LOCAL PUBLIC HEALTH EMERGENCY OPERATIONS PLAN

St. Charles County Department of Public Health

October 2016

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 Prepared by

St. Charles County Department of Public Health

in conjunction with

Division of Emergency Management

and other emergency response partners referred to herein.

Prepared in February 2011

Revised in October 2016

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 RECORD OF CHANGE
ST. CHARLES COUNTY
DEPARTMENT OF PUBLIC HEALTH
LOCAL PUBLIC HEALTH EMERGENCY OPEARATIONS PLAN

DATE OF CHANGE DESCRIPTION OF CHANGE CHANGE MADE BY

6/30/10 Update to Annex H – Changed Planner references Joe Morin

7/9/10 Update to Annex H – Changed job titles for staff Joe Morin
9/10/10 Update to Annex C – Removed PIO titles Joe Morin
10/15/10 Update to Annex H – Updated POD contact info Joe Morin
10/18/10 Update to Annex H – Added section 2.2 commo matrix Joe Morin
11/15/10 Update to Annex C – Familiarization with overall plan and Doug Bolnick
update of media list/contacts.
1/7/11 Update to Annex D – Updated contact info Alison Tucker
1/7/11 Update to Annex H – Added distribution manager section Joe Morin
1/11/11 Reformatting – Began merging annex’s to single document Joe Morin
1/12/11 Update to Annex E – Updated contact info Alison Tucker
Annex C – clean up typos/poor word choices. Changes reflect
1/31/11 suggestions made at 2010 TAR review. Doug Bolnick
2/18/11 Annex C – Update media list and master press release Doug Bolnick
templates to reflect needs of Section 5.4.
4/26/11 Reformatting – Continue merging to one document Joe Morin
Annex C – Created PIO folder for hard copies of Annex C.
5/6/11 Updated all-hazards fact sheets in preparation for National Doug Bolnick
Level Exercise.
5/12/11 Update to Annex H – Added open POD floor plans Joe Morin
8/23/11 Update to Annex A – Updated contact info Joe Morin
8/23/11 Update to Annex B – Updated contact info Joe Morin
8/23/11 Update call-down contacts Joe Morin
Annex C – Clean up language and punctuation. Developed At-
8/31/11 Risk table for community partners. Defined Social Media policy. Doug Bolnick
Updated media list/contact information for partners.
9/29/11 Update to Annex H – Added Open POD security plans Joe Morin
Annex C – Finalized agreements with Back-up Printer and
9/30/11 community partners. Completed edits and improvements to Doug Bolnick
plan narrative, fact sheets and release templates.
11/28/11 Update to Annex H – Updated training of Distribution Manager Joe Morin
1/12/12 Update to Annex H – Separated Safety & Security Positions, Joe Morin
added back-ups
4/1/12 Update to Annex C – Added Community Living to At Risk Table Doug Bolnick
4/19/12 Update to Open POD - Completed Security Assessment for Joe Morin
Francis Howell North
4/20/12 Added Safety and Back-up to Section 2 Contacts Joe Morin
5/14/12 Update to Annex H – Add POD Operations Section Joe Morin
6/22/12 Update to Section 2 Contacts (Change Hospital Contact) Joe Morin
6/25/12 Update to Open POD – Completed MHE inventory for Francis Joe Morin
Howell and SCW High
7/1/12 Update to Annex C – Update contact list and password Doug Bolnick
directors
7/15/12 Update to Section 2 contacts – Changed hospital contacts Joe Morin
7/18/12 Update to Annex H – Removed triage Section from POD’s Joe Morin
8/30/12 Update to Section 2 Contacts (Change Tactical Joe Morin
Communications & Volunteer Contacts)
9/1/12 Update to Annex C – Update At Risk Table and Media contact Doug Bolnick
list
10/19/12 Update to Open POD – Added FHH and Holt Security Plans Joe Morin

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11/1/12 Update to Annex C – Update media list and release templates Doug Bolnick
to reflect SNS program changes
Update to Annex H- Include Elliott Data Systems Inventory
12/5/13 Management Process, Updated policies on unaccompanied Andrew Willman
minors and medication pickup limits
10/19/15 Began update of overall plan: reformatting, cleaning up Nick Kohlberg
language, fixing errors.
10/20/15 Reformatting, cleaned up language, fixed errors; updated Nick Kohlberg
COOP information
10/21/15 Reformatting, cleaned up language, fixed errors, continued Nick Kohlberg
updating COOP
10/23/15 Update to Annex A – reformatting, cleaned up language; Nick Kohlberg
leadership and staff responsibilities, Readiness Check Protocol
10/30/15 Update to Annex B – reformatting, cleaned up language, fixed Nick Kohlberg
errors
11/3/15 Updated to Annex C – reformatted to fit overall plan; info and Nick Kohlberg
processes unchanged; added attachments 12-18
11/4/15 Update to Annex D – reformatting, updated surveillance Nick Kohlberg
processes
12/4/15 Update to Annex E – reformatting, updated investigation Nick Kohlberg
information and contact information
12/7/15 Finished update to Annex E; Update to Annex F – reformatting; Nick Kohlberg
repositioned some content, updated attachments
12/10/15 Update to Annex G – reformatting; cleaned up language; Nick Kohlberg
updated attachments; built info packet for I & Q
12/11/15 Update to Annex H – reformatting; cleaned up language; Nick Kohlberg
updated procedures
12/14/15 Update to Annex H – reformatting; cleaned up language; Nick Kohlberg
removed MOHSAIC and updated SNS ordering procedures;
included new SNS POD inventory tracking sheet
12/15/15 Update to Annex H – removed First Med content and Nick Kohlberg
procedures; included priority dispensing for responders in main
body; updated policies on unaccompanied minors; reformatting
12/22/15 Update to Annex H – moved plan for SNS distribution to main Nick Kohlberg
body; updated DPH ICS structure and descriptions; updated
attachments
12/23/15 Update to Annex I – reformatting; cleaned up language Nick Kohlberg

12/29/15 Finished update to Annex I – included information from RHCC Nick Kohlberg
Shelter Plan; updated attachments
12/30/15 Update to Annex J – reformatting; reworded public health Nick Kohlberg
involvement criteria; included local, state and federal resources
12/31/15 Finished update to Annex J – updated contact info; updated Nick Kohlberg
attachments
1/4/16 Update to Annex K – reformatting; cleaned up language; Nick Kohlberg
updated attachments; added resource availability
1/6/16 Update to Annex L – reformatting; removed duplicate Nick Kohlberg
information; cleaned up language
1/7/16 Finished update to Annex L – reformatting; removed duplicate Nick Kohlberg
information; updated attachments
2/2/16 Update to Annex M – reformatting; cleaned up language; Nick Kohlberg
updated attachments – still need updating of several forms
2/3/16 Update to Annex N – reformatting; cleaned up language Nick Kohlberg
Update to Annex P – reformatting; cleaned up language

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 2/4/16 Finished update to Annex P – updated WHO phase information; Nick Kohlberg
removed duplicate information; updated attachments
9/26/16 Update to Annex H – added need for POST certification for
POD security; added possibility of MDNR, MDC, etc. for
additional security personnel; added state and federal liability
protection language; added WebEOC ordering process
Nick Kohlberg
Update to Annex M – added ECL levels to volunteer
classification information; added language for staff deployment
outside of SCC
9/27/16 Update to Annex I – improved info on AFN sheltering; updated
attachments with Human Services partners
Nick Kohlberg
Update to Annex X – added responsibilities and organization at
local, state, federal levels; updated attachments with resources
for AFN populations
9/28/16 Update to Annex L – added MO Rapid Response Team as a
resource available at the state level; added Zika Action Plan
Nick Kohlberg
Added Annex Q (Mutual Aid) – added information about mutual
aid planning at the state level and tenets of mutual aid
10/19/16 Updated to Annex B – added Sit Reps and ICS forms to info
sharing info

Update to Annex H – added EMA as logistical partner; clarified

primary and backup transp. assets; added steps for requesting Nick Kohlberg
resources from local, state, and federal partners; added steps
to track chain of custody

Update to Basic Plan – added EMA as logistical partner

10/21/16 Update to Annex H – added routes from RSS to POD sites;
added info on bio-waste disposal; improved Healthcare Nick Kohlberg
partners’ responsibilities
10/24/16 Update to Basic Plan – Added procurement procedures for
normal and emergency situations
Nick Kohlberg
Update to Annex A – Added procurement procedures for
normal and emergency situations
10/26/17 Update to Annex H – clarified processes to make decisions for
medical or non-medical POD models; added language for use
of paper dispensing if electronic not available; added private
sector responsibilities; added numbers needed to dispense to
Nick Kohlberg
first responders and other key personnel

Update to Basic Plan – added possible alternate locations for

HEOC
10/27/16 Update to Annex H – clarified which disciplines may be
considered “critical infrastructure staff”; clarified JITT processes
Update to Basic Plan – added methods of information sharing
for responder safety and health Nick Kohlberg

Update to Annex M – clarified procedures for requesting

volunteers from DEM
9/27/17 Annual update/review – updated local contacts; no other major Nick Kohlberg
revisions necessary
12/17/17 Removed references to MO CERT; added reference to Nick Kohlberg
departmental COOP plan; revised SNS pickup auth. letter
9/27/18 Annual update/review – revised SNS ordering processes for Nick Kohlberg
hospitals; updated contact information for Medical Examiner’s
office
11/15/18 Updated qualifications for mental health services; Nick Kohlberg

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6/21/19 Updated notification methods in the Basic Plan; Removed DPH Nick Kohlberg
ICS structure from Annex H and inserted it into Annex A;
updated table of contents to reflect new page numbers

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 FOREWORD

A. This plan will outline actions to be taken by the St. Charles County Department of Public Health
(DPH) in conjunction with local governmental officials and cooperating private or volunteer
organizations to: 1) prevent avoidable disasters and reduce the vulnerability of citizens to any
disasters that create a local public health emergency; 2) establish capabilities for protecting
citizens from the effects of a local public health emergency; 3) respond effectively to the actual
occurrence of disaster; and 4) provide for recovery in the aftermath of any local public health
emergency.

