Santa Clara County
Pandemic Influenza Preparedness and
Response Guidance For Vulnerable
Populations
Preface & Acknowledgments
Preparedness and planning for effective response will save thousand of lives in
Santa Clara County. This plan reflects an ongoing collaboration between
SCCPHD, local emergency managers, the CADRE Network, and a multitude of
CBOs and FBOs to strengthen our community’s ability to prepare for and respond
to a pandemic influenza, especially as it affects our most vulnerable residents.
Helping agencies develop strategies for continuity of operations, creating a
countywide plan for communication and coordination of resources for vulnerable
populations through the CADRE Network, and providing risk communications
tools to more easily educate all of the residents of Santa Clara about pandemic
influenza.
Ongoing collaboration utilizing the CADRE network in partnership with Public
Health will further develop agency roles and a commitment of resources to serve
many diverse vulnerable populations in a pandemic outbreak. This is truly a
continuous community alliance which strives to apply lessons from Hurricane
Katrina and other past disasters to Santa Clara County’s most vulnerable
residents.
We would like to thank the Santa Clara County Public Health Department, the
Santa Clara County Emergency Managers Association and its Vulnerable
Populations Committee, the Collaborating Agencies Disaster Response Effort
(CADRE) Network and its member agencies, and numerous other local
community and faith-based organizations who contributed time, energy and
resources to the development of this plan. We appreciate the interest and
dedication so many agencies have shown in exploring issues of how to best
support their clients in a pandemic influenza outbreak.
Written by Kelle Remmel, Annamaria Swardenski and Margaret Melsh
VCSV Emergency Services Program Consultants
Completed August 30, 2007
Submitted to the Santa Clara County Public Health Department
by the Volunteer Center of Silicon Valley
1922 The Alameda, Suite 100, San Jose, CA 95126
www.vcsv.us
Revised and updated by Remmel Consulting Services, December 2008
Table of Contents
I. Overview .....................................................................3
A. Purpose ........................................................................................................ 3
B. Background ................................................................................................... 4
C. Goals............................................................................................................ 5
D. Organization and Scope .................................................................................. 5
II. Situation and Assumptions ........................................6
A. Definitions .................................................................................................... 6
B. Situation ....................................................................................................... 8
C. Data on Vulnerable Populations ....................................................................... 9
D. Planning Assumptions .................................................................................. 13
III. Roles and Responsibilities of Key Players .............. 15
Public Health ................................................................................................... 15
Santa Clara County Office of Emergency Services ................................................ 15
Municipal Offices of Emergency Services ............................................................. 16
Collaborating Agencies’ Disaster Relief Effort (CADRE) Network ............................. 16
Community-Based Organizations (CBOs) ............................................................ 17
Faith-Based Organizations (FBOs) ...................................................................... 17
IV. Preparedness–Planning and Emergency Resources 18
V. Response—Concept of Operations ............................ 19
Overview of SEMS/NIMS and the Incident Command System ................................ 19
CADRE Network ............................................................................................... 21
VI. Vulnerable Populations Service Providers—Roles and
Strategies ..................................................................... 26
Community-Based Organizations ....................................................................... 26
Immigrant Populations .................................................................................. 26
Homeless and Housing Service Providers ......................................................... 27
Community and Healthcare Clinics .................................................................. 28
Food Service Providers .................................................................................. 29
Developmental Disabilities Populations ............................................................ 30
Transportation ............................................................................................. 32
Faith-Based Organizations ................................................................................ 32
Systems of Care for People with Specialized Medical Needs ................................... 33
VII. Risk Communications for CBOs and FBOs .............. 35
Pre-event Communication and Education ............................................................ 35
“Just in Time” Communications .......................................................................... 36
Suggested Methods and Alternative Forms of Communication ................................ 36
VII. Authorities ............................................................. 38
IX. References .............................................................. 38
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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Overview
At the onset of the 1918 Great Influenza, the deadliest pandemic in history, two
U.S. cities took different approaches to responding to the pandemic. Philadelphia
did not immediately implement isolation and quarantine and did not cancel large
public gatherings. The result in that city was 719 deaths for every 100,000
people. St. Louis responded quickly after reports of the first two civilian cases,
enforced shutdown of schools, churches and other gathering places, and
required influenza cases to register with the public health department. The
result was a death rate of 347 per 100,000 people, less than half of the death
rate in Philadelphia.
The Santa Clara County Public Health Department, working in partnership with
the Collaborating Agencies Disaster Response (CADRE) Network, has initiated
this effort to engage community-based organizations (CBOs) and faith-based
