CDPHE

Colorado Department of Public Health and Environment

EMERGENCY PREPAREDNESS AND RESPONSE

BE READYBE HEALTHYBE INFORMED

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an EVENTful 2008

Emergency Preparedness and Response at thestatehealth department has been involved in awide range of events. Every emergency that is

elevated to the state level is evaluated to determinewhat support is needed for the local response efforts.CDPHE is the Emergency Support Function #8 leadagency, working closely with the Colorado Division ofEmergency Management on incidents.

The two most significant events for the divisionthis year were the water system contamination inAlamosa and the Democratic National Convention.

Alamosa Salmonella EpidemicAlamosa declared a city-county emergency on

March 19 when CDPHE issued a bottled water orderfor the town due to salmonella contamination in thecity’s municipal water system. The sudden outbreak ofsalmonella in the municipal water supply in Alamosatested the state’s ability to manage an epidemic andquickly mobilize key resources.

With the local public health nursing service as thelead agency in Alamosa, it was CDPHE that first wascontacted for support. The regional planner andtrainer, both funded by the Public Health EmergencyPreparedness and Response Cooperative Grant, calledon CDPHE’s EPR staff for guidance. While the infec-tion control staff worked on identifying the salmo-nella cases, the lab identified the specific strain andthe water team brought in experts to identify theproblems and repair the water system. In the mean-time, EPR had the job of helping a community of10,000 cope with no water for drinking, food prepara-tion or even bathing.

:: EPR immediately contacted grocery, water andbeverage bottling companies throughout the state.Within two hours, trucks were en route to Alamosawith bottled water.

:: EPR coordinated staff deployment to Alamosa,with the need for expertise in water quality, consumerprotection, disease control, laboratory services andemergency response. EPR also helped coordinatevolunteer efforts to support emergency responders.

:: EPR managed the financial aspects of the stateresponse, establishing a new cost center and request-ing resources from other local public health agencies.

Fast action, efficient communication and the highlevel of cooperation among various agencies are allcredited with significantly limiting the number ofillnesses in Alamosa. The fact that Alamosa Countystaff had received incident command system trainingprior to the outbreak was critical to the success of theresponse. The regional trainer in the county’s publichealth nursing service has been personally lauded forencouraging other non-medical local partners toparticipate in the trainings as well, anticipating theneed for multi-sector preparedness. At a statewideconference of county commissioners in June 2008,one of Alamosa’s county commissioners told anaudience that he had never understood why his staffwas spending so much time and money on trainings –but now, after the outbreak, he clearly sees the valuein preparedness education.

While a boost in federal funding in recent yearshas allowed Colorado to establish a statewide infra-structure to effectively respond to such disasters, theevent in Alamosa underscores the importance ofcontinued funding for emergency preparedness andthe need to integrate public health activities withemergency management.

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Democratic National ConventionThe Democratic National Convention was desig-

nated a National Special Security Event, which autho-rizes the Secret Service to lead all security-relatedactivities. From the beginning of the conventionplanning, the Emergency Preparedness and ResponseDivision was an integral participant.

With Denver Public Health in the lead for ESF 8response, CDPHE was on duty 24/7 to support thelocal efforts. It was the largest event ever in Denver,with projections of up to 100,000 protestors frommultiple groups hoping to disrupt the convention. Justprior to the convention, the area experienced some ofDenver’s summer extreme temperatures, adding to thepublic health concerns.

The department hosted about 100 staff from localand federal agencies at its operations center in Glen-dale. Emergency Preparedness and Response staff wereassigned to one of several teams that staffed the De-partment Operations Center, the State EmergencyOperations Center in Centennial and the Multi-AgencyCoordination Center at the Federal Center in Lake-wood. CDPHE’s objectives were to support redundant

communication among agencies, to maintain situ-ational awareness by coordinating the various systemsin use and to ensure public health had clear anddecisive leadership 24 hours a day during the entireconvention.

A separate report on the BioWatch alarm during theDNC is available.

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Local governmental agencies are responsible forthe coordination and management of disasters oremergency events affecting their jurisdictions. If

the local jurisdiction’s resources are not sufficient forthe increased level of need during a disaster or emer-gency, local governmental agencies may request assis-tance from the state. When a request is received, theColorado Department of Public Health and Environ-ment may be activated to mobilize resources, or toprovide technical guidance and information to localgovernmental entities, other state departments and thepublic. The state health department also activates, withmany other state agencies, when the State EmergencyOperations Plan, managed by the Colorado Division ofEmergency Management, is activated.

When a disaster or emergency event exceeds localresponse capabilities, jurisdictions are likely to requestcommon types of assistance from the state. The types ofassistance have been grouped at the national level into15 “emergency support functions,” or ESFs. The Colo-rado plan adopted the 15 ESFs and identified certainstate departments as leads for each functional area. TheColorado Department of Public Health and Environ-ment is the lead agency for ESF #8 – Public Health andMedical Services, and a support agency for nine of theremaining annexes.

In its role as the lead agency for ESF #8, CDPHEprovides support to local and tribal governments in theassessment of public health/medical needs, includingbehavioral health and mortuary; public health surveil-lance and laboratory services; medical care personnel;and medical equipment and supplies. CDPHE helpsidentify and meet the public health and medical needsof victims of a disaster, including:• Disease surveillance and outbreak control measures• Indoor and outdoor air quality monitoring• Drinking water and wastewater assessments and

recommendations• Food (except livestock) and dairy integrity evalua-

tions and food safety guidelines• Hazardous materials, including radiological materi-

als, assessments and recommendations• Waste management guidelines• Hospital resources and medical supply monitoring• Activation and deployment of the Strategic National

Stockpile

ColoradoBrings More Accountability to Emergency Preparedness and Response

CDPHE also supports the Colorado Department ofHuman Services, the lead agency for ESF #8a – MentalHealth and Substance Abuse.. CDHS is responsible forproviding behavioral health crisis counseling duringand after disaster response when necessary.

The Colorado Division of Emergency Manage-ment (CDEM) is responsible for the managementand coordination of all state emergency operationsand, when necessary, federal resources. CDEMestablishes the state government presence in theimpacted jurisdiction in anticipation of the needfor immediate and long-term assistance. CDEMsupports all state departments and agencies duringdisasters and emergencies. This division assists withrequests for and acquisition of resources duringemergencies and coordinates the delivery of theneeded resources.

CDEM is responsible for the organization andoperation of the State Emergency OperationsCenter, daily and when activated for an emergency.The center, also known as the Multi-agency Coordi-nation Center or MACC, provides a central locationfor local, state and sometimes federal partners towork together in response to emergency events.

CDEM also is responsible for alerts and notifica-tion, deployment and staffing of designated emer-gency response teams, incident action planning,coordination of operations, logistics and material,direction and control, information management,facilitation of requests for federal assistance, re-source acquisition and management, worker safetyand health, facilities management, financial man-agement and other support as required.

The Role of the Colorado Division ofEmergency Management

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Otero County Health Department’s (OCHD)jurisdiction is Crowley and Otero counties inSoutheast Colorado. Our counties are very low

on the economic scale. The median annual income issignificantly less than that of the state of Colorado.Our main industry historically has been agriculture,which has been significantly impacted the last fewyears by diversion of irrigation water and a multiple-year drought. In addition, businesses have closed theirdoors, resulting in a significant job losses, which has anegative impact on the local economy and its tax base.

This economic situation leads to several gaps andneeds for public services, including preparedness.Thanks to the grant, the state of our public healthpreparedness is good. This grant has undeniablychanged our agency in a very positive way, with a stateof readiness that allows us to respond effectively forlocal incidents. The grant supports emergency pre-paredness and response (EPR) staff training and exer-cises. Our EPR staff are on call 24/7 to respond torequests from the hospital, sheriff’s department, electedleaders and other response partners. Each month, wetrain on NIMS, weapons of mass destruction, commu-nication devices, emergency risk communication,mental health issues in emergency response, StrategicNational Stockpile, pandemic response, biologicalhazards and more.

In 2002, our state general fund support was elimi-nated. With the CDC grant supporting our prepared-ness activities, we had resources to support prepared-ness and readiness, including a regional public healthepidemiologist, trainer and planner. These resourceshave helped the Southeast Region immeasurably withpreparedness and in addressing the 10 essential publichealth services. Without the CDC grant, these positionswould be cut, as the Southeast Region counties do nothave the funds to support them. Not only have we hadgreat successes with trainings and exercises, but alsowith real incidents:

:: We responded to an issue involving great quanti-ties of red, fuming nitric acid. We led the response withthe Colorado Department of Public Health and Envi-ronment, U.S. Environmental Protection Agency, thePentagon, Sheriff’s Department, hospital, local firedepartments, Army Corps of Engineers, ColoradoAttorney General’s Office and others.

:: OCHD responded to a major fire in CrowleyCounty, and the mayor of Sugar City delegated theauthority to serve as Incident Commander of the SugarCity Shelter to OCHD staff. Our go-kits, purchasedwith CDC grant funds, were an invaluable part of ourresponse efforts.

:: OCHD responded to a small out-building con-taminated with organo-phosphate chemicals in SugarCity. We used personal protective equipment, or PPE,purchased with the CDC grant to protect us while wedecontaminated the out-building.

:: We have responded to multiple incidents inchemical labs at our local public schools. We haveassisted the schools in properly disposing of hazardouschemicals, thus making our children safer.

:: We assisted when explosive material was found inthe Crowley County Courthouse in Ordway. Onceagain, our incident command training proved veryvaluable.

In our jurisdiction, OCHD is respected as an inci-dent response partner. This statement would not havebeen possible without the CDC grant funds supportingour preparedness efforts. This grant has made all thedifference between being well prepared and not beingprepared.

In Their Own Words: Otero County

by Rick Ritter, Executive Director, Otero County Health Department, November 21, 2008

These resourceshave helped theSoutheast Regionimmeasurablywith preparednessand in addressingthe 10 essentialpublic healthservices.

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Otero County Sheriff Chris Johnson

“By receiving these funds, the grants have enabledour health department to be an active participant insituations where they would have otherwise beenunable to participate. These funds have made apositive impact between Otero County emergencymanagement and our local health department. Theloss of continued funding would critically hamper ourefforts toward unified chain of command that in-cludes public health as an essential and key compo-nent. The loss of these funds would also endanger ourhomeland security efforts as OCHD is a key player inthis regard.”

Arkansas Valley Regional Medical CenterInfection Control Officer Norm Finkner

“The Southeast Colorado Region public health staffhas been very instrumental in helping our hospital inthe emergency preparedness arena. They have beenexcellent resources for planning and training, and inthe development of training exercises. The grantmoney provided by Public Health has allowed thepurchase of necessary preparedness equipment. Thehealth department’s preparedness leadership hashelped develop a strong partnership among thevarious entities in emergency response in SoutheastColorado.”

Crowley County Commissioner TobeAllumbaugh

“Due to the numerous emergency incidents wehave had in the recent past, the preparedness fundsand services through the local health department areinvaluable to the citizens of Crowley County. Theyreally do make a difference. Crowley County is thepoorest county in Colorado, and if these funds werelost they absolutely could not be replaced locally.”

Otero County Board of Health President PaulYoder, M.D.

“As president of the Board of Health, I see and hearfirst-hand how these grant dollars are being used tohelp the citizens of Crowley and Otero County.Additionally, we have dispatched our EPR staff toother parts of the state when needed and requestedfor preparedness activities and emergency response.

We absolutely need these funds to continue theimportant work of public health preparedness in oureconomically deprived area of the state.”

Crowley County Emergency Manager LarryReeves

“The health department has been an invaluablepartner in our emergency preparedness effortsthrough trainings, resources, etc. The loss of thesefunds would cripple our preparedness efforts andability to respond.”

Otero County Administrator Jean Hinkle

“With funding being cut at the federal and statelevels for various programs it is becoming increasinglymore difficult for local government to withstand theburden. The loss of funding would eliminate muchneeded full time positions including a regionaltraining coordinator, an emergency preparednessresponse coordinator, a regional epidemiologist andothers who are on call 24 hours a day for the safety ofthe public. These individuals are responsible fortraining the public and ensuring the necessary sup-plies are in place should a situation arise. Not only dothese individuals assist locally but regionally as well.Our Public Health Director is exceedingly fiscallyresponsible, maximizing every dollar and stayingabreast of approaching issues. The Otero CountyHealth Department and the Southeast Region wouldsuffer greatly if funding is cut.”

La Junta High School Principal Bud Ozzello

“The health department has assisted us numeroustimes with hazardous chemical disposal. It is comfort-ing to know they have the training and expertise tohelp when needed. I would hate to see their readinessfunding disappear.”

In Their Own Words: Otero County

"If we lose this ability tobe flexible and creativewe will lose every bit ofmomentum we havegenerated."

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by Jody Erwin, Emergency Response Coordinator, Jefferson County Department of Public Health and Environment, November 28, 2008

In Their Own Words: Jefferson County

Our number one priority is to make emergencypreparedness a core public health programthat enhances all other programs, supports the

agency mission of protecting the health of the public,acts as a resource for the entire department and fullysupports the Ten Essential Public Health Services.

The key to this is continued funding of full-timestaff that focus on integrating emergency preparednessinto the daily activities of the department, whiletraining staff and the public on what their role wouldbe in preparedness and response. This works by makinga connection to their daily activities and demonstratingvalue to other health programs. This does not meanthat Jefferson County uses emergency preparednessmoney to fund other programs; rather, the fundingenhances what staff does with emergency prepared-ness-related functions. This makes emergency pre-paredness a part of what they do every day.

An example of this is our ongoing Operation Arti-choke exercises that test the regional/local distributionsite positions and functions for the deployment of theStrategic National Stockpile. These were existing com-munity events focused on providing fresh produce tounderserved residents in Jefferson County. To beeligible for a small emergency preparedness grant, werequired that they add several emergency preparednessobjectives to these events. The functions that were

being done at the fairs closely resembled those of theRegional Distribution Siteand some portions of ourlocal push-plans for mass prophylaxis dispensing. Itwas a perfect opportunity to make a connectionbetween something these staff are excited about andcommitted to, and what their role would be in anemergency. We now have a group that might not havealways embraced emergency preparedness fully

trained, knowledgeable about and excited about theiremergency response roles related to public health. Wehave our feet in the door and they have seen our value.If we lose this ability to be flexible and creative we willlose every bit of momentum we have generated.