B. It is not the intent of this plan to attempt to deal with those events that happen on a daily basis,
which do not cause widespread problems and are handled routinely. It will, however, attempt to
deal with those occurrences that create a local public health emergency, which create needs and
cause suffering to citizens that cannot be alleviated without the assistance of governmental,
private and voluntary resources.

C. The DPH’s Emergency Operations Plan (EOP) was developed through the efforts of the DPH,
along with input from various agencies, organizations and county and city governments regarding
their roles, responsibilities, and capabilities in a local public health emergency. This plan is a
result of their input.

D. The DPH EOP is a multi-hazard, functional plan, broken in to three components: 1) a basic plan
that serves as an overview of the DPH’s approach to a local public health emergency; 2) annexes
that address specific activities critical to emergency response and recovery; and 3) attachments
which support each annex and contain technical information, details, and methods for use in
emergency operations.

E. This plan is to be used primarily by the DPH, but all agencies involved should be familiar with it.
The annexes and attachments are for staff.

F. The contents of this plan must be understood by those who will implement it, or it will not be
effective. Thus, the DPH Director or designee will brief staff on their roles in emergency
management when responding to a local public health emergency. New employees and
government officials must be briefed as they assume their duties.

G. Staff with assigned tasks will assist in the maintenance of their respective segments of the plan.
The plan will be updated as needed based on after action reports from public health
emergencies, deficiencies identified through drills and exercises, and changes within the DPH.

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 GLOSSARY OF ACRONYMS

ACS - Alternate Care Sites

AFN - Access and Functional Needs
ARC - American Red Cross
ARES - Amateur Radio Emergency Service
ARRL - American Radio Relay League
CD - Communicable Disease
CDC - Centers for Disease Control and Prevention
CERT - Community Emergency Response Team
COAD - Community Organizations Active in Disasters
COOP - Continuity of Operations Plan
CRI - Cities Readiness Initiative
DEA - Drug Enforcement Administration
DEM - St. Charles County Division of Emergency Management
DHS - Department of Homeland Security
DMAT - Disaster Medical Assistance Team
DPH - St. Charles County Department of Public Health
DSR - Department Situation Room
ECL - Emergency Credential Level
EH&P - Environmental Health & Protection Division (within DPH)
EMD - Emergency Management Director
EMS - Emergency Medical Services
EOC - Emergency Operations Center
EOP - Emergency Operations Plan
EPA - Environmental Protection Agency
ESF - Emergency Support Function
ESSENCE - Electronic Surveillance System for the Early Notification of Community-based Epidemics
FBI - Federal Bureau of Information
FEMA - Federal Emergency Management Agency
GEOC - Gateway ESSENCE Operational Committee
HAM - Handheld Amateur Radio Operator
HAZMAT - Hazardous Materials
IAP - Incident Action Plan
IC - Incident Commander
ICS - Incident Command Structure
IS - St. Charles County Information Systems Department
I&Q - Isolation & Quarantine
JIC - Joint Information Center
JIS - Joint Information System
JITT - Just-in-time training
NIMS - National Incident Management System
LPHA - Local Public Health Agency
MDA - Missouri Department of Agriculture
MDC - Missouri Department of Conversation
MDNR - Missouri Department of Natural Resources
MO DHSS - Missouri Department of Health and Senior Services
MOA - Memorandum of Agreement
MODOT - Missouri Department of Transportation
MOU - Memorandum of Understanding
MRC - Medical Reserve Corps
MRRT - Missouri Rapid Response Team
MSHP - Missouri State Highway Patrol
NRDM - National Retail Data Monitor
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PEP - Post-Exposure Prophylaxis
PIO - Public Information Officer
POD - Point(s) of Dispensing
PPE - Personal Protective Equipment
RSS - Receive, Stage, Store Site
SEMA - State Emergency Management Agency
SEPH - Section of Environmental Public Health
SCC - St. Charles County
SNS - Strategic National Stockpile
SPHL - State Public Health Laboratory
STARRS - St. Louis Area Regional Response System
STD - Sexually Transmitted Disease
TARU - Technical Assistance Response Unit
TB - Tuberculosis
USDA - United States Department of Agriculture
USPS - United States Postal Service
VEOC - Virtual Emergency Operations Center
VHF - Viral Hemorrhagic Fever(s)
VMI - Vendor Managed Inventory
VRC - Volunteer Reception Center
WHO - World Health Organization
WIC - Women, Infants, and Children

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 TABLE OF CONTENTS
BASIC PLAN……………………………………………………………………………….12
ANNEX A – Direction and Control….........................................................................21
ANNEX B – Information Technology and Communications………………………29
ANNEX C – Public Information……………………………………………………........33
ANNEX D – Surveillance…………………………………………………………………115
ANNEX E – Investigation……………………...............................................................127
ANNEX F – Prevention of Secondary Transmission……….……………………….133
ANNEX G – Isolation and Quarantine………………………………………………….137
ANNEX H – Mass Prophylaxis…………………………………………………………..155
ANNEX I – Mass Patient Care……..…….……………………………………………….186
ANNEX J – Mass Fatality…………………………………………………………………191
ANNEX K – Radiological, Nuclear & Chemical Incidents………………..…………198
ANNEX L – Environmental Health & Protection….…………………………………..203
ANNEX M – Volunteer Management……………………………………………………228
ANNEX N – Recovery……………………………………………………………………..234
ANNEX P – Pandemic Flu………………………………………………………………..235
ANNEX Q – Public Health Mutual Aid………………………………………………….246
ANNEX X – Access and Functional Needs Sheltering……………………………...248

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 LOCAL PUBLIC HEALTH EMERGENCY OPERATIONS PLAN

I. PURPOSE
This EOP has been developed to assist the DPH in protecting the health and safety of St. Charles
County citizens should a local public health emergency, be it natural or deliberate, affect the
community.

II. SITUATION AND ASSUMPTIONS

A. St. Charles County is located in the St. Louis Metropolitan Statistical Area with a population of
approximately 379,493. The County has an area of 560 square miles and is located between
the Mississippi and the Missouri Rivers. Much of the northern part of the County is located in
a flood zone where there are some small population centers. Most of the population is
centered in and around the cities of St. Charles, St. Peters, O’Fallon, Lake St. Louis, and
Wentzville. There are four bridges that connect St. Charles County with St. Louis County.

B. This plan is supported by the St. Charles County Emergency Operations Plan, dated January
2015, which describes the overall emergency response procedures for the community.

C. Depending on the severity and type of event, local public health resources may be
overwhelmed. A statewide mutual aid agreement exists to ensure that regional and statewide
resources can be shared amongst jurisdictions in a time of need. Procedures also exist to
allow for the requesting of state and federal resources through the Division of Emergency
Management (DEM).

D. Potential hazards are identified by a combination of analyses at the County and regional
levels.

III. CONCEPT OF OPERATIONS

A. General Information
1. Ordinance Number 96-24 §1 establishes the Department of Community Health and
the Environment (renamed Department of Public Health), pursuant to Section 2.507 of
the St. Charles County Charter.

2. It is the responsibility of DPH to provide resources during a local public health

emergency. When local resources are overwhelmed, DPH will coordinate with the
Missouri Department of Health and Senior Services (MO DHSS) and State Emergency
Management Agency (SEMA) to address the needs of the community.

3. In the event of an emergency, the procedures outlined in Annex A will be followed to

define direction and control of the incident.

4. Staff and any group included in this plan will be briefed on portions that are relevant to
their role during an emergency. Training will be provided to prepare them for their
emergency response duties.

5. This plan will be exercised annually to test specific capabilities according to

established guidelines.

6. DPH is a member of the St. Louis Area Regional Response System (STARRS) and
has established Memorandums of Understanding (MOUs) with local point of
dispensing (POD) sites.

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 7. DPH will maintain all day-to-day operations until the DPH Director has determined that
assets are no longer available. At that point, the Director will coordinate with the St.
Charles County Director of Administration to determine the proper course of action for
that specific situation.

8. DPH Emergency Operations Center (HEOC) will be located in the Executive

Conference Room within the DPH building, located at 1650 Boone’s Lick Rd. If that
space becomes too limited, operations will be moved to the large conference room in
the same building.
a. Alternate facilities may include the County Administration Building or
another site identified by DPH and/or County leadership.
b. The HEOC can also be activated virtually through WebEOC or via
conference call.
9. In the event of a terrorism incident, DPH will coordinate with local, state, and federal
law enforcement agencies.

10. Responder safety and health will be a primary concern throughout any emergency or
disaster situation.
a. Necessary safety information will be shared via email, phone, fax, or
WebEOC to ensure all agencies are aware of potential hazards.
b. Public health emergencies may present unique challenges related to
infectious agents, hazardous biological waste, and/or the need for
particular personal protective equipment (PPE).

B. Operational Time Frames

This plan addresses all phases of emergency management concerning a local public health
emergency. The following operational time frames are established to accomplish various tasks
within public health.

1. Mitigation – A period of time when public health staff will undertake activities to
improve the capabilities of public health, or eliminate threats, in regards to potential
local public health emergencies.

2. Preparedness – A period of time when public health staff will undertake activities to
improve the readiness of public health in regards to local public health emergencies.

3. Response – A period of time when public health staff will respond to local public health
emergencies.

4. Recovery – A period of time when public health staff will provide for the welfare of the
community and agency, and restore operations to normal after local public health
emergencies.

IV. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES

A. This plan is divided into several annexes with attachments.

B. Assignment of Responsibilities

1. Specific staff is assigned primary responsibility for various functions related to a local
public health emergency. Others are assigned a support responsibility to assist those
in primary roles.

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 2. It is the responsibility of primary and secondary staff to understand their roles and
responsibilities in the event of a local public health emergency.

V. CONTINUITY OF OPERATIONS (COOP)

As of 12/27/17, DPH has developed a draft version of a separate COOP Plan, which includes the
details below but is more comprehensive. The department is awaiting approval from DEM, and will
reference the document here at that time. After such approval, the information below will be removed to
avoid unnecessary redundancies and to ensure information is updated appropriately.