organizations (FBOs) in preparing for and planning for response to a pandemic
influenza outbreak. The Public Health Department recognizes the importance of
working with community partners to meet the needs of a variety of vulnerable
populations who may be adversely affected during a pandemic.
Meeting the needs of vulnerable populations poses many challenges in a
pandemic outbreak. It is only with collaborative efforts among public health,
emergency management, community and faith-based organizations that our
community will be able to address and meet some of these critical needs.
A. Purpose
The Pandemic Influenza Vulnerable Populations Preparedness and Response
Guidance for Santa Clara County outlines preparedness and response strategies
for working with CBOs and FBOs in a pandemic event. The purpose of this
guidance document is to:
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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1. Serve as a guide for local stakeholders and the Santa Clara County Public
Health Department to increase coordination of services for vulnerable
population in a pandemic influenza outbreak.
2. Provide guidance and tools to community-based organizations to prepare for
continuity of operations and service delivery to vulnerable populations in a
pandemic influenza outbreak.
3. Outline a countywide response strategy which integrates CBOs and FBOs as
vital resources in responding to the various needs of vulnerable populations
in a pandemic influenza outbreak.
B. Background
The following methods of gathering information and engaging community
stakeholders were used to develop this plan:
▪
Research of best practices and models throughout the country on planning
for vulnerable population needs in a pandemic.
▪
Development, distribution and analysis of a survey completed by 74
participants from 49 Santa Clara community-based agencies Large group
meetings with stakeholders such as the Santa Clara County Emergency
Managers Association (SCCEMA), the SCCEMA Vulnerable Populations
Committee, and community-based organizations that provide services to
vulnerable populations.
▪
Small group meetings with different CBO service sectors (e.g., homeless and
housing providers, food services) to identify specific issues and strategies for
serving their client populations in a disaster.
In addition to the tools developed as a part of this plan, planning strategies for
future consideration are included (see Attachment I). Because of the vested
interest of so many different community stakeholders, it is critical that planning
and collaboration efforts continue to strengthen the resiliency of Santa Clara
County’s vulnerable population communities.
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C. Goals
Specific goals to support the purpose of this plan/guidance are:
1. To educate agencies and clients on the facts of pandemic influenza
2. To provide planning resources for individual, family and agency preparedness
3. To define the concept of operations for integrating CBOs and FBOs into the
countywide response system in a pandemic influenza event
4. To identify and address special considerations for selected segments of
vulnerable populations
5. To provide risk communications strategies and materials for effectively
reaching various vulnerable populations
6. To encourage CBOs to plan for continuity of operations and develop
strategies to provide ongoing service their clients
D. Organization and Scope
The Pandemic Influenza Vulnerable Populations Preparedness and Response
Guidance is designed for both Public and Health and Community-based
Organizations. CADRE is a key operational component of the Pandemic Influenza
Vulnerable Populations Preparedness and Response Guidance. The CADRE
Network will be activated upon request from the Santa Clara County Office of
Emergency Services (SCC EOC) or the Public Health Department Emergency
Operations Center (DEOC). See Attachment B for more information on the
CADRE Network.
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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This guidance is applicable within the geographical boundaries of Santa Clara
County to coordinate countywide resources available through the CADRE
Network at the time of the incident. While some resources and groups are
identified in the guidance document, lessons from previous disasters have
demonstrated that additional resources will become available during an event.
CADRE will coordinate and communicate with a variety of community and faithbased organizations that wish to provide services to support vulnerable
populations in a pandemic influenza.
Situation and Assumptions
A. Definitions
The Santa Clara County Pandemic Influenza and Preparedness and Response
Guidance defines special populations in the context of pandemic influenza as:
▪
Members of the community with little or no ability to successfully deal with,
implement or be fully responsible for their own emergency preparedness,
response and recovery.
▪
People whose life circumstances leave them unable or unwilling to follow
emergency instructions, as well as anyone unable to unwilling to fully access
or use traditional disaster preparedness and response services.
For the purposes of this plan and based on feedback from various stakeholders
groups, the working definition for vulnerable populations will be those
individuals with:
▪
Economic disadvantage
▪
Limited language competence
▪
Physical, cognitive or sensory disability
▪
Cultural/geographic isolation
▪
Age vulnerability
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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Individuals may fall into one or more of the above categories. The goal of this
plan is to work with service providers that serve clients who have any of these
types of vulnerabilities through the comprehensive CADRE Network.
Additionally, there is language emerging at a federal and local level that further
defines what are sometimes referred to as “vulnerable” or “special needs”
populations. The National Response Framework 2008 NRF definition for ‘special
needs’ provides a function-based approach for planning and seeks to establish a
flexible framework that addresses a broad set of common function-based needs
irrespective of specific diagnosis, statuses, or labels (e.g. children, the elderly,
transportation disadvantaged). In other words, this function-based definition
reflects the capabilities of the individual, not the condition or label.”
1
Additionally, this definition is being utilized by the California Governor’s Office of
Emergency Services as planning on a state and federal level moves towards the
assessment of function-based needs in a disaster.
Special Needs Populations - populations whose members may have additional
needs before, during, and after an incident in one or more of the following
functional areas:

Maintaining Independence

Communication

Transportation

Supervision

Medical care
Individuals in need of additional response assistance may include those who:

have disabilities

live in institutionalized settings

are elderly

are children
Interim Emergency Management Planning Guide for Special Needs Populations: Federal
Emergency Management Agency and DHS Office for Civil Rights and Civil Liberties,
Version 1.0 August 15, 2008
1
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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
are from diverse cultures

have limited English proficiency, or who are non-English speaking

are transportation disadvantaged

are homeless prior to disaster
B. Situation
Certain groups of people will experience greater impact on health and daily
living than the population as a whole as a result of an influenza pandemic. In a
pandemic, these groups will bear a disproportionate burden of illness and
hardship unless government and its partner organizations plan ahead to address
these vulnerabilities.
Impact on Health
▪
People who live in or spend the night in group quarters, such as convalescent
homes and homeless shelters, are especially vulnerable to exposure.
▪
People who depend on public transportation are especially vulnerable to
exposure. They include people with disabilities and people of low income who
do not own cars.
▪
People with immature or compromised immune systems are especially
vulnerable to severe infections. These include infants, the elderly, people
infected with HIV, and patients receiving chemotherapy or
immunosuppressive medications.
▪
People of limited English proficiency and people who do not use the major
news media are at high risk of missing important public information related
to disease prevention and control.
Impact on Daily Living
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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▪
People who depend on urgent or emergency care facilities for primary health
care, such as people of very low income, risk losing these services for the
duration of a pandemic.
▪
People who depend on frequent appointments for medical care or mental
health services are vulnerable to the loss of these services during a pandemic
due to potential limitations or lack of service availability.
▪
People such as those with chronic physical or mental illness and others, who
require frequent refills of prescription drugs, are vulnerable to disruption in
pharmacy services.
▪
People who depend on public transit or paratransit for food shopping,
banking and other essential services are vulnerable to disruptions in these
services.
▪
People who depend on meal sites and/or home-delivered nutrition services
for meals and food are vulnerable, some extremely so, to disruptions in these
services.
▪
People who depend on home health services are vulnerable to delays in
service or loss of service and may require transfer to skilled nursing facilities.
▪
People who reside in group homes are vulnerable to staff attrition and may
require transfer to larger group facilities with reduced staff-to-client ratios.
C. Data on Vulnerable Populations
2000 Census Data
Population of Santa Clara County — In 2000, Santa Clara County had a
household population of 1.7 million. Twenty-five percent of the population were
under 18 years and 10% were 65 years and older.
Households and families — In 2000 there were 566,000 households in Santa
Clara County and 98.2% of the population lived in households. Households
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headed by a female with related children under 18 years and no husband
present numbered 28,653 (5% of all households).
Group quarters — In 2000 1.8% of the population lived in group quarters.2 Of
the 29,714 living in group quarters, 10,975 (.7%) were institutionalized and
18,739 (1.1%) were non-institutionalized.
People living alone — In 2000, 121,109 people in Santa Clara County lived
alone. Of these, 33,418 were 65 years of age and over.
Spoken languages — Thirty-four percent (573,130) of the people living in
Santa Clara County in 2000 were foreign-born. Among people at least five years
old living in Santa Clara County in 2000, 45% spoke a language other than
English at home—18% spoke Spanish, 7% spoke other Indo-European
languages, and 20% spoke Asian and Pacific Island languages. Twenty-two
percent reported that they did not speak English “very well”.
Languages spoken at home
Population 5 years and over
1,564,068
English only
854,337
Language other than English
709,731
Speak English less than “very well”
Spanish
Speak English less than “very well”
Other Indo-European languages
343,320
275,439
142,627
112,351
Speak English less than “very well”
33,396
Asian and Pacific Islander languages
304,332
Speak English less than “very well”
162,031
The Census Bureau classifies all people not living in households as living in group
quarters. There are two types of group quarters: institutional (for example, correctional
facilities, nursing homes, and mental hospitals) and non-institutional (for example,
college dormitories, military barracks, group homes, missions, and shelters).
2
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Disability—In Santa Clara County, among people at least five years old in
2000, 16% (254,729) reported a disability. The likelihood of having a disability
varied by age – from 7% of people 5 to 20 years old, to 16% of people 21 to 64
years old, and to 39% of those 65 and older.
Disability status of the civilian
5 years and over with a disability
254,729
5-15 years with a disability
16-64 years with a disability
23,564
170,555
65 years and over with a disability
60,610
Poverty — In 2000, 8% of people were living in poverty. Five percent of all
families were below the poverty level. 6,308 families with a female householder,
related children under 18 years and no husband present, were below poverty
level. 9,840 individuals 65 years and over were below poverty level.
Occupied housing unit characteristics — In 2000 Santa Clara County had
566,000 occupied housing units. Of these, 40% were renter occupied. 3,318 of
the households did not have telephone service, 2,867 lacked complete plumbing
facilities, and 3,289 lacked complete kitchen facilities. Six percent did not have
access to a car, truck, or van for private use. 34,640 units had a density of 1.01
to 1.50 per room, and 46,264 had a density of 1.51 or greater per room.
Gross rent as a percentage of household income — Of the 226,473 renteroccupied units, 67,064 households paid 35.0% or more of their income in gross
rent.
Unemployment — Of the total civilian labor force of 878,932, 4% were
unemployed in 2000.
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Additional Data
Disability – Silicon Valley Independent Living Center (SVILC) has made its own
assessment of Santa Clara County’s population in terms of disability, utilizing
data from Santa Clara County’s Independent Living Needs Assessment and the
American Community Survey. They estimate that 15% of Santa Clara County
residents have a disability. Of this 15%, they estimate that 15.2% have a
sensory disability, 31.9% have a physical disability, 20.8% have a mental
disability, and 10.9% have a self-care disability. They also note that of the
consumers served by the SVILC, 68% have a physical disability, a much higher
proportion than occurs in the disabled population as a whole.
Developmental disabilities – San Andreas Regional Center recently reported
the following data on people with developmental disabilities. San Andreas serves
12,000 consumers in Santa Clara, Santa Cruz, Monterey, and San Benito
counties. Of the 8,265 consumers in Santa Clara County:
▪
1,448 are in placement in a residential facility licensed by either Community
Care Licensing (80%) or Health Care Licensing (20%).
▪
Approximately 3,500 adults attend some form of day training program
licensed through Community Care Licensing.
▪
There are about 500 consumers living independently or living alone with
support in Santa Clara County. These consumers receive weekly training in a
variety of skill sets, including emergency preparedness.
▪
The remaining consumers live at home with family.
Immigrant populations – The Silicon Valley Community Foundation’s 2005
Santa Clara County Non-Profit Benchmark Study dedicated a large portion of
their report to “Changing Community, Changing Needs.” The study recognized
that sixty percent of the county’s population is composed of immigrants and
their U.S. born children. Less than 50% of the county is non-Hispanic white;
Asians constitute 26% of the population; and Latinos constitute 24% of the
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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population. Santa Clara County has twice the number of immigrants as any
other Bay Area County. Of California’s 58 counties, it ranks only behind Los
Angeles and Orange Counties in number of immigrant residents. Santa Clara
County is home to five of the ten school districts in the Bay Area with the largest
percentage of students with limited proficiency in English. Recent trends include
immigration to Santa Clara County from Africa and the Middle East.
Food needs – A Second Harvest Food Bank Hunger Analysis of Santa Clara
County in 2005 identified the pervasiveness of hunger in our community. In
Santa Clara County:
▪
40,000 individuals suffer from chronic hunger (14,590 are children)
▪
59,798 individuals struggle to find enough food to eat (35,084 are children)
▪
46% of the food needs in Santa Clara County are unmet
▪
Santa Clara County needs an additional 65 million meals annually
D. Planning Assumptions
1. Institutions that provide housing for vulnerable populations—prisons,
convalescent facilities, board and care homes, homeless shelters, etc.—will
take appropriate planning and preparedness steps to address disease
prevention and control.
2. Customized messages addressing various language and cognitive abilities will
need to be utilized via alternate methods of communication to targeted
audiences. Public Health has developed message content for risk
communications which are translated into 10 different languages, including:

Spanish

Vietnamese

Japanese

Chinese

Farsi

Korean

Tagalog
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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
Arabic
English, Spanish, Vietnamese and Chinese are available on the Santa Clara
County Public Health website. Materials in all languages are also available on
the USB drive contained in the CBO Resource Kit.
3. Employers will take appropriate steps to address disease prevention and
control affecting their employees, who may include vulnerable populations.
4. Employee absenteeism due to illness, need to care for ill family members, or
fear of infection, will affect delivery of all services in the community.
Disruption to or closure of many of these services will adversely affect
vulnerable populations.
5. CBOs will plan for the service delivery needs of the vulnerable populations
they serve.
6. Community-based organizations and faith-based organizations will be called
on to help inform and prepare their vulnerable population clients for an
influenza pandemic. Working through the CADRE Network, the Public Health
Department will provide training, tools and technical assistance to help these
organizations enhance their own preparedness and their clients’
preparedness.3
7. Community-based organizations and faith-based organizations will be called
on to supplement and even replace essential services during a pandemic.
However, like all public and private services, they will be affected by staffing
shortages.
8. Residents who are not self-sufficient (such as homebound people who live
alone) and are required to stay in their homes for purposes of isolation or
social distancing to limit the spread of disease, will need help in securing
basic needs (food, water, medications) and health services. Care providers
will need to work with CADRE and their local Office of Emergency Services to
develop alternative methods for provision of nutrition and health services,
e.g., use of primary care vans, telephone hotlines.
A recent survey indicates that most community-based organizations have done little to
no planning for an influenza pandemic.
3
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9. During a pandemic, current standards of care will likely be adapted or
compromised to best meet the needs of the greatest number of people.
III. Roles and Responsibilities of Key Players
Public Health
The SCCPHD has a lead role in mobilizing partners in the county to prepare for
and respond to an influenza pandemic. SCCPHD will facilitate countywide
pandemic planning and preparedness efforts. SCCPHD will coordinate the
community’s emergency public health response through the Medical Health
Operations Center (MHOC). Public Health will also be the lead agency on a
number of activities in a pandemic. These include conducting countywide
surveillance to track the spread of the disease and implementing disease
containment measures. For a more complete list of the SCCPHD roles and
responsibilities in a pandemic influenza, please see the Pandemic Influenza
Preparedness and Response Plan. www.sccgov.org/portal/site/phd
Santa Clara County Office of Emergency Services
As the Operational Area, the Santa Clara County Office of Emergency Services
(SCC OES) is responsible for managing resources in the county during a
disaster. It is the primary point of contact for brokering resources among cities
within the county and requesting resources from State OES, Coastal Region. The
Public Health MHOC is the medical health branch of OES.
In an influenza pandemic, SCC OES will provide support to the Medical Health
Operations Center (MHOC) and provide primarily non-medical support for
Influenza Care Centers (ICCs), Family Assistance Centers, volunteer
coordination and other services needed to support response efforts. SCC OES
will also help access county government resources for vulnerable populations
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such as social services, foster care and senior programs, and will coordinate with
CADRE in joint efforts to serve vulnerable populations.
Municipal Offices of Emergency Services
Local government is often the first point of contact for residents needing help or
services in an emergency. Although some vulnerable people will turn to local
government for assistance, local government may have limited capacity or
resources to meet the needs of many different populations. Santa Clara County
cities work closely with CADRE and will utilize the CADRE Network as a resource
to help meet the needs of vulnerable populations within their jurisdictions. Cities
will also provide a valuable link to other community resources such as schools,
businesses, and potential site locations for Influenza Care Centers (ICCs) that
may be needed to serve the public in a pandemic.
City government staff may also help provide services, such as communications,
law enforcement or volunteer coordination to assist with pandemic response
efforts.
Collaborating Agencies’ Disaster Relief Effort (CADRE)
Network
Working in partnership with the Santa Clara County Emergency Managers
Association, CADRE is a network of community resources that provide essential
services in times of disaster. It draws on the strengths of community-based
organizations and government partners to deliver vital services in times of
disaster and functions as a resource for disaster preparedness, planning,
response and recovery. In the past, CADRE was activated and helped deliver
critical services following Hurricane Katrina in 2005 and the January 2007 Cold
Weather Activation in Santa Clara County.
Addressing the needs of vulnerable populations is a primary goal of the CADRE
Network. Working with the SCCPHD, CADRE plays a central coordination role,
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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bringing together community-based organizations to plan for continuing
operations and delivering services to their clients in a pandemic influenza.
Community-Based Organizations (CBOs)
Community-based organizations play a vital role as the technical experts and
trusted providers for many segments of vulnerable populations. Without their
assistance it would be very difficult to communicate with and provide services to
vulnerable populations in any type of disaster, and especially in an influenza
pandemic response. Because CBOs often have limited resources for disaster
preparedness and planning efforts, multiple components of this guidance
document are designed to provide accessible preparedness and planning
materials for CBOs.
Both before and during a response to a pandemic, CBOs will be critical partners
in providing education, outreach and services to vulnerable populations. Working
through the CADRE Network, CBOs will coordinate resources and service
delivery with SCCPHD, local government and other service providers. CBOs
provide a critical link to certain populations that may not be reached through
traditional communication and outreach channels.
Faith-Based Organizations (FBOs)
Faith-based organizations are respected and trusted by the people they serve
and are a credible source of information for a variety of different populations.
FBOs can play a critical role in education and outreach—preparing their
congregations and teaching appropriate strategies for disease prevention and
control in a pandemic. For some segments of the populations, where trust in
local government is limited, FBOs can serve as a link providing critical
communications before and during a pandemic event. FBOs can also help deliver
a variety of critical services to vulnerable populations within their communities.
