Bureau of Preparedness and ResponseYEAR IN REVIEW

2012–2013

Florida Department of Health

2 • Bureau of Preparedness and Response, Year in Review, 2012–2013

Contents

Collaboration, 4

Information andResources, 6

A Resilient FloridaPopulation, 8

Budget, 10

Our Mission

The Florida Department of Health works to protect,promote and improve the health of all people in Floridathrough integrated state, county and communityefforts.

The Bureau of Preparedness and Responsesupports this mission by ensuring state and federalpreparedness and response investments are wiselyleveraged to build a resilient Florida population andresilient public health and health care system preparedfor any disaster or emergency.

The Bureau supports the state’s health and medicalresponse with grants from the U.S. Department ofHealth and Human Services, Centers for DiseaseControl and Prevention (CDC) and Office of theAssistant Secretary for Preparedness and Response(ASPR).

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Message from LeadershipWe have faced many challenging events this year, soit is gratifying to share some importantaccomplishments in this annual report.

Our collaboration with public health and health carepartners and relationships with national, state and localcolleagues have strengthened Florida’s ability to preparefor, respond to and recover from, man-made and naturaldisasters. Our practical and useful public healthpreparedness and response information, resources,programs and initiatives have made communities moreresilient and ready for any possibility.

With these and many other efforts outlined in this report,Florida is leading the way in public health preparednessand response. The Bureau provides resources, fundingand expertise to support health care coalitions, strongepidemiological surveillance systems, laboratory testing,medical logistics and many other programs. The result ofthis support is an effective public health and health careresponse to incidents and events.

Our determination, efforts and efficiency, allow us toovercome budget challenges and the ever expanding listof health risks and dangers facing our communities. Wewill be prepared. We will respond. And we will recover—no matter what the incident or event. This is the Bureau,Division and Department’s commitment to all Floridians.

Kay Croy, RN, BSN, MEd.

Message from the Co-ChairsDuring our time as co-chairs of the Public Health andHealth care Preparedness (PHHP) StrategicPlanning Oversight Team (SPOT), we have seenFlorida’s capacity in public health preparedness andresponse grow.

Using the expertise of its leaders and subject matterexperts, the Bureau and Department have forged aneffective and unique structure to guide public health andhealth care preparedness efforts within the state. Ourstatewide Program Advisory Teams develop programsand deliverables each year to meet state, local andpublic health preparedness goals. Members of SPOTthen review, prioritize and provide guidance on programsand deliverables.

The SPOT consists of state, local and regional healthand medical partners including hospitals, County HealthDepartments, Poison Control Centers, the Red Cross,Centers for Independent Living and many others. Thestrategic planning process for Florida’s PHHP programshas been very successful over the years in building theresiliency of Florida communities and its public healthand medical support systems.

It has been an honor to serve in a leadership capacitywith SPOT. We look forward to many more years ofextraordinary work by the Bureau and Department aswe continue to advance Florida’s public health andmedical preparedness.

Dr. Judith Hartner John Scott

Bureau of Preparedness and Response, Year in Review, 2012–2013 • 3

“Chance favors the prepared mind.” —Louis Pasteur

Our Program Advisory Teamsrepresent a diverse range ofmultidisciplinary preparedness andresponse partners across the state.Every year, the statewide teamsdevelop projects to ensure Florida’shealth and medical system cansupport the needs of residents whendisasters overwhelm the normal day-to-day operations of the health caresystem. Teams analyze public healthand health care preparednesscapabilities of the regions andrecommend initiatives to close gapsand strengthen relationships withprivate and public partners.

Promoting the development andsustainment of local, community-based health care coalitions are toppriorities in public health and healthcare preparedness in Florida. Strongpublic and private sector healthcare and response partnerrelationships enhance theeffectiveness of response andrecovery of the health care system.Through the Florida Health CareCoalition Task Force, the Bureauprovides information, resources andguidance to support developmentand sustainment of these vitalpartnerships. In 2012–13, coalitionsgrew to cover all regions of Florida.

Disasters can impact children bothphysically and emotionally. Through

the Florida Children’s PreparednessCoalition, the Bureau works withhealth care and community partners,like the Department’s Children’sMedical Services, the Departmentof Children and Families and theFlorida Hospital Association, toensure the health, safety and securityof all children before, during and afteremergencies and disasters. Thisincludes supporting the integration ofchildren’s disaster needs in state andlocal disaster planning and policies toidentify gaps and leverage resourcesfor this unique population. In 2012-13,the Bureau worked with partners tostrengthen regional and localpartnerships, and shape planningpriorities for Florida’s children.