We have a lot left to do. We finally have an excellentset of fully developed plans. We are ready now to reallyget our staff into the details, and they are excited aboutit and committed to the program like never before, andnow the funding is decreasing. We are on the verge ofvery exciting breakthroughs related to integrating theemergency preparedness culture and traditional publichealth culture but need to keep the momentum going.

We are concerned when we hear that some states arebeing required to return funding because their pre-paredness activities were used to support public healthprograms. We are here to protect the health of thepublic. It is essential to maintain dedicated emergencypreparedness staff and weave emergency preparednessinto every public health project or program. We canfind creative ways to use that leverage to train peopleand get them excited about what we need to do, but weneed dedicated staff to carry on this process and ensureevenroutine events have an emergency preparednesscomponent to them.

Jefferson County Department of Health and Envi-ronment serves approximately 535,000 people in bothhigh-density urban areas and rural mountainous areas.The Emergency Preparedness Program was establishedin 2002 and currently employs three FTEs dedicated tothe program: a regional epidemiologist, regionalplanner and program coordinator. For this populationsize, an additional planner, epidemiologist, publicinformation person and support staff would be ideal.

More from Jefferson County

"Since day one our guidance has told us to breakdown the silos between emergency preparedness andother traditional programs. I believe that we are finallyat a point where people accept us and want to keep usaround long term and are really willing to work withus. The true disaster would be to stop or significantlyreduce these programs now. I think there are ways thatthey could work better and more efficiently. I think themost important step that we can take is to integrateinto traditional programs and continue to support theten essential services. If we can’t use what folks do on adaily basis to teach them about their emergency pre-paredness role then they will never understand. I havesaid all along, you can force people to take an IncidentCommand System class or to participate in an exercisebut you can’t force them to care. The only way to trulybuild preparedness is to weave emergency preparednessinto the fabric of public health."

---Emergency Response Coordinator Jody Erwin

We are convinced that Incident Management Teams(IMTs) are the wave of the future for incident manage-ment. In Colorado I know that our state Division ofEmergency Management is committed to deployingIMTs for big events. Since public health now has apresence on the first and most highly trained IMT inthe state, we become a resource for the rest of the state.As funding starts to drop for public health programsand smaller counties don’t maintain the regionalpositions, we can deploy to other parts of the state tohelp coordinate public health response. So there is stilla need for local resources, but if they are not trained inemergency management it is ok because we can bethere to act as that liaison between the IMT and thelocal public health staff.

---Emergency Response Coordinator Jody Erwin

Wow! These plans aregreat and just what isneeded -- simple anddirect. You guys frompublic health areGREAT!

---James Lancy, ArvadaEmergency Manager

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For eight days in March,1.5 million Coloradansvisited their local Wal-Mart or Sam’s Club toview sample emergencypreparedness kit items

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One of the Emergency Preparedness andResponse Division’s accomplishments during2008 involved the country’s first partnership

between public health and a national private corpora-tion targeting emergency preparedness.

The Wal-Mart Emergency Preparedness Campaignwas developed with the corporate leadership for 79Colorado Wal-Mart and Sam’s Club stores to encour-age residents to prepare their own home, office andcar emergency preparedness kits. This partnership wasparticularly important because it the Wal-Mart offi-cials indicated that they considered the campaign tobe a pilot project. Wal-Mart is considering repeatingthe campaign in other states, and perhaps nationwide.This project was Wal-Mart’s first statewide private/public partnership in the area of public health emer-gency preparedness.

The project was closely monitored by federalagencies as a potential model for future nationwideefforts. The state investment in the campaign was$32,000.

For eight days in March, 1.5 million Coloradansvisited their local Wal-Mart or Sam’s Club to viewsample emergency preparedness kit items on displayand pick up an informational brochure, available inboth English and Spanish. The brochure includes achecklist to help customers shop for their own emer-gency kit.

Many of the Wal-Mart displays were staffed withclose to 200 volunteers from the Colorado PublicHealth and Medical Volunteer System and othervolunteer organizations to assist in distributingbrochures and to answer questions from the public.

Some of the campaign successes documentedincluded:

Campaign reached the community statewideat 79 different Wal-Marts and Sam’s Clubs.

Customers were open to taking brochures.

Display kits in the location at the entrancesof the stores were very successful.

National Organization of Disabilities bro-chures were popular.

Volunteers were successful in groups.

People with children and families were veryreceptive and open to being prepared in the event ofan emergency.

Wal-Mart and Sam’s Club staff who assist incommunity involvement and the training coordina-tors were very helpful. Some Wal-Mart stores hadtheir own staff fill hours to staff the display if therewere gaps.

Partnering with Business for Public Education

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Putting it into practiceTraining and Exercises

Colorado state and local public health agenciescoordinate emergency preparedness and response training and exercise activities with

other local, state and federal agencies.

Colorado public health staff participate in all-hazard planning meetings; information exchange;mutual aid; and collaborative training, exercises anddrills to enhance multi-discipline and multi-jurisdic-tional preparedness and response.

Three-year Training and Exercise CycleA three-year training and exercise plan serves as a guidefor planning public health emergency preparednesstraining and exercises within the state of Colorado. TheColorado Department of Public Health and Environ-ment (CDPHE) manages the state-coordinated exer-cises listed in the plan. The local and regional exerciseslisted in the plan are managed and implemented bypublic health staff at the regional and/or county level,with technical support from the state health depart-ment as needed. Colorado is in its second cycle, havingcompleted its first three-year training and exercise cyclein 2008.

The CPDHE Emergency Preparedness and ResponseDivision and its local partners include healthcarepersonnel and other response partners in all trainingand exercise events. The CDPHE Hospital PreparednessProgram coordinates with hospitals and otherhealthcare partners, such as the Colorado MedicalSociety, the Colorado Hospital Association and Com-munity and Rural Health Clinics to ensure that educa-tion and training opportunities are made available to

adult and pediatric pre-hospital, hospital and outpa-tient healthcare personnel. As a result, we can collec-tively enhance the abilities of all response partners torespond in a coordinated, effective and efficient man-ner, while minimizing duplication and filling gaps inknowledge, abilities and skills. By conducting jointexercises, state, regional and local response partnersalso meet multiple and varied grant requirements.

The goal for the training and exercise plan is toenhance and integrate state and local public healthpreparedness and response activities with federal, state,local and tribal governments, the private sector (includ-ing private healthcare industry partners) and non-governmental organizations.

The three-year training and exercise plan is based onseveral sources:

1. Centers for Disease Control and Prevention Emer-gency Preparedness and Response CooperativeAgreement (federal grant requirements)

2. Assistant Secretary for Preparedness and ResponseHospital Preparedness Program CooperativeAgreement (federal grant requirements)

3. 2008 needs assessment conducted by staff

4. Lessons learned from state, regional, and local exer-cise after-action reports and improvement plans

Additionally, CDPHE encourages local public healthand hospital response partners to develop training andexercise opportunities based on facility and commu-nity-level Hazard and Vulnerability Needs Assessmentsconducted throughout each of the nine all-hazardsregions in the state.

... education andtraining opportunitiesare made available toadult and pediatricpre-hospital, hospitaland outpatienthealthcare personnel.


Training and Exercise Plan HistoryIn September 2005, CDPHE developed the first

public health emergency preparedness three-yeartraining and exercise plan. The 2005-2008 training andexercise plan reflected the requirements of the CDCEmergency Preparedness and Response CooperativeGrant and the results from a statewide training needsassessment survey conducted in March 2005. The goalfor this plan was to provide standardized training to allpublic health staff and response partners on varioustopics:

1. Public health’s role in preparedness and response

2. Strategic National Stockpile

3. National Incident Management System and Inci-dent Command Structure

4. Personal Protective Equipment (PPE)

5. Risk and tactical communications

In addition to standardizing training, the 2005-08training and exercise plan focused on mass prophy-laxis.1 The plan called for each public health agency toparticipate in at least three drills the first year, and astatewide tabletop and functional exercise the secondyear (both of which used a pandemic influenza sce-nario). In late 2007, CDPHE coordinated a statewidefull-scale mass prophylaxis exercise to test theColorado’s ability to provide mass prophylaxis andmedical supply management and distribution in theevent of a flu pandemic. With this new three-yeartraining and exercise cycle, the focus has shifted frommass prophylaxis to medical surge.2

Skillbuilding ProcessEstablishing emergency preparedness plans and

effectively training the public health and medicalworkforce is the first step towards preparedness.

With varied levels of experience among publichealth staff throughout the state, the training andexercise plan follows the Homeland Security Exerciseand Evaluation Program (HSEEP) building-blockapproach in the design of the overall exercise program.This approach requires a process of building the neces-sary skills to participate in public health and medical

1 Mass Prophylaxis is the capability to protect the health of the population through the administration of critical interventions in response to a public health emergencyin order to prevent the development of disease among those who are exposed or are potentially exposed to public health threats. This capability includes the provision ofappropriate follow-up and monitoring of adverse events, as well as risk communication messages to address the concerns of the public.

2 Medical Surge is the capability to rapidly expand the capacity of the existing healthcare system (long- term care facilities, community health agencies, acute carefacilities, alternate care facilities and public health departments) in order to provide triage and subsequent medical care. This includes providing definitive care toindividuals at the appropriate clinical level of care, within sufficient time to achieve recovery and minimize medical complications. The capability applies to an eventresulting in a number or type of patients that overwhelm the day-to-day acute-care medical capacity. Planners must consider that medical resources are normally at ornear capacity at any given time. Medical Surge is defined as rapid expansion of the capacity of the existing healthcare system in response to an event that results inincreased need of personnel (clinical and non-clinical), support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logisticalsupport (clinical and non-clinical equipment and supplies).

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exercises that incorporate a range of exercise activitieswith increasing complexity and interaction.

CDPHE exercises are designed so that each eventincreases in scope, scale and complexity. Theoretically,participants move from seminars to workshops totabletop exercises to drills to functional exercises and,finally, to full-scale exercises.

CDPHE also uses a cyclical approach to exercisedevelopment. Once a plan, policy or procedure isdeveloped, training staff create a process to deliver thenecessary training. After training, the participantsexercise the plan and document corrective actions andlessons learned. The cycle begins again as we updatethe plan, policy or procedure based upon the gapsidentified in the exercise.

The building-block approach ensures successfulprogression in exercise complexity and allows for theappropriate training and preparation to occur prior tostaff participation in emergency exercises.

Public health and medical exercises also are de-signed to meet specific target capabilities as defined bythe Department of Homeland Security Target Capabili-ties List. The Target Capabilities List details 37 corecapabilities that address specific prevention, protection,response and recovery capabilities, as wel l as commoncapabilities that support all missions, such as planningand communications.


Three-year Training and Exercise Cycle Timeline1. Create and disseminate a needs assessment survey (Completed April 1, 2008).

2. Analyze needs assessment data to identify performance gaps and training priorities (Completed June 30,2008).

3. Develop draft exercise priorities, objectives and timelines for 2008-09 (Completed June 30, 2009).

4. Identify courses that address key performance gaps for each target audience at the state and local level(Completed August 31, 2009 and ongoing thereafter).

5. Market required and optional training opportunities using CO.TRAIN (Ongoing).

6. Update the Emergency Preparedness Course Catalog and link new courses to CO.TRAIN to allow publichealth employees to search for, register, and track their own learning (Completed September 2008 andongoing).

7. Develop formal course evaluations and pre/post-tests to assess learner retention (Ongoing).

8. Develop local/regional multiyear training and exercise plans (Completed October 2008 and updated annu-ally).

9. Evaluate the effectiveness of training through conducting tabletops, drills, and other exercises (Ongoing).

10. Analyze performance gaps identified in exercise after-action reports and exercise evaluations to develop astrategy for improving public health emergency preparedness training (Ongoing).

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The Emergency Preparedness and Response Divi-sion developed an electronic needs assessmentsurvey, with the assistance of regional public

health emergency preparedness staff. The survey wassent via email to all local public and environmentalhealth employees throughout Colorado in April 2008.This survey was designed to assess the ability ofColorado’s public health workforce to access informa-tion and perform tasks related to the various corecompetencies (“Emergency Preparedness Core Compe-tencies for Public Health Workers” as defined byColumbia University and the Centers for DiseaseControl and Prevention). Our ability to perform eachof these competencies will directly result in a stronger,more prepared public health workforce within the stateof Colorado.

1. Training tools. With federal grant funds to supportmedical response to natural or man-made disas-ters, the EPR Division funded mass casualty andpatient decontamination training tools for 72acute-care hospitals across the state.

2. Decontamination training. EPRD staff conductedtraining for many rural hospitals to teach themhow to set up a decontamination site and how touse decontamination personal protective equip-ment called powered air-purifying respirators, orPAPRs.3

3. Exercise technical assistance. Our staff also guidecommunities in exercises to activate and set-upmedical surge caches intended to provide tempo-rary hospital-bed sites. These could be needed in adisaster that involves serious damage to the localhospital, or it becomes overwhelmed with patients.

4. Coordination exercise assistance. EPRD staffdesigned and implemented mass casualty responseexercises to test the communication and coordina-tion of local law enforcement, fire, EMS andhospitals, and to evaluate their interactions withstate and federal support response agencies, includ-ing the Colorado Division of Emergency Manage-ment, Colorado Department of Public Safety andthe National Disaster Medical Response System. Alarge-scale exercise in two parts in 2006 and 2007,

Training and Exercises Resources for Partners

known as Operation Mountain Move, tested medicalresponse efforts in metropolitan and mountaincommunities.

5. Patient and inventory tracking tools training.CDPHE developed a patient transport tool knownas EMSystem for hospitals, EMS agencies andemergency response communication/ dispatchcenters. EMSystem can play a powerful role inrapid movement of victims from the scene tohospitals during mass casualty incidents. A newtool known as HC Standard was introduced in2008. This tool can help hospitals track bothinventory and patient movement during large-scalemass casualty or community disasters.

