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Appendix H to Hertford County EOP-Public Health All Hazards Plan
Hertford County Public Health Authority
Standard Operating Guidelines
All Hazards Response Plan
~ FOR OFFICIAL USE ONLY ~
HCPHA/Barbara Earley
See previous Bioterrorism and Emergency Health Threat Plan for Origination and Revision Dates Prior to
adaptation of the PHRST 1 Template.
DRAFT DATE: 3/11/2011
by PHRST 1 All Hazards Plan Committee
HCPHA Adaptation Dates: October 2011January 2012
This is a living document under continual refinement and improvement. At a minimum, the base plan is
reviewed and updated annually to reflect procedure and capability changes, as well as deficiencies
identified for corrective action. All changes are subject to approval by the Local Health Director or
designee. This document is NIMS compliant and incorporates after action improvements resulting from
local or regional exercises and/or responses. Local Emergency Management will receive an electronic or
hard copy of this plan to include in the county Emergency Operations Plan (EOP). The local Emergency
Manager will annually receive plan updates and is responsible for ensuring those updates are
incorporated into Public Health sections of the county EOP. Changes to this document are recorded on
the Record of Change Form. A list of document recipients will be noted on the Distribution Control
Record and kept on file by the HCPHA Preparedness Coordinator.
Page 1 of 69
Table of Contents
Record of Distribution......................................................................................................... 4
Record of Review and Changes........................................................................................... 5
Executive Summary............................................................................................................. 6
Purpose and Scope.............................................................................................................. 6
Situation and Assumptions ................................................................................................. 7
Plan Development and Maintenance ............................................................................... 14
Authorities ........................................................................................................................ 14
Alert and Notification ....................................................................................................... 15
Local/Regional Notification and Activation ...................................................................... 17
Command and Control ...................................................................................................... 20
Roles and Responsibilities ................................................................................................. 23
Mutual Aid Agreements .................................................................................................... 33
Resources .......................................................................................................................... 34
Health, Medical, and Community ................................................................................. 35
Potential Hazards .............................................................................................................. 42
Concept of Operations ...................................................................................................... 48
PUBLIC HEALTH RISK RESPONSE MATRIX ..................................................................... 53
Recovery............................................................................................................................ 62
Other Considerations ........................................................................................................ 63
Appendixes........................................................................................................................ 69
APPENDIX A -Continuity of Operations (COOP) Plan .................................................... 69
APPENDIX C - EMERGENCY CONTACTS-See Red Emergency Contact manual in Health
Planner’s office ............................................................................................................. 69
APPENDIX D – Smallpox Vaccination Plan (incomplete) ............................................... 69
APPENDIX E - HCPHA PREPAREDNESS RESPONSE POLICIES & PROCEDURES ............... 69
APPENDIX F - PREPAREDNESS AND RESPONSE POLICIES & PROCEDURES FROM OTHER
COUNTY AGENCIES ....................................................................................................... 69
APPENDIX G – COMMUNICATION: TACTICAL AND CRISIS-see emergency
communications manual............................................................................................... 69
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APPENDIX H – HERTFORD COUNTY PANDEMIC INFLUENZA RESPONSE PLAN see
Pandemic Influenza Preparedness and Response manual. .......................................... 69
APPENDIX I – HERTFORD COUNTY STRATEGIC NATIONAL STOCKPILE/MASS
MEDICATION DISTRIBUTION PLAN see SNS manual..................................................... 69
APPENDIX J – HCPHA ICS Structure and Assignments .................................................. 69
APPENDIX K-HCPHA Communication Flow Chart ......................................................... 69
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Record of Distribution
This plan will be maintained and distributed by the Hertford County Public Health
Authority (HCPHA).
The plan can be accessed at www.hertfordhealth.com. In addition, hard copies are
located in/on the:
Location
Winton
Internet Intranet Board Ahoskie
Room
Site
Emergency Preparedness Plans
Public Health All Hazards Plan-previously
Bioterrorism and Emerging Health Threats
Tactical Communication Plan
Crisis Communication Plan
Pandemic Influenza Response Plan
Strategic National Stockpile Plan
Mass Medication Distribution Plan
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New staff orientation and annual employee training requires mandatory orientation to
this plan and includes a discussion of the following:
 Location of the HCPHA All Hazards Response plan
 Structure and framework of the plan
 Command and Control
 Emergency roles and responsibilities
 Role of public health for all hazards response
 Notification and communication protocols
 Resources for preparedness and disaster response training
 Personal and Family Emergency Preparedness including completion of a family
care plan
The following HCPHA employees also maintain electronic copies of this plan.
Name
Barbara Earley
Ramona Bowser
Ed Evans
Diane McLawhorn
Nikki Moore
Position
Preparedness Coordinator
Do-interim Health Director/Chief Finance Officer
Environmental Health Supervisor
Do-interim Health Director/Director of Nursing
Health Promotion and Marking Coordinator-PIO
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Record of Review and Changes
Plan
Review
Date
1/5/12
Section(s)
Changed
Changes/
Reviewed
By
Notes
All Basically
New
Approval of
Revisions by
Date
Health
Plan
Director
Exercised
(sign &
date)
Barbara
Earley
Diane
McLawhorn
Ramona
Bowser
Page 5 of 69
Submitted
for review
1/4/12
Submitted
for review
1/4/12
Executive Summary
In 2002, the Hertford-Gates District Health Department created a Bioterrorism and
Emerging Health Threats Plan according to NCDPH requirements. The plan was adopted
by the Hertford County Public Health Authority in 2004 and updated, in collaboration
with the LEPC, annually and began morphing into an All Hazards Plan in 2006. The
PHRST 1 All Hazards Plan subcommittee created a template All Hazards Plan as a guide
to all PHRST 1 counties in June 2011. Beginning in October 2011, HCPHA began the task
of tailoring the template to match agency and county practice and information.
It is recognized that this plan is extremely comprehensive, somewhat to the extreme.
As the plan is reviewed and revised, it will most likely become more streamlined and
user friendly.
Purpose and Scope
Purpose
The North Carolina Department of Health and Human Services (NC DHHS) and the North
Carolina Division of Public Health (NC DPH), through the Epidemiology Section, Public
Health Preparedness and Response (PHP&R) Branch, support local planning efforts
through the administration of funding for preparedness activities and the provision of
technical resources. Public Health (PH) All Hazards planning and response take place at
the local level in North Carolina (NC). Decisions, partnerships, and resource acquisition
relative to emergency response, take place primarily within HCPHA. Local preparedness
planning builds on current infrastructure and seeks to bring consistency and
coordination to local public health response, as well as establish relevant protocols and
procedures (e.g. communication, forms usage, and epi response). Wherever possible,
this plan is consistent with emergency procedures in the twenty-five northeastern NC
counties of old Public Health Regional Surveillance Team One (PHRST-1).
The purpose of this plan is to set forth an operational framework for Local Health
Department (HCPHA) response to all hazards emergencies that pose an imminent or
potential threat to the public’s health. The plan is also for use when an event requires,
or has the potential to require, more resources than currently available, which may
adversely affect the health of local residents or threaten normal health department
operations. The plan provides flexible guidelines that can be modified according to the
scope of the event. It also assigns responsibilities for emergency preparedness,
planning, operational coordination, and resource allocation at all stages.
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The Public Health All Hazards Response Plan (PHAHRP) integrates emergency
management concepts into public health response. As such, this document applies to
all phases (preparedness, response, and recovery) of an emergency situation and is
compliant with the National Incident Management System (NIMS) and Incident
Command System (ICS) organizational structure in order to scale response to effectively
meet incident management objectives.
Scope
The HCPHA’s PHAHRP is activated in response to any natural or man-made hazard that
overwhelms, or has the potential to overwhelm, the organization’s day-to-day capacity
to support our mission to provide Disease Prevention, Health Protection and Health
Promotion in an impacted area.
The scope of this plan is limited to the emergency activities necessary to ensure:
 Organizational viability
 Delivery of mission-critical Public Health services
 Provision of staff and resources to support the county’s emergency
management infrastructure
In situations that require coordination and/or support from external sources, HCPHAs
rely on the established county emergency management system.
Situation and Assumptions
Situation
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HCPHA serves the population of Hertford County. According to the US Census
Bureau 2010 estimate, the population of Hertford County is 24,669.
Hertford County is bordered by Gates, Northampton and Bertie counties and Virginia
to the north
The Hertford County Public Health Authority has a defined role for protecting the
public’s health In the county Emergency Operations Plan.
Tourism consists primarily of hunting, fishing, touring the Murfreesboro historic
district and attending the annual Watermelon Fest.
Chowan University, a private Baptist affiliated college, Shaw-Cape University, a
satellite of Shaw University in Raleigh and Roanoke Chowan Community College
provide for post-high school academic education.
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Roanoke Chowan Hospital, Hertford County Public Schools and the Hertford County
Nucor Recycling Plant are the top three employers.
HCPHA provides a variety of programs to support the core functions of public health.
o Communicable disease control activities consist of surveillance,
immunization, food service inspections and training, evaluation of public
swimming places, public education and clinical services for diagnosis and
treatment of sexually transmitted disease.
o Maternal and child health programs include WIC, child blood lead level
testing, obstetrical and child services case management, outreach,
preconception health and family planning.
o Other population-based programming includes community health
assessment, health promotion and education activities, youth tobacco
use prevention program and adolescent parenting program.
o vital records and health statistics collection and dispersement.
o Additional environmental health services include inspection and
permitting of private wells and private sewage treatment systems.
The HCPHA works with local, regional, and state partners to optimize the health and
well being of Hertford County residents.
The HCPHA collaborates with community health care providers to provide personal
and preventive health services.
The HCPHA is involved in the Hertford County local emergency planning committee
(LEPC). The HCHPHA maintains communication with local emergency management.
Assumptions
The HCPHA PHAHRP makes certain general assumptions about incidents in general and
about preparedness.
It is assumed that Public Health incident response varies according to complexity of the
incident. Incidents requiring a public health response can include natural disasters (such
as hurricanes and floods), hazmat events (such as a chemical spill), biological threats
(naturally occurring or man-made), and mass casualty events. This plan will be activated
in situations that affect the public’s health and are outside normal operating conditions
or capabilities.
Additional Assumptions:
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The HCPHA has a public health preparedness and response plan that:
o is NIMS compliant.
o corresponds to existing local and state emergency operations plans.
o establishes roles and responsibilities of plan participants.
o identifies training for participants in those roles.
o establishes a chain of command among plan participants.
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o describes a system of emergency notification to local and state public health
staff and other key decision makers based upon the nature of the event.
o is available to staff on site.
Legal authority for PH response originates from NC laws governing a comprehensive
legal framework for protecting the public’s health.
Depending on their complexity, incidents have the potential to produce substantial
adverse public health consequences including drinking water contamination, food
spoilage, displaced persons, lack of adequate shelter, infectious disease risk,
environmental health issues and increased need for medical treatment. In addition,
there could be considerable damage to infrastructure such as utilities/energy
systems (electricity, fuel, water/sewer), and vital facilities (communications shelters,
essential goods management, and essential personnel management) necessary for
performing immediate response/recovery functions.
The HCPHA need not enter into mutual aid agreements with other government
agencies assuming roles are described in the EOP and HCPHA All Hazards Plan.
Mutual Aid Agreements with private partners will be implemented when needed.
Hertford County utilizes the incident management system to respond to all
incidents within the county. Unified Incident Management will be utilized when
multiple agencies/entities are required within the management structure.
Local emergency PH operations are conducted within the county or at a designated
location if county buildings are compromised. If local EM activates the Emergency
Operations Center (EOC), Public Health is integrated into the larger ICS organization.
A public health liaison will provide a communication link between the EOC and PH
emergency operations. All public health response activities are coordinated by the
local Health Director. If the event is primarily public health in nature and does not
necessitate EOC activation, HCPHA will function according to its internal ICS chart.
For non-public health emergencies the Public Health Division will evaluate the need
for a Local Public Health Coordination Center (LPHCC) to support ESF 8 and ESF 11
functions at the EOC.
Local PH operations will be coordinated by the Health Director at 801 N. King Street,
Winton, NC. 252.358.7833 the Liaison Officer will be located at the PH Coordination
Center or at the EOC depending on the incident and need.
Regional emergency PH operations will be coordinated by a public health liaison
positioned at the Eastern Branch Office located at 3802 Hwy 58 N. Kinston, NC
28502; 252-520-4923.
State agencies have emergency resources and expertise beyond the capabilities of
local government. These can be used to assist local response.
The State Public Health Coordination Center (PHCC) is the primary location from
which State emergency PH operations will be conducted under the direction and
control of the Director of the Public Health Preparedness & Response Office
(PHP&R). The SPHCC is located at the Cooper Building on 225 North McDowell St. in
Raleigh, NC, phone: (919) 715-0988, email: [email protected].
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When a local Public Health response exceeds local capabilities, expertise and
resources from the State and Federal level can be requested through Emergency
Management and mobilized to augment local efforts.
