I. PURPOSE

This annex will establish an organization and procedures to provide needed health and medical services following a disaster of any type.

II. SITUATION AND ASSUMPTIONS

A. Situation

1. St. Clair County has two hospitals located in its boundaries -- Sac-Osage Hospital in Osceola and Ellett Memorial Hospital in Appleton City. These hospitals have developed emergency plans in accordance with State and Federal regulations. Such plans are tested and exercised regularly.

2. Public health for St. Clair County is the responsibility of the St. Clair County Health Department, which has offices in Osceola and Appleton City. They deal with problems such as communicable disease, environmental sanitation problems, contamination of food and water, and other health matters.

3. Ambulance service for St. Clair County is provided by Ellett Memorial Hospital's EMS and Sac-Osage Hospital Ambulance Service, both stationed in the county. Other ambulance services are provided by St. John's Ambulance and Paramedic Service at Cedar County (stations are located in Stockton and El Dorado Springs) which serves the southwest corner of St. Clair County, and Golden Valley Memorial Hospital Ambulance Service (stationed in Clinton) which serves the northern portion of the county. (See Appendix 2 to this Annex).

4. The St. Clair County Sheriff's Office maintains a list of handicapped residents in the county. Also, Ellett Memorial Hospital's EMS and the Appleton City Police Department maintain a similar list for Appleton City.

5. Should the local medical organization become overtaxed or rendered inoperable, resources are available from the state and surrounding counties to help alleviate the situation. Depending upon the emergency, St. Clair County may have a limited capability, through the hospitals, in decontaminating injured individuals that have been radiologically or chemically contaminated. Injured individuals would be transported to one of the hospitals located in Springfield, Kansas City, Clinton, orBolivar.

6. Helicopter pads are available at both Sac-Osage and Ellett Memorial Hospitals.

B. Assumptions

1. A major disaster striking the St. Clair County area will create medical problems beyond the normal day-to-day capabilities of the medical system.

2. Outside assistance is available and will respond when needed.

III. CONCEPT OF OPERATIONS

A. General

1. First responder emergency medical care will be supplied by the ambulance services and support will come from the first responder groups.

2. All medical units responding to an emergency call will be dispatched as described in Section II of Annex B.

3. Requests for outside medical assistance need not go through the EOC -- unless it is to the state or federal government -- but should be reported to the EOC immediately after they are made.

4. Immediately following the initial emergency medical care, public health and mortuary services will have the priority on resources.

B. Actions to be Taken by Operating Time Frames

1. Mitigation

a. Review the identified hazards (Basic Plan, Situation and Assumptions) to determine all the types of disasters that could occur in the county. Provide realistic training for the types of situations that could arise (such as radiological incidents).

b. Develop and conduct programs for the public on first-aid and public health practices.

c. Develop Emergency Mortuary Plans and coordinate these plans with the Missouri Funeral Directors Association and the Emergency Management Director (See Appendix 3 to this annex).

d. Locate and contact storage places of public health supplies to augment and/or satisfy expanded medical needs.

e. Train health and medical personnel and volunteer augmentees in special procedures (i.e., radiological and chemical contamination).

f. Develop and maintain mutual aid agreements with local health and medical services to insure proper coordination during emergency operations.

g. Exercise regularly with area hospitals to see that their emergency plans are up-to-date.

h. Identify medical facilities that have the capability to decontaminate injured individuals that have been radiologically or chemically contaminated.

i. Identify clinics, nursing homes, and other facilities that could be expanded into emergency treatment centers for disaster victims.

j. Participate in tests and exercises of the St. Clair County Emergency Operations Plan.

2. Preparedness

a. Analyze pending situation for potential health problems.

b. Alert personnel and begin locating supplies and equipment, checking for availability.

c. Report on status to the EOC.

d. Begin reducing patient population in the nursing homes and other health care facilities if evacuation becomes necessary. Continue medical care for those that cannot be evacuated.

e. Begin crisis augmentation of health/medical personnel, such as nurses aides, paramedics, Red Cross personnel, and other trained volunteers.

f. Establish contact with hospitals in neighboring cities and counties.

g. Review plans for the inoculation of individuals to prevent the spread of disease.