A. Assumptions & Considerations

1. General
a. Emergencies may affect DPH’s ability to provide essential departmental
services and to provide support to other agencies.
b. Personnel and other resources from DPH will be made available to continue
essential departmental services.
c. Key staff will be available to perform the necessary procedures described later
in this section.
d. St. Charles County Information Systems (IS) will be available to provide
technical support for any COOP activation, including alternate/secondary
facility setup, data recovery and IT setup.
e. Communications equipment and lines are available to establish backup
communications at alternate and/or secondary facilities.
f. Emergencies and threats will be prioritized based upon their perceived impact
on operations.
g. St. Charles County Finance will be available to provide materials acquisitions
and financial support including payroll, equipment and supply requests for any
COOP activation.

2. Minor & Major Incidents

a. Minor Incidents (outside the scope of this document)
• Potential for little or no physical damage to infrastructure
• Potential for temporary loss of critical services such as electricity, water,
HVAC, or communications, causing little to no impact on building
occupants
• Temporary evacuation or partial building shut-down

b. Major Incidents (within the scope of this document)

• Potential for significant physical damage to infrastructure
• Potential for an event to last an extended period of time
• Potential for significant loss of personnel due to injury or illness
• Potential long-term loss or disruption of critical services
• Significant or complete loss of facility usage
• Potential for high rates of injury, illness, or death among building
occupants and visitors

B. Concept of Operations Execution

1. Activation
Potential hazards are identified in the Urban Area Security Initiative Threat Hazard
Identification and Risk Assessment.

The following are situations in which the DPH Director may choose to activate the COOP
Plan. This list is not all inclusive:

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 a. DPH is closed during normal business hours due to a credible threat to the
department or the vicinity.
b. An area of St. Charles County has experienced a(n):
• Biological incident
• Communicable disease outbreak
• Widespread utility failure
• Natural disaster
• Hazardous material incident
• Civil disturbance
• Terrorist threat or attack
• Other significant mass casualty/mass fatality event

c. Day-to-day operations are interrupted and DPH must close for an extended
period of time.

***If the DPH must close, an alternate site will be activated at the discretion of the Director.***

2. COOP Management Team will be comprised of the following personnel:

a. DPH Director
b. Health Services Division Director
c. Environmental Health Division Director
d. Humane Services Division Director
e. Public Health Emergency Planner
f. Public Information Officer
g. Epidemiologist (situation dependent)
h. DPH Fiscal Officer
i. St. Charles County IS Director (or designee)
j. St. Charles County Emergency Management Director (or designee)

Other selected staff members may supplement the COOP Management Team as determined by
the COOP Management Team. The COOP Management Team will ensure the continuance of
essential functions by DPH within 12 hours of activation and will be able to maintain operations
for a minimum of 30 days.

All staff necessary to perform the essential functions of DPH will be contacted and advised
accordingly, including information regarding new supervisors and reporting locations as needed.

In most cases, DPH will receive a warning of at least a few hours prior to an incident. Under these
circumstances, the process of activation would enable the partial, limited, or full activation of
DPH’s COOP with a complete alert, notification of all personnel, and activation of the COOP
Management Team, as determined by the event.

The DPH Director (or designee) will draft informational memoranda for dissemination to DPH
employees regarding the duration of alternate operations, pertinent information on payroll, time
and attendance, duty assignments, travel authorizations, and reimbursement charges as needed.
These memoranda will be distributed to relocated and non-essential personnel through normal
communication methods and other available sources.

3. Essential Services
DPH has prioritized essential services that can be maintained during an emergency.
The priority of these services is outlined below:

➢ Level 1 – Function cannot be delayed

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 a. Disease Containment
• Disease Investigation
▪ Disease containment is a primary function of DPH. As is feasible,
under any and all circumstances possible, disease investigation
shall not cease. The numbers of staff needed to complete reports,
investigations, and perform surveillance will be based on the current
situation and decisions by the Incident Command. Surge capacity
can be instituted as needed. If COOP activation is necessary, but
no current outbreak exists, non-essential personnel in relation to
disease investigation may not be needed, or may be reassigned.
• Dispensing/Vaccination for Disease Containment
▪ Local cache and SNS dispensing are the primary functions of DPH
in the event of a Governor-declared public health emergency. If
dispensing and/or vaccination are needed, all staff is considered
essential, and will be assigned to needed positions (see ANNEX H
for mass dispensing guidelines).

b. Public Information
• Any event will be a PIO function under any priority level (see ANNEX C for
PIO guidelines).

c. Fiscal and Supply Management

• The Finance & Administration section of DPH ICS structure will ensure
proper tracking of all emergency related costs to include staff/volunteer
time, supplies, equipment, and expenses. The Fiscal Officer will follow
established guidelines for purchasing and billing.

d. Active TB Control
• Control of active TB is an essential function of public health and disease
containment. Those who are identified as active cases on direct observed
therapy will continue to receive services. New active case investigation will
be initiated.

e. Response Operations (Mass Dispensing & SNS Management)

• SNS request and management is a responsibility of DPH. As the
coordinating agency for all SNS supplies to the County, the delivery of this
function must be maintained as needed during operations (see ANNEX H
for SNS management).

➢ Level 2 – Function can be delayed, but should resume as soon as possible.

f. STD Evaluation/Control/Treatment
• In order to establish this as a level 2 function, lab support is a primary
concern. This area can be demoted to level 3 as appropriate based on
support available.

g. Foodborne/Waterborne Investigations
• Any confirmed or suspected food- or waterborne illness must be
investigated in a timely manner to address the source. It is the
responsibility of DPH to investigate any suspected food- or waterborne
outbreak as soon as possible.

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 h. Imminent Environmental Public Health Hazards
• This area will be left to the determination of EH&P Director to prioritize any
type of complaint or issue that may fall within the jurisdiction of DPH. This
can include, but is not limited to, food establishment complaints,
recreational water complaints, childcare/adult care complaints.

i. WIC Vouchers (current clients)

• MO DHSS may provide guidance regarding WIC vouchers during a COOP
situation (including authorizing alternate delivery method or relaxed
policies).

j. Latent TB Infections
• Under this level, all other TB control measures will be implemented.

➢ Level 3 – Function can be delayed until normal operations resume.

k. New WIC Applicants

• Routine immunizations
• Health education/outreach
• Routine environmental health inspections
• All other services not previously mentioned

4. Essential Personnel
Essential personnel are those that have been designated as command and general
staff within DPH and those supporting public health operations. If activation of the
COOP occurs during a non-public health emergency (e.g. routine disease
investigation, non-dispensing/vaccination situation), essential personnel will be those
supporting level 1 operations. All other staff may be sent home and called in as
necessary at the discretion of the COOP Management Team.

The DPH Director may direct personnel to work from a remote location (such as home
or another County office) if he/she feels that the risks of staff being on the premises
outweigh the benefits.

As stated above, if complex disease investigations or mass prophylaxis

dispensing/vaccination take place, all personnel are considered to be essential.
Essential personnel will report to their normal duty position unless told otherwise
during the emergency notification process, defined below.

Since alternate facility space and support capabilities may be limited, the DPH
Director or designee may deem as “essential” only those staff that possess the skills
and experience needed for the execution of essential services.

Line of succession and chain of command must be maintained during an emergency

event. It is paramount that all staff knows where they are supposed to be, when they
are supposed to be there, and to whom they are to report.

5. Operations
During COOP activation, DPH’s operating hours will be determined by the COOP
Management Team, based on the necessitating incident/event. As additional services
come on line, these hours may be adjusted.

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 The ability to execute DPH COOP following an incident that occurs with little or no
warning will depend on the severity of the impact on the physical facilities, and
whether DPH personnel are present in the affected facility or in the surrounding area.
The accountability of DPH personnel throughout all phases of emergencies, including
COOP activation, is imperative.

a. Alternate Facilities
• The COOP Management Team will identify current needs and utilize
facilities that are County-owned, or have Memorandums of Agreement
(MOAs) with St. Charles County.

b. Billing/Medical Records
• Billing/Medical Records will be stored at a secure County-owned facility,
which will be determined at the time of the event.

6. Communications
St. Charles County IS is the primary support agency for DPH in all
telecommunications and information systems support. Any need for technical
assistance, physical technology setup, and telecommunications will be provided by St.
Charles County IS at any relocation facility. Any need for radio support will be
requested through the St. Charles County DEM Communications Officer.

7. Alert & Notification

DPH possesses multiple methods to alert staff and issue instructions as necessary:
a. Primary: Everbridge electronic notification system allows for phone call, text
message, and email messages.

b. Secondary: Manual phone tree will be utilized to call personnel in the event
that Everbridge is offline.
• This document is located on the “O” drive in the SCCHealth Folder and is
updated when staff changes occur.
• The Readiness Check Protocol outlines the process for staff to notify one
another in sequence (see Attachment 1).

c. Contingency: Other methods including County email or an alert via the media
will be utilized if necessary and available.

