Rehearsal of Concept - Welcome to NCTCOG.org Galveston Rehearsal of Concept (ROC) Drill 1618 June...

HoustonGalveston Rehearsal of Concept

(ROC) Drill 1618 June 2009

Breakout Group Activity Slides

The information contained in the following slides was gathered during breakout discussions as part of the HoustonGalveston ROC Drill. This information should be considered “raw data” which is intended solely for the purpose of reminding ROC Drill participants of issues and recommended actions discussed during those breakout sessions. The contents of these slides is not intended to be a complete transcript of all discussions. Because of the effort to provide this information to participants upon their departure from the Drill, the product has not been edited for completeness or accuracy.

A formal After Action Report will be provided to participants upon completion.

Activity 1 Resource

Tracking/213RR

Description: The procedures used to accurately track the status of requests for resources made outside the regional area in a timely manner.

Associated Tasks:

1. Develop a flow chart of key events associated with the process.

2. Develop a diagram of key communications associated with the process.

Resource Tracking (New 213RR Process)

Group 1 Houston – Galveston

Area Council

Resource Tracking

Resource Tracking

Task 1: Identify key decision points during evacuation (flow chart).

Begin

Define the need. Fill with local resources if available.

Request generated. Sent

to County.

MACC fills or pushes to DDC for processing.

DDC takes action or pushes

request to the SOC.

SOC fills request.

End

County fills or pushes request to MACC or DDC.

Resources delivered per requestor’s directions.

If medical, send request to CMOC.

CMOC fills or pushes to the

SOC.

SOC or MACC DSHS fills request.

* This is the request process flow for all hazards events; not Pan Flu or other health/medical events.

Resource Tracking

Resource Tracking

Task 2: Develop essential communications diagram.

SOC

County EOC

MACC

City EOC

DDC (RLOs) CMOC

FEMA

Requestor

This shows the formal communication process. Informal communication for checking request status may occur between all entities.

Group 2 North Central Texas

COG

Resource Tracking

Resource Tracking

Task 1: Identify key decision points during tracking requests (follows State Code 418).

Begin

**City requests the resource

**County notified and tries to fulfill

order **MACC

coordinates resources

SOC is contacted if resources still needed (by fax)

SOC transfers to WebEOC system

End

** DDC contacted if resources needed

** Tracked by E Team ** Contact made by emails/phone/fax

Note: Some counties bypass the MACC; or, requests go directly to the DDC if the MACC is not stood up.

SOC fills resource request

SOC notifies ???

Resource Tracking

Task 2: Develop essential communications diagram (follows State Code 418).

SOC (Various Agencies)

DDC

Multiple Counties

MACC

City City City

some cities/counties contact the DDC directly without going through MACC

Group 3 Capital Area Shelter

Hub

Resource Tracking

Resource Tracking

Task 1: Identify key Resource Tracking decision points(flow chart).

Authorized Requestor

(Phone Call/Fax)

Area Command (MACC/MOC)

DDC

Wilco*

SOC

A/TC** HAYS ARC

Wilco EOC A/TC EOC ARC HAYS EOC

* Williamson County ** Austin/Travis County

Resource Tracking


Authorized Requestor

(Phone Call/Fax)

Area Command (MACC/MOC)

DDC

Wilco*

SOC

A/TC** HAYS ARC

Wilco EOC A/TC EOC ARC HAYS EOC

* Williamson County ** Austin/Travis County

Group 4 Bell County

Resource Tracking

Resource Tracking


Begin

Local Shelter Manager (LSM) City/Local ECC County

EOC/RMOC

DDC SOC

End

Multiple Agency Resource

Coordination Center

Resource Tracking


Shelters

City EOCs

County EOCs / RMOC

MARCC

SOC

DDC

800 Mz cities & counties

VHFregional

ARES/RACES: All

City EOCs

Reception Center Hospitals

Activity 2 Special Needs

Evacuation Tracking

Description: Track the evacuation of Special Needs population from home jurisdictions to shelter locations.

Associated Tasks:

1. Identify key decision points during evacuation.

2. Identify required transportation assets and quantities (bus, air, ambulance).

3. Identify support resources that may be required during evacuation and sheltering (fuel, medical personnel, medical supplies, tow trucks, ambulances, facilities, etc.).