3. Response

a. Respond on a priority basis as established by the EOC, activating all necessary personnel.

b. Perform triage as necessary.

c. Begin instituting public health measures in reception centers, public shelters, and at the disaster scene.

d. Activate emergency mortuary plans as needed.

e. Set up and operate emergency clinics if necessary. (These could be required for essential workers in the hazardous area following the evacuation of the general population.)

f. Provide public health information to the County and/or City PIOs for dissemination to the public.

g. Report to the EOC regularly on the medical situation.

h. Assist in the emergency distribution of food and water and in setting up emergency sanitation facilities.

i. Distribute antidotes, drugs, vaccines, etc. to shelters.

j. Track patients that have been injured (i.e., hospital, clinic, shelter, etc.).

k. Maintain this operational level until the medical situation has lessened.

4. Recovery

a. Conduct patient care as necessary.

b. Continue to survey community for public health problems.

c. Provide list of deceased to EOC.

d. Perform tasks as required to return situation to normal.

e. Inoculate individuals if warranted by the threat of disease.

f. Participate in cleanup and recovery operations.

IV. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES

A. Organization

The organizational chart for the Health and Medical services is shown in Appendix 1 to this annex.

B. Assignment of Responsibilities

1. Coordination of the Health and Medical services in St. Clair County will be the responsibility of the St. Clair County Health Department's Administrator. The Health and Medical Coordinators for Appleton City will be the St. Clair County Health Department's Administrator and the Ellett Memorial Hospital's EMS Chief.

2. Patient care will be the responsibility of the receiving hospital.

3. Emergency mortuary procedures will be the responsibility of the St. Clair County Coroner.

4. The Administrator of the St. Clair County Health Department will be responsible for public health matters in the county, to include health education.

5. The ambulance services will be responsible for initial triage, emergency medical treatment and patient transport.

6. Medical supplies will be the responsibility of the responding agency or the Resource and Supply section (Annex G), if necessary.

V. DIRECTION AND CONTROL

A. All coordination of Health and Medical operations will occur at the EOC. Each operating agency/organization mentioned above will provide a representative at the EOC to coordinate their activities.

B. The EOC will not interfere with the internal operations of the area hospitals, but will provide support as required (i.e., assist with ambulance dispatching, etc.).

C. Decisions to evacuate nursing homes and other health care facilities will be made by the institution staff and will be controlled from the EOC.

D. Should the EOC be moved, operational coordination of medical services will be moved with it.

VI. CONTINUITY OF GOVERNMENT

A. Lines of succession for the Health and Medical Coordinators are as follows:

St. Clair County Health Department's Administrator --

Assistant Administrator -- Home Health Coordinator

Ellett Memorial Hospital's EMS Chief -- Assistant Chief

-- Director of Nursing

B. The line of succession for each operating Health and Medical agency/organization will be as explained in their departmental SOPs.

VII. ADMINISTRATION AND LOGISTICS

A. Administration

1. Statistics of various types will become very important during emergency periods. Some of those that should be kept and reported to the EOC are:

a. deaths

b. injuries

c. inoculations given

d. blood supply

e. incidence of disease

2. Records of hours worked and materials used must be reported to the EOC for use in determining the total cost of the incident.

B. Logistics

1. Communications will be the responsibility of the agencies that are operational during the emergency or disaster. They will be supplemented by the appropriate county and/or city government as necessary.

2. Health and Medical services must provide necessary logistical support for food, emergency power, fuel, etc., for response personnel during emergency operations. In most situations, however, the Resource and Supply section (Annex G) will be available to assist with supply matters.

3. Supply requisitions will be made through normal channels as much as possible, but will be made through the EOC when necessary.

VIII. ANNEX DEVELOPMENT AND MAINTENANCE

The St. Clair County Emergency Management Director will instigate an annual review of this annex and its supporting documents. The Health and Medical Coordinators and each health and medical department/agency will assist with this update and are responsible for maintaining their particular SOPs.

Appendices

1. Health and Medical Organizational Chart

2. Area Health and Medical Services

3. St. Clair County Emergency Mortuary SOP

Suggested Appendices

1. Triage procedures

2. Ambulance SOPs

3. Call-Up Lists

A. Hospitals Telephone

1. Sac-Osage Hospital 417/646-8181

P.O. Box 426, Jct. Hwy. 13 and Bus. 13

Osceola, MO 64776

Service: General Medical-Surgical

Beds: 47 licensed/staffed

2. Ellett Memorial Hospital 816/476-2111

610 N. Ohio Avenue

Appleton City, MO 64724

Service: General Medical-Surgical

Beds: 25 licensed, 19 staffed

B. Ambulance Services

1. Sac-Osage Hospital Ambulance Service 417/646-8150-E

P.O. Box 426, Jct. Hwy. 13 & Bus. 13 417/646-8181-B

Osceola, MO 64776

7 Paramedics 4 units

12 EMTs (approx.)

2. Ellett Memorial Hospital's EMS 816/476-2111-E

610 N. Ohio Avenue 816/476-2111-B

Appleton City, MO 64724

12 EMTs

2 basic life-support units which can be converted to advanced life-support units (based at the hospital in Appleton City)