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IV. Preparedness–Planning and Emergency
Resources
An Internet search on “pan flu resources” will reveal many, many resources
related to preparedness, planning and responding to an influenza pandemic, as
well as numerous websites devoted to these topics. Some resources are aimed
at the general population and others are targeted to specific audiences. Santa
Clara County Public Health Department has developed resources for local use, as
have other counties around the nation. Other sources include the US
Department of Health and Human Services, the Centers for Disease Control and
Prevention (CDC), Center for Infectious Disease Research and Policy (CIDRAP),
FEMA and OSHA.
In the following section are sample resources such as:
▪
Guides, checklists and other information focused on individual and family
preparedness
▪
Guides on home care for influenza pandemic
▪
Checklists of recommended emergency supplies to have on hand
▪
Preparedness and planning guidance for agencies and service providers,
some general in nature and some targeted to specific types of agencies
▪
Other resources, such as educational posters and an influenza pandemic case
study
▪
Influenza pandemic fact sheets
V. Response—Concept of Operations
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Overview of SEMS/NIMS and the Incident Command
System
The Standardized Emergency Management System (SEMS) – SEMS is
California’s standardized system for managing emergencies at all levels. The
goal of SEMS is for emergency response organizations to “speak the same
language” and use the same operational procedures so they can better interact
and coordinate for faster mobilization, deployment and use of resources. SEMS
is multi-agency and multi-jurisdictional, and increasingly, CBOs are using SEMS
for better coordination and communication with local government.
The National Incident Management System is a consistent nationwide approach
for all levels of government to work effectively and efficiently together to
prepare for and respond to domestic incident and is based on SEMS.
The Incident Command System (ICS) is common to both SEMS and the NIMS. It
is a key component that allows agencies to communicate using common
terminology and operating procedures. ICS clearly defines staff roles,
responsibilities, and lines of communication. ICS has five major functional
areas:
-
Command/Management
-
Operations
-
Planning/Intelligence
-
Logistics
-
Finance/Administration
Applying SEMS and ICS to Community-Based
Organizations for Pandemic Response
CBOs can develop staff roles in a pandemic utilizing the
Incident Command System (ICS). These functions allow for the effective staffing
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of emergency response operations. ICS allows agencies to communicate using
common terminology and operating procedures. CBOs and FBOs are encouraged
to utilize the ICS System to efficiently organize their own agency emergency
response activities and more successfully integrate with government emergency
response organizations. CBOs can insert names into the following chart of
primary and back-up staff assigned to the different functions.
Management - Incident Commander
1._________________________
2. (Alt)_____________________
Public Information Officer
1._______________________
2.(Alt)___________________
Safety Officer
1.______________________
2. (Alt)__________________
Liaison Officer
1._______________________
2. (Alt) ___________________
Operations
Operations Team Chief
1.____________________
2. (Alt) ________________
Planning
Planning Team Chief
1._____________________
2. (Alt) _________________
Logistics
Logistics Team Chief
1._____________________
2. (Alt) ________________
_________________
Finance
Finance Team chief
1._____________________
2. (Alt) _________________
Depending on the size a CBO, staff can be assigned to the different ICS roles.
Very small organizations may need only an Incident Commander and/or a small
number of staff to take on multiple roles below. Large organizations can assign
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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additional staff to help in each function. Every organization is encouraged to
identify at least one alternate given the nature of a pandemic affecting
your current staff. ICS functions can be activated as needed and/or in a
partial capacity. The Clipboard Checklists in the CBO Kit contains specific
information of the roles of each ICS function.
CADRE Network
Activation
During a disaster that involves a community response in Santa Clara County,
the CADRE Network is activated. For an influenza pandemic, the CADRE Network
will be activated in support of this plan upon request from the Santa Clara
County Emergency Operations Center (SCC EOC) or the Medical Health
Operations Center (MHOC).
Activation of the CADRE Network allows Santa Clara County to access a
multitude of existing CBO and FBO resources within the community to assist
emergency management and public health response efforts. CADRE’s unique
position as an “umbrella network” makes it ideally suited to assist with response
efforts in a pandemic outbreak:
▪
CADRE Network represents access to numerous resources with over 450
agencies registered in the database
▪
CADRE resources represent a wide variety of types of services and types of
populations served
▪
CADRE Network monitors the CBO landscape and tracks changes in it to
understand what member agencies are doing, changes in services, new
developing organizations, where gaps are, etc.
Activation means that CADRE functions switch from preparedness planning to
operational coordination. Operational activities include:
▪
Convening planning dialogues and forums to coordinate the community’s
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response
▪
Developing an event-specific resource directory to streamline the resource
data in the community
▪
Conducting resource fairs and other community events to bridge service
providers with the population affected by the disaster
When activated, CADRE will host a meeting and/or communicate with agencies
within 72 hours to mobilize community resources in support of the incident.
Objectives include:
▪
Identifying resources available for that event/disaster
▪
Identifying resources needed
▪
Forming teams and subcommittees to address incident-specific needs
▪
Identifying leadership within each group
▪
Conducting regular meetings, conference calls, emails within subcommittees
and with the larger CADRE network
In an influenza pandemic event, CADRE would immediately activate appropriate
stakeholder groups identified in the planning process and begin the process of
communication and coordination with them.
Communication and Coordination
CADRE operational standard protocols include e-mail and face-to-face meetings
for communication and coordination in non-health related emergencies. In an
influenza pandemic, CADRE will employ “social distancing” strategies and utilize
other means of communication to support communications between players –
primarily e-mail, webinars, large group phone conference calls, and potentially
GIS mapping strategies (if resources are available).
CADRE Staffing
The CADRE Leadership Council will identify the incident commander, the
government liaison and public information officer in a CADRE activation. During
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a large scale or catastrophic disaster, the roles of section chiefs (Operations,
Planning, Logistics and Finance) and administrative functions will be filled as
needed by CADRE agencies or designated CADRE staff. Groups and units within
