocation. If a single application is filed, the application must include a letter indicating how each individual county member will monitor coalition activities in its jurisdiction.
Each LHD has the first right of refusal to serve as the Local HPP Entity for receiving and administering local funding. If the LHD declines to serve as the Local Entity, it must provide CDPH with a letter of waiver. If the LHD is not the Local HPP Entity in the jurisdiction, the LHD shall convene the local partnership to establish the local HPP program and select the Local HPP Entity.
Each local allocation begins with a base of $135,000 including $50,000 for a half-time HPP Coordinator to carry out program responsibilities. In addition, each Local HPP Entity is allowed to claim a 15% percent fiscal agent fee to cover administrative responsibilities.
Local HPP Entity responsibilities include programmatic and administrative responsibilities and activities as follows:
Programmatic Responsibilities:
• Perform the duties of the local partnership including facilitation of partnership meetings or ensure a member of the partnership is serving as lead in carrying out these activities.
• Oversee development, implementation, and exercising of local surge plans, hospital evacuation plans, fatality management plans, and shelter-in-place plans.
• Monitor implementation of training and exercise programs within all hospitals and health care facilities in the operational area.
• Manage priority projects and ensure that priority project deliverables are met.
• Establish and implement procedures for the collection of data elements from each participating hospital, clinic or other health care facility (Attachment 21a, 21b)
Administrative Duties:
• Act as the convener of the local partnership:
▪ Set meeting dates, times, and locations so that all meetings are accessible to all partners. Maintain attendance reports for all local partnership meetings.
▪ Set agendas and keep a copy of the agenda with the aforementioned attendance reports.
▪ Post meeting dates and agendas on the Local HPP Entity website and provide website location to CDPH.
▪ Identify and invite members to the planning group (see below for required and recommended membership on the planning group).
▪ Chair the meetings, record attendance, take meeting minutes and distribute them to all partners and the CDPH Project Officer.
• Administer funds on behalf of the jurisdiction and participating health care
facilities in accordance with and in compliance with the Signed Agreement between CDPH and the Local Entity.
• To disburse funds to hospitals, clinics, EMS or other eligible partners the Local HPP Entity must enter into subcontracts or memoranda of understanding with each partner.
• Track and report expenditures by target capability and type of entity receiving funds (hospitals, EMS systems, poison control centers, skilled nursing facilities, community health centers, rural health clinics, federally qualified health centers, tribally-owned health care facilities, and other outpatient facilities).
• Prepare the HPP Work Plan and Budget for each grant period.
• The HPP Work Plan will identify the objectives and activities to accomplish the overall project goals by sub-capability during each budget period within the three-year project period.
• The budget should be written in terms of who, what, when, where, why, and how much. The budget justification must specifically describe how each item will support the achievement of the proposed objectives during each budget period within the three-year project period. The budget justification must clearly describe each cost element and explain how each cost contributes to meeting the project's objectives/goals during each budget period within the three-year project period.
• Once every 2 years, ensure one audit of expenditures from amounts received under their HPP award is conducted by an independent entity in accordance with the Comptroller General’s standards for auditing governmental organizations, programs, activities, and functions and generally accepted auditing standards. The audit requirement does not alter the annual audit requirements attached to other HHS program funding. (Local HPP Entities which conduct an annual single-federal audit according to OMB Circular A-133 meet this requirement.)
Evidence-Based Performance Elements
Local HPP Entities should collect data to ensure that hospitals are developing required plans (evacuation/shelter in place and mass fatality) and testing the required measures in their drills and exercises. Local HPP Entities are required to submit data on performance elements with the grant applications using Attachment 21b – Operational Area(OA)/Aggregated HPP Data Elements Worksheet).. Each participating hospital should complete and submit to the Local HPP Entity a worksheet (Attachment 21a – HPP Date Elements Worksheet for Hospitals) which collects data such as:
• The number of participating hospitals that demonstrate dedicated, redundant communications capability during an exercise or incident, as evidenced by exercise evaluations or after action reports at least once during the current project period.
• The number of participating hospitals that demonstrate sustained two-way communications capability with the local EOC and Tier 2 partners during an exercise or incident, as evidenced by exercise evaluations or after action reports at least once during the current project period.
• The number of participating hospitals that have written plans to address mass fatality management.
• The number of participating hospitals that have written plans to address medical evacuation.
• The number of participating hospitals that incorporate NIMS concepts and principles for handling emergency events.
• The number of participating hospitals that have identified appropriate hospital personnel for training and have verified their completion of the following courses or their equivalent - IS 100, IS 200, IS 700, IS 800B.