3. St. John's Ambulance and

Paramedic Service 417/876-2313

El Dorado Springs, MO

4. Golden Valley Memorial Hospital

Ambulance Service 816/885-8000-E

Jct. Hwys. 7 & 13 816/885-5511-B

Clinton, MO 64735

3 units

C. Health Services

1. St. Clair County Health Department

Hailman Blvd., Osceola 417/646-8165

3rd & Poplar, Appleton City 816/476-2285

Personnel:

7 RNs (includes Administrator)

3 LPNs

4 Nurses' Aides

1 Sanitarian (covers three-county area)

1 Health Educator

3 Clerks

2. State District Health Unit No. 5 417/883-1555

P.O. Box 777

Springfield, MO 65801

D. St. Clair County Coroner

C. Randy Sheldon 417/646-8135

Sheldon-Goodrich Funeral Home

Osceola

E. Mortuary Services

Eckhoff-Hill Funeral Home 816/476-2135

213 W. 6th Street

Appleton City

Sheldon-Goodrich Funeral Home 417/646-8135

Osceola

CONCEPT OF OPERATIONS:

To establish means and methods for the most reasonable and proper care and handling of the dead in multi-death disaster situations. The Mortuary Disaster Response Team is responsible for aiding the St. Clair County Coroner in the recovery, evacuation, identification, sanitation and preservation (such as embalming if necessary), notification of the next of kin and facilitating means for release of the identified dead to the next of kin or their agent.

COMMUNICATION PROCEDURES:

Upon the event of a disaster of any nature, which has caused multiple deaths, the following persons should be notified immediately. Preferably in the order shown below, but not limited to this order of priority:

1. C. Randy Sheldon, St. Clair County Coroner

Sheldon-Goodrich Funeral Home

Osceola

417/646-8135

378-4666

2. Barton County Sheriff

417/646-2522

3. Emergency Management Directors of the county and the municipalities affected should be notified.

One of the above persons will immediately notify the Certified Disaster Coordinator listed below:

Neel Baucom, Area Disaster Coordinator (Area 8)

Missouri Funeral Directors Association (MFDA District 8)

Knell Mortuary

914 E. 13th Street

Carthage, MO 64836

417/358-4221

This coordinator has been trained at the National Level by the Federal Emergency Management Agency and by the National Funeral Directors Association. This individual will go immediately to the site to lend his expertise and to act as liaison between the Missouri Funeral Directors Disaster Teams and the National Association should the scope of the disaster require supplies or personnel beyond our resources.

The Disaster Coordinator will notify the Missouri State Funeral Directors Association and will, from time to time as conditions permit, issue briefings to the M.F.D.A. office with regard to additional supplies and as to progress with the mission.

AUTHORIZATION FOR ADMISSION OF DISASTER WORKERS INTO DISASTER SITE

All disaster workers must have in their possession the necessary identification card or pass, etc., as developed by the Emergency Management Director or responsible official to gain admission into the immediate disaster site area. These workers and members of the Mortuary Disaster Response Team will be required to register their name and address at the EOC or area designated for such purpose.

RECOVERY OPERATIONS GUIDELINES:

1. None of the dead shall be moved or touched by workers until approval has been given by the appropriate Sphere of Control, most usually the Coroner.

2. Operations will be coordinated by the Coroner and MFDA Disaster Response Team Coordinator.

3. A survey and assessment of the situation will be made by the Coroner and Mortuary Disaster Response Team Coordinator. They will note the approximate number of dead, equipment and personnel needed.

4. Once workers have reported to the scene a briefing will be held, assignments will be given at this time, and workers will be divided into teams if necessary.

5. Photos or a sketch will be made of the disaster site, and if desired the scene will be divided into sections with the recovery teams assigned to particular sections.

6. Suitable stakes or markings will be placed at the location of each body and numbers will be assigned to each body.

7. Bodies will be tagged and records kept noting the location in which the body was found. (This tag numbering system will be developed by the County Coroner.)

8. Personal effects of the dead will be tagged and data recorded noting location found.

9. When necessary, bodies will be placed in a body pouch and a tag with corresponding numbers will be placed on the pouch.