each section will be headed by designated lead agencies from CADRE’s
membership.
CADRE ICS Model for Pandemic Influenza
Upon activation, CADRE utilizes the Incident Command System (ICS) model,
which is designed to expand and contract as each specific incident unfolds and
as needs emerge. In the planning process of meeting with different stakeholder
groups to prepare for a pandemic influenza, the following ICS functions were
identified as critical for pandemic influenza activation. This chart will be utilized
and expanded with emerging resources during a response. CADRE will work
closely with the Santa Clara County Public Health Department to continue to
determine needs and identify resources in a pandemic outbreak.
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CADRE INCIDENT COMMAND SYSTEM CHART
FOR PANDEMIC INFLUENZA
Public Info
Sets Policy & Direction
Gov’t Liaison
Incident Commander
DOES IT
PLANS IT
Operations
Planning
Hospitals
Influenza
Care Centers
Risk
Communications
Situation
Status and
Information
GETS IT
Logistics
Finance
Financial
Support
Shelter
~
~
~
~
Spec. Needs
Child Care
Residential
Day Prgms
Human
Resources
Disaster
Related
Fundraising
~ Personnel
~ Translation
~ Volunteers
Community
Clinics
Mapping/
GIS
Transportation
Family
Assistance
Centers
Legal
Food
Alternate
Law
Enforcement
PAYS FOR IT
Donations
Management
~Distribution
~ Models
~ Storage
Community/
Social
Services
Pharmaceuticals
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CADRE Demobilization
The incident commander will determine at what point CADRE operations will be
demobilized. Because of the predicted long-term nature of a pandemic and the
involvement of CADRE organizations in many areas of long-term recovery, it is
anticipated that a pandemic activation will take place over the course of several
months and possibly in waves. CADRE’s activation may scale up and down based
on community needs. CADRE’s ability to stay activated will depend upon the
resources available to sustain long-term operations.
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VI. Vulnerable Populations Service Providers—
Roles and Strategies
Community-Based Organizations
CBOs bring a wealth of resources, understanding and knowledge about
vulnerable populations to the response and recovery efforts of any major
disaster. They are the trusted providers and critical partners for delivering
services to many segments of vulnerable populations, especially in a pandemic
outbreak.
In 2007, planning meetings with CBOs were held and framed around issues of
isolated care, stockpiling resources, disease prevention and control, risk
communications and coordination with other service providers and vendors
(e.g., food delivery). It was noted in many of the meetings that CBOs often do
not have the resources to implement some of the strategies, but do have a
willingness and desire to do so.
This section outlines some of the key roles and strategies identified by Santa
Clara County health and human services provider groups and includes research
on best practices for preparedness and response in a pandemic outbreak.
Immigrant Populations
Immigrants and their US born children make up 61% of Santa Clara County’s
total population. Immigrant populations are potentially at risk in a pandemic due
to a variety of factors such as limited language competencies, cultural barriers
related healthcare approaches, possible limited trust in traditional channels of
communication, and a variety of factors related to culture, values and
communications.
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Suggested strategies:
1. Bring CBOs who serve immigrant populations and immigrant groups
themselves to the table to dialogue and discuss on how to best serve these
populations in a pandemic
2. Organize cultural proficiency trainings to help our community better
understand how different immigrant groups may approach pandemic
influenza issues
3. Create public information materials that are simple and at a 5th grade or
below reading level and which utilize pictorial messages for pre-event and
just-in-time risk communications
4. Provide outreach and communication messages to CBO service providers who
regularly interact with these populations
5. Provide translated and bilingual key messages
6. Distribute messages to ethnic media outlets, including newspaper, radio and
television
7. Distribute material on buses and other forms of public transportation
8. Distribute material to places of worship that serve different ethnic
populations
Homeless and Housing Service Providers
People who live in group quarters are especially vulnerable to exposure. They
include people who spend the night in homeless shelters, residential care
facilities, board and care homes, nursing homes, and any other dormitory-style
living. Agencies that provide services to homeless are very diverse and have
different ways of providing clients with a place to stay. For example some
provide services in congregate shelters, others in apartment-style shelters, while
still others utilize voucher programs. Other services include hygiene centers,
employment agencies, drop-in centers, mental health programs and meal
programs. Working with homeless service providers and best practices, the
following suggested strategies were created:
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1. Develop a program model for clients & consumers to help with prevention
and train other consumers as they come through the door – focus efforts on
strategies for prevention
2. Develop different protocols for check-in during a pandemic (some shelters
only require it the first time) that address clients with symptoms entering the
shelter
4
3. Develop protocols for sending sick clients to ICCs as soon as possible
(including transport)
4. Arrange mass shelter clients head to foot on sleeping mats/cots and assure
maximal spacing of clients to decrease social density
5. Separate sick and healthy consumers
6. For family shelters, transitional housing programs and low-income housing
sites, think about ways to minimize interactions and gatherings in common
areas
7. Develop strategy for childcare when parents are sick
8. Create an exit package for people who do not want to stay in the shelter
during a pandemic – it would include items such as a sleeping bag, packaged
food and personal necessities
9. Communications - develop strategies for coordination and communication
among service providers using the internet to implement policies and
protocols during an outbreak
Community and Healthcare Clinics
People who depend on community clinics are vulnerable to the loss of these
services for the duration of a pandemic and for several months afterward,
because of difficulty in finding appointment slots and reduced staffing. Working
with clinics in Santa Clara County, the following planning issues were identified:
4
Agencies can help stop infectious diseases at the door with five simple symptom questions: (1) How are
you feeling today? (2) have you been coughing more than usual lately? (3) have you been having diarrhea or
vomiting today? (4) have you been troubled by a rash or very itchy skin or scalp? (5) do you have any sores or
injuries that are not healed over? For more information, go to the publications section at
www.metrokc.gov/health/hchn and read document “Creating a Health Conscious Culture at Your Homeless
Program Site.”
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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▪
Clinic need to further define their role and community expectations of them
in a pandemic
▪
Clinics realize they will get more than their normal patient load. Need to work
with Public Health to develop a plan for triage – explore potential of parking