Special Needs Evacuation Tracking

Associated Tasks:

4. Describe process to monitor evacuation traffic flow and ability to adjust evacuation traffic management plan/measures as appropriate.

5. Discuss options to refine SN classification system.

6. Develop essential communications diagram.


Group 1 Houston, Harris County/ North Central Texas

COG




Notify local DDC

Elected Official decision during

process Implement plan

Activate EOC

• Require additional support staff to execute the process at all types of hubs (i.e., medical, bus drivers).

• Adequate supplies that are needed to support transportation hub(s) are not available (i.e., wristbands, readers, laptops, scanners).

• Transportation (i.e., additional buses, ambulances, portable medical supplies and medical staff).

• Have preidentified hubs: evacuating hub, reception hub and sheltering hub.


Task 2: Identify required transportation assets and quantities (bus, air, ambulance).

• Refueling and maintenance stations. • Law enforcement needed at all facilities. • Traffic plan and the equipment associated with evacuation, including mobile messages at the receiving entities.


Task 2 (continued).

• Financial support and reimbursement – Need written requests that identify requests by mission assignment and mission responsibility by the receiving entity.

• Law enforcement to assist at receiving entities. • Sheltering community needs medical resources to support MSNs (i.e., supplies, equipment, beds for bariatric patients, and EMTs).

• Provide resources to support pets of SN evacuees.


Task 3: Identify support resources required during evacuation and sheltering (fuel, medical personnel, medical supplies, tow trucks, ambulances, facilities, etc.).

• Make sure that shelter supplies (i.e., food, water, cots, sanitation, including supplies that were at evacuating hub) are available.

• Deaf Link system for hearing impaired and interpreters/translators for nonEnglish speaking and signed (hearing impaired) evacuees.

• Staging support for all responders. • Call center resources should be available to accept last minute requests for assistance.

• Body bags and mortuary assistance at the receiving entities.


Task 3: (continued)

• www.houstontranstar.org – Cameras, etc.

• DPS and local law enforcement. • GPS. • TxDOT. • Telephones. • ARES, RACES.


Task 4: Describe process to monitor evac traffic flow & ability to adjust evac traffic management plan/measures as appropriate.

http://www.houstontranstar.org/

• Conditions of the evacuee may deteriorate during the evacuation (e.g., Type 3 may change to Type 4) – One suggestion is to place Type# on the SN patient for identification purposes.

– Identify what is needed for each evacuee to be able to have the same level of activity upon reaching the shelter.

• Better define the classification level versus where the person will be taken (shelter). – Today’s definitions are blending the “care” for the individual along with the with shelter they will be taken to (shelter, hospital, nursing home, etc.).

– Recommend that the shelters, hospitals and nursing homes have some input on this.


Task 5: Discuss options to refine SN classification system.

• Level 3 includes both ambulatory and nonambulatory persons. – Create a committee that can evaluate current system and make recommendations.

– Educate jurisdictions on how to discern SN levels and make sure all aligned.

– Discussion needed to further define level of care for SN upon arrival to the shelter/nursing home/hospital.

ü Note: a proposed change to the transportation types has been inserted on slide below (developed by City of Houston)

• 211 may interpret the “level” of SN differently due to the amount of detail provided by the patient.


Task 5: (continued)

• The thought process needs to include the patient’s anticipated condition upon arrival.

• Volunteers (Red Cross and others) need to know if either a medical or lay person will be sufficient to care for the SN upon arrival to the sheltering entities.

• No two jurisdictions are currently using the same definitions for SN type (i.e., triage).


Task 5: (continued)

Recommended Levels ‐ Transportation (prepared by City of Houston)

• Level 1 & 2 Assistance with routine care (Dialysis patients included in this level)

• Level 3 Utilize medical equipment not dependent on power oxygen, wheel chair, required continuity of care, etc.

• Level 4 Confined to bed or require power for life support equipment

• Level 5 In Patient Care (Hospital / Nursing Home / Assisted Living)

Group 3 Galveston Evacuation

Area / Capital Area Shelter

Hub




Island Evac Center

Bus Tracking Cash Trans Receipt Center

Mega Shelters Mainland Evac Center

MSN Shelters

Schools

Hospital

Scan in & Out

Scan in & Out

Scan in & Out

Scan Out

• Anticipate need for 200 Buses for full evacuation (County & City).