This plan and its sub-plans are exercised annually per NCDPH Agreement Addenda
Requirements.
Training on this plan and its sub-plans are provided to staff annually.
Authority
Statute
Description
Communicable
Disease Control
G.S. 130A-134
through 130A-142
Establishes requirements for physicians, laboratories and
other designated entities to report listed communicable
diseases and conditions to local health departments and for
local health departments to report this information to HHS.
Also provides immunity for making such reports. Gives
rulemaking authority for listing communicable diseases and
conditions and form, content and timing of reports to the
Commission for Public Health. The rules found at 10A NCAC
41A .0100. G.S. 130A-141.1 allow the State Health Director
to require temporary reporting of symptoms, trends or
diseases that may indicate a danger to the public health
without going through the rulemaking process first.
Communicable
Disease Control
G.S. 130A-143
Provides for strict confidentiality of communicable disease
information unless one of eleven listed exceptions is met.
The exceptions allow such information to be shared with
other public health agencies and, under limited
circumstances, with law enforcement, to prevent or control
the spread of communicable diseases or conditions.
Communicable
Disease Control
G.S. 130A-144
Sets out provisions requiring the investigation and control of
communicable diseases and conditions. The Commission for
Public Health adopts specific control measures for
communicable diseases that must be followed to prevent the
spread of disease. Local Health Directors are charged with
enforcing control measures, and the statutes require persons
to comply with control measures, including Paragraph (f)
that states all persons shall comply with control measures,
including submission to examinations and tests. The control
measure rules are found at 10A NCAC 41A .0200. This statute
also requires physicians, medical facilities and laboratories to
provide public health officials access to medical or other
records as part of the investigation of a known or suspected
communicable disease outbreak or investigation of a known
or suspected case.
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Communicable
Disease Control
G.S. 130A-145
Establishes the authority of the State Health Director and of
a local health director to issue isolation or quarantine orders.
The isolation or quarantine order initially lasts up to 30 days
but can be extended by court order. (Isolation authority is
defined in G.S. 130A-2(3a) and Quarantine authority is
defined in G.S. 130A-2(7a)).
Communicable
Disease Control
G.S. 130A-146
Sets out special requirements for transportation of dead
bodies for persons who have died from highly communicable
diseases.
Communicable
Disease Control
G.S. 130A-147
Gives the Commission for Public Health authority to adopt
rules for the detection, control and prevention of
communicable diseases.
Communicable
Disease Control
G.S. 130A-48
Establishes mandatory syndromic surveillance program to
review electronic hospital emergency department data to
detect and investigate public health threats that may be
related to a terrorist incident using Chemical, Biological,
Radiological, Nuclear and Explosive (CBRNE) agents or an
epidemic or infectious, communicable or other disease.
Remedies
G.S. 130A-17
Provides the Secretary of HHS or local health director with
authority to enter premises when necessary to enforce
provisions of Chapter 130A or rules adopted by the
Commission for Public Health or local board of health.
Remedies
G.S. 130A-18
Allows Secretary of HHS or local health director to pursue
injunctive relief in superior court for violation of Chapter
130A or rules adopted by the Commission for Public Health
or local board of health.
Remedies
G.S. 130A-19
Allows Secretary or local health director to issue order to
abate a public health nuisance. If the person does not
comply, the secretary or local health director can pursue
court action to order abatement.
Remedies
G.S. 130A-20
Allows Secretary or local health director to order abatement
of an imminent hazard or to enter property and abate the
imminent hazard. Imminent Hazard is defined in G.S. 130A2(3).
Remedies &
Criminal Acts
G.S. 130A-25
Makes a violation of any of the laws in Chapter 130A or rules
adopted pursuant to Chapter 130A a misdemeanor.
Paragraph (b) is particularly important because it provides
for specific sentencing outside of the Structured Sentencing
Act for persons violating control measures (G.S. 130A-144(f))
or isolation or quarantine orders (G.S. 130A-145). Persons
convicted under this section can be sentenced for up to two
years in designated prisons with the ability to properly
manage prisoners with communicable diseases.
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Terrorist Incidents
G.S. 130A- 475 –
479
Sets out State Health Director’s powers if he or she
reasonably suspects that a public health threat may exist and
may have been caused by a terrorist incident using Chemical,
Biological, Radiological, Nuclear and Explosive (CBRNE)
agents.
Emergency
Management and
Public Health
Coordination
G.S. 166A-5(3)b1
Requires a special component of the Emergency Operations
Plan to be prepared in coordination with the State Health
Director that includes specific provisions regarding public
health matters, including guidelines for prophylaxis and
treatment of exposed and affected persons, allocation of the
Strategic National Stockpile (SNS) and appropriate conditions
for quarantine and isolation to prevent further transmission
of disease.
Emergency
Management and
Public Health
Coordination
Emergency
Management and
Public Health
Coordination
G.S. 166A-6
Provides for the Governor’s authority to make a Disaster
Proclamation and sets out the Governor’s powers once a
Disaster has been declared.
G.S. 166A-40 - 53
Establishes the Emergency Management Assistance Compact
(EMAC) in conjunction with other states to provide mutual
aid and support in managing declared emergencies or
disasters.
Criminal Procedure
G.S. 15A-401(b)(4)
Allows a law enforcement officer to detain a person violating
an order restricting the freedom of movement of a person or
access to a person issued by the state or local health director
at a place designated by the health director until the
person’s initial appearance before a magistrate or judge. This
provision is intended to prevent the spread of the disease to
others in the courts or jails as part of the normal processing
of someone on criminal charges.
Criminal Procedure
G.S. 15A-534.5
Allows the judge or magistrate at an initial appearance to
deny bail if the judge or magistrate determines that a person
arrested for violation of the state or local health directors
order restricting their freedom of movement or access to
them poses a threat to others. It also allows the judge or
magistrate to confine the person to a designated area that
will prevent the threat to others.
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Federal Authorities
The Robert T.
Stafford Disaster
Relief and
Emergency
Assistance Act,
Public Law 93-288,
as amended
Federal Authorities
Federal Response
Plan, Public Law
93-288
Federal Authorities
The Public Health
Service Act 42
U.S.C.§ § 201 et
seq.
Federal Authorities
42 U.S.C. § 264
The Robert T. Stafford Disaster Relief and Emergency
Assistance Act (Stafford Act) (Pub.L. 100-707) is a United
States federal law designed to bring an orderly and systemic
means of federal natural disaster assistance for state and
local governments in carrying out their responsibilities to aid
citizens. The Stafford Act is a 1988 amended version of the
Disaster Relief Act of 1974 (Pub.L. 93-288). It created the
system in place today by which a presidential disaster
declaration of an emergency triggers financial and physical
assistance through the Federal Emergency Management
Agency (FEMA). The Act gives FEMA the responsibility for
coordinating government-wide relief efforts. The Federal
Response Plan it implements includes the contributions of 28
federal agencies and non-governmental organizations, such
as the American Red Cross. It is named for Robert Stafford,
who helped pass the law.
Establishes the basis for the provision of the Federal
assistance to a State and its affected local governments
impacted by a catastrophic or significant disaster or
emergency which results in a requirement for Federal
response assistance. It is based on the fundamental
assumption that a significant disaster or emergency will
overwhelm the capability of State and local governments to
carry out the extensive emergency operations necessary to
save lives and protect property. Consequently, resources of
Federal departments and agencies, grouped into Emergency
Support Functions, will be used to provide Federal response
assistance to the State. Departments and agencies have
been assigned primary and support agency responsibilities
for each of these functions.
Provides for the Secretary of HHS to declare a public health
emergency under certain circumstances (42 U.S.C. § 247d).
The secretary is authorized to develop and take such action
as may be necessary to implement a plan under which the
personnel, equipment, medical supplies, and other resources
of the Department may be effectively used to control
epidemics of any disease or condition and to meet other
health emergencies and problems. The Secretary is also
empowered to extend temporary assistance to States or
localities to meet health emergencies.
The Secretary of HHS is authorized to make and enforce
quarantine regulations “necessary to prevent the
introduction, transmission, or spread of communicable
disease” from foreign countries into the United States or
possessions, or from one state or possession to another. The
disease for which a person may be subject to quarantine
must be specified by the President through an Executive
order.
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Federal Authorities
Executive Order
13295 68 Fed
Revised list of Quarantinable Diseases, specifies certain
communicable diseases for regulations providing for the
apprehension, detention, or conditional release of
individuals to prevent the introduction, transmission, or
spread of suspected communicable diseases.
Plan Development and Maintenance
Primary responsibility for development and maintenance of the PH All Hazards
Response plan (PHAHRP) belongs to the HCPHA PH Preparedness Coordinator. Since the
plan requires extensive coordination, other Public Health and partner agency staff also
have a role in the process.
Specific Plans are required per CDC cooperative agreement/ agreement addenda and
are incorporated into this All Hazards Plan. The requirements include the following
plans:
1) County All Hazards Emergency Operations Plan that includes public health
components
2) Communications Plan
3) Local SNS Distribution Plan
4) Pandemic Influenza Response Plan
5) Local Health Department Pandemic Flu Continuity of Operations Plan (COOP)
This plan and all related documents are available for review by PHP&R as requested, and
are consistent with state and federal requirements.
Authorities
NC has a strong decentralized Public Health system involving state agencies, regional
teams, and local health departments that provide the foundation for responding to
Public Health incidents and emergencies. NC has a core set of statutes dealing with
communicable disease control, remedies, terrorist incidents, Emergency Management
and Public Health coordination, criminal acts, and criminal procedures. Relevant federal
authorities are also listed below.
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Alert and Notification
The alert and notification section of this plan provides basic information on how various
staff and partner notifications may take place in a disaster/ emergency situation. Alerts
and notifications may vary based on the type of hazard and are therefore further
explained within each hazard sub plan, as needed. However, this will serve as the basis
for all alerts.
Public Health Staff Notifications
Each HCPHA employee should complete and annually update a family care plan. A copy
should be kept by the employee, his or her supervisor, and the personnel department.
In addition, each employee and his/her supervisor is asked to ensure the Health
Department has current contact information. This data is maintained by the personnel
clerk and should include name, physical home address, primary and backup after hours
phone numbers, up to two email addresses, and any other data deemed necessary by
the Health Preparedness Coordinator (PC) and/or Health Director.
Notification Scheme:
1. HCPHA has a information call in number and an automated notification
system in place to enable 24/7 receipt of information and staff call down.
2. Staff member who receives alert of potential or actual health threat will
notify the Health Director, Preparedness Coordinator, Public Information
Officer, and/or other pre-identified staff.
3. If it would be beneficial for the entire staff to receive additional information
during business hours, an email will be sent to all staff. All HCPHA staff
members have access to email.
4. After hours staff notifications are handled through an automated notification
system. A supervisor call down tree will be used if the automated system
becomes unavailable or unreliable.
Local Partner Notification
Local partnerships are crucial when responding to an incident. Partners should receive
initial notification and regular situation updates. Local partners include but are not
limited to: Emergency Management, Law Enforcement, Emergency Medical Services,
Hospitals, Physicians, and Schools. Notification will again be based on threat type and
agencies involved in the response. Additional information and detail regarding
notifications can be found in the hazard specific annexes. The Preparedness
Coordinator and PIO maintain this information and request annual update of all contact
information from partners.
General Notification Scheme:
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1. Business Hours
a. Not urgent: An email update will be prepared by the Preparedness
Coordinator or PIO and sent as soon as possible
b. Urgent: A phone call will be made by the Preparedness Coordinator or
PIO
2. Non-business Hours:
a. Not urgent: An email update will be prepared by the Preparedness
Coordinator or PIO and sent as soon as possible, or the next business day
b. Urgent: A phone call will be made by the Preparedness Coordinator or
PIO.
Attachments A and B provide basic partner contact information and HCPHA staff
member responsible for notification.
Regional and State Public Health and Partner Notification
Each quarter, NC PHP&R provides Health Departments with updated contact
information for State and Regional offices. This information is maintained by the
Preparedness Coordinator. In many cases, PHP&R will alert local health departments of
a potential or confirmed public health emergency (e.g. HAN alert). When HCPHA
receives such alerts from other sources (e.g. EM, NCDETECT), the health director or PC
will make notification up the chain. He or she will notify regional and state public health
partners of the following:
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PH P&R ERO (Eastern Region Office) notification will be initiated by the Local
Health Director or PC by email or telephone depending on urgency. ERO may
coordinate notification to the surrounding jurisdictions.
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NCDHHS Office for PH Preparedness and Response notification will be made by
the Local Health Director, ERO, or designee via telephone or paging device.
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NCDPH Epidemiology Section notification will be made by the Local Health
Director, EVO or designee and/or by the PH Epidemiologist. Notification will by
telephone or paging device.
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The following Chart outlines various levels of alert and notification that may apply to
all hazards events.
Local/Regional Notification and Activation
PHASE
Activation Activities
Notification Activities
(These are examples only and are not all
inclusive)
Level 1
Non – event
Definition:
Maintain routine
public health
functions
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Routine notifications of
reportable disease or
environmental event. No
potentially urgent public
health implications
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Routine, day-to-day public
health operations
 NCDPH PHCC maintained at
state of readiness but not
activated.
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Monitor Homeland Security
Threat information as a potential
trigger
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
Normal/usual
notification
activities based on
general statutes
and professional
judgment
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Notify and consult local,
regional, state Public Health
partners as appropriate
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Routine communication
with local, regional and
state public health and
other external partners
Level 2
Local Public
Health Event
Definition:
Notification of a
public health
event or incident
with implications
for significant
local impact.
Example:
Northampton
County Peanut
Fire, 2009
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Notification of event determined by
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Within
4 hours of event
identification, notify local,
regional, state partners as
appropriate to the event