10. Valuables such as wallets, attached jewelry, etc. will not be removed at the disaster site. These will remain on the body.

11. Bodies will be removed from immediate disaster site via litter or stretcher into the evacuation area.

12. The major support group for this recovery task will be members of the MFDA Disaster Response Team.

BODY EVACUATION OPERATIONAL GUIDELINES:

1. Evacuation operations will be coordinated by the Coroner and the MFDA Disaster Response Team Coordinator.

2. A survey and assessment of the situation will be made by the Coroner and Mortuary Disaster Response Team Coordinator. They will note the approximate number of dead, type of terrain, necessary personnel and equipment needed.

3. Before operations begin, a briefing will be held, assignments given and teams formed if desired.

4. Bodies will be covered when transported.

5. All vehicles used for transport will be covered except when not possible.

6. Vehicles should travel the same route from disaster site to morgue site. This route will be established in coordination with local traffic control agencies.

7. Vehicles should travel at a moderate pace and in convoy style.

8. Records will be kept noting vehicle ID and body tag number, as well as driver ID.

9. Evacuation teams will take care not to overload the morgue site with incoming bodies.

10. The major support group for this task will be the MFDA Disaster Response Team.

MORGUE SITE:

1. A list of possible morgue sites will be maintained for use in the event of a disaster.

2. Once a morgue site has been selected the Coroner and the MFDA Disaster Response Team Coordinator will organize its operations and assign personnel to some or all of the following job titles:

(Uniformed Guards, information clerks, counselors, interviewers, telephone communicators, admissions clerk, general supervisor, ID personnel, orderlies, personal effects custodian, embalming supervisor, embalmers, secretaries, inventory clerk, distribution clerk, etc.)

3. The morgue site will be used for the storage, identification, sanitation, preservation if desired, as well as the distribution point for release of the dead to their next of kin or their agent.

4. Refrigeration units will be utilized as necessary.

5. Bodies admitted to the morgue will be logged and necessary information gathered and recorded about each body.

6. Personal effects will be recorded and placed in a secure area.

7. Should embalming be necessary the Coroner will rely on the MFDA Disaster Response Team to organize the operations, equipment, supplies, and personnel needed.

8. An area will be designated for the press.

9. Counselors such as members of the clergy will be present in waiting areas to assist persons visiting the morgue.

IDENTIFICATION OF THE DEAD:

The Coroner will arrange for the necessary equipment and staff to accomplish this task. The members of the MFDA Disaster Response Team will be at his/her disposal to be of assistance where needed.

NOTIFICATION OF NEXT OF KIN:

The Coroner, with the assistance of the MFDA Disaster Response Team, will determine the most practical method to be utilized in contacting the next of kin. Every effort will be made to lessen the extreme psychological impact on the families of those dead. The nature and scope of the disaster will determine what methods will be used.

COUNSELING OF SURVIVORS:

The Coroner and the MFDA Disaster Response Team will keep listings of local clergy and/or responsible persons trained in counseling with grieving survivors. These personnel will be asked to report to the waiting area of the morgue site to assist families that visit the morgue site. Phone counselors will also assist persons calling the morgue site. Efforts will be made to keep the families of the dead posted as to what is taking place and information will be released to them as best possible.

DISTRIBUTION OF THE DEAD:

Once the body has been positively identified the next of kin will be contacted with this confirmation. At this point the Coroner or MFDA Disaster Response Team personnel will coordinate the release of the body to the next of kin or their agent. All efforts will be made to cooperate with the receiving agent or family. However, the nature and scope of the disaster may require policies that may appear unfair or delayed. These policies may be necessary for the smooth flow of operations at the morgue site. All policies will be made or approved by the Coroner before implemented.

In situations where there are UNIDENTIFIED dead, the Coroner will make the decision about their disposition. Mass burial may be necessary and location of burial sites will be determined at the time. It is suggested, however, that cremation not be utilized as later identification and exhumation may be practical and necessary. Records will be kept of burial locations and body tag number will be interred with the body to make later efforts of identification easier.

TERMINATION PROCEDURES:

After the disaster clean-up operations are completed efforts will be made to return donated equipment and supplies. Cleaning and sanitizing of the morgue site will be necessary. Records compiled during the operations will be arranged in some type of systematic order and efforts will be made to preserve and store these records for future use if necessary.

MORTUARY RESOURCES:

Resource lists pertaining to mortuary services will be compiled by the County Coroner. This information will be furnished to the St. Clair County Emergency Management Director who will incorporate it into the County resource file.