City of Cleveland and Northeast Ohio Strategic National Stockpile (SNS) Receipt and Distribution Plan Overview A system is in place to provide distribution of antibiotics and/or vaccines to first responders, health care providers and to the general public as well as to supply needed supplies and equipment to the hospitals. This specific plan outlines how the Strategic National Stockpile (SNS) will be requested, received and distributed within the City of Cleveland, Cuyahoga County and Northeast Ohio Region. Command and Control Receiving Agency The City of Cleveland, through its Metropolitan Medical Response System (MMRS) and its coordination of the Northeast Ohio Regional Medical Response System (RMRS) has been charged with the responsibility of developing a Northeast Ohio Regional Node which will serve to receive, warehouse and distribute pharmaceuticals, medical supplies and equipment received from the federal government through its Strategic National Stockpile (SNS) plan. This plan dovetails into plans developed by local and county health departments for the mass distribution of antibiotics and vaccines to the general public. Unified Command Unified Command will be used to manage the receipt and distribution of the SNS. The incident commander will be city s RMRS/MMRS Coordinator. The following sections will be immediately established: operations, planning, logistics, finance/administration. Section chiefs will be assigned to oversee each section. Activation of Emergency Operation Centers (EOC) City of Cleveland The City of Cleveland Emergency Operations Center (EOC) will be activated as soon as it becomes apparent through surveillance indicators and/or hospital reports that a major epidemic is occurring that exceeds the health care system capacity in the city, county or region or in response to a credible threat of a biological weapon release.
Staffing The Office of Homeland Security and Emergency Management along with the Health Director, Safety Director and the Mayor, will determine the city s EOC staffing. The EOC will include representation from the following agencies/departments (and any others deemed necessary): City of Cleveland 1. Mayor s Office a. Chief of Staff (or designee) b. Chief of Safety and Health (or designee) c. Press Secretary (or designee) 2. Office of Homeland Security and Emergency Preparedness a. Assistant Safety Director b. Division of Fire Representative c. Division of Police Representative 3. Department of Public Health a. Health Director (or designee) b. Bioterrorism Preparedness Coordinator 4. Department of Public Safety a. Safety Director (or designee) b. Deputy Commissioner of Safety ISS (or designee) 5. Division of Police (CPD) a. Chief of Police (or designee) b. Deputy Chief of Homeland Security (or designee) c. Deputy Chief of Operations (or designee) d. Commander of Communications 6. Department of Public Service a. Service Director (or designee) 7. Cleveland Convention Center a. Director of Parks, Recreation and Property b. Commissioner of Convention Center (or designee) 8. Department of Finance a. Director of Finance (or designee) b. Manager of Telephone Services 9. Department of Public Utilities a. Manager of 800 MHz Radio System Cuyahoga County 1. Cuyahoga County Emergency Services 2. Cuyahoga County Board of Health 3. The Center for Health Affairs 4. American Red Cross Greater Cleveland Chapter State of Ohio 1. Ohio Emergency Management Agency (OEMA) 2. Ohio National Guard Page 2
3. Ohio Department of Health Federal 1. Federal Emergency Management Agency Region V (FEMA) 2. Federal Bureau of Investigations (FBI-Cleveland Office) 3. U.S. Public Health Service Region V (CDC) Representation from additional agencies/departments will be added to the EOC as necessary for incident management. County EOCs Activation Each county in the Northeast Ohio Region will determine if it is necessary to activate their EOC. This will largely depend on the scale of the emergency and resources needed the effectively manage it. Communication Links Communication links will be turned on between the city s EOC and those county EOCs which are on-line. These communication systems include telephone (landline and cellular), radio systems (including MARCS), internet (including the crisis management software) and the videoconferencing systems. Role The role of the County EOCs will be to coordinate with the city s EOC the movement of the pharmaceuticals, supplies and equipment via the county or individual community transportation assets to the points of distribution (PODs) in their respective county. Further, depending on each county s Points of Distribution Plan the county EOCs may be used to identify and report on the amount of pharmaceuticals, supplies and equipment needed in each county and report that information to the city EOC. The city EOC will then communicate those needs to the NEO Regional Node so that the request can be made available. Further, the county EOCs will assist the city EOC in coordinating the timely arrival, staging and loading of each county s transportation assets at the NEO Regional Node. Joint Information Center The Joint Information Center will be activated to coordinate all communication with the media. This is located in the city EOC. The mayors press office will send a representative to this location to function as the media relations coordinator. As soon as possible a public information officer will be named and the media relations coordinator will report to that individual. Public Information Officers from the local, county and federal agencies as well as the American Red Cross and Center for Page 3