Meeting the needs of vulnerablepopulations, like those who arephysically or mentally disabled, blind,deaf, hard-of-hearing, cognitivelyimpaired or mobility challenged, is akey component of public health andhealth care preparedness planning.The Bureau funds a statewidedisability coordinator position andmaintains partnerships with thedisability community including theAgency for Persons withDisabilities and Florida’s Centersfor Independent Living. More than3,500 individuals with access andfunctional needs completed personal

emergency preparedness plansduring the grant year.

During a statewide disaster,Regional Emergency ResponseAdvisors (RERAs) provide criticalsituational awareness information tothe state Emergency SupportFunction 8 (ESF8) emergencycoordination officer, who resideswithin the State EmergencyOperations Center in Tallahassee.When not in the field responding toincidents, the RERAs are responsiblefor assisting public health and healthcare partners, including county healthdepartments, with a wide variety ofpreparedness and response activitiesincluding planning and integratingresponse systems and resources.

Neighborhood EmergencyPreparedness Program (NEPP)engages and mobilizes communitiesthroughout Florida to foster self-sufficiency at the residential level.Twelve counties are currently involvedin neighborhood preparedness,representing 34 Floridacommunities with 462,632residents. All communities sign aMemorandum of Agreement todevelop neighborhood preparednessthrough planning, training andexercises.

Collaboration

4 • Bureau of Preparedness and Response, Year in Review, 2012–2013

Developing partnerships with health and medical professionals across the stateis crucial to the success of Florida’s public health and health care preparednesscapability. The Bureau supports a wide variety of collaborative efforts to ensureFlorida is prepared for and can respond to any man-made or natural disaster.

Regional Behavioral Health Teamsengage with communityorganizations to foster strong socialnetworks to help meet the mental andbehavioral health needs of survivorsand responders. The teams aretrained through a partnership withthe University of South Florida andthe Florida Crisis Consortium toidentify gaps and planningconsiderations and develop exercisesthat test systems and processes.

Special Needs Shelters are animportant component of Florida’s

ability to prepare for and respond toemergencies. Florida collaborateswith the Interagency Committee onSheltering Facilitation Services, theDivision of EmergencyManagement and other mass carepartners to provide technicalassistance and subject matterexpertise to help counties providemass care sheltering to those withspecial medical needs.

Medical Reserve Corp volunteersare more than 18,600 strong inFlorida. Volunteers are pre-screened

health and medical professionalsavailable to deploy during an incidentor emergency. During 2009 to 2012,volunteers provided more than65,000 hours of assistancerepresenting over $2.3 million inhealth and medical services. Thedepartment collaborates closely withcounty health departments tomanage the volunteer network andprovide annual planning, trainingand exercise resources and activities.

Bureau of Preparedness and Response, Year in Review, 2012–2013 • 5

Program Advisory Teams

health care coalitionspublic and private sector health care

response partner relationships

childrenFlorida Children’s Preparedness Coalition

Florida Hospital Associationvulnerable populations

Agency for Persons with Disabilities

Florida’s Centers for Independent Living

Regional Emergency Response Advisors

Neighborhood EmergencyPreparedness Program

34 Floridacommunitieswith 462,632residentsRegional BehavioralHealth Teams

University of SouthFlorida

Florida CrisisConsortium

Special NeedsShelters

Interagency Committee onSheltering Facilitation Services

Division of Emergency Management

Medical Reserve Corpvolunteers

“Private-sector preparedness is not a luxury; it is a cost ofdoing business in the post-9/11 world. It is ignored at a tremendouspotential cost in lives, money and national security.”—The 9/11 Commission Report

A health care system prepared forboth traditional disasters (likehurricanes) and terrorist attacks,including the use of chemical,biological and radiological weaponsis crucial for the overall health andsafety of a community. The Bureauprovides extensive tools andresources to hospitals and otherhealth care partners through onlinetoolkits and webinars where expertsdisseminate information, and shareexperiences and best practicesamong health care partners.

The ability of the health carecommunity to respond to masscasualty incidents, like the BostonMarathon bombings, comes fromcoordinated planning, training andexercising. Health care facilities needcomprehensive emergencymanagement plans that include thepossibility of a sudden surge ofpatients. The Bureau providessupport for community planning,training and exercising for medicalsurge incidents, as well as subjectmatter experts (during incidents) tohelp increase the capabilities ofhospitals and other health carepartners for mass casualty incidents.