6. Medical supplies training. Chempack and theStrategic National Stockpile are two critical medi-cal resources for patient support. CDPHE trainslocal public health professionals as well as withlocal emergency managers, hospitals, EMS agenciesand other first responders on the process foractivation of these systems. CDPHE also offersphysical, hands-on training for community re-sponders to practice security, movement anddistribution of the caches to the receiving loca-tions.

7. Specialized training. CDPHE teaches its special-ized community partners such as law enforcementand fire department hazardous materials teams onthe protocol for suspicious powders and thesubmission of samples to the state laboratory.

8. University curriculum. EPRD staff present twolectures per semester at Colorado State University’sSchool of Environmental and Radiologic HealthSciences on public health’s role in emergencyresponse.

9. Professional development for other CDPHEdivisions. EPRD staff present information onCDPHE’s internal response plan for the 10 divi-sions of the department.

10. Department Operations Center orientation.EPRD trains its internal partners on thedepartment’s Operation Center (DOC), the use ofthe 800 MHz radios and risk communication.

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3 An air-purifying respirator has an air-purifying filter, cartridge or canister that removes specific air contaminants by passing ambient air through the air-purifyingelement. A powered air-purifying respirator, or PAPR, uses a blower to force the ambient air through air-purifying elements to the inlet covering.


Pandemic InfluenzaDepartment of Corrections Pandemic InfluenzaWorkshop. Several CDPHE staff traveled to Canon Cityin April 2008 to conduct a two-day pandemic influenzaworkshop for approximately 100 members of theColorado Department of Corrections. On the first day,participants were provided with presentations todescribe the potential impacts a pandemic might haveon correctional facilities, staff, and inmates. On thesecond day, participants were broken into regions todiscuss planning considerations for how to addresspandemic flu issues and implications.

Pandemic Preparedness. A staff member spoke at the24th Graduate Student Symposium-Infectious Diseaseand Host-Pathogen Interactions hosted by the graduatestudents of the Molecular Cellular and DevelopmentalBiology program at CU Boulder in October. EPRDaddressed Colorado’s pandemic preparedness for theundergraduate and graduate students who attended thesymposium.

Higher Education. More than 50 people from varioushigher education institutions and public health agen-cies participated in a one-day higher education work-shop in July on pandemic preparedness, at the requestof the Colorado Department of Higher Education. Thechief medical officer and staff provided an overview ofpandemic influenza and discussed planning tools, inaddition to presentations from universities that havemade great strides in pandemic planning.

Medical and Nursing SurgeMedical Surge Seminars. Emergency Preparedness andResponse presented a total of six seminars throughoutthe state in April through September 2008. The pur-pose was to enhance medical surge planning withhealthcare and emergency management partnersthroughout the state. The seminars provided informa-tion on alternate care facilities, pandemic influenzaalternate standards of care, mobile medical caches, HCStandard, Strategic National Stockpileplanning, use ofthe Colorado Volunteer Mobilizer system, the ColoradoHealth Emergency Line for the Public (COHELP),Emergency Support Function #8’s draft “Guidance forTriaging and Altering Standards of Care During anInfluenza Pandemic” and other topics of interest.

SELECTED 2008 TrainingS

Participants used checklists, templates and planningguidance to assist them in developing their own medi-cal surge and Alternate Care Facility plans at the localand regional levels. Lessons learned from these semi-nars will be used to focus medical surge planningefforts and develop more advanced training and exer-cises in the future.

Nursing Surge Training. EPRD trainers co-taughtPublic Health Nursing Surge Training for the WestRegion’s nursing staff in July 2008.

Emergency ManagementNIMS. The Emergency Preparedness and ResponseDivision taught two courses required by the NationalIncident Management System (ICS 100 and ICS 700)for the Tri-County Health Department’s Belleview sitestaff in July.

Intelligence. At the request of U.S. Department ofHomeland Security (DHS), a presentation was given inOctober at a National Department of HomelandSecurity workshop. The workshop highlighted the rolethe division plays in intelligence sharing of publichealth and medical security issues through the Colo-rado Information Analysis Center in the Department ofPublic Safety Office of Preparedness and Security.


Crisis and Emergency Risk Communication. Staffpresented for the Emergency Services Public Informa-tion Officers of Colorado (ESPIOC) at theorganization’s annual conference. The workshopfocused on crisis and risk communication duringemergency situations, incorporating real-life examplesand experiences from public health emergencies andother disasters. In July, the staff also went to Alamosato teach a crisis and risk communication training to agroup of public information officers and electedofficials, including two county commissioners from theSan Luis Valley Region. In October, EPRD provided riskcommunication training to public information officersin the Southeast All-Hazards Region. There were about30 people who attended from a wide range of agencies,including public health hospitals, law enforcement,emergency management and county administration.

Emergency Preparedness Core Competencies for all public health workers

1. Describe the role of public health in emergency response

2. Describe the agency chain of command

3. Identify and locate the agency emergency plan

4. Describe and demonstrate one’s functional emergency response role

5. Demonstrate use of communication equipment

6. Describe communication roles during emergency response

7. Identify limits to one’s own authority

8. Apply creative problem solving skills

9. Recognize deviations from the norm

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Joint Information Center. Staff gave a presentationabout the Democratic National Convention to publicinformation officers from county health agencies. Themeeting, hosted by the Weld County Department ofHealth and Environment, provided an opportunity forpublic health information officers to discuss communi-cation issues of mutual interest. The staff presentationfocused on communications during the conventionand the lessons to be learned from the experiences.

Colorado's Public Health Regional Trainers

Public Information and Risk Communication

Conducting exercises is a critical component ofplanning to ensure that the anticipated actionsduring a State of Emergency are functional,

practical and achievable. Through both the HHSHospital Preparedness grant and the CDC PublicHealth Readiness grant, EPRD supports tabletop andfunctional exercises addressing medical and publichealth response to natural and man-made disasters.

• Medical response exercises support hospital andcommunity mass casualty incident response andmedical surge response.

• Public health exercises support large-scale outbreaks,including pandemic influenza, and activation of theStrategic National Stockpile (SNS) for mass prophy-laxis incidents and medical equipment for patientcare.

In 2004 and 2005, Hospital Preparedness Programgrant funds were given to many acute care hospitalsacross the state to support hospitals and community-based mass patient decontamination exercises. Theseexercises tested the communication and coordinationbetween fire departments, emergency medical services(EMS) transport agencies and acute care hospitals. Theoutcome was an enhanced ability to respond to chemi-cal agent incidents, and to conduct ambulatory andnon-ambulatory patient decontamination and hospitallock-down security to minimize contamination of themedical facilities and health care professionals.

Pandemic Influenza Surveillance and Reporting.Disease Control and Environmental Epidemiology staffworked with regional epidemiologists and hospitalinfection control practitioners to conduct a pandemicinfluenza surveillance and reporting exercise in Octo-ber 2008.

• The exercise tested the state’s plan for surveillanceand reporting of pandemic influenza-related hospi-talizations and hospital deaths.

• The goal was to recruit at least 75 percent of acute-care hospitals with more than 49 beds in the state toparticipate and encourage as many smaller hospitalsas possible.

• Hospital infection control practitioners were pro-vided with Colorado data from the 1918 pandemicto enter into CEDRS, Colorado’s disease trackingdatabase.

Emergency Preparedness Exercises

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• State and local staff are working on modificationsand improvements to plans based on lessons learnedfrom this exercise.

Operation Mountain Move. EPRD developed andsponsored a two-year large scale mass casualty incidentin the High Country to assess and enhance masscasualty response in areas of altitude and restrictedroad access. This exercise was known as OperationMountain Move.

• Phase 1 of the exercise took place in the spring of2006.

• Mountain Move examined communication betweenlocal law enforcement, emergency medical services,county emergency managers and acute care hospitalsfor incident activation and coordination, as well aspatient triage issues and the exchange of security-related information related to the incident.

• Building from this initial response exercise, Phase 2occurred in 2007, incorporating lessons learned inPhase 1 of the exercise.

• After the initial activation for an incident, the focusshifted to the next phase of medical response:activation of mutual aid; coordination of stagingsites and patient movement between the sceneresponders, transport agencies and hospitals; andfinal destination patient tracking.

• Tools such as the Internet-based patient transporttool known as EMSystem and 800 MHz radios,which were purchased via the two grants for localresponse, were tested in both Phase 1 and Phase 2 ofthe exercise.


• Fifty-two agencies in five counties plus three stateagencies participated in Phase 1 of the exercise; 72agencies in 19 counties plus three state agenciesparticipated in Phase 2 of the exercise.

• Both exercises were considered successful for thetesting of mass casualty response plans and coordi-nation. Some jurisdictions participating opted toadd additional challenges at the community-level byadding to the scenario, such as patient decontamina-tion, to test medical surge capabilities.

Other Hospital Exercises. In 2008, individual hospi-tals continued to engage local partners to performother mass casualty exercises. Highlights included:

• Mercy Regional Medical Center in Durango con-ducted an exercise called Operation Yellow Jacketthat involved La Plata and Archuleta counties. Itfocused on incident management, patient transport,patient tracking and patient care. There were morethan 30 participating agencies ranging from emer-gency medical resources, local and state law enforce-ment, fire departments, hospitals, search and rescueand dispatch centers.

• Keefe Memorial Hospital in Cheyenne Wells con-ducted a hazardous material and communicationexercise. It involved both the testing of their commu-nication and notification systems in CheyenneCounty, but also the response and set-up of an off-site surge hospital at a local school. Ten agencies,including representatives from the neighboring stateof Kansas and the National Weather Service, partici-pated in the exercise.

• Melissa Memorial Hospital conducted a mass casu-alty incident exercise that involved implementingand testing the use of the hospital incident com-mand system (HICS), the medical version of theNational Incident Management System (NIMS).This exercise was an internal hospital exercise toenhance staff knowledge and skills in operatingwithin the incident management process.

The public health exercises funded by the CDC grantthat EPRD developed or sponsored were equally allencompassing and successful in enhancing local andstate plans for public health emergency responseefforts.

Fowl Play. In the summer of 2005, EPRD worked withlocal public health agencies, federal and state lawenforcement and CDC for the activation and move-ment of the Strategic National Stockpile (SNS) in alarge-scale exercise known as ‘Fowl Play.’

• Fowl Play, which unfolded over two days, used anavian influenza scenario to test CDPHE’s ability toactivate and receive the SNS shipments, manage theinventory at a temporary warehouse and distributethe appropriate medication and supplies to localpublic health agencies. Activation was authorized bythe Governor’s Expert Emergency Epidemic ResponseCommittee, which initiates the request for the SNS.

• A major focus of the exercise was the communica-tion and the activation of a Joint Information Centerat the local level for the development of consistentpublic information messages at the communitylevel.

• The second day engaged local public health responsein the Northeast and West Regions of Colorado.EPRD tested communication using 800 MHz radiosand the ability to receive requests from local publichealth agencies, process those requests and physi-cally move the requested inventory to the regions.The exercise then progressed to testing the localresponse to receiving the supplies and subsequentlysetting up points of distribution for the public.

• This successful exercise became the foundation formass prophylaxis response. Eight county-levelagencies, nine state agencies and three federalagencies participated. In addition to communica-tion, coordination, logistics and transport capabili-ties outlined in the CDPHE and local public healthSNS plans were evaluated.

Operation Iron Terminus. CDC approached EPRD inJuly 2006 and asked if Colorado would assist in afederal exercise that would test the CDC activation andmobilization steps of the federal SNS plan. Thisexercise, known as ‘Operation Iron Terminus,’ was afull-scale federal exercise involving seven federalagencies in three states: Washington, Colorado andVirginia.


• EPRD led the Colorado component of the exercise,engaging two other state agencies, the ColoradoDepartment of Public Safety and Colorado DivisionEmergency Management, the Governor’s ExpertEmergency Epidemic Response Committee and theRegional Transportation District in Denver, as wellas local public health agencies, county emergencymanagers and a select group of private businesses.

• CDC’s scenario involved the dispersal of aero-solized Bacillus anthracis (anthrax) throughout ametropolitan area and required CDPHE to playnon-stop over a 48-hour period.

• EPRD tested the communication between CDPHEdivisions and with state and local partners as well aswith CDC’s emergency operations center and thefederal partners outlined in the Colorado SNS plan,while CDC tested its communication with itsfederal partners and the state emergency operationscenters.

• CDPHE successfully requested and distributed theSNS resources in a timely manner, ensuring thesuccess of both the state and federal plan for Colo-rado. While other states participated in this federalexercise, Colorado was the first and only state toagree to open and operate an SNS receiving ware-house site in the middle of the night. CDC verbal-ized being impressed with EPRD and Colorado forour ability to adapt and adjust to changes, includ-ing delivery times and scenario changes as theexercise unfolded.

Squawk Talk. EPRD sponsored a large tabletop exer-cise in the fall of 2006 with local public health agen-cies that focused on interagency communication. Thisexercise, called ‘Squawk Talk,’ utilized an avian influ-enza scenario to test interagency communication,collaborative development and delivery of publicinformation messages, and existing Joint Information 18

System (JIS) activation procedures. In addition to localpublic health agencies, four other state departmentsparticipated:

1. Department of Human Services – Division of MentalHealth

2. Department of Public Safety3. Department of Military and Veteran’s Affairs –

Colorado National Guard4. Colorado State University – Veterinary Diagnostic

Laboratory

Pod Squad. EPRD then challenged itself and the localpublic health agencies as well as state partners byexercising four major areas of public health emergencyresponse planning:

1. Mass Prophylaxis2. Emergency Public Information and Warning3. Medical Supplies Management and Distribution

(SNS)4. Emergency Operations Center Management


POD Squad took place over three days in the fall of2007. The scenario was focused on a major influenzaoutbreak and administering the flu vaccine to a largepopulation in the state. CDPHE provided a massvaccination clinic to employees and first respondersfrom agencies that have memoranda of agreement withthe state health department. This allowed for EPRD totest a component of the department’s internal emer-gency response plan and the department’s continuity ofbusiness operations plan.

• The second day of the exercise, EPRD tested theDepartment Operations Center’s ability to managethe full activation of the SNS plan.

• Participants moved influenza vaccine and othermedical supplies to three distant regions in the state:the Southeast, South Central, and San Luis Valleyregions.