C. Roles & Responsibilities

1. St Charles County DPH
a. Initiate COOP Management Team
b. Activate Public Health ICS and begin notification process
c. Prioritize public health services
d. Respond as needed

2. St. Charles County DEM

a. Manage St. Charles County EOC Operations
b. Provide logistical support to DPH and other departments
c. Coordinate resource requests

3. St. Charles County Police Department

18
 a. Provide security for SNS
b. Provide security for County infrastructure and personnel
c. Provide security for remote sites if needed

4. St. Charles County Office of the Executive

a. Declare state of emergency if necessary
b. Maintain County operations to the extent possible

5. St. Charles County Facility Management

a. Provide County owned property to continue operations
b. Provide logistical support to DPH and other departments

6. St. Charles County IS

a. Provide technical support for staff
b. Provide data recovery
c. Maintain primary and alternate communications systems

7. St. Charles County Finance

a. Fiscal monitoring, grant coordination, budgeting, billing, auditing
b. Track staff/volunteer time and payroll
c. Monitor and control disaster related expenses during event and recovery

8. MO DHSS
a. Coordinate public health mutual aid requests if needed
b. Provide guidance for SNS dispensing/vaccination
c. Provide guidance on biological agents to protect responders

9. SEMA
a. Request SNS assets through Governor’s office
b. Coordinate delivery of SNS assets to Receive, Stage, Store (RSS) site
c. Manage and staff RSS site
d. Manage resource requests

D. Administration & Support

1. Refer to ANNEX A for Direction and Control

VI. ADMINISTRATION AND LOGISTICS

A. Whenever possible, procurement of necessary resources will be accomplished using normal,
day-to-day channels.
a. A purchase request form should be submitted to the appropriate division director,
assistant director, or department director, who will approve the request and forward it
to an administrative assistant.
b. St. Charles County Finance will ensure proper documentation is provided, and will
process the order through Munis and make the purchase from the vendor.
c. Certain approvals may be required based on the purchase amount for a good or
service.
i. < $15,000 → Department Director/Elected Official and Finance Director
ii. $15,000 - $49,999 → Director of Administration or designee
iii. ≥ $50,000 → County Council

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 B. In the event of a local public health emergency, in which normal processes and time
constraints might result in the loss of life and property, normal requisition procedures can be
circumvented by utilizing the County EOC for necessary resources.
a. An official request will be likely be submitted to the EOC via the ICS 213 form.
b. Requests should be approved by the Incident Commander, or the appropriate Section
Chief within the Incident Command Structure (ICS).
c. The appropriate Emergency Support Function (ESF) will process the request and
respond affirmatively or negatively.

C. Accurate records of all actions taken in a local public health emergency are essential for
future mitigation activities, reimbursements, training, exercising and settling litigation issues.

D. Disaster assistance from the state or federal government will be utilized in accordance with
their provisions and statutes. Requests for federal assistance will be coordinated through the
DEM.

E. Discrimination on the grounds of race, color, religion, nationality, sex, age, physical
impairment or economic status will not be tolerated in the execution of local public health
functions, during routine and emergency situations.

VII. PLAN DEVELOPMENT AND MAINTENANCE

A. This plan has been developed by the DPH with information from other participating agencies
and response partners. The plan will be reviewed at least annually by the Public Health
Emergency Planner and revised as necessary.

B. Plan updates will be distributed to all staff and others who have a role during a local public
health emergency.

VIII. AUTHORITIES AND REFERENCES

This plan is authorized as part of the overall St. Charles County Emergency Operations Plan,
approved by the County Executive in October 2015.

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 ANNEX A

DIRECTION AND CONTROL

ATTACHMENTS:
Attachment 1: Readiness Check Protocol
Attachment 2: St Charles County Local Emergency Planning Committee (LEPC)

PURPOSE
The DPH EOP outlines the department’s organization, policies, and responsibilities for support of local
emergency response operations. The EOP describes the system for early detection, investigation,
alerting, assignment of duties, and employing medical and public health resources during a disaster or
emergency event.

ORGANIZATION
1. DPH Director

2. DPH Assistant Director/Health Services Division Director

3. Environmental Health Division Director

4. Humane Services Division Director

5. St. Charles County Emergency Management Director

ORGANIZATIONAL COMMAND STRUCTURE DURING AN EMERGENCY

DIRECTOR
/
INCIDENT COMMANDER

PIO

SAFETY LIAISON

SCRIBE

OPERATIONS PLANNING LOGISTICS FINANCE & ADMIN

21
 St. Charles County DPH ICS

Incident Commander
DPH Director

Public Information
DPH PIO
Safety Officer
EH&P Director
Liaison
Reg. PH Coordinator

Operations Planning Logistics Finance & Admin

Asst. Director PH Em. Planner Admin. Assistant Finance Manager

The St Charles County DPH ICS complies with the National Incident Management System guidelines.
This ICS structure is internal to DPH and is utilized to bring about a coordinated agency response, while
also allowing for collaboration with other responding organizations. It will be activated at the direction of
the DPH Director, or designee, in response to a public health emergency. Once activated, the DPH ICS
will be housed within the HEOC, unless otherwise indicated.

The incident commander (IC) and command staff are responsible for executing direction and control of
response and recovery operations; are authorized to issue mission assignments that commit local, state,
and/or federal personnel and/or material resources; and have authority to expend agency funds to
achieve emergency and/or disaster objectives.

When multiple local, state and/or federal agencies are responding, the Unified Command structure will
be activated, allowing all agencies who have jurisdictional or functional responsibilities to jointly develop
a common set of incident objectives and strategies. This will be accomplished without losing or
relinquishing agency authority, responsibility, or accountability.

Job Descriptions
Incident Commander
The IC is responsible for setting overall incident-related priorities and objectives; allocating critical
resources according to objectives; ensuring that incident management objectives are met and do not
conflict with law or agency policy; identifying and reporting critical resource needs and requirements; and
ensuring that short-term emergency response and recovery operations are coordinated to assist in the
transition to full recovery operations.

The DPH Director will be appointed Incident Commander (IC) during all public health emergencies.
However, he or she may appoint a designee to command the response and take on another role if
necessary. He or she may also be the Public Health representative in a unified command structure.

22
Public Information Officer
The PIO serves as the official spokesperson for the DPH and is responsible for interfacing with the
public, the media, and/or with other local, state, and federal agencies with incident-related information
requirements. The PIO develops and disseminates accurate and complete information and education on
the incident’s cause, size, and current situation; resources committed; and other matters of general
interest for both internal and external consumption. This individual may also perform a key public
information-monitoring role. The DPH IC must approve the release of all incident-related information.
See Annex C for more detailed information.

***St. Charles County Communications Department will provide a deputy or backup PIO in the event the
primary DPH PIO is unable to perform some or all of his/her duties. A deputy or backup PIO is expected
to meet the same qualifications and adhere to the same operational policies as the primary PIO.***

Liaison Officer
During larger incidents or events, representatives from other agencies may be assigned to the incident to
coordinate their agency's involvement. The Liaison Officer is the point of contact for these agencies and
organizations. Agency representatives assigned to an incident must have the authority to speak for their
parent organizations on all matters, following appropriate consultations with their agency leadership.

Safety Officer
The Safety Officer monitors safety conditions within incident operations, develops measures for assuring
the safety of all assigned personnel, and advises the DPH IC on all matters relating to operational safety,
including the health and safety of the response personnel.

The ultimate responsibility for the safe conduct of incident management operations rests with the DPH IC
and supervisors at all levels of incident management. The Safety Officer is responsible for the set of
systems and procedures necessary to ensure ongoing assessment of hazardous environments and
implementation of measures to promote the general safety of incident operations. Safety considerations
may change based on incoming information from surveillance sources and/or subject matter experts.

The Safety Officer has emergency authority to stop and/or prevent unsafe acts during incident operations
and may be a member of multiagency safety efforts. The Safety Officer, Operations Section Chief, and
Planning Section Chief coordinate closely regarding operational safety and emergency responder health
and safety issues. The Safety Officer must also ensure the coordination of safety management functions
and issues across jurisdictions, across functional agencies, and with private sector and nongovernmental
organizations. It is important to note that the agencies, organizations, or jurisdictions that contribute to
joint safety management efforts do not lose their individual identities or responsibility for their own
programs, policies, and personnel. Rather, each entity contributes to the overall effort to protect all
responder personnel involved in incident operations.

Scribe
The Scribe will keep detailed records of information coming in to and decisions made by the Director/IC
during the incident. A scribe can be assigned to any section or supervisor within the ICS structure to
facilitate more efficient record management and documentation.

Operations Section Chief

The Operations Section Chief is responsible to the DPH IC for the development and management of all
incident-related operational activities. They will establish tactical objectives for each operational period,
with other section chiefs and unit leaders providing support to ensure activities can be completed safely
and efficiently.

Planning Section Chief

The Planning Section Chief is responsible for gathering, evaluating and disseminating information about
the incident; developing the Incident Action Plan (IAP) for each operational period; conducting long-
23
range planning; and developing plans for demobilization. The IAP should include the overall incident
objectives and strategies established by the IC and other command staff and must adequately address
the mission and policy needs of the DPH, as well as interaction between jurisdictions, functional
agencies, and private organizations. The IAP should also contain provisions for continuous incorporation
of “lessons learned” as incident management activities progress.

The following forms must be included in the IAP (and others are likely necessary):
• ICS Form 202
• ICS Form 203
• ICS Form 204
• ICS Form 205
• ICS Form 206

Situation reports can be completed with the DPH template, or with ICS Forms 209 and/or 214, which
allow for a summary and a running log of personnel and group activities, respectively.

Copies of these forms and instructions for completion can be also found in the following places:
• Field Operations Guide: ICS 420-1
• ICS Forms Booklet: FEMA 502-2
• https://training.fema.gov/emiweb/is/icsresource/icsforms.htm

Logistics Section Chief

The Logistics Section Chief is responsible for all service and support requirements of an incident. This
includes coordination of DPH resource allocation regarding personnel, facilities, transportation, supplies,
equipment maintenance, food services, communications, and information technology support. Functional
units can be established within the logistics section and may include communications units, a medical
unit (to treat responders), supply unit, facilities unit and others as indicated to facilitate span of control.

Finance & Administration Section Chief

The Finance & Administration (F&A) Section Chief is responsible for procurement, contracting, cost
estimates, time monitoring, and staff/volunteer compensation and claims. In addition to monitoring
sources of funding, the F&A Section Chief will track and report the financial “burn rate” as the incident
progresses. This allows the IC to forecast the need for additional funds before operations are affected
negatively. This is particularly important when operational assets are under contract from the private
sector.