Notify local health care

Report of a suspect case/cluster
providers if case finding is
of disease or HAZMAT event with
necessary or clinical
potentially urgent public health
information should be
implications
shared

Presentation of a suspicious

Within 4-8 hours, complete
substance
key partner notification as
associated with a credible and/or
necessary for the event
health threat (or until such threat is

Teleconference with
ruled out)
appropriate partners once

Approaching weather with potential
notifications are made to
for significant public health impact
coordinate response.

Mass gathering or event
Establish a schedule for
requiring deployment of
follow up teleconferences
public health resources
and operational coordination

Event with public health

HAN alert within 6-12
hours if potential for
information implications
impact to other
 Minimal degree of PHCC
jurisdictions or there is
activation
need for additional

Monitor Homeland Security
information from other
Threat information as a potential
jurisdictions
trigger

Craft relevant crisis related
messages. Provide to the
community and media as
soon as available. Establish
regular intervals to update
media and community
Local Health Director (or designee)
to have potential but limited
Public Health impact
Page 18 of 69
Level 3
Local Event,
with Potential
for MultiJurisdictional,
Regional
and/or
Statewide
Impact
Definition: Higher
level notification of
a public health event
or incident with
potentially urgent
public health
implications
and/or
widespread
impact.
Example: EQ
Fire, Apex, NC,
2007

Notification of event determined

Within
one hour
following event
identification, notify and
consult local, regional,
state partners

Report of a suspect case/cluster
appropriate to the event
of a disease or HAZMAT event

HAN alert within 2-4 hours to
with urgent public health
alert
other jurisdictions of
implications and potential for
the
situation
or to request
multijurisdictional involvement
additional information

Report of credible threat of
 Activate ICS structure as
terrorist activity in the State of
needed
North Carolina

Teleconference with

Approaching weather with potential
appropriate partners within
for significant public health impact
one hour following
 Extended degree of PHCC
notifications to coordinate
response. Establish a
activation
schedule for follow up

Monitor Homeland Security
teleconferences and
Threat information as a potential
operational coordination
trigger

Craft relevant crisis
related messages.
Provide to the community
and media as soon as
available. Establish
regular intervals to
update media and
community
by Local Health Director (or
designee) to have significant
Public Health impact
Page 19 of 69
Level 4
Regional/State/
Federal
Emergency
Definition: Public
health event or
incident with a
regional or
statewide impact,
necessitating the use
of multi-regional,
state or federal
assets.
Example: 2009
H1N1 Pandemic

Notification of event determined by

Within
one hour
following event
identification, notify and
consult local, regional,
state partners
appropriate to the event
 Report of a suspect case/cluster of
 Teleconference with
a disease or HAZMAT event with
appropriate partners within
urgent public health implications
one hour to coordinate
which overwhelms local, regional
response. Establish a
and state response assets
schedule for follow up

Credible threat of terrorist attack
teleconferences and
in the State, region or regions
operational coordination

Suspect or confirmed case of non- Activate ICS structure/Unified
naturally occurring Category A
Command
agent
 HAN alert within 1 hour to
alert
 Use of any chemical, biological,
other jurisdictions of the
radiological or nuclear weapon
situation or to request
within the State of NC.
additional information

Pandemic Event

Notification of other

Multiple emergency events
(outside the State)
occurring in a limited time frame
agencies such as: CDC,

Multiple jurisdictions within the
neighboring States and
region requesting assistance
countries
Craft relevant crisis related

Full activation of PHCC or any
messages. Provide to the
State agency EOC for any reason
community and media as

Natural or technological disaster
soon as available. Establish
interrupting or potentially
regular intervals to update
interrupting local and regional
media and community
public health operations (COOP

Prepare or submit
impact)
justification for disaster

Monitor Homeland Security
declaration
Threat information as a potential
trigger
Local Health Director (or designee)
or other regional, state, federal
health official to have significant
and severe Public Health impact.
Command and Control
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Command and Control is often referred to as the Incident Command System (ICS). It is
designed to coordinate the activities of responding agencies and to ensure responder
health and safety. In addition, it is structured around goals and objectives to maintain
an organized and efficient response. ICS is a part of the National Incident Management
System (NIMS). Every responder agency is required to maintain compliance with NIMS
as it is the primary response mechanism in the U.S.
North Carolina local health departments utilize ICS as a framework for response. HCPHA
is responsible for public health emergency management in its jurisdictional boundaries
and will conduct emergency operations according to established plans and procedure.
The health department will be responsible for the following:







Identifying the types of incidents that might occur in their communities
Planning emergency activities in advance to ensure a coordinated
response to the PH consequences of credible threats
Building capabilities necessary to respond effectively to the consequences
of those threats
Identifying the type or nature of a PH incident when it happens
Implementing the planned response quickly and efficiently
Recovering from the incident
Conduct improvement planning
During emergencies, local health departments activate agency emergency operations
plans. These plans are integrated into the overall local Emergency Operations Center,
Area Command, or Unified Command structures and are based on specific incident
need. Local EM maintains a multi-hazard Emergency Operations Plan that describes the
function and authorities of health and medical forces, and the roles and local
assignments of responsibilities to such personnel. This All Hazards plan provides a
functional approach to public health preparedness, response and recovery at the local
level. Additional specific PH plans, such as the Strategic National Stockpile and Pan Flu
plan, are included as annexes to the HCPHA All Hazards plan and county EOP.
Should an incident exceed local response capabilities, requests for assistance should be
made through appropriate local/state Emergency Management, State Public Health,
and/or Federal authorities. HERTFORD County Emergency Management has designated
a location for the County Emergency Operations Center (EOC). HCPHA has designated
the HCPHA Administrative Building for carrying out PH emergency operations, and has
identified a liaison officer assigned to work with the county EOC when it is activated.
The public health emergency operations site is staffed with local public health officials,
and volunteers (as needed), who receive emergency information, coordinate public
health response activities, make population protection decisions, and communicate with
partner agencies. When the County Emergency Operations Center is activated a local
Page 21 of 69
PH representative will be assigned to the EOC. The health department will evaluate
disaster impact and establishing operational priorities for the following public health
issues: health surveillance; epidemiology; public health information; vector assessment
and control; general health and sanitation issues; and shelter operations. PH emergency
operations will be conducted within established county ICS and will request necessary
resources through EM.
HCPHA will work with local response partners to delineate their role in a multi-agency
response. Similarly, cross jurisdictional partnerships must be encouraged and
developed to allow for an organized public health response across county lines.
Incident Management
The Incident Management System will be utilized and the operational format scaled to
incident scope. When PH operations are integrated into a multi-agency response,
decisions on size and composition of the incident management structure are made by
the Incident Commander and based on an initial and ongoing assessment of the
incident. For every incident the following positions and initial activities should be
considered.
Position(s)
Incident
Commander
Responsibility
Responsible for directing the response,
identifying roles and responsibilities
and determining response objectives.
Hazard Use Examples
All
Public Information Responsible for coordination of
Officer
information with other responding
agency Public Information Officers and
the public, as well as participating in
the JIC when activated.
Safety Officer
Monitor worker safety and provide
guidelines for protective actions.
All
Liaison Officer
Interface with external agencies.
Coordinate contacts and updates with
local partners
All
Operations
Responsible for tactical response
activities.
SNS – Point of Dispensing
Operations; Hurricane –
Clinical/Shelter
Operations; Pandemic –
Vaccine Management;
Page 22 of 69
All
Isolation & Quarantine
Management; Outbreak
Investigation
Logistics
Responsible for providing personnel
and logistical support to the response
including resource requests and
dispatch.
SNS – Local Receiving
Site; Staff well-being/
care
Planning
Responsible for incident briefings, the
All
incident action plan, data processing,
analysis, and information management,
and resources tracking.
Finance and
Administration
Monitor all expenses related to the
response, regulatory compliance and
business continuity.
All
ICS Chart
The ICS Chart outlines the base response structure. Not all positions may be needed,
depending on the response – ICS is scalable based on need. In addition, one person may
hold multiple positions; however, positions cannot be combined and must follow this
structure.
See Attachment J for the most recent ICS organization chart for HCPHA
Roles and Responsibilities
This section outlines the roles and responsibilities of local public health, local partner
agencies, regional and state public health partners.
Public Health
This section will outline Public Health roles and responsibilities related to emergency
and disaster response. Staffing and technical support may come from other County
agencies and divisions. This would impact services in their assigned program areas
potentially requiring a shift to continuity of operations plans. Staff support may also be
Page 23 of 69
required from other local health departments, regional partners, State, and Federal
resources to ensure an effective public health response.
The following summarizes how HCPHA will deal with all hazards emergencies. Incident
management in HCPHA follows the Incident Command System (ICS), a nationally
standardized organizational structure used to command, control, and coordinate
resources and personnel during emergency response.
Prepare
1. Assess threats and vulnerabilities to the community in
conjunction with local and regional emergency response
partners.
2. Develop and maintain a NIMS compliant PHAHRP and related
annexes/appendices, and participate in Hertford county
emergency operations plan development.
3. Build and maintain relationships and provide communications
with other local first-responders, as well as regional and state
partners.
4. Participate in Local Emergency Planning Committee (LEPC)
meetings; and maintain awareness of relevant Domestic
Preparedness Region (DPR) activities via meeting minutes or
reports from DPR PH representative.
5. Conduct a comprehensive Community Health Assessment
every 48 months that includes questions related to emergency
preparedness and at-risk populations, as well as work with
local hospitals to coordinate with their assessment process.
6. Identify population groups at risk for health problems during a
public health emergency.
7. Adequately train the HCPHA PIO and back-up to sharpen
written and verbal skills in routine health risk communication,
crisis communication, and media presentations.
8. Develop a Local Information Team (LIT) to support Crisis
Emergency Risk Communication and facilitate relationships
with other agency PIOs. Work with the LIT to educate the
public on preparing for all hazards emergencies. An Eastern
Regional Information Team of Public Health PIOs has also
been established to support LITs/ PIOs.
9. Compile and analyze available county-specific Public Health
surveillance data and identify triggers for action (e.g.
NCDETECT or school absentee data).
10. Ensure internal and external notification protocols are
developed and in place.
Page 24 of 69
11. Support and promote local Epi Teams and designate staff to
monitor for, identify and report significant Public Health
events. Ensure staff is trained to the level necessary to
conduct initial case investigations.
12. Develop and maintain an inventory of HCPHA deployable
response assets/resources. Identify gaps in response capability
based on inventory review. Budget for and purchase
additional items using 514 Aid to County funds.
13. Conduct training to develop preparedness and response
competencies internal and external to HCPHA. Assign an
HCPHA staff member to maintain records of training.
14. Test existing public health emergency response plans by
hosting or participating in local, regional, and state all hazards
response exercises. Conduct and document quarterly
notification drills and update relevant contact information.
Participate in at least one regional exercise annually.
15. Create a local 3-Year Training and Exercise Calendar
developed in coordination with local, regional, and state
partners.
16. Share best practices with other local health departments in
our region and across the State via Regional team and/or
PHP&R.
17. Identify local, regional and state resources that can be used in
a PH response.
Respond
1. The HERTFORD County Health Director, or designee, will
coordinate response activities during a public health incident.
2. Organize operations using NIMS/ICS principles.
3. Integrate with other response agencies through ICS.
4. Activate internal and external notification protocols as
appropriate.
5. Maintain communications with participating response
agencies; notify regional team and/or DPH offices as
appropriate.
6. Provide a liaison to the Hertford County EOC when activated
during a response.
7. Implement control measures in cooperation with local,
regional, and state agencies.
8. Health Director and Epi Team lead determine need to activate
the Epi Team. Team members, or other staff will be notified
as to when and how to report.
Page 25 of 69
9. Anticipate needs and request external resources as soon as
need is anticipated.
10. Activate LIT as appropriate to coordinate public information
and media response. Work with PHP&R ERO and DPH as
necessary.
11. HCPHA PIO will anticipate need for crisis communication and
coordinate with HERTFORD County Health Director to engage
the public and the media as soon as feasible based on the
situation.
12. Ensure accurate financial record keeping during the response,
including staff hours, activities, purchases, and other related
expenditures. This will aid in reimbursement process if a state
or national disaster is declared.
Recover
1. Demobilize activated personnel.
2. Reconstitute routine operations.
3. Update deployable equipment inventory spreadsheet and
plan for replacement of depleted items.
4. Provide updated public information as needed.
5. Participate in follow up public health actions, such as patient
tracking or environmental testing/tracking for effects of public
health.
6. Engage external resources for continued monitoring of
affected populations, if needed (e.g. CDB, OEEB).
7. If state or federal disaster is declared, submit paperwork to
support reimbursement.
Mitigate/ Improve
1. Collaborate with partners to assure public health input
incorporated in local mitigation plans.
2. Replenish necessary supplies.
3. Collaborate with response partners to assure public health
component of after action reports.
4. Complete public health after action report and corrective
action plan within 60 days of response termination.
5. Revise all relevant plans, including the training plan, based on
AAR and CAP.
6. Distribute copies of updated plans.
Page 26 of 69
Partners
Management of public health emergencies is the responsibility of local
government. Consequently, partnering with external agencies is critical to
successful planning and response efforts. Below are descriptions of PH relevant
roles and responsibilities for primary partner agencies.
NC Division of Public Health (NC DPH)
When local public health capacity is overwhelmed, additional assistance may be
requested from the State. DPH is responsible for coordination of services,
equipment, supplies, and personnel to meet these needs. The Division of Public
Health, Epidemiology Section oversees response to Communicable Diseases and
Public Health Emergencies. Where necessary, DPH will assist local agencies in
obtaining services from appropriate resources. This assistance is initiated upon
county request once DPH has determined a State response is warranted.
Although Hertford County EOC serves as the conduit for local requests, the Local
Health Director will make contact with DPH to describe the situation.
PHP&R
Within the Epi Section, planning for PH emergencies is charged to the Office of
Public Health Preparedness and Response (PHP&R). PHP&R handles state level
planning for public health emergencies, is a liaison to federal partners and shall
be a primary point of contact for all incidents with the potential to impact public
health. They also provide oversight and guidance for regional PH teams.
PHCC
When a public health emergency in NC overwhelms local and/or State resources,
DPH may activate the Public Health Coordination Center (PHCC). The PHCC
directs and advises on State, regional, and local operational activities;
coordinates filling operational needs of local public health agencies; and
communicates information internally, to community partners, and to external
partners/agencies.
PHP&R Eastern Region Office
Eastern NC is supported by the ERO, which is comprised of a planner, nurse
consultant, pharmacist, industrial hygienist and program assistant. The primary
responsibilities of ERO are to serve the health departments/districts in Eastern
NC by providing consultation and technical support; acting as an organizational
liaison; providing regional surveillance (as needed); and facilitating training and
exercises for local public health. To request assistance, Hertford County Health
Director (or designee) will contact the ERO DPH Office of Public Health
Page 27 of 69
Preparedness & Response. ERO response activities may involve investigation,
recommendation of control measures, data evaluation/management, media
messages, post event evaluation and long term follow up such as patient
tracking.
Emergency Management
Hertford County Emergency Management is a primary planning partner,
ensuring that roles and responsibilities outlined for PH in the Hertford County
EOP are accurate and feasible. Similarly, PH works with local EM to ensure its
emergency response plans correctly identify partner agency roles and
responsibilities in relation to a PH emergency. As part of the planning process,
EM coordinates (or participates in) exercises and tests of the emergency system
within the jurisdiction. Additionally, the Emergency Manager serves as
Community Emergency Coordinator as defined by SARA Title III and the Local
Emergency Planning Committee (LEPC), of which HCPHA is a member. EM, in
cooperation with involved partner agencies, is responsible to coordinate
emergency operations in the local jurisdiction. This includes appropriate and
timely partner notifications. When HCPHA is involved in response operations,
EM coordinates requests for resources and assets. When response needs
exceed local capability, or if certain assets are needed (e.g. HAZMAT RRT), State
EM personnel (Area Coordinators) will assist with coordination. In that regard,
Public Health may work with Area Coordinators, in conjunction with local EM,
particularly when PH is on site during an incident (e.g. suspicious substance
response).
Emergency Medical Services
HERTFORD County EMS provides emergency medical service personnel who
respond to improve the health and wellness of the community and address the
individual's need for emergency medical care within the scope of practice as
defined by the North Carolina Medical Board in accordance with G.S. 143-514
<http://www.ncleg.net/EnactedLegislation/Statutes/PDF/BySection/Chapter_14
3/GS_143-514.pdf> in order to prevent loss of life or further aggravation of
physiological or psychological illness or injury (G.S. 131E-155
<http://www.ncleg.net/EnactedLegislation/Statutes/PDF/BySection/Chapter_13
1E/GS_131E-155.pdf> ).
Hertford County Emergency Management Services is managed by a director.
There is no plan for surge other than requesting support from State OEMS
through Hertford County Emergency Management. The PPE kept in the trucks
are the standard faire of gloves, masks, goggles, gowns. There are no chemical
antidotes kept on board. The EOC, EMS, or hospital representative will gather
relevant information and provide to the PH liaison as needed.
Page 28 of 69
The North Carolina Office of Emergency Medical Services (NCOEMS) provides
technical assistance, services, and regulatory oversight. NC OEMS can provide
information on system surge capability through the SMARTT, which can monitor
hospital, EMS system and health center resources on a regular basis. Hospitals
provide information on a daily basis that monitors hospital bed availability,
specialty service capability, and disaster resources. Health Centers provide
information on a weekly basis that identifies clinical services offered, laboratory
capabilities, and any inpatient bed capacity. EMS provides information on a
weekly basis to identify personnel and vehicle availability as well as resource
capabilities which may be needed in the event of a disaster. Through the use of
SMARTT, resources are quickly identified and made available for use in the event
of a local, regional, or statewide disaster. Designated hospital staff and ERAC
Regional Response and Recovery Coordinators have access to this information at
all times.
Hertford County EMS participates in the North Carolina Disease Event Tracking
and Epidemiologic Collection Tool (NC DETECT) surveillance system through
PreMIS - Pre Hospital Medical Information System. PreMIS allows EMS providers
to enter patient information into a central surveillance database. Syndromic
surveillance can function as an early event indicator, as well as provide clinical
situational awareness.
Hospitals
Once a local assessment has been completed and a medical support mission
directed to the State ESF-8 lead, local and state assets from the non-affected
area may be mobilized to respond per the mission assignment. Those assets may
include activation of the State Medical Response System (SMRS). The SMRS is
made up of various components of NC's many healthcare systems and partners
and is managed per the state response plan and National Response Framework.
The SMRS is composed of medical response agencies, hospital employees, public
health employees, private medical clinic employees, and volunteers, with NC
OEMS as the lead. Responses requiring hospital resources necessitate initial and
ongoing assessment of Roanoke Chowan Hospital's capacity to fill the identified
need (bed or personnel surge, medical evacuations, etc.).
Roanoke Chowan Hospital participates in the North Carolina Disease Event
Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance system.
The hospital Emergency Department staff uploads chief complaint and relevant
syndromic patient care data into the system. The Public Health Epidemiologist
based at PCMH reviews NC DETECT data for University Health Systems hospitals .
Page 29 of 69
HCPHA regularly monitors local NCDETECT data, while the Public Health
Epidemiologist reviews regional level data.
vi. Eastern Regional Advisory Committee
ERAC was originally organized in 1998 to implement a regional trauma system
for 29 counties in eastern NC that make up the referral region for Pitt County
Memorial Hospital, - the only Level 1 trauma center in eastern NC. Members of
ERAC represent pre-hospital providers; physicians, nurses, and other medical
and non-medical personnel from the regional hospitals; and community
volunteers. Since the events of September 11, 2001 and Hurricane Katrina, the
ERAC scope of responsibility has expanded to include regional disaster
preparedness. ERAC has a multidisciplinary Disaster Preparedness
Subcommittee (DPC) that includes HOSPITALS, EMS, Public Health, State
operated facilities, Regional Response Teams and Emergency Management
personnel. The ERAC Regional Emergency Response and Recovery Coordinator
(RERRC) and the Regional Emergency Response and Recovery Assistant
Coordinator (RERRAC) assist the region in medical response planning, as well as
assist Emergency Management in the coordination of ESF 8 medical response
assets deployed during an event. ERAC can provide medical surge capability
through the State Medical Assistance Teams (TYPE II AND III). SMAT II is a
hospital based team of medical professionals established to provide patient
decontamination, mass medical care, alternate care facilities (50 bed field
hospital and 80 bed functional medical needs shelter support), and mass drug
distribution for at least three days. These teams can be ready within the RAC in
six hours or statewide within 12-24 hours. ERAC SMAT II is deployed locally or
regionally by Pitt County Memorial Hospital through NCEM or hospital mutual
aid. ERAC is currently in process of developing a regional plan that will
encompass multiagency integration into ESF-8 response. There are five SMAT III
teams in ERAC. Type III SMATS are tasked primarily with field decontamination..
These teams in ERAC also have medical surge capabilities available for
deployment
Alternate Care Facility (ACF) Trailers: Each of the twenty hospitals in the ERAC
region have a trailer that can be used in their hospital or in a harden structure
for medical surge event. All 20 trailers contain the same equipment including: 50
army-style cots, 10 West Cot beds, disposable linen, IV poles, personal protective
equipment (gloves, gowns, N95 masks), bag-vale mask, BP cuffs, tables, chairs,
AED, and Oxygen distribution system for 10 patients. Trailer use can be scalable
in that they can be used individually or brought together, depending on the
request.
Page 30 of 69
Law Enforcement
Law enforcement in Hertford County is provided by the HERTFORD County
Sheriff’s Department as well as three municipal police departments. State Law
Enforcement agencies that operate within HERTFORD County's borders are the
NC Highway Patrol, NC Division of Marine Fisheries, NC Wildlife Resource
Commission, Alcohol Law Enforcement, and State Bureau of Investigation.
Federal Law Enforcement agencies that operate within the borders of HERTFORD
County are the National Park Service, US Fish and Wildlife, and the US Coast
Guard. A spirit of cooperation exist between the local, State, and Federal Law
Enforcement agencies that operate within Hertford County, and Federal and
State agencies routinely cooperate with local Law Enforcement operations
during emergency events.
Activities of local law enforcement agencies will increase significantly during
emergency operations. If local capabilities are exceeded, support may be
obtained from state and federal law enforcement agencies. Following an
emergency event, it may be necessary to augment local law enforcement
personnel with out of County resources for security and traffic control.
Emergency law enforcement operations will interrupt routine functions and
responsibilities. Expanded emergency responsibilities will include maintenance
of law and order, traffic control, crowd control and security. Law enforcement
activities will remain under the control of the senior law enforcement officer for
the jurisdiction in which the emergency operation is taking place. Law
enforcement agencies will have primary responsibility for traffic control and
security in and near an evacuated area and in other areas of emergency
operations. Law enforcement agencies may be called upon to assist with
warning the public.
The Hertford County Sheriff's Office will be the coordinating agency for law
enforcement operations in Hertford County during multi-jurisdictional
emergency events.
Fire
Hertford County has nine fire departments, all of which are located in the
municipalities of rural communities. Existing fire and rescue personnel and
equipment will be able to cope with most emergency situations through the use
of existing mutual aid agreements. Fire and Rescue personnel are trained and
equipped to respond to emergency situations within their response area. If an
Page 31 of 69
incident requires additional resources, fire departments have standing mutual
aid agreements with other agencies.
Incident Command will be implemented at the scene of every fire/rescue event
occurring in Hertford County. The Fire Marshal is the liaison between Hertford
County Fire Departments and Hertford County local government and will reside
in the EOC during activation.
For each incident requiring a multi-agency response, an Incident Commander will
be assigned and he/she will manage the incident using NIMS. Under authority of
the North Carolina Hazardous Materials Right-to-Know Law and the Federal
Emergency Planning and Community Right-to-Know Act (EPCRA), the Fire Chief,
or designated representative, will survey facilities within his jurisdiction to
identify types and volume of hazardous materials located within the jurisdiction.
He should consider this information when developing response plans for
hazardous materials accidents within his district. Coordination of facility
emergency response plans with the local Emergency Operations Plan will be
included in fire service planning.
Schools
Academic institutions represent a significant, and often untapped, collection of
resources for public health emergency-response activities. The extent to which
academic institutions are integrated with state and local response plans is
dependent on the relationships and past shared experiences between school
faculty and local public health. Schools can help assure that the support provided
to first-line responders is as effective as possible by working with HCPHA health
department to identify and clearly articulate possible areas of assistance in
advance of an event. Roles and activation plans include: diagnostic capabilities,
surge capacity, mass dispensing and emergency-event enhanced surveillance.
Furthermore, schools provide support with evacuations and reentry during an
event. They also can provide support personnel, equipment and facilities as
necessary. Hertford County schools will provide a liaison to the Hertford county
EOC during a disaster.
Department of Agriculture and Consumer Services
The NCDA&CS Emergency Programs Division mission is to reduce the
vulnerability to or the impact from, any disaster, disease or terrorist attack on
the agriculture community of North Carolina. The Emergency Programs Division
provides leadership within the NCDA&CS and the agricultural community for
emergency preparedness and response. Emergency Programs Division
establishes public-private partnerships between vital government agencies,
industry and volunteers.
Page 32 of 69
HCPHA partners with Hertford County Cooperative Extension in nutrition and
health related endeavors. Cooperative Extension has not be formally included in
the LEPC by the Emergency Manager.
American Red Cross
The American Red Cross distinguishes itself by aiding victims of devastating
natural disasters. Over the years, the organization has expanded its services,
always with the aim of preventing and relieving suffering. Today, in addition to
domestic disaster relief, the American Red Cross offers compassionate services
in five other areas: community services that help the needy; support and
comfort for military members and their families; the collection, processing and
distribution of lifesaving blood and blood products; educational programs that
promote health and safety; and international relief and development programs.
An agreement to include Red Cross in managing shelters in Hertford County was
reached in August 2011. Final roles of public health versus Red Cross in the
shelters have not been developed.
Mutual Aid Agreements
Many state and local governments formulate mutual aid agreements to provide
emergency assistance to each other in the event of disasters or other crisis. Conditions
of the agreements may be to provide reciprocal services or to receive direct payment
through specific labor and equipment rates outlined in the agreements. These
agreements usually are written but, occasionally, are by understanding or are arranged
after a disaster occurs.
Emergency Management Assistance Compact (EMAC) and Mutual Aid
The use of the Emergency Management Assistance Compacts (EMACs) and established
mutual aid agreements will be utilized to supplement local and state resources.
The Emergency Management Assistance Compact is an interstate mutual aid agreement
that allows States to assist one another in responding to all kinds of natural and
manmade disasters. It is administered by the National Emergency Management
Association (NEMA). NC participates in EMAC.
Page 33 of 69
NC has a statewide mutual aid agreement in place. This is a voluntary agreement
among participating North Carolina jurisdictions, and Eastern Band of the Cherokee
Indians. This agreement enables those jurisdictions to request or provide assistance
during a disaster. Because needs of the local residents are first priority, a municipality
may decline to provide assistance if resources must be reserved for their own residents.
Mutual aid requests are made through local EM.
Although participating county and municipal departments are covered by the statewide
agreement, there may be a need for local health departments to individually initiate
mutual aid agreements with private agencies, military installations, or others, during
planning or in times of a declared disaster. Similarly, explicit county to county mutual
aid agreements may be needed for situations in which a disaster is not officially
declared. Such Mutual Aid Agreements are maintained locally.
Hospital Association Mutual Aid
The North Carolina Hospital Association has developed a Mutual Aid Agreement with
the hospitals in North Carolina. This is a voluntary agreement among the participating
Hospital to provide mutual aid at the time of need. This document address the
relationship between and among participating hospitals and is intended to augment, not
replace, each Participating Hospital’s disaster plan.
Local Agreements
When HCPHA is in need of resources, the local health director will contact the HCPHA
EOC liaison or designee to share the following with EM:


Explanation of assistance needed, including amount and type of personnel,
equipment, materials and supplies (please be specific and include the intended
purpose of the resource in order to ensure you receive the proper assistance);
Estimated of length of time assistance is needed.
Resources
As a general rule, formal resource requests are routed through local Emergency
Management. However, informal requests directly to the supplier may be made based
on existing relationships or MOUs/ MOAs, with notification to Emergency Management.
The tables below outline various health, medical, and community resources, a brief
description, contact, and types of resources that may be available from that agency/
source.
Page 34 of 69
Health, Medical, and Community
RESOURCE/
CONTACT
INFO
Epi Team
PHPR-Eastern
Region Office
MRC
DESCRIPTION
Epi Teams are a resource for the local health director in
fulfilling the statutory responsibility for investigating and
responding to outbreaks and other public health threats
to the community. The health director or designee will
activate the Epi Team as they see the need for resources
beyond the routine capability of the communicable
disease nurse/section of the health department.
The primary responsibility of the ERO is to serve the 24
health departments/districts in Eastern NC by providing
consultation and technical support; acting as an
organizational liaison; providing regional surveillance (as
needed); and facilitating training and exercises for local
public health. To request assistance contact the DPH
Office of Public Health Preparedness & Response. Team
response activities may involve investigation,
recommendation of control measures, data
evaluation/management, media messages, post event
evaluation and long term follow up such as patient
tracking.
The Medical Reserve Corp (MRC) is an ongoing project
that will enhance the capacity of public health through
the development of a core group of non-medical and
medically trained and credentialed volunteers. This pool
of volunteers may be used to support epidemiological
investigation activities, dispensing site activities,
quarantine and isolation monitoring and provide
personnel for informational call centers during an event.
Activation of the MRC is through notification of the MRC
Coordinator by the Logistics Chief who will in turn notify
members of the MRC giving them incident specific
information and requesting availability. MRC volunteers
will be asked to report to a Staging Area to register,
receive an assignment, briefing and be integrated into the
event. The Public Health Division will coordinate with the
ESF 17 (Volunteers and Donation Management) around
the referral and management of spontaneous volunteers
from Volunteer Reception Centers.
Page 35 of 69
RESOURCES
AVAILABLE
Outbreak
investigations
The primary
responsibilities of ERO
are to serve the health
departments/districts
in Eastern NC by
providing consultation
and technical support;
acting as an
organizational liaison;
providing regional
surveillance (as
needed); and
facilitating training and
exercises for local
public health.
Medical surge
assistance, POD
assistance, epi
investigations,
quarantine and
isolation monitoring,
call center workers
RESOURCE/
CONTACT
INFO
Local Lab (HD)
Regional Lab
Duty phone
919 807 8600
NC State
Laboratory of
Public Health
(SLPH)
BTEP (919)
807-8765
Chemical
Terrorism
(919-8078771)
DESCRIPTION
Limited to basic screening tests on site.
There are 3 Regional labs in NC. Located in Pitt,
Mecklenburg and Buncombe county, these labs provide
standardized protocols for testing biothreat agents and
emerging pathogens in clinical, environmental and food
samples. Regional labs provide most of the same
response services as the BTEP in Raleigh, and can provide
some surge capacity. All testing is coordinated by
contacting duty phone (919) 807-8600.
The North Carolina SLPH is part of the Laboratory
Response Network and provides consultation for
laboratory services, management and technical
operations of local health departments. Environmental
Sciences (ES) offers comprehensive analysis of drinking
water. The SLPH Preparedness Unit houses a Chemical
Terrorism (CT) and Biological Threat and Emerging
Pathogens (BTEP) lab. BTEP is a referral laboratory to all
labs and agencies in NC for possible Select Agent viruses,
bacteria and some toxins. Current Chemical testing
capability is for heavy metals and CN. NC LRN labs can
provide some surge capacity.
SLPH full scope of services and contact information is
available at:
http://slph.state.nc.us/doc/administration/SCOPE_2010.
pdf
Page 36 of 69
RESOURCES
AVAILABLE
Can submit specimens
provided by Law
enforcement or health
care providers to the
State Public Health Lab
via courier.
Transport
Media
Specimen Containers
Guidance
Transport
Media
Specimen Containers
Swabs
RESOURCE/
CONTACT
INFO
Roanoke
Chowan
Hospital
Private Health
Care Providers
Community
Health Center
RESOURCES
AVAILABLE
DESCRIPTION
Roanoke Chowan Hospital is the only hospital in the
HERTFORD County community.
Staffed beds – 114
Emergency Department Capacity –15 treatment rooms (1
negative pressure rooms)
Morgue Capacity - 2
Staffed ICU Beds - 10
Number of Ventilators - 5
Decontamination Capability – Decontamination tent for
people presenting to ED
Radiation Screening Equipment – none at hospital
Alternate Care Facility Location - Through PCMH
Pralodoxime or Two-Pam On Hand – None-too expensive
to stock.
Atropine On Hand - 35-1 mgm Carpujects on hand plus 3
in each of 21 crash carts. Have 5- 0.4 mgm vials plus
multiple vials in Pyxis throughout hospital.
Surge Capacity: Roanoke Chowan Hospital has plans to
provide surge capacity of 11 additional bes or 10% above
staffed bed. This will be achieved through a combination
of discharges and cancellation of day and elective
surgeries.
The Roanoke Chowan Community Health Center, a FQHC,
employs all but one family practice primary care provider
in Hertford County, Dr. S. Khoury. There are two
independent Pediatricians and one OB/GYN. Another
OB/GYN practice is owned by the hospital. A community
health care provider is a qualified person who provides
treatment and prevention of illness to any individual in
need of health care services. Health care is delivered by
professionals in medicine, dentistry, nursing, pharmacy,
and allied health. A health care provider may refer to a
health professional, or an organization that provides
services of a health professional.
Roanoke Chowan Community Health Center: Community
Health Centers focus on meeting the basic health care
needs of their individual communities. Health centers
maintain an open-door policy, providing treatment
regardless of an individual’s income or insurance
coverage.
Page 37 of 69
Surge
Personnel
Isolation capacity
Morgue Space
Personnel
Supplies
Personnel
Supplies
RESOURCE/
CONTACT
INFO
Home Health
DESCRIPTION
Hertford Gates Home Health Services are coordinated and
provided by the HCPHA. The HGHHA is the only Home
Health Agency with physical offices is the two counties..
HGHHA is accredited by The Joint Commission and
licensed. Patients may be referred by their physician,
hospital discharge planners or community service
organizations. All services are ordered by and rendered
under the supervision of the patient's physician and
meets skilled as well as intermittent guidelines. The
patient must be homebound and require a skilled service
rather than custodial care. Services offered through
home health include the following services and directly
related medical supplies and appliances, which are
provided to an individual in a place of temporary or
permanent residence used as an individual's home:
1.
2.
3.
4.
5.
6.
RESOURCES
AVAILABLE
Personnel
Supplies
Homebound
Coordination
Nursing care provided by or under the
supervision of a registered nurse;
Physical, occupational, or speech
therapy, when provided to an individual
who also is receiving nursing services,
or any other of these therapy services,
in a place of temporary or permanent
residence used as the individual's
home;
Medical social services;
In-home aide services that involve
hands-on care to an individual who is
also receiving skilled nursing services;
Infusion nursing services; and
Assistance with pulmonary care,
pulmonary rehabilitation through
Physical Therapy.
The HGHHA participates in Hertford County
emergency planning. They are able to offer
information on at risk community members and
identify their roles and capabilities to respond
during All Hazards emergency. In the HCPHA,
there are 13 nurses, 5 social workers and 13
leadership or administrative staff.
Emergency
Medical
Services
Personnel
HERTFORD County Department of EMS is responsible for
providing Basic Life Support (BLS) for the citizens and
visitors of HERTFORD County.
Transport
Incident Support
Page 38 of 69
RESOURCE/
CONTACT
INFO
Regional
Response
Team 1
42nd Civil
Support Team
CHEMPACK
Closest is At
Albemarle
Regional
Hospital-60
miles away
SNS
DESCRIPTION
RESOURCES
AVAILABLE
The RRT’s responsibilities include the appropriate actions
to prepare for, respond to, and recover from a threat to
public health, welfare, or the environment caused by
actual or potential oil and hazardous materials incidents.
Appropriate general actions can include, but are not
limited to: actions to prevent, minimize, or mitigate a
release; efforts to detect and assess the extent of
contamination (including sampling and analysis and
environmental monitoring); actions to stabilize the
release and prevent the spread of contamination;
analysis of options for environmental cleanup and waste
disposition; implementation of environmental cleanup;
and storage, treatment, and disposal of oil and hazardous
materials.
These National Guard teams provide DoD's unique
expertise and capabilities to assist state governors in
preparing for and responding to chemical, biological,
radiological or nuclear (CBRN) incidents as part of a
state's emergency response structure. Each team consists
of 22 highly skilled, full-time National Guard members
who are federally resourced, trained and exercised, and
employs federally approved CBRN response doctrine.
The CHEMPACK program’s mission is to provide state and
local governments a sustainable nerve agent antidote
cache that increases capability to respond quickly to
nerve agent exposure incidents. This resource is obtained
through local EM in consultation with NCDPH PHP&R.
Chempacks are strategically located throughout NC. As of
December 2010, those in proximity to Eastern NC
counties include:
-Albemarle
-Carteret
-Halifax
-Johnston
-Lenoir
-Nash
-Onslow
-Pitt
-Wake
Haz-Mat Consultation
and Response
The SNS is a national repository of antibiotics, chemical
antidotes, antitoxins, life-support medications, IV
administration, airway maintenance supplies, and
medical/surgical items. The SNS is designed to
supplement and re-supply state and local public health
agencies in the event of a national emergency anywhere
and at anytime within the U.S. or its territories.
Pharmaceuticals
Page 39 of 69
Suspicious
packages/substances
Response
CBRN/WMD
Consultation and
Response
Anti-nerve agent
medications
Medical/surgical items
See SNS Plan
RESOURCE/
CONTACT
INFO
ERAC
SMAT
DESCRIPTION
ERAC is composed of representatives from the 29
counties that make up the referral region for the Level I
Trauma Center at Pitt County Memorial Hospital. The
Regional Emergency Response and Recovery Coordinator
(RERRC) and Assistant Coordinator (RERRAC) will assist
the region in medical response planning as well as assist
Emergency Management in the coordination of medical
response assets that may need deploying during an
event. ERAC has two RERRCs and one RERRAC due to the
geographical size of the region.
Type I (State Level): State Medical Assistance Team I
(SMAT I) or Special Operations Response Team (SORT) is a
private, non-profit organization located in WinstonSalem. This organization is a federally supported Disaster
Medical Assistance Team (DMAT) that responds to events
nationwide.
Type II (Regional Level): State Medical Assistance Team II
(SMAT II) focuses on hospital-based capabilities (medical
surge capabilities). Each county and hospital in North
Carolina is included in at least one of eight Regional
Advisory Committees (RACs). This team can augment
medical surge capacity needs for the region and State
through mobile medical and decontamination resources
in the event of a disaster.
Public Health
Epidemiologist
(PHE)
Academic
RESOURCES
AVAILABLE
Type III (Local Level): State Medical Assistance Team III
(SMAT III), is a county-based pre-hospital disaster team
that is highly mobile and responds to the mass disaster
and decontamination needs in the County or region.
Region-1 PHE is located at Pitt County Memorial Hospital.
The Public Health Epidemiologist provides assistance to
the Infection Control Director in conducting activities for
early detection of community-acquired illnesses of Public
Health importance, including those related to
bioterrorism. This employee is a part of a network of
public health epidemiologists working in the leading
hospitals of North Carolina on the early detection of
illnesses related to bioterrorism and community
outbreaks of disease.
Hertford County Public School System
Chowan University
Roanoke Chowan Community College
Page 40 of 69
Medical staff and
equipment
Alternate Care Facility
Trailer
Decontamination
services (especially
SMAT III)
Outbreak analysis
Registered Nurses
Possible lodging
Communication to
residents via students
RESOURCE/
CONTACT
INFO
Military
DESCRIPTION
National Guard
Volunteer
Groups
All health departments in the region are covered by the
statewide mutual aid system, however, each agency is
responsible for initiating any agreements for nongovernmental responses such as pharmacies, volunteers
from non-governmental agencies, etc.
Community
Emergency
Response
Team (CERT)
CERTs are comprised of community volunteers, trained in
basic disaster response skills to assist their communities
following an emergency when professional emergency
responders are not immediately available.
Other Local
Stockpiles
Describe any local stockpiles or medical supply resources
(e.g. atropine, antibiotics, lab supplies)
State Animal
Response
Team (SART)
& CAMET
State Animal Response Teams (SART) are interagency
state organizations dedicated to preparing, planning,
responding and recovering during animal emergencies in
the United States. SART is a public private partnership,
joining government agencies with the private concerns
around the common goal of animal issues during
disasters. SART programs train participants to facilitate a
safe, environmentally sound and efficient response to
animal emergencies on the local, county, state and
federal level. The teams are organized under the auspices
of state and local emergency management utilizing the
principles of the Incident Command System (ICS).
RESOURCES
AVAILABLE
Personnel if Federal
Emergency
Amory
In a large outbreak,
especially those
involving multiple
counties, volunteers
may be used to
provide surge capacity.
“Just in time training”
will be needed and this
is something that
needs to be developed
in the future.
Volunteers
Extra supplies for
PODS or mass
vaccination stations
CAMET
The Companion Animal Mobile Equipment Trailer
(CAMET) provides the necessary mobile infrastructure,
technical support and standardized forms for collocation
sheltering.
Disaster
Mortuary
Operations
Response
Team
(DMORT)
DMORT is a federal team of experts in victim
identification and mortuary services. DMORTs are
activated in response to large scale disasters to assist in
victim identification and body storage.
Page 41 of 69
Mortuary Services
RESOURCE/
CONTACT
INFO
State
Mortuary
Operations
Response
Team
(SMORT)
DESCRIPTION
NC SMORT is a state managed resource under
development that will perform similar functions to the
DMORT.
RESOURCES
AVAILABLE
Mortuary Services
Planning Resources
RESOURCE
Planning
Groups/Committees
DESCRIPTION
Local Emergency Planning Council is led by the
Hertford County Emergency Management
Director and convened twice a year. Public
Health has time on the agenda to update the
members on plan revisions, provide education
or discuss exercise development. Task Forces
will be created by HCPHA for short-term public
health related emergency planning, when
needed.
The Local Information Team is comprised of
the PIOs from the county, schools, Community
Health Center, Chowan University, RCCC and
led by the HCPHA PIO. Usually convened only
during times of emergency.
RESOURCES REQUESTED
Points of contact when
needing to relay
information to large groups
of people at a work place.
Info on specific chemical
storage sites.
Other – Regional/
Local
Potential Hazards
Depending on the size and scope, incidents have the potential to produce substantial
consequences concerning human needs to include food, water, shelter, and medical
treatment. In addition, there could be considerable damage to infrastructure. These