• On the third day, all nine public health regionstested their mass immunization plans by distributinginfluenza vaccine to the public from 29 temporaryclinic sites. Several county emergency operationscenters and the State Emergency Operations Center(SEOC) were activated to coordinate exercise activi-ties across the state.

• Public information staff successfully demonstratedits advancements in public health emergency re-sponse by working with the media, developingsimilar or joint messages and coordinating withmultiple local agencies successfully.

CHEMPACK. CDPHE participated in afunctional exercise with local partners incommunication centers, at EmergencyMedical Systems (EMS) agencies and inhospitals for the activation and move-ment of CHEMPACK to hospitals.CHEMPACK is a cache of medicationsintended to support chemical exposures.

Democratic National Convention ExercisesBiowatch. The Colorado Department of Public Healthand Environment, in conjunction with local, state andfederal partners, held a tabletop exercise in May 2008that tested the inter-agency response that would occurin the event of a BioWatch Actionable Result (BAR).BioWatch is an early-warning system that can detectcertain pathogens present in the air. The purpose of theexercise was to provide participants an opportunity toassess the current response concepts, plans, and capa-bilities. The exercise proved to be timely, as there was aBioWatch concern during the convention.

Public Information. Public Information Officers(PIOs) from nine counties representing eight localpublic and environmental health agencies in the NorthCentral Region, including the PIOs from EPRD andCDPHE, held a tabletop exercise in January 2008 todiscuss protocols and procedures for communicatingwith one another in the event of a public health emer-gency – in this case, an inhalational anthrax attackpotentially affecting 2.8 million individuals through-out the entire region.

• The workshop was conducted as part of the CitiesReadiness Initiative’s mass prophylaxis planningefforts to discuss and document how the regionwould establish a Joint Information System and howthat system would coordinate with a state JointInformation Center.

• Participants were also to describe current state,regional and local notification systems; develop“pre-event” messages and press release templates;and how they would utilize existing resources fordissemination to the public.

• The intent of the workshop was to practice how tomost effectively and efficiently communicate consis-tent information to the public when time is of theessence.

• The outcomes of the exercise were incorporated inthe North Central Region’s Cities Readiness InitiativeMass Prophylaxis Plan.

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CO.TRAIN, Colorado’s Public Health LearningManagement System, is the primary methodused by state and local health departments for

emergency preparedness course marketing, trainingand exercise registration and data collection.

Colorado introduced the CO.TRAIN LearningManagement System to the public health workforce inAugust 2004. There are more than 17,000 users andmore than 900 local and online courses have beenmade available on CO.TRAIN since its inception. Everyuser has his or her own record, which contains infor-mation on their accounts and allows them to manageinformation about registered courses, completedcourses and certificates. Users can create a transcript oftheir accomplishments to document requirements.

Colorado’s Learning Management System

The CO.TRAIN reports feature allows the 95 differ-ent, registered course providers to create and viewreports on users and courses. The Colorado Depart-ment of Public Health and Environment, for example,uses the system to track National Incident ManagementSystem training compliance for federal grant purposes.

The CO.TRAIN system can generate numerousreports to track emergency preparedness training andexercise participation, including:

• Number of course participants by course title• Total number of course participants• Number of participants by subject and/or topic area• Number of trainings conducted or released• Participant evaluation results for specific courses• Pre-test and post-test scores for specific courses

Who uses CO.TRAIN?95 Learning Management System Course Providers

• Public health organizations• Emergency management and homeland security• Law enforcement• Non-profits, preschools, colleges and universities• Mental health service providers• Other state and local government agencies within

Colorado

FEMA Incident Command System (ICS) Training Certifications Tracked by CO.TRAIN

Course Name Certifications

ICS-100 Introduction to ICS 3167

ICS-200 ICS for Single Resources and Initial Action Incidents 1058

ICS-300 Intermediate ICS for Expanding Incidents 758

ICS-400 Advanced ICS Command and General Staff—Complex Incidents 405

ICS-700 National Incident Management System (NIMS), An Introduction 3603

ICS-800 Introduction to the National Response Plan 565

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CO.TRAIN by the numbersTotal CO.TRAIN users – 17,093

Total CO.TRAIN course providers – 95

Total Colorado training registrations – 51,911

Total verified training completions – 34,529

Total Colorado course offerings – 985

• On-site classroom trainings – 539• Web-based online trainings – 182• Conference sessions – 158• Exercises – 85• Satellite broadcasts – 21 www.co.train.org

The Hospital Preparedness Program (HPP) helpshospitals and health care systems to prepare forand respond to public health emergencies.

Hospitals, outpatient facilities, health centers,poison control centers, EMS and other healthcarepartners work with their state or local health depart-ment to acquire funding and develop healthcare systempreparedness through this program. Funding is distrib-uted directly to state health departments or politicalsubdivisions of a state, such as cities and counties.

Program PrioritiesThe HPP supports priorities established by the

National Preparedness Goal established by the Depart-ment of Homeland Security (DHS) in 2005. The goalguides entities at all levels of government in the devel-opment and maintenance of capabilities to prevent,protect against, respond to and recover from majorevents, including incidents of national significance.Additionally, the goal helps all levels of governmentdevelop and maintain the necessary capabilities toidentify, prioritize and protect critical infrastructure.

• Current program priority areas include:• Inter-operable communication systems• Bed tracking• Personnel management• Fatality management planning• Hospital evacuation planning

During the past five years, HPP funds have alsoimproved bed and personnel surge capacity, decon-tamination capabilities, isolation capacity, pharmaceu-tical supplies, training, education, drills and exercises.

The Hospital Preparedness Program supportspriorities established by the National PreparednessGoal established by the Department of HomelandSecurity (DHS) in 2005. The goal guides entities at alllevels of government in the development and mainte-nance of capabilities to prevent, protect against, re-spond to and recover from major events, includingincidents of national significance. Additionally, thegoal helps all levels of government develop and main-tain the necessary capabilities to identify, prioritize andprotect critical infrastructure.

The Pandemic and All Hazards Preparedness Act of2006 transferred the National Bioterrorism Hospital

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Hospital Preparedness ProgramKeeping Medical Systems Working

Preparedness Program from the Health Resources andServices Administration to the Assistant Secretary forPreparedness and Response. The focus of the programnow is all-hazards preparedness and not solelybioterrorism.

Authorizing LegislationThe Pandemic and All-Hazards Preparedness Act of

2006 (Public Law 109-417) amended section 319C-2 ofthe Public Health Service Act authorizing the secretaryof the U.S. Department of Health and Human Services(HHS) to award competitive grants or cooperativeagreements to enable eligible entities to improve surgecapacity and enhance community and hospital pre-paredness for public health emergencies.

Program Options• Alternate Care Sites (ACS)• Mobile Medical Assets• Pharmaceutical Caches• Personal Protective Equipment• Decontamination

Program FundamentalsThe following components must be incorporated

into the development and maintenance of all capabili-ties that are funded by the states and jurisdictions:

• National Incident Management System (NIMS)• Education and preparedness training• Exercises, evaluations and corrective actions


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The Colorado Department of Public Health andEnvironment awards competitive grants or cooperativeagreements from HHS to eligible entities to improvesurge capacity and enhance community and hospitalpreparedness for public health emergencies.

Surge capacity is defined as the ability of ahealthcare system to adequately care for increasednumbers of patients. In 2003, as a planning target HPPdefined surge capacity for beds as 500 beds/millionpopulation. In 2006, the HPP expanded the definitionof surge capacity to the ability of healthcare systems totreat the unusual or highly specialized medical needsproduced as a result of surge capacity.


HC StandardProject Goal and Objectives: To provide a resource-tracking and communication tool to healthcare providers.

• Continue developing policy and procedures for thesystem

• Continue to populate data fields• Continue to roll out the system• Continue to train personnel on proper use using

drills and exercises

HC Standard is a web-based emergency responsetool and database that can be used to track internalresources and equipment, contact information, variousreports and mapping features. It was added to ensurehealthcare organizations would be able to integrateand coordinate with each other during an event.

Project Assets

• HC Standard allows coalition partners to shareinformation related to their observations and sup-plies or needs. It provides real-time reporting onresource categories such as ventilators, staff, medica-tions, supplies, patients, etc.

• HC Standard has the ability to upload and shareevacuation plans, floor plans, forms, pictures, etc.∴ This is important in chemical and explosion/mass

casualty as well as natural disaster incidents.∴ The standardized communication foundation

enhances the response capacity and overall coor-dination of medical resources.

∴ HC Standard also is a communication tool thatcan maximize medical surge capability by provid-ing an efficient and rapid mechanism for trans-mitting critical information from the scene to allacute care hospitals.

∴ The overall communication between acute carehospitals, healthcare entities and EMS agenciesthrough this web-based communication toolhelps the organizations support each other,allowing for response integration and partnershipduring incidents. This has been demonstrated incommunity-based exercises.

• HC Standard has the ability to track information ofthe deceased, their location, refrigerated storagecapacity amongst facilities, availability of body bags,transportation information, death certificate statusand disposition of the deceased.

• Hospital evacuation plans can be stored in HCStandard. The plans may be downloaded andprinted directly from HC Standard to ensure thesafety of patients, visiting family members and staffin the hospital during an emergency.

• Locations of Alternative Care Sites can be stored inHC Standard.∴ GIS mapping, with real-time availability of equip-

ment, supplies and personnel related to each ACS∴ Plans, staffing, supply and re-supply information

related to mobile medical capability∴ Designation of emergency contacts that will have

access to the cache∴ Location of caches can be plotted out by autho-

rized users only∴ Real-time data on medications identified by

location and availability∴ Tracking of the locations, types and amounts of

personal protective equipment (PPE)

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Finally, HC Standard supports the program funda-mentals as required by HHS.

• HC Standard offers an inventory of response assets(medical surge supplies, pharmaceuticals, personalprotective equipment, staffing, patients, etc.).

• HC Standard exercises help participants practiceusing the system and building partnerships.

The Hospital Preparedness Program owns HCStandard, powered by two servers at a governmentdata-hosting center in Colorado. A second locationhouses a back-up server, for system redundancy.

EMSystemProject Goal and Objectives: To provide medicalentities a means of communicating alert information.

• Train users on proper use• Purchase Interface Bridge• Expand the NDMS bed poll drill to include other

entities• Maintain and expand the system

Colorado’s bed tracking system is EMSystem, a real-time communication and patient transport system thatenhances preparedness and response to medical emer-gencies, mass casualty events and public health inci-dents. This system can provide the acute care hospitalemergency department bed status, incident patienttracking, mass casualty incident support, hospitalinpatient bed tracking and event alerting notificationswith updates. The system is web-based, facilitatingcommunication about regional emergency resources inreal time and allowing for dispatch communicationcenters, local emergency managers and other adminis-trators to rapidly query hospitals during an event forpatient capacity, by triage category, and other availableservices.

EMSystem is used daily in Colorado to enhance usercompetency during actual events. The reporting func-tion allows users to run various reports to analyzetrends and manage hospital resources on a daily basis,which assists them in understanding their capabilitiesand capacity during surge events. The third partyhosting allows for the system to be operational, inde-pendent of events occurring in Colorado, and incompliance with standards set at the national level.

EMSystem can query hospitals on the followingcategories as defined in the U.S. Department of Healthand Human Services’ HAvBed system:

• Staffed vacant/available bed count∴ Intensive Care Unit (ICU)∴ Medical and Surgical∴ Burn Care∴ Pediatric ICU∴ Pediatrics∴ Psychiatric∴ Emergency Department∴ Negative Pressure Isolation∴ Operating Rooms

• Emergency Department Divert Status – Used dailyfor routine 911-response calls every day for hospitals’divert status, with real-time information that isupdated every three minutes. Hospitals list theirdivert status as ‘Green’ (fully open), ‘Advisory’(certain limitations exists) or ‘Divert’ (divert status).

• Decontamination Facility Available – Used to queryhospitals during an event to determine when eachhospital decontamination facilities are fully func-tional and able to receive patients.

• Ventilators Available – Allows for queries any type ofresource requested, including ventilator quantity andavailability.

Part of the projected system costs include an inter-face for EMSystem and HC Standard. During an emer-gency incident, response time can be affected by havingto operate two separate systems, switching from one tothe other for pertinent information. This interface willallow HC Standard system users to pull data fromEMSystem, populate a standardized form and access theneeded information from one system instead of two.


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Project Goal and Objectives: To improve the healthand safety of communities in Colorado by organizingpublic health, medical and other volunteers.

• Integrate with existing programs and resourcesincluding the hospitals

• Identify, credential, train and prepare in advance forall hazards

• Bolster public health, medical and emergencyresponse infrastructures

Colorado added seven new units in the last grantyear, bringing the state total to 21 units. Medical Re-serve Corps units are community-based, though underthe leadership of the U.S. Surgeon General. The com-munity units provide a means of organizing localvolunteers who want to donate their time and expertiseto promote healthy living throughout the year, and toprepare for and respond to emergencies.

Colorado supports its units with technical assis-tance, training and grants. In the last complete grantyear, CDPHE offered nearly $115,000 in grants, fund-ing that goes right back to the communities in whicheach unit is based. In the current grant year, units areeligible for an additional $3,000 each to purchase 800Mhz radios, the standard for public health emergencycommunications. And, the purchase of medical go-kitshas helped to establish the MRC units as true mobilemedical assets.

Among the 21 units are three with specializedfunctions:

• Joint MRC with a 2,500-resident gated communityand the hospital in its area

• MRC with volunteers who have backgrounds in bothlaw enforcement and medical

• Veterinarian unit

COLORADO'SMedical Reserve Corps

The Medical Reserve Corps is a partner program ofCitizen Corps, the national network of volunteersdedicated to ensuring hometown security. MedicalReserve Corps volunteers support local public healthinitiatives as well as the goals of the U.S. Departmentof Health and Human Services’ Healthy People 2010 andthe priorities of the Surgeon General:

• promoting disease prevention;• improving health literacy;• eliminating health disparities; and• enhancing public health preparedness.