In addition to paperwork associated with procurement and contracting activities, ICS forms that will be
useful to document costs and claims made during the response include:

• ICS 206
• ICS 211
• ICS 214

Whenever possible, procurement of necessary resources will be accomplished using normal, day-to-day
channels.
• A purchase request form should be submitted to the appropriate division director, assistant
director, or department director, who will approve the request and forward it to an administrative
assistant.
• St. Charles County Finance will ensure proper documentation is provided, and will process the
order through Munis and make the purchase from the vendor.
• Certain approvals may be required based on the purchase amount for a good or service:

24
 i. < $15,000 → Department Director/Elected Official and Finance Director
ii. $15,000 - $49,999 → Director of Administration or designee
iii. ≥ $50,000 → County Council

In the event of a local public health emergency, in which normal processes and time constraints might
result in the loss of life and property, normal requisition procedures can be circumvented by utilizing the
County EOC for necessary resources.

• An official request will be likely be submitted to the EOC via the ICS 213 form.
• Requests should be approved by the Incident Commander, or the appropriate Section Chief
within the Incident Command Structure (ICS).
• The appropriate Emergency Support Function (ESF) will process the request and respond
affirmatively or negatively.

***For complete job descriptions, please see the Job Action Sheets for each position,
located on the O: Drive, Emergency Preparedness folder.***

RESPONSIBILITY
1. Primary Responsibility
a. The St. Charles County Executive has delegated authority for emergency management
within the county.
b. The DPH Director will be the incident commander or will join the unified command structure
during a public health emergency or any county emergency that may affect the health of the
general public in the region.
c. St. Charles County DEM will operate the EOC and during an event, the EMD or the County
Executive may direct DPH staff, along with other Departments’ staff, to report to the EOC to
assist in the coordination of response activities as outlined in the St. Charles County EOP.

2. St. Charles County EMD

a. Activate EOC to necessary capacity
b. Assign primary and support roles for St. Charles County staff within the EOC
c. Coordinate activities with SEMA

3. St. Charles County DPH

a. Department Director
• Activate DPH EOP
• Set DPH response objectives
• Manage all DPH response activities

b. Health Services Division Director

• Manage communicable disease and epidemiological functions
• Oversee surveillance, data analysis, and prevention of secondary transmission

c. Environmental Health Division Director

• Manage necessary environmental monitoring and reporting
• Report potential environmental exposure hazards faced by staff and/or public

d. Humane Services Division Director

• Manage necessary response efforts related to pets and/or livestock
• Coordinate temporary sheltering of animals during event
• Manage necessary collection of specimens

25
e. DPH staff
• Report to DPH building unless otherwise indicated
• Participate in Readiness Check Protocol procedures to facilitate staff activation
• Perform duties as assigned, including but not limited to:
▪ Typical day-to-day functions as part of normal duties
▪ Epidemiological investigations
▪ Vector and vermin control
▪ POD operation
▪ Data entry
• Keep appropriate supervisor informed of response activities in the field
• If necessary, provide support services to other local agencies

26
Attachment 1:

‘Readiness Check’
Protocol
A Readiness Check is used during a pre-emergency situation to assess the number of employees that we would
have available within the area should an emergency/disaster occur. This will be conducted on a bimonthly basis.
To avoid individuals who are above you on the list having to make multiple calls, it is important that everyone
answers their phone and maintains progression down the chain.

A Readiness Check does NOT mean that you are to report to work.
Please use the following guidelines during a Readiness Check call-down:
▪ The Emergency Phone Chain is used during a Readiness Check.
▪ When you are called you will be asked to “Report in for a Readiness Check.” To do so, follow steps 1-4
below:

1. Call the Readiness Check voicemail box at 636-949-1889 and indicate whether or not YOU will be available
to report to work. The code to review the message is the default 1889. After the beep, please give the
following information:
a. Your name
b. Whether or not you are available to come into work
c. Contact number(s) where you can be reached
If you indicated YES, that you would be able to report to work, you will receive further information by
phone or email, should you be needed. You are NOT to report to work unless you have received
notification to do so.
After reporting in, please proceed to step 2.

2. Call the person below you on the phone chain and ask them to “Report in for a Readiness Check.” Some
employees may have two numbers listed; if necessary, try both numbers.
If you make contact with them, you are finished. If not, proceed to step 3.

3. If you are unable to reach the person below you on the Emergency Phone Chain, leave them a voicemail
with instructions to call 636-949-1889 and report in. Then, move to the next person in the chain and
attempt to make contact with them.

4. Repeat this process until you successfully make contact with someone below you on the list.
At this point you are finished.

Note: If there is information to be shared by e-mail, you can access your county email account from your home computer by
following these steps:
a. Open your internet browser
b. In the address box, type: https://webmail.sccmo.org
c. Enter your username and password
d. You will be directed to your county email account

Please contact Paula Childs if your contact information changes. Thank you!

27
Attachment 2:

St Charles County Local Emergency Planning Committee (LEPC)

*see roster maintained by St. Charles County Division of Emergency Management*

28
 ANNEX B

COMMUNICATION & TECHNOLOGY

ATTACHMENTS:
Attachment 1: St Charles County Communications Coordinators

PURPOSE
The purpose of this annex is to provide information technology and communication resources to public
health staff and other supporting agencies during a local public health emergency.

ORGANIZATION AND RESPONSIBILITY

1. Those positions and persons responsible for coordinating communications and information
technology during a local public health emergency, include, but are not limited to:

a. Communications and Warning Officer

b. Director of Information Systems
c. GIS Information Systems Supervisor and Team members
d. Network Services Manager and Team members
e. Technical Support Supervisor and Team members
f. Telecommunications Coordinator

2. Communications equipment available to DPH for emergency services:

a. St Charles County Department of Community Health and the Environment:
• Desktop Computers
• Laptops
• Mobile printers
• Land Lines
• Cell phones
• Two Way Radios
• Radio Base-Station
• Satellite Phone
• Fax
• Satellite Feeds
• Weather Radios
• WebEOC

b. Division of Humane Services

• Two Way Radios
• Radio Base Stations
• Dispatch phones
• Cell phones
• Desktop computers
• Weather Radio

c. St. Charles County Emergency Management Division

• Two way portable radios
• Dispatch phones
• Desktop computers
• Fax
• Cell Phones
• HAM Radio
• Laptops
29
 • VEOC

3. All internal information will be disseminated by utilizing our Emergency Phone Chain or by the
County email system.

4. There are several unlisted phone numbers within DPH that can be activated for emergency use.
a. During the time of an event, number(s) will be designated, activated, and shared with
appropriate local agencies.
b. This number can be activated by contacting the County’s Telecommunications Coordinator.

5. County-wide staff activation will be performed utilizing the County email system.
a. A request for staff will be sent to the IS Help Desk
b. IS will send the request to all employees.
c. The request will include the incident, who is needed, and where to report.

6. The St Charles County DPH has established a 1-800 number to be used in times of emergency.
a. If needed, this phone number could be released to the public as another means of
disseminating information or can it be used for internal information on a secure line.
b. This can be coordinated through the County’s Telecommunications Coordinator.

7. Amateur Radio Emergency Service (ARES) is an independent organization of licensed amateur

radio operators sponsored by the American Radio Relay League (ARRL) to provide
supplementary or emergency communications for public service purposes other than emergency
management agencies.
a. Agencies served include the American Red Cross, Civil Air Patrol, Salvation Army, Police
and Fire Departments, Ambulance District, and Hospitals.
b. St. Charles County ARES is composed of HAM Radio operators and representatives from
various HAM radio clubs within the county
c. St. Charles County ARES may supply communications services where no established links
exist or supplement existing system(s) if they are over-loaded or disabled. Such services
may include:
• Routine and emergency communications between St. Charles County and other local,
state and federal governmental agencies
• Inter-communications among city, county, private and public service organizations. .
• Deployment is requested through the St Charles County DEM

8. The County has designated two-way radio frequencies that are available to a number of First
Responder agencies.
a. A complete list of two-way radio frequencies and channels available to use within the
County is available through DEM.

9. The VEOC is coordinated through DEM.

a. To obtain access, individuals must contact the Communications and Warning Officer

INFORMATION SHARING
Sharing information with internal staff and external partners will be crucial to maintaining situational
awareness throughout an emergency situation. The following tools are available to assist with
disseminating information, reporting on key events, and documenting departmental activities:

1. Situation Reports – to be distributed at least daily

2. Incident Command System Forms – to be completed for each active operational period
a. Fillable online at https://training.fema.gov/emiweb/is/icsresource/icsforms.htm
30
 b. On County server

3. WebEOC – to be utilized to maintain awareness within the region and/or state

31
 Attachment 1:

St. Charles County Communications Coordinators

Position Name Ext. Cell Email
Communications & Brad 3031 (314) 267-3319 bbarkhoefer@sccmo.org
Warning Officer Barkhoefer
Director of Simon Huang 7472 shuang@sccmo.org
Information Systems
GIS Information and Mark Duewell 7466 MDuewell@sccmo.org
Systems Supervisor
Network Services David Ridgway 4055 dridgway@sccmo.org
manager
EOC Emergencies: imccain@sccmo.org
WebEOC Ina McCaine- 7352 636-949-3023
Coordination Obenland 636-949-7352
(314) 267-6908(cell)

32
 ANNEX C

PUBLIC INFORMATION

Attachment 1: Designated Spokespeople and/or PIO during a Bioterrorism Event

Attachment 2: SCCDPH Employee Emergency Email addresses
Attachment 3: Media Inquiry Form
Attachment 4: Call-Down list for LPHA PI Team Members
Attachment 5: News Release Template for PODs
Attachment 6: Media List
Attachment 7: Regional & State PIO Contacts
Attachment 8: Anthrax Fact Sheet
Attachment 9: Botulism Fact Sheet
Attachment 10: Viral Hemorrhagic Fevers Fact Sheet
Attachment 11: Pneumonic Plague Fact Sheet
Attachment 12: Smallpox Fact Sheet
Attachment 13: Tularemia Fact Sheet
Attachment 14: At-Risk Assessment Table
Attachment 15: Call Log
Attachment 16: Cipro Drug Information Sheet
Attachment 17: Doxy Drug Information Sheet
Attachment 18: Phone Script Template

PURPOSE
The St. Charles County Department of Public Health (DPH) will coordinate and deliver preparedness,
risk communication and public health information support prior to, during, and after a public health
emergency affecting St. Charles County (and will assist St. Charles County Government in responses to
all-hazards emergencies, where needed). These support operations will be accomplished through
coordination between the DPH’s Public Information Officer (PIO), the event IC, DPH Director, the St.
Charles County Department of Communications (County Communications), the St. Charles County
Executive and/or Executive Staff, the St. Charles County DEM, MO DHSS, and SEMA. Should an event
impact the greater St. Louis Metropolitan Area, the PIO may assist the distribution of public health
information by appropriate regional and national agencies in accordance with local, state and federal
emergency plans and/or agreements.