lot triage model to limit spread of disease
▪
Clinics need to offer ongoing education on pan flu to staff
▪
Clinics are willing to dispense drugs and medications, but need to coordinate
delivery of supplies
Suggested strategies:
1. Develop plan to utilize clinics as neighborhood resource centers
2. Utilize clinics as potential resource in county for ICCs as they are rich in
multi-lingual staff capabilities
3. Work more closely with Public Health to develop protocols for surveillance
and detection
4. Identify and utilize self-directed learning tools – video, web, etc. to educate
staff and clients in a pandemic
5. Utilize simple risk communications materials for clients/patients – both preevent and during a pandemic
6. Develop back-up resources for staff who are sick if intending to remain open
during a pandemic, concerns about ability to staff and stay open
7. Utilize Community Health Partnership as lead on communications with clinics
for ongoing preparedness
Food Service Providers
People who depend on meal sites for proper nutrition are extremely vulnerable
to closures. They include people of very low income, especially people who are
homeless and people with disabilities who live alone. People who depend on
home nutrition services such as Meals on Wheels are vulnerable to delays in
service or the loss of service. They include the homebound, most of whom are
very frail elders and disabled adults who live alone.
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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Suggested strategies:
1. Procure and deliver 3 day shelf-stable kits of food to homebound and at risk
clients. Replace kits on an annual basis5
2. Develop new “drop and leave” protocols for food delivery in a pandemic -Meals on Wheels typically checks on clients when they drop off food. While
they are open to developing new strategies it will be a challenge with some
clients who have limited mobility
3. Develop roster of former/potential drivers to maximize the number of
substitute drivers available when volunteer drivers are unavailable due to
illness or fear of risking exposure
4. Develop protocol for use of 2-day meal packages instead of daily deliveries to
leverage driver resources in a pandemic
5. Distribute educational information every other month with deliveries to
educate consumers and family members.6 initiate dialogue and planning
efforts with other service providers
Developmental Disabilities Populations
People who are developmentally disabled face vulnerabilities due to the loss of
programs and services that support their daily living. Discussions with San
Andreas Regional Center (SARC) staff, which provides services to over 8,000
consumers in Santa Clara County yielded the following:
Suggested strategies for day programs:
1. Utilize SARC network of service providers to educate clients/consumers on
pandemic preparedness and concepts like “social distancing” and “isolation
and quarantine”
2. Follow SCC Health Officer Recommendations for closure (just like schools) for
traditional day programs. Funding/staffing issues need to be further explored
5
The Health Trust Meals on Wheels program has already implemented this as a “lesson learned” from
Hurricane Katrina efforts.
6
Willing to start with SCCO pocket guide, but needs materials in at least 14 point font, recommends
“empowerment” messages. Pictorial format also good
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to minimize the fiscal impact on staff and programs over the course of the
pandemic
3. Develop protocols for care of clients living independently in the community,
as they present the greatest challenge if family members become ill and
cannot care for them. Limited support resources are available, but these
would be quickly overwhelmed in a pandemic
4. Risk Communications – Promote use of educational materials in day
programs, and at family workshops for independent living consumers.
Pandemic influenza education could be added as a training requirement for
service providers through San Andreas Regional Center
Suggested strategies for residential programs:
1. Explore licensing modifications and/or exemptions needed by Community
Care Licensing and Healthcare Licensing for identifying isolated care options
in a pandemic – County Health Officer and an emergency declaration may be
helpful to obtain modifications (room capacity issues, etc.)
2. Steps for limiting exposure are already in place such as “universal’
precautions” (hand washing, treating blood spills, etc.) at all residential care
facilities supported through San Andreas Regional Center
3. Utilize same disease prevention protocols based on experience with chicken
pox, TB and other outbreaks with their consumer populations for pandemic
4. Risk Communications – materials can be promoted in residential programs
and pandemic influenza education could be added as a training requirement
for service providers
5. Education – Pan flu preparedness questions could be added to site visits for
all types of programs
6. Funding – it was generally agreed that ample funds for pandemic influenza
preparedness could be obtained from the state for service providers
7. San Andreas Regional Center agreed to be a designated lead agency for
Developmental Disability Populations for future pandemic flu planning efforts
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Transportation
People who depend on public transportation and/or para-transit services are
especially vulnerable to exposure. They include people with disabilities and
people of low income who do not own cars, including many students.
Suggested strategies:
1. Develop Continuity of Operations plans for public transportation services and
para-transit services
2. Spacing – run additional buses on crowded runs (routes/times) and try to
schedule additional disaster/emergency transit services during non-peak
times to reduce impact on regular paratransit clients
3. Emergency schedules – develop emergency schedules to balance the needs
of riders with the loss of drivers
4. Substitute drivers – develop a roster of former drivers; provide them with
refresher training in a variety of vehicles on a variety of routes to maximize
the number of substitute drivers immediately available for duty during an
influenza pandemic
5. Anticipated maintenance – at the earliest signs of an influenza pandemic,
accelerate vehicle maintenance to minimize the need for regularly scheduled
maintenance during a pandemic, when loss of maintenance workers is
anticipated
6. Explore development of that a new “purchased-based” transit program that
could be activated in a declared disaster using a voucher-type system
7. Explore use of other public and private transit resources in pandemic
influenza planning and educational outreach such as cab companies,
ambulance drivers, school buses, Department of Corrections fleet, private
paratransit vehicles, etc.
Faith-Based Organizations
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Faith-based organizations serve a variety of cultural, economic and socially
diverse populations in Santa Clara County. A primary role they can play in
preparedness and planning is to educate congregations about pandemic
influenza and appropriate measures they can take for disease prevention and
control. Faith-based organizations very often mobilize resources to assist
disadvantaged populations in their communities. They can help fill a gap by
providing food and care to people who may not be able to access regular
services in a pandemic.
Faith-based organizations may also provide a variety of services for a pandemic
response, including, but not limited to:
▪