might include utilities/energy systems (electricity, fuel, water/sewer), and vital facilities
(communications shelters, essential goods management, and essential personnel
management) necessary for performing immediate response/recovery functions.
Emergency Management is responsible for characterizing local hazards and
vulnerabilities. This is done by performing risk assessments, working with the LEPC,
partner agencies, local businesses, and industries. Hertford County has identified the
hazards that are addressed in this plan through review of the NC Division of EM Hazard
Page 42 of 69
and Vulnerability Report completed October 2007 with input from the LEPC members,
researching past disaster declarations and historical emergency events in the County. It
also included a review of the County Emergency Operations Plan and recent risk
assessments. This section will be revised upon completion of the risk assessment
currently being conducted by Emergency Management.
According to the 2007 NCEM Statewide Risk Assessment, the most hazardous area of
the state is towards the east in the Coastal Plain region. Approximately one third of the
State’s total population lives in the Coastal Plain, with much of that population
concentrated in the southern section. Hertford County is geographically located in the
Coastal Plain.
In coordination with local, regional, and state partners, and through direction provided
by county and agency plans, HCPHA will monitor available intelligence information from
local/state sources, as well as the National Terrorism Advisory System (NTAS) to guide
actions during all hazards emergencies or threats. The National Terrorism Advisory
System (NTAS) replaces color codes of the Homeland Security Advisory System (HSAS).
The new alert system is currently in a 90 day implementation period that began on
January 27, 2011 – until the end of the implementation period, the existing HSAS will
remain in effect. NTAS will more effectively communicate information about terrorist
threats by providing timely, detailed information to the public, government agencies,
first responders, airports and other transportation hubs, and the private sector. The
National Terrorism Advisory System alerts will be based on the nature of the threat: in
some cases, alerts will be sent directly to law enforcement or affected areas of the
private sector, while in others, alerts will be issued more broadly to the American
people through both official and media channels—including a designated DHS webpage
(www.dhs.gov/alerts), as well as social media channels including Facebook and via
Twitter @NTASAlerts.
The following table outlines various potential hazards for this jurisdiction.
Hazard
Airplane Crash
Definition
Within or neighboring this region are several commercial airports and military
air bases that raise the potential for crashes of large military, passenger, and
cargo aircraft.
Coastal Red Tide
Red Tide is caused by a toxic concentration of microscopic algae organisms
which turn coastal waters rusty red or yellow, and irritates the skin and eyes of
coastal occupants. It collects in oysters, clams, and scallops, making them unsafe
to eat. This disease destroys seafood and has a major economic impact on
commercial fishing and tourism.
Page 43 of 69
Hazard
Droughts
Definition
Droughts occur and can affect the agricultural interests in any part of the State.
Water shortages related to drought conditions can affect entire community
Earthquake
North Carolina’s vulnerability to earthquakes is moderate. The eastern part of
the state is in seismic risk zone 1 and less vulnerable to earthquake damage than
the western part, which is in seismic risk zone 2. The North Carolina coast,
however, is possibly vulnerable to tsunamis that might result from seismic
activity well into the Atlantic Ocean.
Energy Emergency
An energy emergency exists when there is an acute shortage of required energy
resources to the extent that necessary services are threatened and the
protection of public health is imperiled. A general energy emergency may
involve all facets of multi-hazard planning to include alert and notification,
response, evacuation, and sheltering of certain populations.
Flooding
Generally associated with other severe weather, flooding may be in the form of
flash floods, main river floods, dam failure, or flooding from wind driven or wind
held water. Flooding in one of these forms affects certain areas of the State
each year.
Hazardous Material
Incidents
Individuals, businesses, and government agencies in North Carolina generate,
store, and transport hazardous materials throughout the state. Gilliam and
Mason in Harrellsville store anhydrous ammonia. A leak could result in deaths..
Hurricanes
Hurricanes constitute threats in the form of high winds, wave action, storm
surge, inundation, and other flooding to coastal areas. Wind and water damage
can extend to inland parts of the state. Excessive rainfall from hurricanes can
result in extensive and damaging inland-river flooding.
Infectious Human
Disease
Natural and emerging infectious diseases can occur at any time, pose a serious
threat to the health of the public, and have the potential to overwhelm the
resources of a single jurisdiction. Infectious disease threats in Northeastern NC
derive primarily from natural human or sporadic zoonotic outbreaks.
Livestock Disease
There is a possibility of widespread livestock disease (even epidemic or
pandemic) in Northeastern NC. Large hog and poultry populations, for instance,
present the opportunity for widespread disease in that industry could cause
economic devastation. Further, an infected animal population can increase risk
for transmission of disease to humans.
Mass Casualties/ Mass
Fatalities
Many of the hazards listed here may result in mass casualties and even mass
fatalities. This would require special attention from health care facilities, medical
examiners, and mortuary authorities. Most counties in the Northeastern NC
region do not have local cold storage capability or the human resources
available to handle mass fatalities.
Medical Debris
Contaminated medical debris has been found in landfills and on the numerous
beaches along the North Carolina coast.
Page 44 of 69
Hazard
Radiation
Railroad Incident
Definition
Fixed Nuclear Facility Accidents: Three nuclear power plants operate in
North Carolina. Seven others have 50-mile ingestion pathways that
include parts of North Carolina. In all, seventy counties are affected.
Nuclear Threat/Attack: An attack upon the United States could subject all
counties to radioactive fallout. According to the Department of Defense
and the Federal Emergency Management Agency (FEMA), North
Carolina has several probable target areas. This could subject many
counties to the direct effects of nuclear weapons.
Hazardous materials are transported along the miles of commercial railroad
track in this region creating a potential public health threat due to railroad
accidents.
Structural Fire
Structural fires are fairly common, however, it is only a remote possibility that
one might spread to damage or destroy an entire city.
Terrorism
Potential terrorism targets in eastern NC include military installations,
agricultural assets (e.g. hog and poultry farms), public works facilities, water
supply, academic institutions, public gatherings, etc.
Tornadoes
The entire State of NC is vulnerable to the effects of tornadoes, and other severe
weather associated with thunderstorms including damaging winds, hail,
dangerous lightning, and flooding.
Wild Fires
Fires can cause disastrous timber and agricultural losses. Dry foliage, terrain and
climatic conditions for fires are elements of nature; however, most fires are
caused by man. Increased risk of loss of life and property is presented where
urban areas interface with forested areas. North Carolina ranks second only to
California in forest fire potential.
Winter Storms
Snow and ice storms can affect any part of the state, although blizzards with
extreme cold, snow and high winds are infrequent.
Other possible hazards include crop disease, insect damage, oil spills, school bus
accidents, major traffic accidents, severe windstorms, and mud slides and long
periods of extreme heat.
Other Hazards
The North Carolina Hazard Mitigation Plan of 2007 identifies exposure vulnerability
areas for important natural hazards according to several exposure categories: economic
activity, structural, transportation, environmental, flood, hurricane, and wildfire.
Hazard and Vulnerability Analysis source:
http://www.nccrimecontrol.org/Index2.cfm?a=000003,000010,000177,000891,000912
June 2006
NC Hazard Mitigation Plan source:
http://www.nccrimecontrol.org/Index2.cfm?a=000003,000010,001623,000177,001563
October 2007
Page 45 of 69
The following chart outlines hazard probability of occurrence by county
QUALITATIVE CLASSIFICATIONS FOR PROBABILITY OF OCCURRENCE
EarthExtreme
HurriCounty
Drought
Flood
Hail
quake
Heat
cane
Highly
Possible
Unlikely
Unlikely
Likely
Likely
Beaufort
Likely
Bertie
Camden
Chowan
Craven
Currituck
Dare
Edgecombe
Gates
Greene
Halifax
Hertford
Hyde
Jones
Lenoir
Martin
Nash
Northampt
on
Pamlico
Pasquotan
k
Perquiman
s
Pitt
Tyrrell
Washingto
n
Wilson
Landslide
Unlikely
Thunder
-storm
Highly
Likely
Tornado
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Likely
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Likely
Possible
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Unlikely
Highly
Likely
Likely
Likely
Unlikely
Likely
Likely
Possible
Unlikely
Unlikely
Likely
Highly
Likely
Possible
Unlikely
Possible
Likely
Likely
Possible
Unlikely
Unlikely
Possible
Unlikely
Likely
Possible
Unlikely
Possible
Possible
Unlikely
Possibl
e
Highly
Likely
Likely
Likely
Likely
Unlikely
Likely
Likely
Unlikely
Likely
Likely
Unlikely
Unlikely
Likely
Likely
Likely
Unlikely
Likely
Likely
Unlikely
Highly
Likely
Highly
Likely
Likely
Highly
Likely
Highly
Likely
Likely
Likely
Possible
Likely
Possible
Unlikely
Possible
Highly
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Likely
Possible
Unlikely
Unlikely
Possibl
e
Possible
Unlikely
Unlikely
Likely
Likely
Highly
Likely
Likely
Unlikely
Highly
Likely
Likely
Likely
Unlikely
Likely
Possible
Unlikely
Unlikely
Highly
Likely
Possible
Unlikely
Unlikely
Likely
Likely
Likely
Unlikely
Highly
Likely
Highly
Likely
Likely
Possible
Unlikely
Possible
Highly
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Possible
Unlikely
Unlikely
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Likely
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Highly
Likely
Possible
Unlikely
Possible
Likely
Likely
Likely
Unlikely
Likely
Likely
Highly
Likely
Possibl
e
Highly
Likely
Likely
Unlikely
Highly
Likely
Likely
Likely
Likely
Unlikely
Likely
Likely
Likely
Likely
Unlikely
Likely
Likely
Unlikely
Highly
Likely
Likely
Possible
Unlikely
Unlikely
Possible
Unlikely
Unlikely
Possible
Unlikely
Unlikely
Likely
Possible
Highly
Likely
Possible
Unlikely
Likely
Likely
Page 46 of 69
Wildfire
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Winter
Weather
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
Highly
Likely
The table below lists the potential loss estimates for Region-1 as annualized figures for each for
each of the “greater” hazards identified in this risk assessment including flood, earthquake,
hurricane, severe winter weather and wildfire. These loss estimates were generated using the
methods described below and using the best available data to meet the FEMA planning
requirement under the Interim Final Rule of the Disaster Mitigation Act of 2000 (44 CFR Part
201.4(c)(2)(iii)). Loss estimates were also compared with estimates provided in local risk
assessments, where possible, and found to be generally consistent with some expected
variation attributed to the different loss estimation techniques and methods applied at the
local level.
Potential Loss Estimates by Hazard for Northeastern NC (annualized)
County
Flood
Earthquake
Hurricane
Severe Winter
Weather
Wildfire
Beaufort
$6,650,474
$4,263
$7,325,295
153,849
$5,655
Bertie
$1,312,653
$1,206
$1,011,368
45,198
$4,315
Camden
$1,211,730
$265
$1,654,753
36,270
$5,400
Chowan
$195,945
$827
$1,595,926
36,270
$7,800
Craven
$8,155,228
$10,803
$22,901,408
153,670
$23,300
Currituck
$2,875,744
$1,001
$8,063,863
36,270
$5,860
Dare
$6,471,163
$1,991
$25,417,917
153,670
$5,250
Edgecombe
$4,347,196
$5,568
$1,789,449
36,071
$5,355
No data provided
$682
$602,751
45,198
$2,750
$141,235
$2,369
$957,071
40,405
$105,060
Gates
Greene
Halifax
Hertford
Hyde
$3,792,311
$6,210
$1,259,152
36,071
$9,615
No data provided
$1,676
$830,574
45,198
$7,205
$1,251,996
$433
$1,987,823
153,670
$500
Jones
$913,072
$1,329
$1,447,095
153,849
$1,600
Lenoir
$4,775,657
$11,774
$5,674,327
153,849
$18,150
Martin
$1,671,557
$95,253
$106,564
153,849
$10,850
Nash
$7,686,982
$13,796
$2,938,568
36,071
$2,950
$3,400
Northampton
$907,451
$2,087
$557,324
36,270
Pamlico
$1,865,697
$1,169
$4,425,009
153,849
$5,200
Pasquotank
$5,347,510
$1,525
$5,832,120
36,270
$35,355
Perquimans
$1,354,747
$586
$1,628,757
36,270
$2,750
Pitt
$6,759,868
$15,976
$10,161,343
153,849
$11,800
Tyrrell
$630,983
$186
$747,025
153,849
$600
Washington
$1,715,565
$883
$1,710,843
162,777
$600
Wilson
$6,020,324
$13,457
$3,201,786
36,071
$14,305
Page 47 of 69
Concept of Operations
This concept of operations is designed to provide an overall picture of how HCPHA would
respond to a potential or actual public health threat or incident. It establishes conceptual
guidance for assessing and monitoring a developing threat, notifying appropriate local,
regional, State and Federal agencies of the nature of the threat, and requesting the necessary
advisory and technical resources to assist with consequence management activities.
The response phase of an emergency covers initial actions taken as the result of an actual or
potential public health threat. This phase includes the actions taken to eliminate or reduce
health consequences, provision of medical treatment to those affected, and any measures
taken to preclude additional health risks or consequences. Although many emergencies are not
primarily public health emergencies, a variety of required response phase activities fall directly
within the health department’s jurisdiction. If demands for emergency resources, personnel or
equipment, conflict, the greatest operational need at that time will take priority.
Page 48 of 69
Health Department Emergency Response Action/ Activation
Event Occurrence:
Outbreak, Epidemic, Pandemic, Biological Event, Chemical Event, Natural Disaster, etc.
NOTIFICATION
DECISION
Notification Recipients:
Clinical Staff/
Communicable Disease
Staff
Environmental Health
Health Director
Preparedness
Coordinator
Alert Additional Staff/ Partners
as needed
Notification Sources:
911, Hospital Infection
Control, Response Agencies,
Clinics, Private Practice MDs,
Veterinarians, National/
Regional/ State Public Health
Network, Medical Examiner,
Public Health Epidemiologist,
NCEDSS, NC DETECT, Public
Notification
Action Items:
Determine Level of Activation and Next Steps
Areas to Consider:
Order immediate actions, as needed
Confer to decide Local Health Dept. role:
o No Plan Activation (Monitor & Expand Inquiry)
o Activate Plan, Assign IC, delegate responsibility and
authority, select initial Incident Management Team
members and arrange other resources, initially define
integration with other response organization(s) and
jurisdictions
OR
Alert & Activate Based on Level of
Need/ Response
Alert Staff and/ or Partners via Call
Lists and/ or HAN
ALERT/
ACTIVATION
Form dedicated HD resources into
ICS organization, supplemented by
partners to e.g.:
Manage Tx/ Prophylaxis
Implement Risk
Communication
Assess Hazards and
Implement prevention
measures
Isolation & Quarantine
Support Response Agencies;
Provide a Public Health Support
Function
Page 49 of 69
Continue Routine
Operations, Monitor and
Expand Inquiry
Surveillance
Investigation(s)
Routine EMS and
hospital activity
Assign Agency
Representatives as
needed
If changes in status or need
occur, a re-evaluation in the
decision phase may be
needed.
b. Incident Recognition and Situational Assessment
i. Situational Assessment
An initial situational assessment is done to characterize the impact on public health. The
local Health Director or designee will make the initial assessment. The initial size-up will
include sharing information with partners in a standardized format. Ongoing situational
assessments will be managed under the planning section of the incident command
system.
ii. Recognition of a Public Health Incident
The potential risk for a public health incident makes it imperative that any enhanced
surveillance and epidemiologic system be integrated smoothly into routine public health
activities.
The following are early warning signs that may indicate a naturally occurring, accidental,
covert, or overt release of an infectious agent or toxic substance that may exceed local
public health capability:










Unusual cluster of signs or symptoms in a population
Large number of deaths or ill persons with similar disease or syndrome
A higher morbidity and mortality than expected with a common disease or
syndrome
Failure of a common disease to respond to usual therapy or multiple atypical
presentations
Single case of disease caused by an uncommon agent, including CDC identified
Category A agents
Multiple unusual or unexplained disease entities coexisting in the same patient
without other explanation
Disease with unusual geographic or seasonal distribution
Similar genetic type among agents isolated from temporally or spatially distinct
sources
Unusual, atypical, genetically engineered, or antiquated strain of agent
Endemic disease with significant, unexplained increase in incidence
In most cases recognition of an emerging public health incident will come as a result of
physician reports, hospital emergency department observations, astute recognition of
clusters of disease from EMS operators, laboratory workers, or concerns from the Office
of the Chief Medical Examiner.
Page 50 of 69
iii. Recognition of a Non-Public Health Incident
Non-public health incidents are important to public health because of the potential for
PH impact in certain situations (e.g. post hurricane). Reporting of such incidents may
come from multiple sources, such as media, community reports, or first responder
agencies. Public health should monitor these types of situations, and maintain
awareness in the event of need for PH involvement. Emergency Management is
expected to engage PH in emergency operations as soon as a public health component
to the response is identified or anticipated.
Incident Declaration
In a public health emergency, the local Health Director or designee will request a rapid
conference call/meeting with key response partners to discuss incident particulars. All
evidence concerning the public health threat will be presented. If response to the
threat may overwhelm county resources, Emergency Management may recommend a
declaration of emergency for Hertford County. Local EOC activation will take place
when a county emergency is declared, or if the response requires significant resource
coordination. HCPHA will work with NC DPH to manage the response. The PH Regional
team may be asked to assist in with initial situation assessment and management until
DPH resources can be identified and mobilized. Activation of the NC DPH Public Health
Coordination Center (PHCC) will be determined by the State Health Director, the Chief of
the Epidemiology Section, the Deputy Chief of the Epidemiology Section and/or the
Director of PHP&R if resource requirements necessitate State level coordination. The
PHCC is designated to coordinate roles and responsibilities during a multi-agency, multijurisdictional response to a public health event. In the event the State EOC (SEOC) is
activated, the PHCC will serve in a consulting capacity to the SEOC, through the DPH
representative at the SEOC. Both the PHCC and the SEOC utilize the National Incident
Management System (NIMS) structure for operational processes. The NC DPH roles and
responsibilities fall under the Emergency Support Function (ESF) #8 Health and Medical
Service . In North Carolina, ESF-8 responsibilities are split with Public Health as the lead
of Health, and Office of Emergency Medical Services the lead of Medical Service.
In emergencies that exceed, or potentially exceed, state response capabilities, the State
Health Director may recommend the Governor make a State Declaration of Public
Health Emergency. This will confer additional operational authority to the Health
Director, which allow for additional resource acquisition. A declaration of a public
health emergency may also come from the Governor in response to events in other
states.
Response Actions
The following tables outline various public health risks and response actions. Within
each table, potential goals, objectives, and strategies/tactics are outlined to assist with
Page 51 of 69
the response.
Page 52 of 69
PUBLIC HEALTH RISK RESPONSE MATRIX
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
Determine
suitability of
existing sources
Establish alternate
source of water
Limited Access/
Unsafe /
Contaminated
Water
STRATEGIES AND TACTICS
Test water –
Conduct Field Tests/ Perform Analysis/
Define scope of contamination
Provide safe water – Ensure safe and
adequate distribution process
Eliminate Water
Supply as a
Disease Vector
Identify affected
persons
Assess Need- Determine number of
persons affected and specific needs
they may have
Ensure the
Timely Delivery
of an Adequate
Supply of Clean,
Safe Water to
Affected
Persons
Provide an
Alternate Means of
Delivery
Provide Water – Establish priority/
Coordinate delivery
Provide alternate
means to ensure
safety of existing
sources
Make water safe to drink – Issue Boil
Water Advisory
Conduct on-going
public health/
public information
campaign
Inform/ Reassure Public – Inform and
instruct public in precautionary
measures and desired public response
Page 53 of 69
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
Isolate the Source
of Contamination
Unsafe/
Contaminated
Food
Eliminate Food
Supply as a
Disease Vector
Ensure an
Adequate
Supply of Clean,
Safe Food
Inspect Restaurant,
Retail Food
Providers, and
other Food
Providers (i.e.
Schools, Daycare,
etc.)
Inspect Groceries/
Food Vendors
Monitor/ Inspect
Wholesale
Suppliers and
Transporters
On-Going Public
Health/ Public
Information
Campaign
Page 54 of 69
STRATEGIES AND TACTICS
Investigate Contamination –
Determine source, extent,
type, and scope of
contamination
Provide Inspections –
Conduct inspections/ Issue
sanitation placards/ Issue
Citations
Monitor Food Handling –
Preparation/ Service/
Refrigeration and Storage
procedures
Monitor Food Disposal –
Collection disposal, and/ or
destruction of food waste
and contaminated food
Inform/ Reassure Public –
Inform and instruct public in
precautionary measures and
desired public response
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
Reduce Exposure to
Contamination
Threat
Contaminated
Persons
Conduct Investigation – Identify
agent and determine extent of
contamination
– Interview exposed or
potentially exposed persons
– Monitor patients for illness or
symptoms
Advise/ Assist in the
Coordination of
Decontamination Procedures
Reduce the
Number of
Casualties
Prevent the
Spread of
Contamination
STRATEGIES AND TACTICS
Determine Need – Establish
course of action
Medical
Countermeasures
Request resources – Order local
supplies or SNS delivery
Establish PODs – Set-up and
staff facilities as needed
Conduct On-Going
Public Health / Public
Information
Campaign
Page 55 of 69
Inform / Reassure Public –
Inform and instruct public in
precautionary measures and
desired public response
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
STRATEGIES AND TACTICS
Conduct Investigations – Identify
disease agent and extent of
spread
Reduce Exposure to
Infectious Threat
Order Quarantines – Reduce the
exposure of potentially exposed
persons to others
Minimize
Exposure to
Others
Infectious
Persons
Prevent the
Spread of
Infection
Institute Control
Measures
Order Isolations – Reduce the
exposure of infection to a
minimum number of persons
Determine Need – Establish
course of action
Medical
Countermeasures
Request resources – Order local
supplies or SNS delivery
Establish PODs – Set-up and staff
facilities as needed
Conduct On-Going
Public Health / Public
Information
Campaign
Page 56 of 69
Inform / Reassure Public – Inform
and instruct public in
precautionary measures and
desired public response
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
STRATEGIES AND TACTICS
Observe shelter
population
Monitor Shelter
Operations
Sheltering
Assist shelter managers as
necessary
Maintain contact with
EOC for resource needs
Provide safe
location for
affected
residents
Shelter Surveillance
Observe shelter
population for signs and
symptoms of disease
First Aid
Perform triage, Basic First
Aid, and/ or Basic Life
Support in Emergency
Situations pending
definitive care
Page 57 of 69
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
Reduce Exposure to
Contamination (i.e.
Meth Lab, Mercury
Spill)
Contaminated
Equipment and
Facilities
Ensure a
Clean, Safe
Environment
STRATEGIES AND TACTICS
Conduct Investigations –
Determine source, extent,
type, and scope of
contamination
Re-occupancy of
Contaminated
Facilities
Make recommendations
for re-occupancy based
on appropriate
decontamination
strategies and
environmental
monitoring
Conduct On-Going
Public Health / Public
Information
Campaign
Inform / Reassure Public –
Inform and instruct public
in precautionary
measures and desired
public response
Page 58 of 69
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
GOALS
OBJECTIVES
Determine Health
Impact Assessment
to Humans and
Other Animals
STRATEGIES AND TACTICS
Conduct Investigations –
Determine source, extent, type,
and scope of infection
Make prophylaxis and/ or
treatment recommendations
Infectious
Animals
Minimize
exposure to
humans and
other animals
Human and Animal
Medical
Countermeasures
Order Isolations – reduce the
exposure of infected animals to
humans or other animals
Order Quarantines – reduce the
exposure of potentially infected
animals to humans or healthy
animals
Prevent the
spread of
infection
Destruction /
Disposal of Infected
Animals
Order Destruction / Disposal of
Animals – follow protocols for
destruction and the disposal of
dead animals
Conduct On-Going
Public Health / Public
Information
Campaign
Inform / Reassure Public – Inform
and instruct public in
precautionary measures and
desired public response
Page 59 of 69
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH RISK
Limited Access to
Medicine
GOALS
Ensure timely
delivery of
medications
OBJECTIVES
STRATEGIES AND TACTICS
Provide Needs
Assessment /
Triage
Assess needs – Determine
number and location of
people in need,
determine specific needs
they have
Conduct Inventory
of Local Resources
Inventory Supplies –
Determine the sufficiency
of local supplies to meet
current demands
Request Additional
resources
Provide Delivery
and Follow-up as
Required
Conduct on-going
public health /
public information
campaign
Page 60 of 69
Manage Deliveries and
Resupply – Perform or
assist in distribution
Inform / Reassure Public –
Inform and instruct public
in precautionary
measures and desired
public response
PUBLIC HEALTH RISK RESPONSE MATRIX (cont.)
PUBLIC HEALTH
RISK
GOALS
OBJECTIVES
Determine Health Impact to
Humans
Characterize risk to
Public Health
Recommend control
measures
Chemical
Biological
Radiological
HAZMAT
Suspicious
Substance
Recommend/Provide medical
counter measures
Prevent spread of
contamination
Partner w/ Law
Enforcement if
criminal threat
present
Mass Decontamination
Human/environmental
Containment
Maintain forensic integrity of
crime scene/evidence
Minimize duplication of
efforts
Conduct On-Going Public
Health / Public Information
Campaign
Page 61 of 69
STRATEGIES AND TACTICS
Conduct Investigations – Determine
source, extent, type, and scope of
infection
Investigate and evaluate human
health exposures
Environmental monitoring, sampling
Biological/human testing
Make prophylaxis and/ or treatment
recommendations
Request/Distribute SNS/CHEMPAK
assets
Implement appropriate personnel &
environmental decon
Issue isolation/quarantine orders
Make recommendations for safe reoccupancy
Consult LE for sampling strategies
and/or handling of potential evidence
Conduct investigation/interview in
parallel w/ LE assets
Inform / Reassure Public – Inform and
instruct public in precautionary
measures and desired public response
Recovery
At the onset of an emergency, actions are taken to enhance the effectiveness of recovery
operations. Recovery is both a short-term activity intended to return vital life-support systems
to operation, and a long-term activity designed to return infrastructure systems to pre-disaster
conditions.
Following a disaster or emergency, the recovery phase will restore critical and normal health
department functions to pre incident level. Critical and normal essential functions will be
outlined in the agency Continuity of Operations Plan (COOP). Depending on the size and scope
of the incident, recovery will involve:









Work with State and Federal agencies to set up systems to monitor individuals who may
have been exposed to biological, chemical, radiological agents, or other hazardous
substance
Prepare and deliver public information in collaboration with local, state, and federal
PIOs as needed
Provide public health information to community physicians and health care providers
Provide disease surveillance function to monitor community for health effects
Work with NC DPH Epi Division, CDC, and other partners, to provide long-term
community studies to gauge changes in morbidity and mortality, which could provide
important information about the health threat and it’s prevention
Coordinate with Occupational and Environmental Epidemiology Branch to identify
potential environmental hazards with resultant limitations for land or building use that
may have resulted from the incident
Facilitate sharing of mental health recommendations from local/state/federal
authorities with responders and community members
HCPHA works with local schools to identify/track student and staff illness, as well as
implement control and prevention strategies as deemed necessary
Assure that HCPHA employees receive adequate support and services
Additional Responsibilities




Incorporate organizational learning attained from after action reports into future agency
operations and plans
Restore pre-incident preparedness in terms of equipment, supplies and agency integrity
Assist with monitoring individual responders for potential post event effects
Assist with financial and administrative responsibilities related to reimbursement
Page 62 of 69
Other Considerations
Surge Capacity
During a significant public health response, the ability of HCPHA operations is limited. At the
HCPHA of 55 FTEs. Of the 57 staff, the HCPHA has 0 physician, 1 contracted part-time nurse
practitioner, 7 nurses, 0.3 emergency planner, 0 epidemiologist, 1 laboratory technician, 0
dentist, 2 environmental health specialists and the remaining 47 are in non-medical staff
including social workers, health educations and administrative staff. For a population of
approximately 25,000 additional assistance in the form of personnel, supplies, equipment, and
other general assistance may be required soon after initial response. To garner the required
surge capacity the HCPHA Director or designee will initiate the following internal actions as
required by the situation:
1. Initiate operational plans and request Emergency Management support for Health
Department response actions. Activate essential personnel and notify remaining
staff to stand by and be prepared to report.
2. Determine need to reduce or suspend routine health department operations and/or
activate COOP.
3. Once local resources are utilized, additional resources must be requested through
local EM. Under the Statewide Mutual Aid agreement, neighboring jurisdictions will
be notified of the situation and requested to stand by or assist as appropriate. The
normal chain of communications in an emergency with EOC activation is that the
local EOC makes resource requests to the State EOC.
4. For multi-jurisdictional or region-wide events where additional assistance is
required, requests are submitted through the local EOC and the NCDPH Public
Health Coordination Center (PHCC).
5. The HCPHA is currently serviced by 1 hospital. Roanoke Chowan Hospital has a
surge capacity of 10 beds.
6. In the event that HCPHA exceeds its staffing surge capacity, a request for volunteer
assistance may be initiated. Requests for volunteer assistance will go through local
EM or the local EOC. HCPHA relies on local volunteer organizations and Medical
Reserve Corps (MRC) to ensure volunteers are properly credentialed.. Just in time
training (JIT) will be provided to volunteers as necessary for assigned responsibilities.
Page 63 of 69
7. Community mental health – Disaster victims often require behavioral health
interventions. Consequently, behavioral health volunteers may be needed during a
large scale emergency. The Hertford County emergency operations plan (EOP) has
identified the Local Management Entity (LME) as mental health service provider for
the general public where needed in an emergency. Additional behavioral health
volunteers may be available through EM via churches, Critical Incident Stress
Management (CISM) teams, and/or staff with psychological first aid/CISM training.
8. Responder mental health – Responders involved in disaster recovery operations are
likely to experience significant stress. Supervisors should ensure adequate
debriefing takes place following demobilization. CISM is an intervention protocol
developed specifically for First Responders dealing with traumatic events. It is a
formal, highly structured and professionally recognized process for helping those
involved in a critical incident to share their experiences, vent emotions, learn about
stress reactions and symptoms and given referral for further help if required.
Responder Health and Safety
Responder health and safety is a primary concern during response operations; consideration
must be given to the following:
 Personnel roles, chain of command, training and communication
 Emergency recognition and prevention
 Safe distancing
 Site security and control
 Evacuation
 Decontamination
 Emergency medical treatment and first aid
 Emergency alerts
 PPE and emergency equipment
 Partner coordination
Also see HCPHA SNS plan, CD Plan, CD Policy and Employee Health Plan
Environmental Surety
In NC, a response to an environmental emergency, such as a HAZMAT incident will be
coordinated through Emergency Management. While very small incidents may be handled
within individual County boundaries, they still may have public health implications. Larger scale
incidents may involve multiple counties and resources; therefore it is important for Public
Health to consistently fit into the response equation. Consequently, following any public health
crisis, HCPHA Environmental Health staff will:

assess damage/health risks to any communities or individuals affected
Page 64 of 69

prioritize those at greatest health risk

provide advice and guidance on how to best manage the hazards to prevent disease
transmission

contain the source of threat

perform all necessary environmental tests to determine when hazards have been
greatly reduced or eliminated
While more HAZMAT incidents will be managed locally, North Carolina Department of
Environment and Natural Resources (DENR), Environmental Protection Agency (EPA), and/or
Unites States Coast Guard (USCG) will fill a significant role with evaluating environmental
exposure and contamination issues. Additionally, these agencies may provide oversight for
cleanup efforts. Public Health will be significantly involved if the public is potentially exposed to
hazardous substances, either directly or indirectly. As such, it is important for County Public
Health Departments to be familiar with their County’s Emergency Operations Plan. These plans
will vary somewhat per County, but should include many of the following elements:
Environmental Surety Partners
Emergency Management on the County level would initially evaluate the threat and coordinate
local response and resource requests within the jurisdiction. In a multi-agency incident,
development of response strategies is the responsibility of a Unified Command. Technical
assistance specific to the situation comes from various agencies. State level coordination of onscene expertise is handled by the NCEM Area Coordinator.
Depending on scope and magnitude of the event, as well as of the need for additional assets,
any of the following Federal, State, and Local resources may be involved:















North Carolina Division of Emergency Management
North Carolina Department of Environment and Natural Resources.
Environmental Protection Agency
Centers for Disease Control and Prevention
North Carolina Division of Public Health
Regional Response Team 1 (RRT 1/ HAZMAT)
Public Health Regional Surveillance Team 1 (PHRST 1)
United States Coast Guard
North Carolina Department of Agriculture and Consumer Services
County Public Health Departments
North Carolina Department of Labor/ OSHA
North Carolina SBI: Diversion and Environmental Crimes Unit
Federal Bureau of Investigation (FBI)
42nd Civil Support Team
Federal Emergency Management Agency
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Site owners, contract resources, and other involved parties
Environmental Decontamination and Cleanup of HAZMAT
For incidents that require environmental decontamination and hazardous materials cleanup,
consideration must be given to the following:
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Environmental cleanup and decontamination based on standard Hazardous
Waste Operations and Emergency Response (HAZWOPER) practices and
procedures (29 CFR 1910.120).
If a responsible party is identified for the spill, that party may be responsible for
costs associated with response and remediation activities.
Environmental testing and monitoring of air, water and soil based on standard
sampling and testing procedures.
Population protection for those with potential exposure in surrounding areas.
Medical implications for potential exposure to agents before, during and
following decontamination.
Unified Command will be responsible for determining when buildings, dwellings
and/or other public areas are safe for re-occupancy.
Additional Requirements
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Public information messages about major environmental concerns and
hazardous materials cleanup will be provided by NC DPH (DENR, OEEB, PHP&R)
in concert with HCPHA and local Emergency Management.
HCPHA will develop a plan to monitor illnesses/complaints from persons
reentering the environment after clean up. Monitoring will be based on
recommendations from CDC, DENR, EPA, OSHA (as applicable) and coordinated
through Public Health.
Identify potential environmental hazards. The new regulations in the Chemical
Accident Prevention Program build on existing chemical information and
emergency planning requirements (Emergency Planning and Community Rightto-Know Act, EPCRA). In 1986, Local Emergency Planning Committees (LEPC)
were established to create emergency plans based on chemical information
provided by facilities using certain chemicals above specific quantities. Although
the primary responsibility for accident prevention lies with the facility, local
government agencies, emergency responders and LEPCs play an important role
in ensuring the health and safety of their community. Local emergency
responders coordinate emergency response and prepare the community for
potential consequences of accidental releases.
Provide public health information to community physicians and health care
providers. Coordinated on the County level through the local County Health
Department through use of Interagency Communication Plan. Messages will be
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sent through various redundant systems (Health Alert Network, blast fax, email,
telephone) depending on size and resources of the county. State Public Health
and/or the Public Health Eastern Region Office may assist counties and facilitate
message dissemination.
HERTFORD County will have a plan to determine any limitations in future land
use. Remediation and verification will be the responsibility of all Potentially
Responsible Parties. Cleanup will be in accordance with (where applicable):
Comprehensive, Environmental Response, Compensation, and Liability Act
(CERCLA), Resource Conservation and Recovery Act (RCRA), Clean Water Act
(including Oil Pollution Act), Safe Water Drinking Act, Clean Air Act.
At Risk Populations
NC DPH Agreement Addendum 514 states that HCPHA will conduct a comprehensive
Community Health Assessment (CHA) every four years and include questions that will help to
identify population groups at risk during a public health emergency. EM and Social Services in
HERTFORD County are responsible for at risk populations planning and response, while the
HCPHA provides support services. Public health tasks vary according to the situation, and
incident specific plans describe how at risk populations are addressed.
People at risk are individuals or groups whose needs are not fully addressed by traditional
service providers or who feel they cannot comfortably or safely use the standard resources
offered during preparedness, response, and recovery efforts. The following groups are
considered at risk populations in HERTFORD County and taken into consideration during
planning for public health response operations:
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Economically disadvantaged
Physical or mental disability, developmentally challenged (some senior citizens,
mobility, visual, hearing, cognitive abilities, coping skills)
Live in isolation (no local TV stations received, radio stations with canned
programs only, lack transportation, undocumented aliens, migrant workers,
homeless)
Homebound
Institutionalized
Incarcerated
Children < 18 years old separated from their parents or caregiver.
Communications
Communication and dissemination of information are critical to effective response activities.
The HCPHA will participate in these activities in a variety of ways.
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The high-risk populations will be reached through the County At-risk Population Community
Resource Group
Hertford County At-risk Population Community Resources Group
Agency
Office of Aging
AARP
Population Served
Contact Person
Telephone #
Elderly
Linda Blackburn
358-7856
Elderly
Katie Lee
332-5628
Carpenter’s Shop Church
332-6113
Spanish-Speaking
Ino & Maribel Bernal
287-1587
287-1548
358-1820
East Carolina Behavioral Health
Murfreesboro Chamber of
Commerce
Ahoskie Chamber of Commerce
Chowan University
Roanoke Chowan Community
College
Division of Social Services (CAPDA/Ahoskie DSS)
HC Public Schools/Family Literacy
Center
Roanoke Chowan Community
Health Center
Hertford County Cooperative
Extension Center
List Motels in Hertford County
Ahoskie Inn
Mentally Disabled
Lisa Bonnett
332-5306
Tourists/Visitors
Sherri Sullins
398-4886
Tourists/Visitors
Jerry Castelloe
332-2042
College Students
Josh Barker
398-6319
College Students
Physically &
Developmentally
Impaired
Justin McKeithan
862-1253
Glenda Simmons
358-7830
Low Literacy
Alice Cale
332-3960
Migrant Workers
Edgar Irizarry
209-0237
Migrant Workers
Crystal Smith
358-7822
Homeless/
Transient
Chief Motel
332-4165
332-2138
Tomahawk Motel
332-3194
Murfreesboro Inn
398-3175
See references to communication in the following plans:
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Communications Section of All Hazards Plan
Crisis Communication Plan
Communication Section in SNS Plan
Pan Flu Plan-Support for Vulnerable Populations
See Appendix K-HCPHA Communication Plan
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Appendixes
APPENDIX A -Continuity of Operations (COOP) Plan
APPENDIX C - EMERGENCY CONTACTS-See Red Emergency Contact manual in
Health Planner’s office
APPENDIX D – Smallpox Vaccination Plan (incomplete)
APPENDIX E - HCPHA PREPAREDNESS RESPONSE POLICIES & PROCEDURES
APPENDIX F - PREPAREDNESS AND RESPONSE POLICIES & PROCEDURES FROM
OTHER COUNTY AGENCIES
APPENDIX G – COMMUNICATION: TACTICAL AND CRISIS-see emergency
communications manual.
APPENDIX H – HERTFORD COUNTY PANDEMIC INFLUENZA RESPONSE PLAN see
Pandemic Influenza Preparedness and Response manual.
APPENDIX I – HERTFORD COUNTY STRATEGIC NATIONAL STOCKPILE/MASS
MEDICATION DISTRIBUTION PLAN see SNS manual
APPENDIX J – HCPHA ICS Structure and Assignments
APPENDIX K-HCPHA Communication Flow Chart
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