• No Air Evac Requirement (UTMB conducts air evac within the medical point to point system).

• Anticipate need for 100+ ambulance evacs (insufficient ambulances available).

• Anticipate need for additional transportation for nursing, assisted living, & group homes.



• Working on agreement with UTMB to provide nursing/medical students to accompany evacuees on buses.

• Anticipate need for 100+ ambulance evacs (insufficient ambulances available).

• Minimal medical equipment will be brought by UTMB (needs to be discussed).



• Shelter Evacuation Center registration for tracking last year used paper form in triplicate that could become lost or incomplete – Solution is to use SNETS this year.

• Former problem in tracking MSNs from shelters into hospitals Solution is to use SNETS this year.

• SNETS and Web EOC will be used to monitor evac traffic flow (SN buses).

• Flights of buses accompanied by DPS trooper.





Not discussed



Cities Galveston County EOC

Austin / Travis EOC

SOC

Group 4 Brazoria County /

Bell County




Begin

H72 Special Needs

Shelter/Evac Conf call

H60H48 Evac Spec Needs

starts H4846 SN

evac complete

County evacuated by

H36

End

If Cat 3, plan for Cat 4mandatory evac from Co

judge

• No air evac available in Brazoria Countydon’t plan on it.

• 11 EMS groups in countyvolunteers/limited resources.

• Requested ambulances from CMOC.

• Tracking system has limitations in identifying evacuee actual needs. Frequently, those medical needs change during transportso shelter has to deal w/ something more critical/urgent. Levels need refining so shelter can be prepared.



• City/counties voiced a disconnect between nursing homes and the local EOC. Cities have issue with nursing homes getting residents evacuated. Nursing homes do have contracts with commercial buses. At times, the same buses are also under contract with the State. Other times, the nursing home may elect to “not” execute the plan (created as a result of DSHS rule to “have a plan / contract for transportation based on number of residents”). During back brief GDEM rep stated that this will continue to happen. When buses are needed, request them from SOC.

• No issues for evacuation of Brazoria County’s four hospitals.

• Brazoria County: School buses/drivers issue. Previously planned to use ISD buses in addition to state provided buses. Ran into licensing issues with the “insurance companies” not with the ISD. Most ISD are supportive of the community requirements and welcome the chance to get their assets out of the impact zone.


Task 2: (continued)

• Brazoria County Cities pick up transportation SN evacuees within city limits. The county picks up other transportation SN evacuees in the unincorporated areas of the county.

• Brazoria County expressed an issue with significant time delays in getting an Ambulance request filled. When CMOC receives an ambulance request, they must first identify a destination location before the ambulance is dispatched. The volume seems to be a contributing factor to this problem. Consequently, evacuation community risks not getting patients out on time. Needs resolution.


Task 2: (continued)

• Bell County EMS resources are not available because needs continue at local level and cannot be deployed to impacted area.

• Licensing issue of ambulancesspecifically Bell County has 2 licensed ambulances staffed and equipped and a third ambulance is used as replacement when others are in repair. Current regulations prevent use of third ambulance during a disaster because it is not “licensed.” During back brief, GDEM said a request can be made to them and they will fill if possible.


Task 2: (continued)

• Brazoria County. The county’s four hospitals shut down, evacuated patients, with no issues and had patients taken to other hospitals throughout the state or discharged to family. No plan changes needed/anticipated for this season.

• CMOC coordinated transport of critical patients.



• People in a private residence that have special needs are expected to get on buses this is an issue. Registration in 211 data base may not accurately reflect an individual’s actual medical condition, and therefore the county is likely to have more MSNs evacuees than anticipated. This was true during Ike when they moved about six times as many as they anticipated moving. This will have to be addressed for this season.


Task 3: (continued)

• No mandates for home health care during evacuation procedures/storms. They can pull out and leave patients at the mercy of local govt. No resolution, the county realizes they have to plan for worse case.

• Excellent sheltering plan by Bell County was real asset for Brazoria County.

• Excellent communications and coordination exists between the evacuation communities in Brazoria County and the sheltering communities in Bell County.