Risk communications
▪
Food preparation and distribution
▪
Transportation for homebound or frail populations
▪
Spiritual support and counseling
▪
Financial assistance due to job loss or shut-downs
▪
Translation resources
▪
Childcare
▪
Volunteer mobilization
▪
Facilities and resources for serving segments of vulnerable populations in
their congregations and communities
FBOs vary in their ability to serve the community. Although most services are
provided by congregation members, there may be some limitations due to a
small number of paid staff. A small staff can also pose challenges for efficient
communication and coordination.
Systems of Care for People with Specialized Medical
Needs
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People with specialized medical needs such chemotherapy, dialysis, living with a
brain injury and other medical risks pose a huge challenge for pandemic
planners. Influenza Care Centers will not be setup to handle their specialized
needs, and hospitals will most likely be overwhelmed with critically ill patients.
A proposed strategy for addressing this issue is to identify specific service
providers and explore opportunities of partnering with them to setup specialized
ICCs to meet the needs of these populations. A commitment of time and
resources will be necessary from different partners, and specialized ICCs present
an opportunity to address the needs of these people who might otherwise fall
through the cracks. Providers will typically advocate for their clients, and if
agreements can be brokered to develop specialized ICCs, CADRE can assist with
building relationships between such agencies and public health. Once specific
plans have been outlined, participating agencies can seek funding support for
these plans.
VII. Risk Communications for CBOs and FBOs
Pre-event Communication and Education
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Pre-event communication and education play a critical role in preparing all
segments of the population to help control the spread of disease. Teaching
cough etiquette, hand washing, staying home from work when ill, and educating
parents to keep children home from school, are all simple steps individuals can
take to better prepare the community for a pandemic.
Use of simple educational materials in pictorial format is one of the best
methods for teaching the non-literate and/or non-English speaking populations.
Information can be disseminated via flyers, posters, and handouts distributed
with other services that are provided to special populations. For example,
materials could be left on Meals on Wheels trays and distributed to homebound
populations with food delivery. Posters installed in restrooms in public places, or
easily accessible sites such as lunchrooms and break rooms will help spread the
message to diverse audiences in Santa Clara County.
The binder in the Resource Kit contains these pre-event communication posters
that can be utilized to educate special populations about pandemic influenza:
▪
Cough and Sneeze Etiquette
▪
Emergency Supplies
▪
Isolation and Quarantine
▪
Social Distancing
▪
Adults – Stay Home When Sick
▪
Children – Stay Home When Sick
▪
Wash Hands
Of the CBOs that participated in the survey for this project, over 35% listed
information and referral for vulnerable populations as the primary type of
service their organization provides to vulnerable populations. It is critical we
utilize these CBO links to communicate important messages for both
preparedness and response to a pandemic.
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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“Just in Time” Communications
“Just-in-time” communications are materials prepared before an event that are
ready to send once a pandemic hits. For example, pre-scripted e-mail messages
to clients, phone trees, text message or flyer distribution can be used to
disseminate warnings, situational updates and educational information on how
to care for oneself and family in a pandemic flu event. In addition, pre-event
educational materials can continue to be used for basic messages such as the
ones listed here.
▪
Cough and Sneeze Etiquette
▪
Emergency Supplies
▪
Isolation and Quarantine
▪
Social Distancing
▪
Adults – Stay Home When Sick
▪
Children – Stay Home When Sick
▪
Wash Hands
See posters in binder for examples of these types of communications.
Suggested Methods and Alternative Forms of
Communication
It is critical that CBOs and FBOs educate themselves and their clients on
concepts around communications in pandemic flu event. Because of the need to
limit social and face-to-face contact, meetings and other types of in-person
communication will need to be limited or eliminated and agencies will need to
incorporate the concepts of “social distancing’ and “isolations and quarantine”
into their planning for service delivery. Examples to consider include:
Agency to client communication - Agencies should consider how they will
communicate with and continue to provide services to clients in an influenza
pandemic. GIS mapping capabilities, phone, e-mail, regular mail, and other
SCC Pandemic Influenza Preparedness and Response Guidance for Vulnerable Populations
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methods will facilitate contact and help limit the spread of disease. For example,
Meals on Wheels program may need to adapt their drop-off strategy and leave
food at the front door rather than bringing it into a client’s home. Limiting
person-to-person contact will help control the spread of disease.
Agency to agency communication—CBOs should think about ways to
coordinate with vendors, other agencies and service providers in their sector.
Operational meetings that normally involve face to face interaction will need to
be replaced with seminars, phone conferences, e-mail, text messaging, and
other means of communication to limit the possibilities of spreading the disease.
One important step for preparedness step for agencies planning to respond in a
pandemic is to identify and procure resources for these types of communication
before a pandemic hits. They should conduct table-top exercises and discuss
with staff how communication strategies in a pandemic will be altered.
VII. Authorities
Please refer to the Santa Clara County Pandemic Influenza Preparedness and
Response Plan for all authorities pertaining to this plan.
IX. References
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Centers for Disease Control and Prevention, Public Health Workbook to Define,
Locate and Reach Special, Vulnerable and At-Risk Populations in an
Emergency, Draft 2007
Federal Emergency Management Agency and DHS Office for Civil Rights and Civil
Liberties, Interim Emergency Management Planning Guide for Special Needs
Populations: Version 1.0 August 15, 2008
EDEN, Extension Disaster Education Network, Pandemic Influenza Preparedness
for Faith-based Organizations, 2007
Rhode Island Department of Health, Pandemic Influenza Plan, January 25, 2006
San Mateo County Public Health Department, Continuity of Pandemic Influenza
Operations Guide and Template for San Mateo County Faith-Based
Congregations and Community Organizations, June 2007
Santa Clara County Public Health Department, Santa Clara County Pandemic
Influenza Preparedness and Response Plan, 2006
Seattle-King County, Washington Public Health, December 2006, An Influenza
Pandemic Planning Guide for Homeless and Housing Service Providers,
Edition #1
US Department of Health & Human Services, Pandemicflu.gov., Accessed
multiple checklists and resources for the development of this document and
planning with CBOs
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