Physical and ManMade Hazards

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Physical and Man-Made Hazards

• Boston University School of Medicine
• GMS 600
• John J. Burke
• jjemt8_at_bu.edu

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The Colville Indian Reservation H1N1
Distribution Exercise

• Colville Indian Reservation
• Nespelem, Washington
• September 30, 2009

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Introduction

• Colville Indian Reservation is 1.4 million acres,
  located 250 miles East of Seattle, WA
• Tribal Nation part of Confederate Tribes of
  Colville
• Health Care provided by Federal Government,
  specifically, Indian Health Service.

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Introduction

• Nespelem, WA is main city of the Reservation.
• Never done an EDS exercise or drive thru.
• Indian Health runs medical clinic.

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Introduction

• Scheduled to be an exercise but seasonal flu
  vaccine arrived 12 hrs prior.
• Staff made decision to give actual shots. Blast
  phone message sent to the community informing of
  such.
• Local employers allowed workers to leave work to
  attend the clinic, dual benefit for the employer.

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Colville Indian EDS
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EDS Site

• Tribal POW WOW Fairgrounds site, which offered
  oval roundabout and proximity to clinic and
  several covered buildings.
• Excellent traffic plan developed by DPW and
  TOSHA. Shows value of Traffic experts in
  developing traffic routing for these types of
  events.

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Unified Incident Command

• Federal Indian Health Service, US Public Health
  Service, Red Cross
• Tribal Public Safety, Corrections, EMS and
  Health.
• County Sheriff, Emergency Management, and
  Amateur radio.
• Local DPW and Fire

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Unified Incident Commander

• John Dick Corrections Commander for jail.
• ICS trained and 20 plus years of experience.
• Able to bridge gap between ALL entities involved.

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EMS Observation Area

• Staffed by Colville Tribal Ambulance and Colville
  Fire Staff.
• Handled 3 adverse reactions.
• Supervised by Physician on site.

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Vaccination Area
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Vaccination Area Part II
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Colville Vaccination Area
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Colville Vaccination Area II
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Operations Section

• OSC was Elizabeth Sullivan, PH RN for the Indian
  Health Service.
• First time OSC and first time non-public safety
  personnel took operational role.
• Military background in US Navy prior to coming to
  IHS.

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Operations Section

• Divided up into (5) working groups, good for span
  of control.
• Groups were Vaccination, Education, Traffic,
  EMS/Observation and Registration.
• Took basic working groups from Town of Sandwich
  Exercise 2008.

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Operations Section

• Good use of non-public safety personnel in the
  DIV/GRP Supervisor position.
• Trade off was lack of experience in radio traffic
  and management of ICS situation utilizing an
  Incident Action Plan.
• Tendency to do face to face instead of using
  radio which caused some delays.

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TOSHA

• Tribal Occupational Safety and Health
  Administration.
• Provides safety, inspections and training for
  tribal services. Instrumental in development of
  drive thru traffic plan and safety procedures.
• SOFR for Exercise was TOSHA member.

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SAFETY

• Most critical element of any drive-thru exercise.
• SOFR was TOSHA director with good safety
  background.
• 215A not filled out and safety briefing was not
  done. Need to highlight exposure protocols,
  traffic vests, vehicle being in park, and
  protocol for intoxicated drivers.

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SAFETY

• More than one SOFR needed, recommend that (3) be
  in place for every drive thru event.
• SOFR needed for just universal precaution and
  medical waste management areas.
• Needed to emphasize 215-A and gain input from IC
  and Operations

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INTELLIGENCE UNIT

• Needs to be active for any public health
  emergency.
• Intelligence Officer could have briefed IC, OSC
  and SAFETY on potential troublemakers and Level 3
  offenders that would be utilizing the clinic.
• Needed to ID anti-government members who would
  disrupt the exercise or even

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INTELLIGENCE UNIT

• Should be comprised of Tribal Law Enforcement,
  BIA Police, County Sheriff and FBI Liaison.
• Could be active weeks before distribution
  devising contingency plans for potential
  disruptive activities at the event.
• Recommend isolation of unit from main activities
  to provide cover.

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Lessons Learned

• Have Medical Waste Manager assigned.
• Longer operational period is possible with amount
  of workers.
• Need full Operational Briefing before
  commencing plan.
• Plan for early birds arriving 30 minutes prior
  to start time.

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Lessons Learned

• Prisoner vaccinations need a protocol in place
  for guards and staff to follow.
• EMS on scene expected an exercise and not actual
  vaccine, problem with staffing the event and
  providing coverage to the area.
• Selection of Incident Commander for Tribal
  Nations may be different than what we are use to.

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Lessons Learned

• Unified Incident Command worked and all agencies
  worked together.
• Plan can be utilized for any mass distribution
  (water, supplies)
• TOSHA group is very valuable asset to the
  community.
• Corrections Commander as IC for Public Health
  event showed unity amongst agencies.

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Lessons Learned

• Traffic maps to be handed out prior to event for
  staff and public.
• More traffic personnel along the route to assist
  in traffic flow and direction.
• Logistics Section Chief needed, shared duty by
  PSC for this event.
• Police need to be visible in the drive thru area
  for deterrence and traffic control.

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Summary

• Target was for 150 vaccinations to be given which
  would be an all time high.
• At the conclusion, 159 vaccines given, entire
  tribal community was very pleased!
• All major players came thru, including Tribal
  Council President, Indian Health Service
  Director, and Native American leaders which
  provided HUGE buy in.

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Questions??