A successful public information campaign will allow more effective response to and recovery from a
variety of emergencies such as natural disasters, acts of terrorism, and large communicable disease
outbreaks.

OBJECTIVES AND ORGANIZATION

1. This annex establishes the capabilities to increase public awareness about hazards specific to St.
Charles County and provides for the timely release of accurate response information in the event
of a disaster. The overall objectives of those responsible for disseminating information are:

a. To gain public confidence by developing and disseminating information that is accurate,

timely, and pertinent to the well-being of the residents, businesses, and visitors in the area
during or after the incident
b. To prevent public panic and alleviate fears
c. To direct public action
d. To be accessible for meeting the needs of the news media
e. To coordinate with other agencies involved in responding and providing information to the
public
RESPONSIBILITY AND ASSIGNMENTS
1. The Department Director/IC, together with the PIO, the St. Charles County Executive (and/or
designees) and the County PAC, in coordination with other municipal, state, regional and federal
officials, will:

33
 a. Use the media and other distribution systems to provide risk communication that informs
and instructs individuals, families, business, and others about health and medical
information related to the emergency.

**No St Charles County Department, Division, Unit or Personnel may independently release emergency response-related information
(statements, news releases, fact sheets, etc.) without approval of the St. Charles County Executive, the St Charles County Public
Affairs Coordinator, or other designee.**

b. Use Medical/Disease Fact Sheets, which will be maintained by the Public Health
Emergency Planner and the Epidemiologist in coordination with the PIO, to provide details
for the public on said event.

• CDC website - http://www.bt.cdc.gov/firsthours/index.asp - provides support

information in various languages for specified hazards (including bioterrorism
agents, public health incidents, natural disasters and weather threats, chemical
emergencies, and radiation emergencies)

• DPH website - http://www.sccmo.org/394/Community-Health-the-Environment - may

be translated by users as well.

• The National Library of Medicine website -

http://www.nlm.nih.gov/medlineplus/biodefenseandbioterrorism.html - offers support
material, translated in various languages, for the medical treatment of these
emergencies.

• In addition, pre-approved message templates, fact sheets and advisories, and

suggested methods for reaching vulnerable populations have been developed by the
DPH staff, the County PAC, the state and/or CDC and are available in the PIO
response folder and saved on a portable computer drive.

c. Oversee and coordinate a 24-hour information hotline, if deemed necessary, with the
assistance of the St. Charles County DEM and/or the IS department, the MO DHSS, the
United Way of Greater St. Louis, the St. Charles County Community Organizations Active in
Disaster chapter (COAD) and others.

2. The DPH PIO will:

a. Coordinate messaging with the Department Director/IC and other command staff to enact
desired results.

b. Determine whether to schedule media briefings, news conferences or other distribution

channels and arrange for the issuance of these events, if warranted.

c. Maintain a list of all DPH staff who may serve as bioterrorism and/or public health
emergency spokespersons for the department. This staffing list will be reviewed annually
and will indicate if the individual has completed required risk communication training.

d. Ensure the accuracy, timeliness and appropriateness of all event information for distribution
before its release to the media and public. Templates that may be used to form media
releases are begun, but these will need to be completed at the time of the event, based

34
 upon the situation.

e. Effectively distribute information to the media and public using email, fax, phone, social
media, websites and other outlets, as necessary.

f. Monitor media reports, social media and other communications channels for accuracy and
controlling the spread of rumor or misinformation.

g. When appropriate, coordinate with regional, state and/or federal public health agencies to
ensure that consistent messaging is being delivered. Maintain a list of individuals (staff,
volunteers and regional partners) who may be available to serve various Emergency Public
Information/Communication roles, as needed.

Should they be needed, PIO will request utilization of additional support for operations and
manage the efficient use of individuals and/or resources. The DPH PIO, County PAC
and/or St. Charles County DEM will assign roles to support the County PAC and DPH PIO
in the emergency public information operations. The DPH PIO, in cooperation with the
County PAC and DEM, will manage those assisting in the collection, evaluation, creation,
distribution and monitoring of public information materials.

h. Ensure that the DPH uses its website and social media outlets to provide important health
and safety information for target groups. Groups will include the media, general public,
health care providers, first responders, regional partners, etc. Information may include
news releases, fact sheets and other pertinent health information.

i. Respond to and record media and/or public requests for health or medical information. All
health and medical information will be shared, when appropriate, in accordance with HIPAA
privacy laws.

j. Maintain a chronological record of public information activities and media release

distribution.

k. Update the Department Director/IC, the County PAC, DPH staff, regional public health
agencies, and others (where appropriate) with messages released to the media. Utilize
periodically distributed situation reports to inform command staff and others on the situation.

l. In the event of a large-scale emergency requiring the coordination of public information

among multiple organizations, the DPH, the County PAC, the regional Unified Health
Command or other designee will activate a local or regional Joint Information System (JIS).
The decision to implement a DPH JIS will be designated in consultation with the Department
Director/IC and/or the County Executive staff. This may also be implemented, if designated,
by the Unified Health Command - under the leadership of regional health administrators.

If needed, a physical or virtual Joint Information Center (JIC) can serve as a means for
coordinating local, state and federal level information activity with the County Executive's
35
 Office, the DPH, the DEM, as well as regional, state and federal partners or other response
organizations prior to release to the media. The JIC also functions as a one-stop center
where the media and regional agencies can get the most recent official information
concerning the event.

All personnel working within a JIC are expected to function in a PIO capacity, and therefore
should, at a minimum, meet the qualifications of the position (see the PIO Job Action Sheet
for more detail).

m. Develop and distribute materials for media and public awareness on an ongoing basis to
prepare and educate the public on emergency response activities prior to the event.

n. Review PIO Job Action Sheet for additional duties and responsibilities.

***St. Charles County Communications Department will provide a deputy or backup PIO in
the event the primary PIO is unable to perform some or all of his/her duties. A deputy or
backup PIO is expected to meet the same qualifications and adhere to the same operational
policies as the primary PIO.***

3. FBI/DHS

a. If the emergency has been suspected as or ruled a terrorist event, the Homeland Security
Act may designate the Federal Bureau of Investigation (FBI) and/or the Department of
Homeland Security (DHS) to be represented in the JIS. These entities have the authority to
designate a lead JIS PIO that will oversee media/public communication for this incident.
Unauthorized releases may impact ongoing operations, place responders and/or the public
at risk, and impact later judicial actions.

GO KITS AND PUBLIC INFORMATION RESOURCES

1. A Public Information Go-Kit is prepared to provide necessary materials in one convenient

location. The kit is located in the DPH PIO office. The Go-Kit will include:
a. DPH PIO Emergency Operations Plan Binder and removable storage device containing
response templates
b. DPH Emergency Call-Down Roster
c. DPH Employee Emergency Email addresses
d. DPH contacts/Regional PIO contacts
e. Media inquiry Form
f. Public Information Activity Folder
g. Call-down list for DPH Public Information team members
h. Templates for program staff to use in drafting news releases. These will need to be
completed at the time of the event, based upon the situation.
i. Procedures for locating/using laptop computer that has been designated for the Public
Information emergency use. The laptop will have a current and operating version of
Microsoft Office and connectivity software.
j. Procedures for sending news releases
k. Media Lists (hard and electronic copies)
l. News/Conference Briefing form
m. Region and state PIO Public Health Contacts
n. Fact Sheets - Category A Diseases
36
 o. “At-Risk” population demographics and contact information
p. Call Log
q. Office supplies
r. List of hardware, software, and social media user names and passwords

PUBLIC INFORMATION DISTRIBUTION

1. Public Information staff will draft media content pieces from details provided by the Department
Director/IC, command staff and other approved parties.

2. Approval for all outgoing public information must be obtained through the Department Director/IC,
other command staff (as approved), and/or the County PAC. All information affecting the region
as a whole or the state should be coordinated with the proper agencies at the regional and state
level.

3. After receiving the approval noted above, the County PAC and/or DPH PIO, in cooperation with
the Department Director/IC, the County Executive, and/or other designated parties, will determine
the distribution procedures that best fit the situation:
a. Distribution to major media
b. Distribution to regional media
c. Distribution to all media
d. Posted releases on the County and other websites
e. Establishment of a 24-hour “800” number
f. Distribution through social media websites (Twitter, Facebook, etc.)
g. Other appropriate opportunities (ie: door-to-door, phone calls, letters, etc.)

4. If a massive power disruption or other events prevent information release through conventional
means, the DPH PIO, the County PAC or designee may utilize one or more of the following
methods:
a. Contact the County COAD, local businesses, faith-based groups, and other organizations to
volunteer space for announcements on their non-electric message boards.
b. Distribution via printed flyers. Mass reproduction shall be handled by the St. Charles
County Print Shop, with secondary back-up provided by Gibson Printing and/or other
commercial printers.

c. Broadcast via emergency warning siren/speakers in coordination with the County DEM.

d. Use of County Police Department or Sheriff’s Department personnel and/or other law
enforcement agencies, utilizing loudspeakers

e. Use of programmable construction signs from the County Highway Department

f. Coordinate with County DEM and IS to establish a 24-hour “800” number to address
questions/concerns/needs of public. MO DHSS/SEMA, United Way 211 and other
organizations are available for further phone bank assistance
COUNTY DEM and UNITED WAY 2-1-1 HAVE A SIGNED MOU TO OPERATE THIS

g. Contact businesses and agencies on the “At-Risk” Population Needs table, the media list
(for local Chambers of Commerce), the County COAD and volunteer groups for direct
communications with their specified targets

37
 5. Social Media – The County PAC, the DPH Director and the DPH PIO are responsible for
managing, posting, and monitoring the department’s presence in the social media realm. The
County operates a Facebook page, Twitter feed and YouTube library, while the DPH operates a
Twitter feed. Username and password are available through the County Executive staff and the
DPH Director.
a. Additional suggested resources for social media postings may be found on the CDC website
at http://www.bt.cdc.gov/disasters/psa/

6. Web EOC – To coordinate messaging and response activity with other County-wide emergency
agencies and regional partners, the DPH will utilize the Web EOC system.