Index of Attachments
Overview
Attachment 1 – 2010-11 Local Allocations, CDC, GF Pandemic Influenza, HPP
Attachment 2 – Strategic Direction Committee Recommendations/Priorities
CDC Public Health Emergency Preparedness (PHEP)
Attachment 3 – 2010-11 LHD CDC and GF Pandemic Influenza Work Plan
Attachment 4 – 2010-11 LHD CDC and GF Pandemic Influenza Budget (Instructions and Template)
Attachment 5 – Sample 2010-11 LHD CDC and GF Pandemic Influenza Budget
Attachment 6 – SNS RAND Drill – All Staff Call-Down Data Collection Sheet
Attachment 7 – SNS RAND Drill – Site Activation Staff Call-Down Data Collection Sheet
Attachment 8 – SNS RAND Drill - Facility Set-Up Data Collection Sheet
Attachment 9 – SNS RAND Drill – Picklist Assessment Data Collection Sheet
Attachment 10 - SNS RAND Drill - Dispensing Assessment Time Study Data Sheet
Attachment 11 – Laboratory Training Programs for Local Health Departments
Attachment 23 – Generic TAR Workplan
Hospital Preparedness Program (HPP)
Attachment 14 – Local HPP Entity 2010-11 Work Plan
Attachment 15 – 2010-11 HPP Budget (Instructions and Template)
Attachment 16 – Sample 2010-11 HPP Budget
Attachment 17 – 2010-11 HPP Participating Health Care Facilities Form
Attachment 18 – NIMS Implementation Objectives Hospital Compliance Tracking Tool
Attachment 19 – AAR Reporting Form – HPP Drills Exercises
Attachment 20 – Hospital Incident Command System Acronyms
Attachment 21a – HPP Data Elements Worksheet for Individual Hospitals
Attachment 22b – HPP Data Elements Worksheet Aggregated by OA
CDC and HPP
Attachment 12 – Training Drills and Exercises Form
Attachment 13 – Surge Bed Capacity Form
Embedded in Budget Templates – Information Technology Justification
Attachment 24 - 2010-11 Comprehensive Agreement
Exhibit A – Scope of Work
Exhibit B – Budget Detail and Payment Provisions
Exhibit C – Additional Provisions
Exhibit D – Special Terms and Conditions including Certification Regarding Lobbying
Exhibit E – Non-Supplantation Certification Form
|2010-2011 Local Guidance Documents |
|Submit with grant |For reference only|For use during | | |
|application | |the grant year | | |
|CDC |HPP | | | | |
| | |X | |Attachment 1 |2010-11 Local Allocations |
| | |X | |Attachment 2 |Strategic Direction Committee Recommendations - Priorities |
|X | | | |Attachment 3 |2010-11 LHD CDC and GF Pandemic Influenza Work Plan |
|X | | | |Attachment 4 |2010-11 LHD CDC and GF Pandemic Influenza Budget |
| | |X | |Attachment 5 |Sample 2010-11 LHD CDC and GF Pandemic Influenza Budget |
| | | |X |Attachment 6 |SNS RAND Drill – All Staff Call-Down Data Collection Sheet |
| | | |X |Attachment7 |SNS RAND Drill - Site Activation Staff Call-Down Data Collection Sheet |
| | | |X |Attachment 8 |SNS RAND Drill - Facility Set Up Data Collection Sheet |
| | | |X |Attachment 9 |SNS RAND Drill - Picklist Assessment Data Collection Sheet |
| | | |X |Attachment10 |SNS RAND Drill - Dispensing Assessment Time Study Data Sheet |
| | |X | |Attachment 11 |Laboratory Training Programs for Local Health Departments |
|X |X | | |Attachment 12 |Training Drills and Exercises Form |
|X |X | | |Attachment 13 |Surge Bed Capacity Form |
| |X | | |Attachment 14 |2010-11 Local HPP Entity Work Plan |
| |X | | |Attachment 15 |2010-11 Local HPP Entity Budget |
| | |X | |Attachment 16 |Sample 2010-11 Local HPP Entity Budget |
| |X | | |Attachment 17 |2010-11 HPP Participating Health Care Facilities Form |
| | | X | |Attachment 18 |NIMS Compliance Tracking Tool |
| | | |X |Attachment 19 |AAR Reporting Form - HPP Drills Exercises |
| | |X | |Attachment 20 |Hospital Incident Command System Acronyms |
| |X | | |Attachment 21a |HPP Data Elements Worksheet for Individual Hospitals |
| |X | | |Attachment 21b |HPP Data Elements Worksheet Aggregated by OA |
| | |X | |Attachment 22 |DRAFT Allowable Non-Allowable Items Matrix |
| | |X | |Attachment 23 |Generic TAR Work Plan |
|X |X | | |Attachment 24 |Comprehensive Agreement |
|X |X | | |Embedded in the budget |Information Technology Justification |
| | | | |documents | |
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