Health Affairs will be asked to work from the Joint Information Center. All press releases will be developed and issued jointly and all news conferences will be held jointly. Communications Dispatching and Ongoing Communications In order to provide necessary communication between the entities that will carry out the function of the NEO Regional Node the following positions will be staffed at the city s EOC. Operations Section - CPD Dispatcher Operations Section - Cleveland Transportation Assets Dispatcher Operations Section Cuyahoga County Transportation Assets Dispatcher Operations Section Regional Transportation Assets Dispatcher Logistics Section Dispatcher A position in the EOC is assigned to each key department/division (Division of Police, Department of Public Service) to staff with a dispatcher or supervisor who is in direct contact with their respective dispatch center or coordination center via base station radio (800 MHz and MARCS), telephones (landline and cellular), internet and email. CPD Dispatcher The CPD dispatcher assigned to the EOC is referred to as Operations Section CPD Dispatcher and works through police dispatch for assignment of needed police assets. Depending on the situation there may be some police units which will be dispatched by the police dispatcher assigned to the EOC. Cleveland Transportation Assets Dispatcher The dispatching and tracking of city vehicles used for the purpose of transporting material from the NEO Regional Node to the city Points of Distribution will be done from the EOC by a dispatcher assigned to the Operations Section. This position is referred to as the Operations Section Cleveland Transportation Assets Dispatcher. Cuyahoga County Transportation Assets Dispatcher The dispatching and tracking of vehicles from Cuyahoga County used for the purpose of transporting material from the NEO Regional Node to the points of distribution (PODs) within Cuyahoga County will be done from the EOC by a dispatcher assigned to the Operations Section. This position is referred to as the Operations Section Cuyahoga County Transportation Assets Dispatcher. Page 4
Regional Transportation Assets Dispatcher The dispatching and tracking of vehicles from Lorain, Lake, Ashtabula and Geauga Counties used for the purpose of transporting material from the NEO Regional Node to the points of distribution within the region will be done from the EOC by a dispatcher assigned to the Operations Section. This position is referred to as the Operations Section Regional Transportation Assets Dispatcher. Logistics Section Dispatcher The movement of supplies and materials from location to location to support the operations section will be coordinated from the EOC by a dispatcher assigned to the Logistics Section. This position is referred to as the Logistics Section Dispatcher. All dispatchers will be assigned positions near each other so that coordination can take place between the various affected entities. Radios Communications within the City of Cleveland All city radio communications will be conducted via the 800 MHz radio frequencies. Operational elements of each division will communicate through their assigned intradivisional channels. CPD dispatch will communicate directly with CPD units assigned to provide traffic control, escort and security via tactical channels. Interdivisional, citywide communication will take place over City 2. City 2 will be cleared of other radio traffic to allow for uninterrupted radio traffic among the operational agencies. The incident commander will determine the need for communication on City 2 and how it will be utilized and by whom. All key city officials are supplied with 800 MHz radios and trained in their use. The city vehicles used to transport the material from the regional node to the distribution points throughout the city will communicate to the Transport Dispatcher via City 2. Communications between the City EOC and the Counties The vehicles used to transport materials to the distribution points in Lorain, Cuyahoga, Lake, Ashtabula and Geauga Counties and/or their security escort will communicate to the Cuyahoga County and/or Regional Transportation Assets Dispatcher(s) via MARCS radios and/cellular telephones. Surplus MARC radios from throughout the region will be issued to the drivers or security forces escorting the transportation assets. Page 5
Command and control communications done countywide and regionally will take place over the MARCS radio system. Key city, county and regional officials are equipped with at least a portable MARCS radio. Telephones Each station in the EOC is equipped with a landline telephone. Cellular communications will also be used to conduct necessary communications. All key city officials are equipped with Nextel cell phones or Blackberry phones. An available backup to the city is that many of the 800 MHz radios are equipped to also function as a phone, accessing a landline through the existing radio system (giving us an alternative method of communication in case the cellular system is overloaded or fails). Interoperability If other municipal or county agencies play a role and there is a need for coordinated radio