Task 3: (continued)

• Brazoria County is part of TxDOT plan. The only designated evacuation routes in the plan are Hwy 36 and Hwy 288 (however, 288 only leads to Houston which is not an effective route to Bell County considering Harris County evacuation requirements).

• During Ike the traffic flow was acceptable and updates were sent and received by Bell County in a timely manner. No changes are anticipated for this season.



• Both counties suggested that the SN classification system should base the classification category on evacuee’s needs/not ailment during transit and at shelter. Some require constant care/equipment, that does not meet state qualifiers. This effects shelters’ assets/facilities needed to provide adequate care, such as, institution vs private care in home.

• “Selfclassification” could be improved. Individuals do not accurately classify themselves during 211 registration process. Consequently, as stated in Task 3, Brazoria County expects to have more MSN evacuees than are listed as MSN in the database. The county is currently using CERT personnel to make calls to all who are currently in the database to correct / update content.





City EOCs

Bell County EOC

Embark A&P County

EOC DDC

CMOC

MACC Resources

WebEOC, Emtrack, Telephone, Email, RACES/ARES, Sat phones, Sat Internet, Response vehicle radio interoperable

Hospitals & EMS

Brazoria / Bell Counties

Activity 4 Repatriation of Special

Needs

Description: Upon notification that the affected area is safe, ensure that inshelter Special Needs population/evacuees are safely reintroduced to the area.

Associated Tasks:

1. Identify responsibility for directing closure of Special Needs shelters.

2. Describe criteria needed to displace Special Needs evacuees to secondary shelters.

3. Describe criteria needed to repatriate Special Needs evacuees.

Repatriation of Special Needs Evacuees

Associated Tasks:

4. Describe plans for care of supporting medical personnel

5. Develop essential communications diagram

6. Develop a Flow Chart of key events


Group 1 Houston, Harris County/ North Central Texas

COG


• The evacuating jurisdiction makes the decision and communicates via the chain of command as to when they can receive evacuees back to their home jurisdiction.


Task 1: Identify responsibility for directing closure of Special Needs shelters.

• Sometimes the primary shelters need to move SNs to secondary shelters. – The local jurisdiction reacts based on the need and communicates back up the chain.

– One recommendation is to consolidate remaining shelters – Another option is to have alternate shelters available.

• There appears to be a lack of senseofurgency to accommodate the SNs. – Negotiate with other providers for shelter space. – Proactively communicate the need for moving the shelter.


Task 2: Describe criteria needed to displace Special Needs evacuees to secondary shelters.

• SNs return to evacuating jurisdiction without having support services available or, SNs do not evacuate and want to leave after the disaster. – Per GDEM, the SOC will help sustain the SNs if this occurs. – Families need to work with DRS/DADS to assist in finding shelter.

The Division for Rehabilitation Services (DRS) Department of Aging and Disability Services (DADS).


Task 2: (continued)

• The receiving jurisdiction had the following concerns: – Make sure caregivers are available, if needed. – Make sure that supplement services are available (i.e., Meals on Wheels, healthcare, pharmacies).

– Ensure that power lines are safe, water treatment facilities working, safe structures, pharmacies, some retail, supplemental resources, etc.

– The SN evacuees need be returned to the same hub.


Task 3: Describe criteria needed to repatriate Special Needs evacuees.

• The evacuating jurisdiction had the following concerns: – The evacuating jurisdiction has to wait for the phone call from the chainofcommand that the receiving jurisdiction is ready to accept SNs.

– The MACC and DDC needs to coordinate repatriation with transportation resources.

– Repatriation depends on the special needs of each person. – Public Health (sheltering jurisdiction) and DSHS need to coordinate the MSNs returning requirements .

– Need to document a clearlydefined process on who is checking on returning MSNs.


Task 3: (continued)

• Medicalunique transportation assets are assigned to the MOC and are at their disposal. However, the DDC is not in this decisionmaking process. – Recommend that the DDC be more involved with the allocation of SNs/general needs transportation.

• A clearing house (SOC) is needed to resolve individual jurisdiction conflicts. – Individual jurisdictions attempting to resolve repatriation issues is not acceptable.


Task 3: (continued)


• The concept that responders need to be selfsufficient for 72 hours is not realistic. – Recommend that a base operations area be made available to support wellbeing of responders at both hosting and receiving jurisdictions.