The Colorado units respond and practice as fre-quently as needed. Recent efforts include:

• Alamosa salmonella outbreak• Statewide points-of-dispensing exercise• Sheltering• CDPHE “WhatIf? Colorado” in Wal-Mart and Sam’s

Club stores• Building explosion in Durango• Democratic National Convention

Upcoming MRC activities• Exercises with local, regional and/or state emergency

response partners• Participation in a state-standardized training schedule• Volunteer recruitment• More integration with public health and other

emergency response agencies• Expansion of the number of units within Colorado• Implementation of 800 MHz radio system for

redundant, inter-operable communication• Purchasing and training with personal protective

equipment, cardiopulmonary resuscitation, pulse oxmachines, glucometers and triage tarps


Volunteers Supporting Preparedness

The Colorado Department of Public Health and Environment has two programs to recruit and manage peoplewho would like to volunteer to help their community prepare for and respond to emergencies. The MedicalReserve Corps and the Colorado Volunteer Mobilizer are managed through the Hospital Preparedness Program.

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Project Goals and Objectives: To provide a volunteermanagement tool to be used by local partners and torecruit competent and credentialed volunteers.

• Recruit volunteers and market to local, regional andstatewide public health partners

• Train and educate volunteers• Train regional and local administrators and volun-

teer managers• Integrate with Medical Reserve Corps

The Colorado Volunteer Mobilizer is helping thestate develop and maintain a cadre of competent andcredentialed volunteers who can be activated at amoment’s notice to respond to any type of hazard. As aresult, Colorado will have a confident volunteerworkforce with the skills to sustain themselves andprovide care to others very quickly upon mobilization,instead of just a list of possible medical volunteers.

The Colorado Volunteer Mobilizer (CVM) is a web-based system, first launched in November 2006. Therecurrently are more than 1,400 volunteers within itspublic health and medical volunteer database, includ-ing members of the state’s Medical Reserve Corps units.There are more than 30 local administrators who aretrained to manage the system in their communities andactivate volunteers as needed.

CVM was developed in accordance with the U.S.Department of Health and Human Services’ require-ments for for each state to maintain an EmergencySystem for the Advanced Registration of VolunteerHealth Professionals, or ESAR-VHP.

Colorado Volunteer Mobilizer

CVM in ActionCDPHE administers the CVM, contracting with the

Colorado Association of Local Public Health Officials(CALPHO) to help manage marketing, training coordi-nation, legal issues, system access and networking forthe project. Global Secure, Inc., contracts with CDPHEto maintain the CVM system, including quarterly tests.

CDPHE conducts a background check and docu-ments the credentials of each volunteer. This circum-vents the problems of the past where well-intentionedvolunteers want to help, but emergency managementstaff are not able to quickly verify their medical li-censes. Individuals register themselves online, whichtriggers the credentialing process by Hospital Prepared-ness Program staff. After the credentials of the regis-tered volunteers are confirmed, the program uses theColorado Bureau of Investigation to complete back-ground checks, at a cost of $7.00 per individual record.CVM collaborates with the Department of RegulatoryAgencies, which issues renewal notices to people withmedical licenses. CVM registration is expected toincrease significantly within the year, as 60,000 peoplewith medical licenses that are up for renewal willreceive information about CVM.

Volunteers who are approved are required to have abasic understanding of the National Incident Manage-ment System (NIMS) by taking, at minimum, theIncident Command System 100 and 700 courses. Uponcompletion of the training regimen, these individualsare now considered “deployable” volunteers for theState of Colorado, and receive approved, standardizedcredentials developed at the local level.

Volunteers are encouraged to put their training touse in exercises. Exercises test protocols, confidentialityagreements and emergency and volunteer managementprinciples. Future efforts will be geared to increasingthe participation of mental health specialists.

Since the Colorado Volunteer Mobilizer coordinatorand the State Medical Reserve Corps coordinator areboth located at CDPHE, these programs are fullyintegrated, giving MRC coordinators ready access totheir volunteers’ contact information and credentials.

continued on following pagehttps://covolunteers.state.co.US

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Project Goal and Objectives: To inform, educate andintegrate physicians regarding public health emergencyresponse and medical surge. Colorado physicians will:

• Integrate with public health and hospital surge plan-ning through regional partnerships and coalitions.

• Exercise to identify gaps in disaster planning includ-ing hospital surge, alternate care sites, fatality man-agement, medical evacuation and communications.

• Register on CO.TRAIN and participate in volunteertraining to respond better to an event.

• Prepare through continuity of operations planning.• Understand what is needed to prepare themselves

and their families for a disaster, understanding whatwill happen when a large-scale response is initiated.

The Colorado Medical Society, with its componentand specialty societies, works closely with Coloradohospitals to help achieve specific benchmarks:

• Communications: All hospitals demonstrate dedi-cated, redundant communications capability duringan exercise or incident.

• Volunteer Management∴ 60% demonstrate the ability to query the Colo-

rado Volunteer Mobilizer and generate a list ofpotential volunteers by discipline and credentiallevel within two hours or less of request.

∴ 60% can compile an initial list of volunteers, bydiscipline and credential level, within 12 hours orless of request.

∴ 60% can report a verified list of available volun-teers, by discipline and credential level, within 24hours or less of request.

• Planning: All hospitals have written plans for massfatality management and medical evacuation thatinclude personnel, training, equipment and supplies,transportation, alternate facilities, standard operat-ing procedures and senior management approval.

• National Incident Management System∴ All hospitals have incorporated National Incident

Management System (NIMS) concepts and prin-ciples for handling emergency events.

∴ All hospitals have had the appropriate personnelcomplete Incident Command System 100, 200,700 and 800 courses.

Colorado Medical Society

∴ All hospitals participate in training or exercisesthat incorporate NIMS and provide after-actionreports that comply with federal requirements.

• Regional partnerships/coalitions: All hospitalswork with their all-hazards region to develop anoperational partnership/coalition and memorandaof understanding.

The Colorado Medical Society’s primary activitiesfor CDPHE include:

• Integration – increase communication and coordi-nation of the physician community to bridge thehospital-physician gap and improve hospital surgecapacity.

• Exercising – integrate physicians into emergencyresponse efforts through preparedness exercises withregional hospitals, local public health and emer-gency management. Exercises focus on topics includ-ing alternate care sites, communication and volun-teering. With these exercises, physicians can help byidentifying gaps in disaster planning, learn how toperform work under disaster conditions and buildrelationships with local emergency partners.

• Volunteer preparedness – CMS compiles lists ofphysicians interested in volunteer opportunities,targets interested physicians by encouraging andfacilitating registration with the Colorado VolunteerMobilizer and local Medical Reserve Corps, encour-ages physician volunteer attendance at trainingprograms throughout the state, works with the stateCVM coordinator to make required trainings acces-sible to physicians and works with the state MedicalReserve Corps coordinator to increase MRC capacitythroughout the state.

• Business preparedness – distribute materials andoffer education to medical practices without conti-nuity of operations plans, tests existing plans andintegrates plans into local and state emergencymanagement planning.

• General emergency preparedness training – trainColorado physicians for disasters, including a pan-demic; keep physicians informed about any poten-tial disasters in the state, nation and world, and whatlocal hospitals are currently doing to prepare fordisasters including pandemics.


Project Goal and Objectives: To increase networking,training and support for the hospital and medicalresponse community through the recently developedDisaster Behavioral Health System.• Continue the development of the “Resilience in the

Workforce” training; provide the “Pandemic Influenza:Quarantine, Isolation and Social Distancing: Toolbox forPublic Health and Public Behavioral Health Profession-als” training at least three times.

• Complete the CoCERN plan for a statewide behav-ioral health network; educate the emergency/medicalresponse community of its availability for support.

• Address gaps identified in the CoCERN tabletopexercise.

• Advance standardization for disaster behavioralhealth; register at least 350 individuals in the Colo-rado Volunteer Mobilizer.

• Collaborate with the North Central Regional SpecialNeeds Committee and find better ways to respond tospecial needs populations.

Mental health aspects of a disaster and the needs ofat-risk populations during emergencies continue to befelt as recovery continues from the Hurricane Katrinadisaster. This recovery process has once again shownthe importance of addressing the mental health needsof responders.

The Colorado Department of Public Health andEnvironment’s Emergency Preparedness and ResponseDivision contracts with the Colorado Division ofBehavioral Health (formerly Mental Heatlh) for theseservices.

The Colorado Division of Behavioral Health(CDBH) is continuing its “Resilience in the Workforce”training. This year, this training and three others willbe converted into electronic format for onlinetraining,resources permitting, including a podcastavailable on the CDPHE and CDBH websites. CDBH ismarketing its training across the state, starting at eachof the local public health agencies and expanding intothe hospitals and the medical community.

In developing CoCERN, CDBH is collaborating withpublic health, hospitals, Colorado chapters of theAmerican Red Cross, COVA (Victim Advocates),COVOAD (Colorado Volunteer Organizations Active in

ColoradoDivision oF behavioral Health

Disaster) and other identified behavioral health re-source agencies.

Last May, CoCERN participants had a tabletopexercise with representatives from CDPHE, COVOAD,Tri-County Health Department, community mentalhealth agencies, U.S. Veterans Affairs, police andsecurity and the Colorado Division of EmergencyManagement. The goal was to put the CoCERN struc-ture and the communication system to the test. Threeneeds arose during the tabletop exercise, which CDBHis addressing during the 2008-2009 grant cycle.

1) Regional training on CoCERN involving COVOAD,police, behavioral health and other local emergencymanagement partners.

2) Continuing exercises and trainings using realisticscenarios emphasizing communications within andbetween CoCERN partner agencies.

3) A CoCERN job aid for field staff, including incidentcommand structure and CoCERN structural/commu-nication system job descriptions.

An important component of the CoCERN behav-ioral health network is communications. CoCERN’sbasic communications and technology plan integratesbehavioral health assets with the larger public healthand emergency management disaster response system,for significant improvement regarding communicationin a crisis for behavioral health.

CDBH has worked closely with the ColoradoVolunteer Mobilizer (CVM) to develop trainings forvolunteers and a post-deployment brief screening tool.The goal is to have at least 350 individuals registered inCVM who have credentials in behavioral health fields.

Furthering CDBH’s work on a regional behavioralhealth response network, the agency has reached out tothe 10 states from U.S. Regions VIII and VII. The otherstates are very interested in the CoCERN model, whichhelps all states strengthen their deployment and re-sponse capacity.

This year, the Colorado Division of Mental Health isexpanding its connection with the North CentralRegional Special Needs Committee to improve re-sponse to individuals and communities with specialneeds during a disaster.


Project Goal and Objectives

To help hospitals integrate and improve emergencypreparedness, which in turn will make Colorado’shealthcare systems function in a more efficient, resil-ient and coordinated manner.

• To integrate hospital response plans into the broaderNational Response Framework and National Inci-dent Management System.

• To help hospitals comply with the requirements ofthe National Incident Management System.

• To support training and exercises for hospitals toincrease their capacity to respond and manage surgesin healthcare needs.

• To improve communications between hospitals andpublic health.

CDPHE collaborated with the Colorado HospitalAssociation in a research study on hospital surgecapabilities. The result, a final report entitled“Healthcare Preparedness and Surge Capacity Evalua-tion in Preparation for the Democratic National Con-vention,” offered recommendations for hospitals, EMS

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Colorado Hospital Associationproviders and emergency management agencies to fillidentified gaps in the North Central Region for theDemocratic National Convention. The contract alsofunded video conferencing equipment to enable CHAto conduct trainings for hospitals throughout the statefrom its base in Denver.

For one grant year, the Colorado Hospital Associa-tion focused on helping hospitals get training for NIMScompliance, contracting with nationally known sub-ject-matter experts to develop a series of statewideregional training programs. The association alsoformed an advisory group to develop templates for astatewide memorandum of understanding. Hospitalsdid their part by identifying areas of agreement andresource-sharing within and between Colorado hospi-tal systems.

This year, the association added special populationsneeds to its goals. CHA will work to improve cross-cultural understanding and identify common groundfor collaborative projects and efforts between local andstate public health, emergency management and otherspecialty partners.

Project Goal and Objectives: To provide Colorado ameans to get needed funding to hospitals in rural areas.

• To provide the state a means of funding projectswith numerous small hospitals and other ruralhealthcare providers.

• To help hospitals purchase equipment needed forsurge capacity.

• To reimburse healthcare providers in rural areas foractivities such as training or exercises.

The Colorado Rural Health Center (CRHC) contractwas created to fund preparedness projects for ruralhospitals and healthcare providers within very time-restrictive grant cycles. The level of complexity fortraining and exercises is increasing this year, followinggoals of the Hospital Preparedness Program to build

capabilities, in addition to increased capacity. Participa-tion in healthcare coalitions, another grant require-ment, will include planning for regional Alternate CareFacilities, in preparation for a statewide full-scaleexercise. This collaboration creates the partnershipneeded for emergency response and medical surgecapability.

The grant also expands 800MHz communications tonew areas and for base stations and antennas. CRHC isimproving the capacity to manage mass fatalities andand facility evacuation by funding planning, training,exercises and equipment needed for these purposes. Inkeeping with the projected needs associated with apandemic, the CRHC also is helping hospitals developtheir Strategic National Stockpile plans.

Colorado Rural Health Center


Western Slope CacheProject Goal and Objectives: To maintain emergencyequipment and supplies in a location prone to supplyroute disruption due to the geographic location.• To develop deployment and distribution policy and

procedures.• To continue integrating regional medical response

partners, expanding to the 21 counties west of theContinental Divide in Colorado.

• To develop just-in-time training for emergencywarehouse operations.

• To design and execute one activation and trainingtabletop exercise in cooperation with area medicalresponse partners.Every winter, transportation and supply lines are

paralyzed on Continental Divide passes. The WesternSlope Cache is a pilot project that pre-positions emer-gency medical supplies in western Colorado, developsstrategies for estimating needs, purchases and ware-houses the supplies, develops inventory managementmethodologies and creates cache deployment protocolsfor the supplies.

Mesa County Health Department manages theproject as the area’s ESF#8 lead agency. This year, MesaCounty will:

• Expand from 16 counties to all 21 counties in thethree all-hazards regions in western Colorado,including supply projections, product rotation,standard operating procedures, transportation plans,security and at least one activation exercise thatincludes volunteers.