communications the city will create interoperable communications through use of its (3) ACU 1000 units. Additional ACU 1000 units will be requested from throughout the region as is necessary (see NEO region wide resource list). Notifications and Alerts Notifications, advisories and directives will also be made over existing Nextel Blackberry and cell phones. Citywide paging software is in place and will be used for this purpose. Further, the city will utilize the WARN system for wide area notifications. Strategic National Stockpile (SNS) Requesting the SNS If resource needs are determined to exceed local and regional supplies, the affected community (s) will request that a Level 5 emergency be declared. In the City of Cleveland, the Mayor will initiate this request as outlined in the Cuyahoga County Emergency Management Plan. This determination will be based upon the magnitude of the epidemic and the agent causing disease. Events involving 1-100 casualties may be handled with existing resources (if the agent is not transmissible from person-to-person). However, events involving 100-10,000, and >10,000 casualties or exposed individuals will likely require additional resources such deployment of the Strategic National Stockpile (SNS), especially if the potential for person-to-person transmission is high. Page 6
Once this is done the Cuyahoga County Commissioners will contact, the Ohio Governor s Office (through the Ohio Management Agent), to request deployment of the Strategic National Stockpile (SNS). Unified Command will implement the plan for distribution of vaccine and/or antimicrobials based on input from city, county and state health departments, CDC and other expert consultants. Coordination from the City of Cleveland s EOC The City of Cleveland s EOC will coordinate with ODH for receipt of the material at the Regional Node and the subsequent delivery of the material to the appropriate distribution points. ODH is assigned a position in the EOC for this purpose. NEO Regional Distribution Node Location for Receiving SNS The Ohio Department of Health will receive the SNS from the Center for Disease Control (CDC). After it is appropriately packaged (to meet the need of the event) ODH will transport the material by ground transportation from Columbus to the NEO Regional Node which is located at the Cleveland IX Center. The trucks will be escorted from Columbus to Cleveland by security forces according to existing ODH procedures. Once at the city border the traffic unit of the Cleveland Division of Police will assist in providing the escort. The caravan will travel up I-71 north to the IX Center. Portions of freeway and streets around the IX Center will be temporarily closed to allow unimpeded movement of the ground transportation. If necessary, the caravan can be staged at a site in close proximity to the IX Center. Individuals the city s Office of Homeland Security and Emergency Preparedness and Departments of Public Health and Public Safety will meet and receive the shipment from Ohio Department of Health (ODH). Backup Sites An alternative location will be used if this site is unavailable. The Cleveland Convention Center and Cleveland Hopkins International Airport are backup sites. If the shipment arrives by air Cleveland Hopkins International Airport will be used as the primary site. It is a city-owned airport and a protocol is in place to land the airplane, receive and unload the SNS cargo containers, break it down and store it until it is distributed. Airport personnel and off-loading equipment will be available to assist with unloading the SNS. Page 7
Offloading, Warehousing and Loading of Material Under direction of the ODH representative, identified as the SNS Coordinating Officer, upon arrival of the ground transportation at the IX Center, ODH and CDC staff along with city employees and volunteers (see attached SOP and staff list) will unload the trucks and manage the warehousing of the material. They will also break out the material as necessary; reload the trucks which will transport the material to the distribution points. Using their inventory management software the ODH staff is responsible for tracking the distribution of the pharmaceuticals, supplies and equipment to the various points of distribution (PODs). Staging Area A staging area will be established in close proximity to the NEO Regional Node. All transportation assets will report to the staging area and then be dispatched to the NEO Regional Node where the vehicles will be loaded with the requested material. A person, identified as the Staging Area Officer is responsible for communicating with the city s EOC and the SNS Coordinating Officer to determine when the vehicles are to move to the loading area. Pick Up of Material Transportation assets from the city, county and region, upon direction from the Staging Area Officer, will move to the loading area where the warehouse staffing will load the requested material. The driver of the vehicle will be provided with an itemized list of what has been loaded. Upon arrival at the points of distribution (PODs) the driver will provide this list to POD Coordinator. Security of NEO Regional Node and Transportation Assets The Cleveland Division of Police (CPD) supported by the Cuyahoga County Sheriff s Office will provide security of the site. If necessary, these forces will be supplemented with security officers from the private security agency with which the city maintains a contract. Site and Perimeter Security The Cleveland Division of Police (CPD) is responsible for securing the perimeter and internal areas of the warehouse site. Access to the area will be immediately closed off to everyone other than authorized city, ODH and CDC officials. A Security Coordinator will be assigned to the site 24 hours a day and will determine entry of other persons to the area. Police officers will be staged at entrance points to the key areas to control ingress and egress of vehicles and people to the IX Center. Page 8