Maintaining a competent, trainedepidemiology workforce capable ofconducting investigations and

providing surge capacity for largeoutbreaks and other emergencies is aprimary function in preparedness andresponse. Bureau funding supportsactivities within the Bureau ofEpidemiology, as well as at the countylevel. Funding supports trainings forstaff at all levels of the agency(county and state), and supportsoperating several state surveillancesystems: the alert network, EpiCom;Merlin, where high priority diseasesare reported; and the syndromicsurveillance system, ESSENCE-FL.The Bureau also funds biweekly callswith Florida’s 67 county healthdepartments reaching 1,780participants, and EpidemiologyGrand Rounds presentationsreaching 919 participants across thestate.

Whether the disaster is a hurricane,anthrax attack or bombing,environmental health practitionersplay an important role in emergencyresponse. The Bureau providesfunding to support training,equipment and consultation forenvironmental health staff at countyhealth departments throughoutFlorida. This support was crucialduring two out-of-state wastewaterspills that impacted several Floridacommunities. With the Division of

Emergency Management, the Bureaualso developed the PreparednessFotonovela and Activity Guide forMigrant Families.

Children and the elderly are some ofthe most vulnerable residents duringa disaster. The Bureau created aVulnerable Population Toolkit forcounties to assess the vulnerablepopulations within their area andidentify gaps in emergency planningand sheltering. The Bureau alsodeveloped a Discharge PlanningGuide for special needs sheltermanagers and provided webinarsabout the process of dischargingshelter clients with special needs.

Ensuring communities haveemergency medical supplies andways to distribute these resources arecornerstones of public health andhealth care preparedness. Throughthe Bureau’s logistics, Bureau ofPublic Health Pharmacy, StrategicNational Stockpile, CitiesReadiness Initiative and Chempackprograms, the Department workswith county health departments andother partners to provide an inventoryof emergency medical supplies and asystem to manage these resourcesbefore, during and after an event.The Bureau also provides training inmedical materiel management and

Information and Resources

6 • Bureau of Preparedness and Response, Year in Review, 2012–2013

The Bureau supports the development of useful and practical information andresources to increase the innovation and responsiveness of Florida’s publichealth and health care preparedness partners across the state. Support isoften provided in the form of toolkits, trainings, information technology andmedical supplies.

distribution for logistics coordinatorsand staffing unit leaders at the state,regional and local level.

Communicating information to thepublic during an emergency is acrucial preparedness and responsecapability. The Bureau coordinateswith the Office of Communications tofund and provide regular crisis andemergency risk communicationtrainings for public information

professionals and spokespersonsacross the state, particularly those atcounty health departments, healthcare organizations and emergencyresponse partners. Twelve onsitetraining opportunities were held for428 Department personnel andpreparedness partners. The Bureaualso supports the development anddissemination of public health-relatedmessaging tools in multiplelanguages and formats, including

audio and video public serviceannouncements, fact sheets,frequently asked questions, talkingpoints, stock news releases and otherproduct templates on variousdisasters, diseases, incidents andevents.

The Bureau supports thedevelopment and effective use ofmany Information Technology (IT)systems and tools to help respondersmake informed and timely decisionsduring a disaster. Some of theseresources include: the InventoryResource Management System(IRMS), which provides real-timeasset inventory of ESF8 resourcesduring an incident; the GeographicInformation Services (GIS) team, whoprovide vital data analysis andmapping services accessible to allcounty health departments during anevent; and Everbridge/SERVFL, theonline system for managing publichealth and medical respondervolunteers and staff teams. It alsoserves as Florida’s Health AlertNetwork, which provides a widerange of methods to send and receiveinformation among health partners.These resources allow the Bureau tocollaborate with health partners andshare important health informationfor risk assessments and analysis.

Protecting health and medicalresponders during a disaster is aprimary concern for the Bureau. TheBureau provides Level C personalprotective equipment to licensedEmergency Medical Services (EMS)providers throughout the state.

Bureau of Preparedness and Response, Year in Review, 2012–2013 • 7

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“By failing to prepare,you are preparing to fail.”

—Benjamin Franklin

A Resilient Florida Population

8 • Bureau of Preparedness and Response, Year in Review, 2012–2013

When the state emergency responsesystem responds to an event, theDepartment is activated as the leadstate agency for Emergency SupportFunction 8 or ESF8. EmergencySupport Function 8 is comprised ofhighly trained departmentalemployees, private sectorstakeholders and other state agenciessuch as the Agency for Health CareAdministration, Agency for Personswith Disabilities and Department ofElder Affairs. The Bureau is chargedwith maintaining a trained andqualified public health and healthcare response staff who are ready torespond when called upon during adisaster. In addition to providing on-going monthly training forpreparedness staff, the Bureauupdates statewide plans andoperating procedures, developsspecial event planning guides andtoolkits, maintains a state medicalresponse system consisting of teamsand medical caches, and participatesin statewide trainings, exercises andsignificant events such the 2012Republican National Conference.