• Expand the number of memoranda of understand-ing from 10 hospitals to all 20 in western Colorado,and develop memoranda of understanding withpartners such as Red Cross, service clubs and retailersfor emergency use of their durable goods.

• Update, standardize and coordinate the contents ofmedical surge trailers in the region with supplies thatare in the main cache.

• Help CDPHE develop plan for stockpiling suppliesthroughout the state by creating guidance and atoolkit for establishing warehouses.

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Supply Coordination

El Paso County Alternate Care Center CacheProject Goal and Objectives: To establish a sustain-able mobile and stationary cache of medical equip-ment to support the operations of alternate carecenters in El Paso County.• Purchase medical supplies to support the predeter-

mined level of care for alternate care centers• Purchase medical supplies and equipment to sup-

port on-scene triage activities• Develop or purchase an inventory tracking system

The El Paso County Alternate Care Center Plan wasdeveloped by a multi-agency coalition as a realisticplan for providing basic care to patients when anoverwhelmed medical system would be unable to doso. Healthcare providers can offer the most good forthe greatest number of people while using limitedresources.

The stationary cache will support the operation ofalternate care centers, when hospitals are at capacity orpatients must be diverted from the hospitals for otherreasons, such as infectious disease. The Alternate CareCenter Plan describes the operational execution andconsiderations, and the logistical and staffing require-ments associated with alternate care centers:

• Facility: location, size, characteristics, security needs,resources, supplies

• Staffing: personnel needs, volunteers, credentialing• Philosophy of care: disaster care vs. non-disaster

care, agent-specific care vs. generic care, alteredstandard of care in mass casualty environments

• Command, control and communication: IncidentCommand System

• Integration with federal and state response: frame-work of local response compatible with outsideresourcesFor planning purposes, the alternate care centers

must care for patients until the local healthcare systemrecovers enough to absorb the extra patient load. ElPaso County is evaluating current caches and suppliesto ensure the most efficient use of funds.

The Hospital Preparedness Program manages two projects that make sure that supplies are available through-out the state. These caches are vivid examples of the collaborative efforts of emergency preparedness and responsestaff throughout Colorado. Without these caches of medical supplies, “surge capacity” resources would be con-centrated in the metropolitan area, making access difficult, if not impossible in some situations, for those re-sponders in other areas.


Project Goal and Objectives: To help federally quali-fied health centers (FQHC) integrate and enhancepreparednessto encourage Colorado’s healthcaretofunction in a more efficient, resilient and coordinatedmanner during emergency incidents.

• Help federally qualified health centers (FQHC)adopt NIMS-compliant emergency managementplans, trainings and exercises.

• Integrate FQHC planning with regional partnershipsand coalitions.

• Ensure that all FQHCs have redundant communica-tions with emergency response partners.

• Assess FQHC role in supporting vulnerable patientpopulations in disaster.

The project began with a survey of Colorado’s 15federally qualified health centers (FQHCs) to gaugetheir level of preparedness. The survey found that onlyone FQHC had an emergency management plan inplace and only a few were involved in any kind ofcommunity emergency planning. The Colorado Com-munity Health Network created a health center emer-gency management plan template, incorporating statebioterrorism and federal hospital requirements, for theFQHCs and the rural health clinics. The CCHN emer-gency preparedness manager worked with each FQHC

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on pandemic flu and all-hazards plan development, allbased on a hazards vulnerability analysis.

Each FQHC was provided with an 800 MHz radioand training, with quarterly communications exercisesto test the equipment and users. NIMS training forCCHN and FQHCs allowed staff to participate incommunity-wide exercises. The benefit of the emer-gency preparedness program was demonstrated whenone FQHC, Valley-Wide, activated its plan and usedNIMS and incident command system principles torespond to the Alamosa salmonella outbreak. Valley-Wide was able to keep open two family practice clinics,one dental clinic, a women, infants and children (WIC)office, a physical therapy practice and the administra-tion building. They were able to continue serving thepeople in 14 counties without usable running water.

FQHCs play a crucial role in disaster and emergencypreparedness, especially in the rural communities.CCHN is committed to supporting the 118 fixed-clinicsites in their efforts to achieve high levels of readiness ofpeople and resources in the event of a disaster or emer-gency incident. In year three, CCHN is working todevelop and strengthen FQHC relationships withregional and local emergency partnerships and coali-tions, for a more cohesive medical community response.

During recent emergencies in El Paso Countyinvolving multiple patients, such as the New LifeChurch shooting and the Castle West Apartment fire,rapid deployment of additional medical equipmentand supplies was critical to reinforce pre-hospital care.With this year’s grant, the Colorado Springs Fire De-partment will expand the treatment capacity of itstrailer from 70 to 100 patients. Equipment may includea generator, a portable shelter, lighting and heating. Inthe event that a mass casualty incident occurred withina city, town or rural area, this trailer could provide anenclosed treatment area until victims can be trans-ported to hospitals or alternate care centers. The Colo-rado Springs Fire Department will provide a truckcapable of towing the trailer and the personnel re-

quired to transport the trailer when it is requested,from among its 119 personnel on-duty every day, forthe most rapid deployment possible. The local agenciesare responsible for replenishing supplies as needed.

This project is coordinated with the MetropolitanMedical Response System to leverage funding. El PasoCounty is planning to have a full-scale exercise in thefuture to test the capabilities of the responding agen-cies, the alternate care centers and resource and supplymanagement.


Project Goal and Objectives: To build Colorado’scapacity to address the needs of people with LimitedEnglish Proficiency during an emergency incident,particularly pertaining to Asian and Hispanic commu-nities.

• To develop communications trainings for hospitalsthat will help hospital staff assist Asian patientsduring an emergency incident.

• To help hospitals locate, exercise and begin usingmedical interpretation training and/or services.

• To help hospitals apply principles of Limited EnglishProficiency communications related to Asian andSpanish languages and cultures during an emergencyincident.

Colorado Asian Health Education and Promotionthe Hispanic Medical Health Organization have devel-oped partnerships with the Colorado Hospital Associa-tion, Colorado Medical Society and the ColoradoDepartment of Public Health and Environment toimprove interactions with the Limited English Profi-ciency (LEP) population, designated as a special needspopulation, within Colorado hospitals.

• Assessment of LEP capacity in hospitals• Basic training for those with no current services• Resources related to medical interpretation for

bilingual physicians and staff• Exercises to acclimate hospitals to working through

LEP issues in an incident

Reaching people with limited english profiency

The importance of outreach to populations withspecific cultural needs or communication barriers is avital, yet labor-intensive, component of preparingColorado communities. The Hospital PreparednessProgram issued two grants this year to help CDPHEhelp others prepare communities with limited Englishproficiency.

Time and again, research shows that difficult mes-sages are best delivered by someone who is trusted bythe message recipients. For many groups, that meanssomeone who understands their cultural background.Working through local advocacy groups, Colorado isdeveloping model programs for reaching communitieswith special needs. The Hospital Preparedness Program

funds two agencies,Colorado Asian HealthEducation and Promotionand Hispanic MedicalHealth Organization, tobuild relationships be-tween Asian and Hispaniccommunities and theColorado Department ofPublic Health and Envi-ronment, and to teach twogroups from the Denverarea more about emer-gency preparedness andresponse.

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The Public Health Information Network (PHIN) is anational initiative to promote the electronic exchangeof information among public health agencies. Thestandards and technical requirements are determinedby best practices related to efficient, effective andinteroperable public health information systems thatsupport both routine public health activities andemergency preparedness and response. The Center forDisease Control and Prevention (CDC) serves as thefacilitator of the PHIN community and the steward forPHIN resources.

Public Health Information Network (PHIN) certifi-cation provides an objective assessment, designed toevaluate the compliance of public health informationsystems with PHIN Requirements Version 2.01. The goalof PHIN certification is to support the developmentand implementation of applications and informationsystems that comply with the PHIN requirements. Thishelps ensure that public health partners can securely,effectively and efficiently exchange data. PHIN certifi-cation is designed to provide meaningful and achiev-able targets, a consistent method to report capabilitiesand demonstrate progress. It also offers flexibility tosupport the evolving nature of PHIN and the Nation-wide Health Information Network (NHIN).

Public Health Information Network Partner Communication and Alerting Certification

PHIN certification recognizes the ability of anapplication (or multiple applications, components orsystems) to perform specific functions in compliancewith the PHIN requirements and certification criteria.There are several modules in which a health depart-ment can be certified.

PHIN Direct Alerting was one application for whichColorado sought certification in January 2009. Colo-rado was the first jurisdiction to achieve PHIN Certifi-cation in the area of direct alerting.

“Colorado’s efforts and willingness to be the first jurisdiction to successfullycomplete this task is noteworthy, and should be commended. While the PHINCertification Criteria validated your ability to send a Direct Alert to the CDCusing PHIN standards and security, this accomplishment has broader implica-tions. It demonstrates Colorado’s commitment to implement PHIN standardsand practices that improve your overall capacity to exchange electronic publichealth information across jurisdictional lines, a benefit during both emergencyand day-to-day operations.” --Mark N. Winarsky, CDC1

1 Mark N. Winarsky, MPA, IT Project Manager Team Lead, PHIN Support Team, Division of Alliance Management and Consultation, National Center for Public HealthInformatics, Coordinating Center for Health Information and Service, Centers for Disease Control And Prevention

Mission: to improvethe capacity of publichealth to use andexchange informationelectronically bypromoting the use ofstandards and definingtechnical requirements.

Thanks to funding from the Hospital PreparednessProgram within the Emergency Preparedness andResponse Division at Colorado Department of

Public Health and Environment, Denver Health hasbeen able to purchase close to $400,000 worth ofequipment to strengthen the efforts of emergencypreparedness at Denver Health. These are just a fewexamples of some of the things Denver Health haspurchased and used. All of these items contributed tothe overall preparedness of Denver Health by increas-ing the surge capacity, communication and decontami-nation capabilities.

1. 325 cots for increased surge capacitya Ten are stored outside the Emergency Department

(ED) for quick access and to help the immediateED surge. Twenty cots are stored in a closet for aninitial surge into the hospital. The rest are storedon campus and can be accessed and distributedquickly.

b, Ten cots were sent to Denver Cares for the DNC inanticipation of a surge.

c. The cots were also used in disaster exercises:deploying in the ED, moving patients to inpatientunits with cots and converting one of the nursingunits into an alternate care site.

d. Each inpatient unit used the cots to “practice”surge on their floors. Cots were set up in rooms tosee which could be doubled up and some wereplaced in conference rooms and hallways. Thisallowed planners to project the maximum surgenumber for Denver Health.

2. 800 MHz radio for effective communicationa. Although the Emergency Department has several

MACOM radios, those do not work with the otherhospitals’ 800 MHz radios.

b. Denver Health purchased an 800 MHz Motorolaradio to be used in the hospital command centerin emergencies. The radio has been used duringexercises.

3. Triage tagsa. New triage tags were purchased after it was discov-

ered in an exercise that the older triage tag was notan effective tool for the Emergency Department.No one was completing the information on thetag, and its parts were ripped off and discarded.

In Their Own Words: Denver County

By Chuck Smedly, Emergency Preparedness and Response Program Manager, Denver Public Health

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Denver Health is the state’s biggest providerof care for the uninsured, providing about $276million last year in uncompensated care.Approximately 25 percent of all Denver resi-dents, or about 160,000 people, receive theirhealth care at the hospital.

Denver Health is an essential healthcareprovider and a major corporate contributor tothe well being of Colorado. It is nationallyrecognized for its integrated health care system,contributing not only to personal, communityand public health, but also in significant waysto the economic health of the community, thehealth care industry and the state.

b. Colors on the tags werehard to see and the tagsall had to be thrownaway after a single use.

c. To replace these triagetags, a bracelet style wasordered. They can goaround wrists or ankles,are reflective, and aremore easily spotted andapplied.

d. The new tags were tested in another mass-casualtyexercise and the feedback was very positive.

4. Decontaminationa. One of the big initiatives this year has been

decontamination.b. Decontamination supplies, including shampoo,

sponges, squeegees, brushes and other suppliesthat are necessary for the decontamination processwere purchased with funding from the HospitalPreparedness Program.

Denver HealthColorarado’s Largest Safety-Net

Healthcare System

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The Waste Isolation Pilot Plant (WIPP), thenation’s repository for defense-related transu-ranic radiological wastes, is located 26 miles

southeast of Carlsbad, New Mexico. The facility is builtin a 250 million year-old salt formation 2,150 feetbelow the surface. Wastes generated from research,development and production of nuclear weapons at USDepartment of Energy sites across the country aretransported by highway to the WIPP.

Regional CooperationThe State of Colorado has been working with the US

Department of Energy for more than 22 years, bothindependently and with a coalition of 11 other westernstates through the Western Governors’ Association, tomaintain a system for safe and uneventful transport ofradioactive materials through western states. The WIPPTransportation Safety Program is a collaborative effortamong the shipment-corridor states, tribes, localofficials and the US Department of Energy. The pro-gram goes well beyond what is required by law. Noother shipments on the road have undergone as muchscrutiny by transportation safety specialists as WIPPshipments.

History of Radiological Waste ShipmentsThe leaders and residents of Colorado are concerned

about the transportation of radiological wastes throughthe state. The Colorado Waste Isolation Pilot PlantProgram has accomplished a great deal in implement-ing and maintaining a rigorous preparedness andresponse program for shipping along the Interstate 25corridor. Preparedness activities have been focused inthe areas of accident prevention, planning, training,public education and collaboration between states andthe regional coordinating groups across the nation.

Back in 1970, the US Department of Energy (DOE)stored transuranic wastes from the production of thenation’s nuclear weapons at the Rocky Flats Environ-mental Technology Site and at other facilities through-out the nation. By 1987, preparations for waste ship-ments to the Waste Isolation Pilot Plant were under-way, and the transports to WIPP began in late March1999. One month later, Colorado experienced its firstshipment of transuranic waste shipments through thestate. Over the almost 30-year life of WIPP, it has been

WIPP transportation safety programKeeping Radiological Waste Shipments Safe and Secure

projected that 74.8 percent of all DOE transuranicwaste in the United States will move through Colorado.