Credentialing The city Office of Homeland Security and Emergency Preparedness is responsible for the credentialing of individuals and will staff the site with a team who will be charged with this responsibility. An on-site area that has been cleared for safety and security will be used. Signage will be posted at appropriate locations and officers guarding the perimeter will advise incoming persons of the requirement to report to the Credentialing Center. All persons will be required to wear appropriate credentials identifying they are authorized access to the area and to the various sites. All persons representing local, county, state or federal agencies entering the warehousing area will be required to report to the Credentialing Center where they will receive appropriate credentials. Traffic Control and Security During Transportation to City PODs The Cleveland Division of Police will be responsible for assuring timely travel of the transport vehicles to and from the IX Center and the city PODs. The plan also calls for off duty police officers to be called back to work to bolster the work force, their working hours to be changed from 8-hour shifts to 12-hour shifts and the use of spare police cars to supplement the existing car plan. City auxiliary police officers and Utilities Department police officers will be used to assist in the duties described above. Also, with a Level 3 Emergency (or higher) the Cuyahoga County Sheriffs Department, suburban police departments and other police agencies (Regional Transit Authority, Cuyahoga Metropolitan Housing Authority) will be asked to assist. If the situation escalates to a Level 5 Emergency the Ohio National Guard will be brought in to help. Transportation of Material City Transportation Assets The city will provide vehicles from the departments of safety, service, utilities and parks and recreation to transport the equipment, medical supplies and pharmaceuticals to the various locations. See attached Standard Operating Procedure for Transportation Assets to City Points of Distribution (PODs). Additional vehicles from county, state and federal sources will be requested if necessary. Pre designated city personnel will drive the city vehicles, with additional support from state and federal resources, as needed. The Cleveland Division of Police (CPD) will provide security and traffic control for this operation. Page 9
City Distribution Points The city has identified twenty one sites which are located throughout the city for distribution of antibiotics and/or vaccines to the general public (see attached list). They are referred to as the city s Points of Distribution (PODs). These same sites may also serve as patient evaluation and triage centers for less symptomatic patients, as noted above. The EOC will track the distribution of medications and vaccines using computer software. This will be in addition to the tracking done by ODH from the NEO SNS Regional Distribution Node. Points of Distribution throughout the Region Each county has identified sites for distribution of antibiotics and/or vaccines to the general public (see attached list). They are referred to as the county s Points of Distribution (PODs). County and Region Transportation Assets Each county will determine whether it will provide transportation assets or if each community requesting the SNS will be required to provide the transportation assets. See attached Standard Operating Procedure for Transportation Assets to County and Regional Points of Distribution (PODs). Additional vehicles from state and federal sources will be requested if necessary. Each county or requesting community will provide staff to drive the city vehicles, with additional support from state and federal resources, as needed. Each county or requesting community will provide security and traffic control for this operation. Rehabilitation Sites Vehicle Repair In order to deal with any unexpected vehicle problems or breakdowns a satellite repair site will be set up at the IX Center. The mobile repair unit from Cleveland Division of Fire will be used to provide this service. Refueling of vehicles will take place at city refueling facilities or by use of mobile refueling tankers. These activities will be coordinated by the city s Public Service Department which will maintain a position in the EOC. State and federal resources will be used as needed to supplement this plan. The city will activate the GPS system through the Nextel phones in order to track the vehicle movements. Page 10
Rehabilitation of Workers The American Red Cross will set up a rehabilitation area the IX Center to allow transport personnel and law enforcement officers to eat, rehydrate themselves and rest as necessary. Further, a rehabilitation area will be set up and maintained at the EOC. Page 11