Epidemiological surveillancesystems provide Florida’spreparedness and response decisionmakers with timely and usefulinformation to effectively identify andprevent the spread of infectious

diseases. Surveillance systems aroundthe world alerted public healthofficials to threats like AvianInfluenza, SARS and Ebola. Mostrecently, Florida’s surveillancesystems, Merlin and ESSENCE-FL,played a critical role in Florida’sresponse to the national fungalmeningitis outbreak. The Bureauprovides funding to supportepidemiologic investigation staff andsystems throughout the state incoordination with the state publichealth laboratories. Florida alsoprovides timely data to public healthpartners via a secure, moderatedalerting system for all-hazards calledEpiCom. Recent accomplishments ofFlorida’s surveillance systems includeincreasing the number of emergencydepartments participating inESSENCE-FL to 168, making it thelargest syndromic surveillance systemin the nation and shortening thetransmission/receipt of emergencydepartment data from once every 24hours to every two hours for 63Florida hospitals. Bureau grantfunding also continues to supportelectronic laboratory reporting (ELR),which reduces case identification timefrom nine to five days.

The ability of Florida’s public healthlaboratories to identify and analyzeclinical and environmental samples

for threat agents and chemicals playsa crucial role in public healthpreparedness and response. Statelabs are critical in rapidly identifyingthe presence of biological toxins,emerging infectious disease agentsand chemical threats. The Bureausupports four state public healthlaboratories through staff trainingand exercising, integration ofepidemiological data and training forother laboratory staff across thestate. Florida’s laboratories havesome of the most sophisticatedcapabilities in the country, andFlorida is one of only ten states in thenation with the ability to performchemical threat surge testing for theCDC.

Re-establishing routine health caredelivery systems after a disasterhelps restore a sense of normalcy forcommunities and strengthensresilience. The Bureau worked withthe Florida Association ofCommunity Health Centers toprovide training to senior leaders offederally qualified health centers onhow to develop continuity ofoperations plans for their facilities.

Emergency and disaster planning forlong-term care facilities, like nursinghomes, is a primary concern given thehealth and medical needs of their

Healthy Floridians are resilient Floridians who can bounce back and learn fromdisasters. The Bureau supports crucial statewide systems like EmergencySupport Function 8 or ESF8, epidemiological surveillance and state laboratoriesto increase the responsiveness of communities during a disaster. These andother similar programs improve the strength and flexibility of communities.

patients. The Bureau workedclosely with health carecoalitions to developplanning considerations forthese centers, which servemore than 70,000 patientsin Florida.

Florida is prepared even forthose events that may resultin mass fatalities. Through apartnership with theUniversity of Florida’sMaples Center for ForensicMedicine, the Bureauensures the capability to takeover mortuary services whenlocal resources areoverwhelmed. The FloridaEmergency MortuaryOperations ResponseSystem (FEMORS), has theability to store, identify andprocess victims of a massfatality. Victim informationcenters are set up to aidmembers of the publicsearching for loved ones whomay have become victims ofan event.

Bureau of Preparedness and Response, Year in Review, 2012–2013 • 9

“Prepare for the unknownby studying how

others in the past

have coped with the

unforeseeable and

the unpredictable.”

—Gen. George S. Patton

trained and qualified public healthand health care response staff

on-going monthly trainingplans

operating proceduresspecial event planning guides

Epidemiological surveillance systems

Merlin

ESSENCE-FLEpiCom

public healthlaboratorieshealth care delivery systems

Florida Association of CommunityHealth Centers

long-term care facilities

health care coalitions

University of Florida’s MaplesCenter for Forensic MedicineThe Florida Emergency MortuaryOperations Response System

Budget

10 • Bureau of Preparedness and Response, Year in Review, 2012–2013

Grant Period Total Funding Received (CDC & ASPR)

2011–2012..............................................$50,496,151

2012–2013 .............................................$48,860,404

2013–2014 .............................................$45,761,945

During 2012–2013, the Bureau received six Prudential DavisProductivity Awards for innovative programs and initiatives,

representing a savings to taxpayers of over one million dollars and13,000 staff hours.

Florida Department of HealthBureau of Preparedness and Response

4052 Bald Cypress Way

Tallahassee, Florida 32399

850-245-4040www.floridahealth.gov/preparedness-and-response

Bureau of Preparedness and Response, Year in Review, 2012–2013