There are four main sites from which the waste iscarried:

1. Idaho National Laboratory2. Rocky Flats (completed in April 2006)3. Hanford Site in Washington4. Argonne East site in Illinois

The conclusion of WIPP shipments is tied to theclosure of Hanford Site., which is expected to be thelast site to be completed. In addition, it is anticipatedthat there will be some site-to-site shipments. Forinstance, shipments are occasionally made to Idahofrom Los Alamos National Laboratory or the SavannahRiver Site in South Carolina.

At the regional level, Colorado and other westernstates developed protocols in collaboration with theWestern Governors’ Association (WGA), the US Depart-ment of Energy and other interested agencies for thesafe transportation of transuranic waste to WIPP.

Radioactive Transuranic WasteTransuranic wastes are generated primarily during

the research, development and production of nuclearweapons. The waste is contaminated with man-maderadioactive materials and consists primarily of dis-carded items such as laboratory clothing, tools, plastics,rubber gloves, wood, metals, glassware, ash, and solidi-fied waste. There are no free liquids in the drums.


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• Transuranic waste is contaminated with radioactivematerials that have atomic numbers greater thanuranium, such as plutonium, americium and curium.

• Transuranic waste is officially defined as wastecontaminated with alpha-emitting radionuclideshaving atomic numbers greater than 92 and withhalf-lives greater than 20 years and in concentrationsgreater than 100 nanocuries per gram of waste.

• Transuranic waste isotopes remain radioactive for along period of time and must, therefore, be handledseparately from other wastes.

• Some of these wastes, known as “mixed” transuranicwaste, also contain hazardous chemical constituents.

• Most of these wastes are “contact-handled,” meaningthat the radiation they emit does not require heavylead shielding. The primary radiation hazard posedby this waste is through inhalation or ingestion.

• The remaining waste is referred to as “remote-handled” because it requires heavy shielding andpresents a much more significant external radiationhazard than contact-handled waste. About fourpercent of WIPP-bound waste by volume is classifiedas “remote-handled.”

Waste Transportation ContainersAll transuranic radioactive waste is transported to

the WIPP in US Nuclear Regulatory Commission-certified Type B containers, even though the highlysecure containers are not required. Type B casks havebeen designed to withstand any conceivable trafficaccident, with much stronger packaging than thatwhich is used in the transport of other hazardousmaterials.

All contact-handled transuranic wastes are trans-ported in the Transuranic Packaging Transporter(TRUPACT-II), a reusable shipping package or “cask,”certified by the Nuclear Regulatory Commission.Remote handled transuranic waste must be shipped indifferent containers that provide more shielding frompenetrating gamma radiation.

Accident PreventionMost truck accidents can be avoided by alert, skilled

drivers who avoid driving when road and weatherconditions are particularly hazardous and who usehigh quality, well-maintained equipment. These pre-ventive measures were used in developing the accidentprevention portion of the program to reduce the risksassociated with transporting hazardous materials.

• Driver and Carriers. The US Department of Trans-portation sets standards for drivers of trucks thatcarry hazardous cargo. The Department of Energyagreed to go beyond these requirements for its WIPPdrivers and carriers. DOE has contracted with dedi-cated carriers whose drivers have extensive, accident-free experience. WIPP drivers are subject to unan-nounced drug testing and are given no financialincentive to drive at excessive speeds. The states havea program to audit the shipping contractors forcompliance with the vehicle and driver require-ments. The Colorado State Patrol audits the Colo-rado-based WIPP motor carrier, CAST Transporta-tion, on behalf of the Western States Governors’Association.

• Independent Inspections. To identify and correctany mechanical defects in the vehicle and to ensurethat radiation levels are within allowable limits, allshipments are subject to multiple inspections bystate officials using safety standards that are muchmore stringent than those for other hazardousmaterials shipments. The uniform inspection proce-dures are called the “Commercial Vehicle SafetyAlliance (CVSA) Enhanced North American SafetyInspections – Level VI.” CVSA inspections areconducted by specially trained state inspectors threetimes: prior to departure from the generator site,upon entry into Colorado and when the shipmentreaches the WIPP site. In addition, in compliancewith their contract with the Department of Energy,drivers are required to stop approximately everythree hours or 150 miles to conduct a mechanicalinspection of the vehicle.


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• Bad Weather and Road Conditions. The states andthe Department of Energy have agreed on proceduresto monitor weather and road conditions so thatshipments can avoid hazards. If unexpected badweather or road conditions are encountered, pre-selected safe parking areas are available at specificmilitary facilities or Department of Energy sites. Noshipments are scheduled during rush hour traffic inmajor metropolitan areas in Colorado.

• Shipment Notification and Tracking. All transu-ranic waste shipments are monitored and trackedthrough a satellite-based system called TRANSCOM.The State of Colorado has direct access to thissystem, which provides shipping schedules and real-time tracking of shipments on the road. ColoradoState Patrol, Port of Entry and the Colorado Depart-ment of Public Health and Environment monitorthe system. TRANSCOM allows communicationswith drivers and immediate emergency responseguidance information, if necessary. Satellite digitalphones are available on each truck.

Transportation PreparednessEmergency preparedness is a significant part of the

WIPP Transportation Safety Program. While the ship-ments are conducted in such a way as to preventaccidents from occurring, if one does take place, thestate and local jurisdictions are prepared to respondquickly, safely and effectively.

• Emergency Response Plans and Procedures. A well-organized and coordinated effort is necessary for aswift and effective response to an accident. Emer-gency responders along the route have plans andprocedures in place to deal with transportationincidents involving the WIPP shipments. The State ofColorado has prepared several guidance documentsthat specify notification and response procedures foruse in the event of a WIPP accident.

• Training. The Department of Energy has developed atraining program, recognized by the US Departmentof Homeland Security and OSHA, called “ModularEmergency Response Radiological TransportationTraining” (MERRTT). MERRTT has 16 concise andeasy to understand modules that can be integratedinto existing programs for hazardous materialtraining. MERRTT exclusively covers Hazard Class 7radioactive material and builds on informationreceived in other hazardous material courses. Thecourse covers awareness, operations and technician-level radiological training.

∴ The Colorado WIPP Program identified an unmetneed for medically-based radiological training.While it is highly unlikely that a patient would beradiologically contaminated as the result of aWIPP accident, the Department of Energy nowprovides a training program for hospital andprehospital personnel.

∴ The Department of Energy recently partnered withFEMA in the revision of FEMA Course G-346,“Hospital Emergency Department Management ofRadiation and Other Hazardous Materials Acci-dent.”

∴ To meet the needs of medical examiners andcoroners, and at the request of the ColoradoWIPP Program, the Department of Energy devel-oped a specialty course called, “Recovery, Accep-tance, and Handling of Radiologically Contami-nated Human Remains.”

• Exercises. Exercise programs are an integral part of atraining program. The Department of Energy sup-ports two full-scale exercise activities a year, calledWIPPTREX, in the Western States. The exercises aredone by the states on a rotating basis.

• Emergency Response Equipment. Radiation detec-tion equipment has been provided to emergencyresponders and hospitals along Interstate 25, theWIPP transportation corridor through Colorado.Responders have been trained to properly use thisequipment in the event of any radiological incident.

Public InformationColorado WIPP developed a comprehensive website

(www.cdphe.state.co.us/epr/rad.html) with links to keyagencies, programs and topical information, including:

• Management of radioactive materials and radiationservices including licensure


• Radiological information for professionals (emer-gency response personnel, public health and envi-ronment, medical personnel and clinicians, medicalexaminers, coroners and crime scene investigators)

• Radiological information for the general public• Gubernatorial Radiological Waste Transportation

Policy through the Western Governors’ Association• National regional planning effort across the nation• Training and education• Fact sheet and additional resources

Other Radiological Waste CampaignsCommunication, collaboration, coordination and

consultation are the keys to effective radiologicaltransportation planning at a local, state, regional andnational level. Regional planning for the shipment ofnuclear waste began in the Western United States andhas spread across the nation.

Through the Western Governors’ Association andthe Western Interstate Energy Board, the ColoradoWIPP Program works with other regional groups acrossthe United States including the Midwestern Council ofState Governments, Northeastern Council of StateGovernments and the Southern States Energy Board.The regional groups work with the Department ofEnergy, the Nuclear Regulatory Commission and theUS Navy on developing the transportation plans andpublic information outreach for other campaigns ofradiological waste as well.

Radiological WasteTransportation Policy

Colorado is a member state of the Western Gover-nors’ Association as well as the Western InterstateEnergy Board. The Western Governors’ Associationaddresses important policy and governance issues,advances the role of the Western States in the federalsystem and develops policy. The Western InterstateEnergy Board serves as the energy arm of the WesternGovernors’ Association. Through both organizations,Western governors contribute to the federal effort tomove defense-related waste and to anticipate programneeds for shipments of commercial spent nuclear fuelto interim or permanent geologic storage.

• Defense-Related Waste. In 1987, the Western Gover-nors’ Association expanded its mission to include USDepartment of Energy radioactive waste transporta-tion issues. A collaborative relationship was estab-lished with the US Department of Energy to develop acomprehensive transportation safety program forshipments of radioactive waste to interim and perma-nent storage sites across the nation. Since the major-ity of major storage sites are in the western UnitedStates, the WGA attends to all waste streams that arethe result of cleanup of defense operations. WGApassed resolutions conveying the interests and poli-cies of the Western governors:∴ Policy Resolution 06-4: U.S. Department of

Energy Waste Isolation Pilot Plant and Transporta-tion of Transuranic Waste

∴ Policy Resolution 08-5: Department of EnergyFacilities Cleanup Program

• Commercial Spent Nuclear Fuel and High-LevelWaste. The Western Governors’ Association, throughthe efforts of the Western Interstate Energy Board,supports the objective of permanent, safe geologicdisposal as the long-term national policy for manag-ing and finally disposing of commercial spentnuclear fuel and high-level waste. In support of thateffort, the WGA passed the following resolutions:∴ Policy Resolution 08-6: Transportation of Spent

Nuclear Fuel and High-Level Waste∴ Policy Resolution 06-7: Private Storage and

Transportation of Commercial Spent Nuclear Fuel∴ Policy Resolution 07-2: Assessing the Risks of

Terrorism and Sabotage Against High-LevelNuclear Waste Shipments to a Geologic Repositoryor Interim Storage Facility

∴ Policy Resolution 08-4: Enhancing SecurityDuring Transport of Radioactive Materials inQuantities of Concern (shipments of “product”rather than “waste”)

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San Miguel County Nursing has been preparing fora major public health disaster since the fall of2002 when the first purchase order for $5,000 was

received from the Colorado Department of PublicHealth and Environment in order to upgrade ourcommunication system.

Since that time SMCN has been training, exercisingand preparing for all aspects of biological, nuclear,incendiary chemical and explosive attacks by workingclosely with our West Region partners from the MesaCounty Health Department in Grand Junction. Thisstaff of experts has provided the necessary training,educational preparation and opportunities in order tocomplete the important deliverables for each aspect ofour contracts. San Miguel County has raised awarenesswithin our community and has received support fromour major stakeholders such as our local medicalclinics, private physicians’ offices, schools, businesses,emergency manager and the County Sheriff’s andMarshall’s departments, as well as our County Com-missioners, who serve as the Board of Health.

Our Emergency Preparedness Response and Pan-demic Flu Planning has been a collaborative effortdemonstrated by financial support form the towns ofTelluride and Mountain Village and the Board ofCounty Commissioners. With their investment in ourmission, we have built up our cache supplies andaugmented our communications system.

Exercising our ability to meet the goals and objec-tives of our contracts has been challenging. However,working with others in the West Region has allowed usthe opportunity to expand beyond these road blocksdespite decreasing funding.

In Their Own Words: san miguel County

By June Nepsky, RN, MN, Certified Family Nurse Practitioner; San Miguel County Director of Nursing and Administrator

“After attending many task force meetings, I candefinitely state that San Miguel County Nursinghas mobilized our stakeholders and raised aware-ness in preparation for any public health disastersin San Miguel County. I support the grants but werequire much more funding to make it possible forour staff, stakeholders and community to continueto be educated, trained and prepared for a pan-demic or major disasters so we can feel confidentthat we are prepared for future emergencies.”

-- Sheriff Bill Masters

Jennifer Dinsmore, San Miguel County’s emergencymanager, said, “The Emergency Operations Plan for thecounty never had a public health annex. The return hasbeen huge as far as these grants making a difference.Spending hours as a stakeholder and attending taskforce meetings for EPR and pandemic flu contracts, anddeveloping our plan to address the ESF8 functions hasgreatly increased awareness within the public healthinfrastructure. Without additional funding, we may notbe able to devote the necessary energy toward futureplanning for any public health disaster.”

However, by training our partners, community andstaff in all aspects of emergency preparedness andresponse, the Public Health Emergency Preparednessand Response contracts have generated strong momen-tum, proving that our capabilities to respond to suchdisasters can be feasible, affordable and sustainable.

San Miguel County’s2008 Pandemic Influenza Exercise

• Strengths Identified∴ Community planning and knowledge of the

ICS command structure for pandemic∴ Readiness and ability to organize quickly into a

functional command structure.∴ Full community support for pandemic plan-

ning from San Miguel County and the threeincorporated towns of Telluride, Norwood andMountain Village

• Areas for Improvement∴ Interoperable communication during an

incident∴ More training for those who need it∴ Surge capacity

The Division of Emergency Preparedness andResponse has managed grant funding from theCenters for Disease Control and Prevention to

help public health agencies prepare for and respond toemergencies since 1999. By 2002, the grant had in-creased, allowing the program to begin rebuilding thelong under-funded public health system in Coloradowith the placement of more epidemiologists, plustrainers and planners, in regions all over the state.

Today, there are 36 full-time equivalent positions inthe nine all-hazards regions. It more than doubled thenumber of fully trained epidemiologists in our state,and brought hundreds of training opportunities inemergency preparedness and response to all publichealth staff in Colorado.

The division works closely with the ColoradoAssociation of Local Public Health Officials, supportingits work on the reorganization of public health inColorado, as a result of Colorado Senate Bill 07-094.The organization hosts the Local Advisory Committeefor the emergency preparedness and response grants,providing recommendations on funding allocationsand establishing priorities.