7. All media interaction (calls, emails, texts, in-person contact, etc.) will be logged using a media
inquiry form. Forms of completed media inquiries will be kept in folders by date/time received.
Media inquiries that require follow-up will be kept in a ‘pending’ folder.

8. For large events, where there are multiple sites or the implementation of a Point of Dispensing
(POD) facility, all media inquiries will be referred to the DPH PIO, County Communications and/or
a designated appointee. No information is to be disseminated at the local POD site unless
previously authorized by the DPH Director/IC, County Communications or DPH PIO. The POD
Manager will notify DPH PIO if media shows up at local event. Where necessary, the DPH
Director/IC and/or DPH PIO may designate an on-site representative to escort and assist media
or designate a specific media interview location.

Should the situation warrant, media will be credentialed to gain access to briefing areas and other
aspects. Credentials will be accepted for those who have proof of participation with a bona fide
media outlet or to those who receive approval from the DPH PIO, County Communications, the
DPH Director /IC or their designee. All media interacting with staff and participating in DPH
Public Information events will sign a log sheet.

9. Some pre-printed materials are stored on-site and/or on POD trailers. However, for events where
new material is needed, the PIO will have all materials printed by the County Print Shop, with
secondary back-up provided by Gibson Printing and/or other commercial printers. Any materials
that need to be stored will be stored in the DPH cage located in the Administration Building on the
fourth floor.

ADDRESSING AT-RISK POPULATIONS

1. Individuals within vulnerable groups face heightened challenges during and after an unusual
incident. These “at-risk” individuals are simply defined as any child or adult that cannot or will not
receive, comprehend, or act upon instructions issued in times of crisis. Linguistically isolated
populations (those with whom English is not well understood); persons without access to reliable
transportation; those with mobility, communication, and/or comprehension disabilities; and those
new to, visiting, or traveling within the area face disproportionate risk during a disaster due to
these challenges. In response to these individuals’ needs for support services, the DPH will
address specific issues through assistance from cooperating agencies including the St. Charles
County COAD, the Community Council of St. Charles, and the individual members of said
organizations.
(Attachment “At-Risk Assessment Table”)
38
Attachment 1:

Designated Spokespeople and/or PIO during a Bioterrorism Event

Name Title Work Cell Trained?

St. Charles
Steve Ehlmann County 636-949-3700 YES
Executive
Hope Woodson DPH Director 636-949-7407 636-219-5495 YES
Public Affairs
Coordinator
Colene McEntee 636-949-1864 314-707-4004 YES
(SCC
Government)

Director of
Sara Evers Health 636-949-7559 314-609-4350 YES
Services

Director of
Ryan Tilley Environmental 636-949-7406 314-808-6842 YES
Health

Director of
Katie Willis Humane 636-949-7366 636-745-2272 YES
Services

Public
Doug Bolnick Information 636-949-7408 314-479-6701 YES
Officer

Public Health
Nick Kohlberg Emergency 636-949-7554 314-471-1294 YES
Planner

CRI Response
Cody Minks 636-949-7564 573-421-4622 YES
Planner

Samantha
Epidemiologist 636-949-7565 563-357-8287 YES
VanNatta

39
 Additional Resources for Public Information Dissemination

Name Title Work Cell/Email

Video Production 636-448-8393
Manager (SCC- 636-949-7900
Jim Dreyer
TV Station x1853 EMAIL –
Manager) jdreyer@sccmo.org
SCC Print Shop
Debbie
Supervisor (Mass 636-949-1891 EMAIL –
Kennedy
Reproduction) dkennedy@sccmo.org

Nancy SCCMO.org EMAIL

636-949-7900x3442
Teply webmaster nteply@sccmo.org

Sherry EMAIL
Back-up printer 636.970.6316
Gibson sherry@gibsonprinting.com

40
Attachment 2:

St. Charles County DPH Emergency Email Addresses

*see password protected document in PIO Folder*

41
Attachment 3:

Media Inquiry & Coverage Summary Log

Topic: __________________________________________________________________

Press release title: (attach final version) _______________________________________

Release date: ___/___/___ Time: __:__ □ A.M. □P.M.

Distributed to: (attach distribution list)

Via: □ email □ fax □ mail

Submitted to website __/__/__

Published on website __/__/__

# of phone calls received from media: ______ Other phone calls received_______

# of interviews conducted by media: ______

Resulting coverage received:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____

Additional activities:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

Date completed __/__/__

42
Attachment 4:
Call-Down list for LPHA PI Development Team Members (as of 8/7/15)

St. Charles County Department of Public Health

Name Title Work Cell EMAIL

Doug Bolnick DPH Public 636-949-7408 314-479-6701 dbolnick@sccmo.org
Information
Officer
Hope DPH Director 636-949-7407 636-219-5495 hwoodson@sccmo.org
Woodson
Sara Evers Director, Division 636-949-7559 314-409-4350 severs@sccmo.org
of Health
Services
Ryan Tilley Director, Division 636-949-7406 314-808-6842 rtilley@sccmo.org
of Environmental
Health
Katie Willis Director, Division 636-949-7366 636-745-2272 kwillis@sccmo.org
of Humane
Services
Samantha Epidemiologist 636-949-7565 563-357-8287 svannatta@sccmo.org
VanNatta
Nick Kohlberg Emergency 636-949-7554 314-471-1294 nkohlberg@sccmo.org
Planner
Cody Minks Regional 636-949-7564 573-421-4622 cminks@sccmo.org
Planner
Michelle CD Nurse 636-949-7319 314-779-5859 mreynolds@sccmo.og
Reynolds
Theresa CD Nurse 636-949-7319 314-323-9792 tturnbull@sccmo.org
Turnbull
VACANT Health Educator 636-949-7400

Colene SCC Public 636-949-1864 314-707-4004 cmcentee@sccmo.org

McEntee Affairs
Jim Dreyer SCC-TV Video 636-949- 636-448-8393 jdreyer@sccmo.org
Production 7900x1853
Val Joyner SCCPD, Public 636-949-3057 636-515-5457 vjoyner@sccmo.org
Affairs
Debbie SCC Print Shop 636-949-1891 dkennedy@sccmo.org
Kennedy Supervisor
Nancy Teply SCCMO.org 636-949- nteply@sccmo.org
webmaster 7900x3442
Additional Regional Contacts on ensuing pages

43
 St. Charles County Division of Emergency Management

Name Title Work Email

Joann Leykam SCC County Administrator 636-949-7520x3702 jleykam@sccmo.org
Cell – 314-703-1739
Chief Dave Todd SCC Police Chief 636-949-3000 x3005 dtodd@sccmo.org
Cell – 314-393-8390
Lt. Dave Tiefenbrunn SCC Police, PIO 636-949-4458 dtiefenbru@sccmo.org
Cell – 314-393-8237
Capt. Tom Koch SCC Police, Special 636-949-4952 tkoch@sccmo.org
Enforcement Bureau/EMD Cell – 314-393-8390
Ina McCaine- Training Officer EMD 636-949-7352 imccaine@sccmo.org
Obenland Cell – 314-267-6908
Jeff Smith Director, SCC Dispatch 636-949-1871 jpsmith@sccmo.org
and Alarm

Kyle Gaines SCC Ambulance District, 636-344-7634 kgaines@sccad.com

Marketing

Jim Fingerhut SCC Ambulance District, 636-344-7600 jfingerhut@sccad.com

Special Operations Officer

Mike Myers Chief, St. Charles City 636-949-3572 mike.myers@stcharlescitymo.gov

Fire/Emergency Manager CELL
Erik Lawrenz St. Charles City Police, 636-949-3539 erik.lawrenz@stcharlescitymo.gov
PIO

Rob Wylie Cottleville Fire, Chief 636-447-6655x8700 rwylie@cottlevillefpd.org

Craig Hebrank Cottleville Police 314-814-7410 Craig.hebrank@cityofcottleville.com

Department, PIO

Christopher Fey Lake St. Louis Fire, Chief 636-561-9200 lslfire@lslfire.com

Captain Chris Lake St. Louis Police, 636-625-8018 cdigiuseppi@lakesaintlouis.com

DiGiuseppi Emergency Manager

Tom Vineyard O’Fallon Fire, Chief 636-272-3493x106 tvineyard@ofallonfire.org

Keith Koehler Orchard Farm Fire, Deputy kkoehler@offpd.com

Chief
Dennis Gusky New Melle Fire, PIO 636-828-5528 info@newmellefire.org

Officer Pat Helton O’Fallon Police/EMD 636-379-3816 phelton@ofallon.mo.us

Steve Brown Central County Fire & 636-970-9700x403 steveb@ccfrmail.org

Rescue, Assistant Chief
Tim Hickey St. Peters Police, 636-278-2244x3522 thickey@stpetersmo.net
Emergency Management
Officer Melissa Doss St. Peters Police, PIO 636-278-2244 mdoss@stpetersmo.net