Task 4: Describe plans for care of supporting medical personnel.



Not completed.

Task 6: Develop a Flow Chart of key events.


Evacuating community conducts

assessment

General Population returns

Complete assessment

SNs

MSNs Host create list of who will return

Coordinated return

Group 3 Galveston Evacuation

Area / Capital Area Shelter

Hub


• Adequate definition for MSNs and ability to care for all levels of special needs 13.

• Active triage prior to assignment to a hotel room or apartment (considering physical and mental ability).

• Whatever you provide for one evacuee be prepared to provide for all.

• Issue of mattresses/blankets/sheets/pillows for evacuees appropriate to facility.


Lessons learned from Ike.

• Decision on the closure of a SN shelter is the responsibility of the shelter manager, in coordination with Area Command.



• Unresolved Issue: Need to determine responsibility for evacuees that need sheltering beyond 35 days.

• Unresolved Issue: Need to identify responsibility, source of support and resources needed for intermediate & long term sheltering.



• SN Evacuees must have a place to go with adequate support (emergency services such as water, wastewater, electricity, hospital) and day to day infrastructure.

• Evacuating jurisdiction must give “all clear” before allowing evacuees to return.





Not discussed.



Cities Galveston County EOC

Austin / Travis EOC

SOC

(PFM Radio Link)

* This is the reverse of the system used for evacuation.



Island Evac Center

Bus Tracking Cash Trans Receipt Center Mega Shelters

Mainland Evac Center

MSN Shelters

Schools

Scan Out

Scan Out

Scan Out

Scan Out

Hospital

Communication only

• Intermediate shelters usually did not accept companion animals.

• Undue pressure to establish animal shelters in the sheltering area.


Miscellaneous issues:

Group 4 Brazoria County /

Bell County


• Decision rests with the Judge of Brazoria County. He will make that decision when cities review rosters and evaluate all conditions effecting timing for return of their citizens. Brazoria County EOC sends list to Bell County EMC. Homes must be habitable before residents are allowed to return.

• Brazoria County keeps Bell County updated on progress of each area in Brazoria County and Bell County sends evacuees back as directed by Brazoria County.



• Brazoria County Cities did daily conference calls with Brazoria County nursing homes to keep all informed on status of conditions in the impact area and the timeline expectations for keeping their (Nursing home) staff in Bell County shelters to assist shelter manages with evacuees.

• Brazoria County opened shelters for transportation special needs & medical special needs throughout the county when power was restored so residents could return to their home area.


Task 1: (continued)

• It is based on capacity / population of the shelter itself and the evacuee needs. Some evacuees were moved from original shelter to a medical special needs shelter in Temple. Bell County looks at what facilities are available based on conditions of evacuees and medical criteria to support their needs. If a cityowned facility is under contract they will consolidate shelters to other facilities that creates an overall shelter management efficiency. Cities will provide support personnel to staff the shelter.

• City EMCs along with county EMC make the decision to consolidate shelters.



• Bell County EMC requested buses from SOC to send people back to hub in Brazoria County. Was told that the Brazoria County Judge needed to contact SOC authorizing the return of Brazoria county evacuees based on satisfactory conditions. He had to call three times to give the okay, because with each shift change at SOC, they requested the judge call again. Bell County EMC was not notified—no process was in place.

• SN evacuees went back to hub they left from, Brazoria County picked them up and returned them to their homes. Texas Military a big help in getting evacuees from buses to homes.




• Brazoria County took care of medical responder personnel with food, water, etc.

• Bell County provided daily physical needs (food / water, etc) and psychological support for shelter staff.

• When Bell County sent evacuees back, medical personnel traveled with them, and Brazoria County took care of them with food and basic needs until they returned to Bell County.




SOC?

Brazoria County Bell County

Note: DDC Waco was not activated during Ike, and Bell County is making plans based on that being the reality again to include addressing procedures for processing 213RRs. Regardless, Bell county did and intends to continue to keep the Waco DPS Captain informed of pertinent activities.



Shelter

Brazoria ready for return

Judge calls SOC x3

Bell County calls SOC

x6

Bell County receives buses

Shelters release evacuees

Brazoria Hub accepts evacuees

Home or shelter!

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