Emergency Preparedness and Response supportspublic health education in the state as well, by staffingan informational exposition at the new UCHSC cam-pus to show students the wide variety of careers thatmay be available in public health. It was the first timethat CDPHE has promoted emergency preparednessand response as a public health career. The division isworking with the school to develop effective place-ments for student interns, with the first appointmentsto begin in the spring of 2009.

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supporting public health across Colorado

With Emergency Preparedness and Responseprofessional staff spread throughout the state inthe nine all-hazards regions, CDPHE providesopportunities for collaboration at periodic re-gional staff meetings.

In October 2008, about 55 regional epidemi-ologists, planners and trainers attended a two-daymeeting in Denver with both discussion andpresentations delivered by state and local staff.

It was a packed agenda, with Denver’s pre-paredness for the Democratic National Conven-tion, the role of public health on Incident Man-agement Teams, Project Public Health Ready froma local health department perspective, and theColorado Regional Model Survey findings pre-sented by Colorado Association of Local PublicHealth Officials (CALPHO) in just the first day.

The second day, epidemiologists, planners andtrainers separated into their respective groups towork on grant-specific activities and receivetraining to assist with performing their job tasks.Epidemiologists focused on different types ofdisease outbreaks and how to respond; trainerslearned about an online course building softwareapplication; and planners discussed strategies foridentifying an Emergency Support Function #8representative for each county. These periodicmeetings allow the regional staff to collaboratewith their peers in other regions, and work onprojects of statewide significance. Technicalassistance for the regional staff is always availablefrom CDPHE.

Regional Staff Meetings

Urban Area Security Initiative“For the past three years, the Colorado Depart-

ment of Public Health and Environment (CDPHE)has partnered with the Denver Urban Area SecurityInitiative (UASI) and the North Central Region(NCR) in providing and coordinating many trainingopportunities to the region. They have been pro-active in hosting UASI/NCR sponsored NIMS/ICStraining in support of Homeland Security Presiden-tial Directive (HSPD-5) at all levels from basic NIMS/ICS to advanced Unified Command and Area Com-mand Training.

“CDPHE provides a well laid out classroomconducive to student learning with modern presenta-tion equipment from computers, projectors andinternet access to an Emergency Operations Centerthat provides the student with a typical layout forIncident Management Team training.

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supporting public health across Colorado

-- Tom Witowski, Training Program AdministratorUrban Area Security Initiative (UASI)

November 25, 2008

“CDPHE’s Training representatives have alwaysbeen active participants in the Regional TrainingCommittees and are a pleasure to work with,accommodating the needs of the instructor cadre aswell as providing host agency assistance whereneeded.

“I look forward to a continued positive workingrelationship with the CDPHE as UASI/NCR movesforward with future training needs in the years tocome.”

Clear Creek has participated in several publichealth emergency exercises both inside andoutside the county. Public Health has had

excellent coordination between emergency medicalservices, emergency management and law enforcementin conducting these exercises. Several real life emergen-cies have also tested Clear Creek’s readiness and coordi-nation between the regional epidemiologist, publichealth nurses and environmental health.

The funding from the Emergency Preparedness andResponse grants has helped us strengthen our relation-ships both inside and outside the agency, throughincreased coordination. Using emergency preparednessfunding for dual purposes has also increased services tothe community. Examples of this include immunizingthe public through mass vaccination exercises, pur-chases of much-needed equipment and health educa-tion.

Before the grant, public health was not perceived asa piece of the emergency preparedness strategy andresponse. Now every emergency services agency under-stands that public health has a least some role in anyconceivable county-wide emergency situation. This is ahuge transformation, allowing public health personnelto become familiar with those personnel and agenciesthat they would be working with in small to large scaleemergencies. An example of this is public health’sparticipation in Clear Creek’s monthly public safetymeetings attended by the other emergency supportfunction leads.

By Aaron Kissler, MPH, Clear Creek County Public Health Director

in their own words: clear creek County

About Clear Creek County

• Population: 9, 400• Median age: 42.5 years• Median household income: $57,000 - $62,000• Racial mix: Primarily white with about 4%

Hispanic/Latino• Largest employers: Henderson Mine, county

government, public schools• Designated as a Health Provider Shortage Area• One primary care provider in Idaho Springs

awaiting Rural Health Certification status• Hospitals: none

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Another important development for Clear CreekCounty is coordination in developing plans for resi-dents with special needs. The special needs emergencypreparedness discussion between traditional emer-gency groups and public health has lead to tabletopexercises and creation of a special needs registry.

Emergency Preparedness and ResponseSelf Assessment

Clear Creek Public Health’s Strengths• Cooperative political environment• Excellent reputation among county personnel and

residents• Proactive emergency preparedness with excellent

communication between emergency managementand public health

Clear Creek Public Health’s Gaps/Needs• Health care coverage• Socio-economic disparities• Lack of healthcare providers• Specific population health needs (dental, prenatal,

substance abuse)

The level of emergency preparedness now forProwers County as compared to eight years agois a night-and-day difference. Public Health staff

have worked hard over the past few years to train,exercise our new skills, develop emergency prepared-ness and response plans and inform the public.

Bringing partners together has been difficult attimes. Public Health has been instrumental in gather-ing people from various disciplines together to usethe funding, training, tools and other resourcesdeveloped and supplied by the Colorado Departmentof Public Health and Environment’s EmergencyPreparedness and Response Division effectively.

The state assistance has been invaluable to theprocess. We would not be where we are today --working as local leaders and being much betterprepared -- if were not for the EPR funds, the leader-ship of CDPHE EPR staff and the partnerships thatgrew from these efforts. Prior to 2002, emergencymanagement and other responders did not see us aspartners, and they framed their preparedness effortsand exercises on explosions, crashes and other typesof disasters. They did not understand us and we didnot understand them. Now all of us have a betterunderstanding of each others’ capabilities and abili-ties, and the benefits to all of our communities ofpartners working together.

March 2004 brought the first real test of ourability to respond. The Prowers County Annex Build-ing was damaged by a large fire on a Friday morning,requiring evacuation of all county staff, includingPublic Health, and activating emergency plans.

By Jacqueline Brown APRN, MSN,FNP, Prowers County Public Health Director and Health Officer

in their own words: Prowers County

Prowers County Public Health had received fundsto assemble a “go-kit” with a computer, printer, faxand other supplies the year before. Staff immedi-ately put it to use in another county building laterthat day as county administrators and departmentheads met to determine the next steps. Those EPRsupplies certainly made the process much easierand demonstrated the need to plan for any and allhazards.

Prowers County has hosted two large-scaleexercises. First, in October 2004, we spearheaded anine-county mass vaccination clinic with 1,700participants and more than 100 volunteers inProwers County alone. The exercise helped uspractice our pandemic response by practicingmoving large numbers of people through vaccina-tion clinics. Our November 2007 exercise was adrive-through mass vaccination clinic, vaccinatingnearly 700 people, with over 60 volunteers. Bothevents were made possible through the leadershipand assistance of the regional and state EPR staff,requiring many months of preparation, trainingand planning.

Prowers County also suffered from two majordisasters in the last three years. A five-day, record-breaking blizzard in late December 2006 kept usbusy well into January 2007. Public Health’s workhelped ensure that heathcare systems continued tooperate in spite of enormous obstacles throughoutSoutheast Colorado.


Not long after, on March 28, 2007, the town ofHolly in eastern Prowers County was hit by a tornadothat killed two people, devastated the town and de-stroyed over 65 homes.

Both events required public health and environ-mental health staff and other partners to put intopractice the skills and knowledge that we had devel-oped through training, planning and exercises over thelast few years, funded by the Emergency Preparednessand Response grant. While we won’t claim everythingwas perfect, if we had not trained, practiced andplanned, there could have been even greater disasters.The public saw first-hand the role that public healthplays in these events. Prowers County residents werequite vocal in their great appreciation for our efforts.

Prowers County is a real example of what the EPRfunding has accomplished. During 2002 the state was

experiencing a real down turn in the economy andmany public health programs had experienced fundingcuts, including Prowers County. The EPR funding madeavailable through CDPHE, along with their leadership,brought public health into emergency preparednessand response incorporating the knowledge and skillslearned into all aspects of public health, strengtheningpublic health and weaving the EPR work into the dayto day operations of each agency. Prowers County hasbeen significantly impacted by this and has demon-strated the outcomes of EPR funding in real events andexercises planned and coordinated by public health.These real events showcased the investment into localpublic health by the CDPHE EPR section and the localcounty funds used to augment those funds provided bythe state.


“Prowers County Public Health has been very proactive with emergency preparedness. The staff is very knowl-edgeable, not only in public health, but also has a general understanding of other all-hazards partners andtheir experience. Prowers Public Health is very cognizant of the Incident Command System and other relatedsystems. All the exercises that I have been involved with as a partner have displayed great coordination andplanning on their part. In short, I feel that they display the knowledge within all scopes of emergency pre-paredness, beginning at the Emergency Operations Center and extending to the on-scene

commander. Their outreach to the citizens of Prowers County has been great.”-- Staffon Warn, Director, Prowers County Office of Emergency Management

• Population: 13,100 (-7.4% in 10 years)• Population density: <9 people per sq. mile• Median age: 37.3 years• Median household income: $34,000• Poverty: 19% below poverty level• Racial mix: Primarily white with about 37%

Hispanic/Latino• Largest employment sectors: retail, healthcare,

schools, local government, agriculture• Designated as a Health Provider Shortage Area• Hospital: Prowers Medical Center

About Prowers County

“Public Health has taken a leadership role withemergency preparedness. They have been instrumen-tal in expanding the beliefs about what is needed inan emergency or disaster situation and so has beenable to include more agencies in the planning

process for the community.”--Deb Jones, Outpatient Program Director, Southeast Mental

Health Services’ Lamar office

I appreciate the Health Alert Network. CO.Train is easy touse and a good way to coordinate our efforts for trainings.And I appreciate the informative quarterly EPR meetings.Iplace a high value on being able to utilize the regional staffand their expertise. I feel there is greater understanding ofpublic health’s role in emergency response and planning inour communities, especially with staff at medical facilitiesand with our first responders. We need to keep the interestof all parties in order to plan, practice, evaluate and reviseplans on a continuous basis so we will have the bestpossible coordinated response.

--Kelli Gaines, Director, Prowers County Environmental Health

Essential Service #1: Monitor Health Status to Identify Community Health Problems

• Need -- To ensure that we maintain the level of skills, abilities and resources, both human and financial, to monitor health status for ourcounty, region and state to identify threats either man-made or naturally occurring.

• Plan -- Continue to work with local public health agency components to ensure continued collaboration, utilizing the data andinformation to design plans and interventions and build partnerships.

Essential Service #2: Diagnose and Investigate Health Problems and Health Hazards in the Community

• Need -- To ensure those epidemiological skills and abilities for investigations of disease outbreaks and patterns of infectious andchronic diseases and injuries, environmental hazards, and other health threats are maintained at each public health department, largeor small.

• Plan -- Maintain access to the CDPHE public health laboratory for rapid screening and high-volume testing, which is imperative topreparedness and protection of the public. Ensure that qualified and trained regional epidemiologists are maintained to assist localpublic health agencies.

Essential Service #3: Inform, Educate and Empower People about Health Issues

• Need -- To ensure that local and state public health officials continue to work together to develop messages and resources to inform,educate and empower people to be better prepared and ready in the event of any disaster, man-made or naturally occurring.

• Plan -- Providing ongoing, consistent training annually to ensure that we maintain current skill levels.

Essential Service #4: Mobilize Community Partnerships to Identify and Solve Health Problems

• Need -- To maintain a high level of partnership and collaboration, in spite of limited resources, both people and money.• Plan -- As counties struggle with funding and EPR funds decrease it will be even more imperative to mobilize community partnerships.

We have to figure out how to do it together, with less.

Essential Service #5: Develop Policies and Plans that Support Individual and Community Health Efforts

• Need -- To maintain systematic community-level and state-level planning for emergency preparedness which will impact health in alljurisdictions.

• Plan -- Continue to align local public health resources and strategies with the local emergency preparedness and response planning.

Essential Service #6: Enforce Laws and Regulations that Protect Health and Ensure Safety

• Need -- To ensure that we are knowledgeable and trained in emergency preparedness and response laws and regulations, ongoingtraining and exercises testing and evaluation of what is in place and what needs to be done different.

• Plan -- Include legal and regulatory issues in training.

Essential Service #7: Link People to Needed Personal Health Services;Assure the Provision of Health Care when Otherwise Unavailable

• Need -- To ensure that special populations are pre-identified and included in emergency preparedness and response planning.• Plan -- Invite representatives to participate in training and exercises.

Essential Service #8: Assure a Competent Public and Personal Health Care Workforce

• Need -- To ensure that ongoing emergency preparedness and response training at all levels is maintained, with many avenues for access(face to face, web/internet, etc.).

• Plan -- Move toward accreditation for public health and tie that to outcomes and emergency preparedness and response work at thelocal level as it relates to essential and core services. Schools of Public Health and universities should include degree or certificateopportunities for emergency preparedness and response specialists who can be leaders at the state, federal and local levels.

Essential Service #9: Evaluate Effectiveness, Accessibility and Quality of Personal and Population-Based Health Services

• Need -- To ensure that local and state emergency preparedness and response programs and deliverables are effective, accessible and ofhigh quality.

• Plan -- Encourage CDPHE’s grant managers to enforce deliverables and not let grantees off the hook. Everyone in every county needs tobe assured that their county is doing all that it can to be part of the big picture.

Essential Service #10: Research for New Insights and Innovative Solutions to Health Problems

• Need -- To ensure that emergency preparedness and response programs participate in research and innovative solutions to make surethe work that we do is proven and will work.

• Plan -- Encourage program evaluation. When we find things that don’t work, let them go, move on and build on the successes.

The 10 Essential Public Health Services and Emergency Preparedness and ResponseProwers County Public Health

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CDPHE

Documents

water quality

municipal water supply

bottled water orderfor

alamosawith bottled

local public health

local response efforts

emergency support function

emergency responders