Mike Marlo Wentzville Fire Chief 636-332-9869 mmarlo@wentzvillefire1.org

Chief Kurt Frisz Wentzville Police NAME EMAIL

Jennifer Bell Wentzville Police, PIO 636-639-2143 Jennifer.bell@wentzvillemo.org

44
 St. Charles County Regional Public Information Officers/Spokespeople

Name Title Work Email

Colene SCC Public Affairs 636-949-1864 cmcentee@sccmo.org
McEntee Coordinator Cell (314) 707-4004
Carol Felzien City of St. Charles, 636-949-3361 cfelzien@historicstcharles.com
Public Information Cell 636-578-6933
Lisa Bedian City of St. Peters, 636-477-6600x1229 lbedian@stpetersmo.net
Communications Cell 314-265-8555
Director
Tom Drabelle City of O’Fallon, 636-379-5508 tdrabelle@ofallon.mo.us
Director of Public Cell 314-581-2579
Relations
Kara Roberson City of Wentzville, 636-639-2004 Kara.roberson@wentzvillemo.org
Communications Cell 636-327-9901
Manager
NAME Dardenne Prairie PHONE EMAIL

Paul City of Lake Saint 636-625-1200 pmarkworth@lakesaintlouis.com

Markworth Louis, City
Administrator
Douglas City of Foristell, Police 636-463-2123 x227 dgjohnson@foristellpd.org
Johnson Chief/Emergency Mgt

Michael City of Weldon Spring 636-441-2110x102 mpadella@weldonspring.org

Padella

William “Lynn” City of St. Paul, City 636-980-1063 wlholloway@centurytel.net

Holloway Administrator

Chief Brett City of Cottleville PD 636-498-6464 brett.mitchell@cityofcottleville.com

Mitchell

Becky City of Flint Hill, City 636-327-4441 cityclerk@cityofflinthill.com

McCollum Administrator

James Dryer City of St. Charles TV 636-949-3288 james.dryer@stcharlescitymo.gov

City of O’Fallon TV 636-240-2000 kenneths@ofallon.mo.us

City of St. Peters TV 636-477-6600 SPTVBulletinBoard@stpetersmo.net

or Lisa Bedian (see above for contact)

45
 St. Charles County Area Hospitals/Care Centers/Other Entities
Contacts/Public Information Officers/Spokespeople

Name Title Work Email

BJC St. Peters /Progress
Jack Dabrowski PHONE EMAIL
West
BJC St. Peters /Progress
Larisa Mahlin PHONE EMAIL
West
Michelle Tanton BJC St Peters/Progress
636-916-9695 mlt7592@bjc.org
(Emergency Mgt) West
SSM St. Joseph Health
Greg Neunuebel 636-947-5621 Greg_Neunuebel@ssmhc.com
Center – St. Charles

NAME Crider Health Center PHONE EMAIL

Jean Campbell CenterPointe Hospital 636-477-2120 jcampbell@cphmo.net

314-516-2756
Red Cross Disaster Cell – 314-409-
Kathrine Vigil kathrine.vigil@redcross.org
Coordinator
3896
Red Cross,
Peggy Barnhart Communications 314-516-2712 Peggy.barnhart@redcross.org
Director
Director, Community
Mary Hutchison Council of St. Charles 636-978-2277 mhutchison@communitycouncilstc.org
County
St. Charles School
Chris Bennett 636-443-4991 Publicrelations@stcharlessd.org
District

Fort Zumwalt School

Laura Wagner 636-474-8501 lwagner@fz.k12.mo.us
District

Wentzville School 636-327-

Mary LaPak marylapak@wsdr4.org
District 3800x20352

Francis Howell School

Joe Richter 636-851-5832 Joseph.richter@fhsdschools.org
District

Orchard Farm School

NAME PHONE EMAIL
District

46
 Other Helpful Contacts

Name Title Work Email

St. Charles County Parks
Nancy Lee Gomer 636-949-7535 ngomer@sccmo.org
– Marketing Coordinator
St. Charles Family Arena
Tom O’Keefe 636-949-7538 tokeefe@familyarena.com
– Marketing/PR Manager
MO DHSS Public
Ryan Hobart 573-751-6062 ryan.hobart@health.mo.gov
Information, Chief
MO SEMA/DPS,
Mike O’Connell 573-751-4819 Mike.oconnell@dps.mo.gov
Communications Director
MO DHSS/CERT, Public
Brian Quinn 573-526-4768 Brian.quinn@sema.dps.mo.gov
Information
St. Louis County Health, 314-615-8922
Michael de los Reyes mdelosreyes@stlouisco.com
PIO Cell 314-280-4262
St. Louis County Health, 314-615-0116
Craig LeFebvre clefebvre@stlouisco.com
PIO Cell 314-591-9502
St. Louis City Health, 314-657-1568
Harold Bailey baileyh@stlouis-mo.gov
PIO Cell 314-456-9838
St. Louis City Health, 314-657-1486
Stacie Zellin zellins@stlouis-mo.gov
PIO Cell 314-409-3873
Jeff Hershberger Kansas City Health, PIO 816-513-6327 Jeff_hershberger@kcmo.org
Springfield/Greene
Kathryn Wall 417-874-1205
County Health, PIO
Columbia/Boone County
Andrea Waner 573-874-7632 anwaner@gocolumbiamo.com
Health, PIO
Madison County (IL) 618-296-6103
Amy Yeager ajyeager@co.madison.il.us
Health PIO Cell 618-779-2893
Linda Joiner/Kourtney East Side Health District ljoiner@eshd.org
618-874-4713
Hicks PIO khicks@eshd.org
St. Clair County (IL)
Marilyn Vise 618-233-7703x4401 Marilyn.vise@co.st-clair.il.us
Health PIO

Missouri Hospital
Dave Dillon 573-893-3700 ddillon@mail.mhanet.com
Association

SCC Engineer/Highway
Craig Tajkowski 636-949-7305 ctajkowski@sccmo.org
Dept

St. Charles County 636-332-2129

Shelia Harris-Wheeler Sharris-wheeler@cridercenter.org
COAD/Crider Center Cell 314-397-0772

47
Attachment 5: News Release Templates for PODs

MEDIA RELEASE TEMPLATE TIMELINE/EXPLANATION

First hour of notice

• Response Draft – narrative on what steps are underway and way; focuses on local activities and
agencies involved (THIS SHOULD BE SENT AT FIRST KNOWLEDGE OF THE INCIDENT –
AFTER RECEIVING APPROVAL)
• Response Draft for On Air Broadcast – simplified version of above to be read in 15/30 second
blurb by radio or tv cut-ins.
• Alternative Dispensing Procedure – explanation of the SNS plan; call to action for volunteers and
Closed PODS; alerts public as to what will be needed and will occur in the near future (SEND
THIS AFTER MORE INFORMATION IS OBTAINED)

Upon SNS plan activation

• Dispensing Sites To Open – explains the hours of operations, what to bring, who should attend,
and why to take your medicines. Alerts to cautions and warns what to do if exposed with
symptoms. (THIS SHOULD BE SENT FIRST)
• Medication Dispensing Procedures – explains procedures and what information to bring with
you. Explains why you need to take medicines.

Within Two hours of POD site openings

• POD Directions – explains procedures and gives notice to open POD site locations

Periodic updates during distribution process (or at media briefings)

• Distribution Update – Gives details about the success of the distribution effort and provides
follow-up on the process (SEND THESE UPDATES AS NEEDED – SEND A CONCLUSION
ALERT AT THE END OF THE PROCESS)

48
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

Alternative Dispensing Procedures

For Care of [AGENT] Outbreak
St. Charles County, Missouri – Due to the recent cases of (agent/illness/disease), the St. Charles County
Department of Community Health and the Environment is enacting its Strategic National Stockpile (SNS)
plan to offer preventive medication to potentially exposed persons at no charge. This process will bring
enough medication to cover everyone affected in our community, and each potentially exposed person
will have the opportunity to receive medication. EXPLAIN THAT ALL INDIVIDUALS SHOULD
MAKE ARRANGEMENTS TO OBTAIN THIS MEDICATION, AS THIS IS A POTENTIALLY
DEADLY EVENT.

In order to efficiently enact this plan, individuals and groups in our community have volunteered their
services. Participating volunteers are asked to report to the work site outlined in their training by
__TIME___ on __DATE_. If your business or organization has joined the St. Charles County Emergency
Prophylaxis program, please follow the prescribed procedures for your group. MORE ABOUT CLOSED
POD/VOLUNTEER PROCEDURES, IF NECESSARY.

The SNS plan will provide mass quantities of life-saving pharmaceuticals, antidotes, vaccines, and other
medical supplies for all residents and visitors to our community as a result of this event. These
medications will be distributed through Points of Distribution (POD) sites throughout St. Charles County.
POD sites will open at __TIME__ on __DATE__, and remain open from __HOURS__ each day until all
residents have received medication. More information on these locations and on ways that you can
prepare for this treatment will be coming soon.

If you are unable to visit one of these POD sites, the department requests your assistance in alerting us to
your location. WHAT IS THE PROCESS AND NUMBER TO CALL? Please be prepared to provide the
names, address, ages, weight, and medical history for all individuals in your household that are unable to
visit a POD site in your community.

A large number of individuals and organizations are preparing for this distribution of medicines, but
additional volunteer assistance is requested. St. Charles County staff will train interested volunteers in the
various job duties necessary to complete this plan. If you are interested in volunteering your efforts,
please __WHAT IS THE PROCESS FOR BECOMING A VOLUNTEER – GO WHERE OR CALL
WHOM___.

More information will be provided as the plan is further enacted. Please visit
http://www.sccmo.org/394/Community-Health-the-Environment, call __PHONE NUMBER__ or follow
local media broadcasts for additional information and instruction.

FOR MORE INFORMATION, CONTACT:

Doug Bolnick, Public Information Officer, (636) 949-7408

49
FOR IMMEDIATE RELEASE
Month XX, 20XX

St. Charles County To Open Point of Dispensing Sites (PODS)

For Care of [AGENT] Outbreak
St. Charles County, Missouri – In coordination with St. Charles County Executive Steve Ehlmann, the
Department of Community Health and the Environment has activated the county’s Mass Prophylaxis
Emergency Plan.

Any County resident or area visitor who (DEFINE WHO NEEDS TO GET MEDICATION) will be
eligible to receive antibiotic medication (or vaccine) to reduce the risk he/she will become ill. The (event)
took place at (location) on (date). The preventive medication will be provided at no cost. INCLUDE
IMPORTANCE OF TAKING MEDICATION EXACTLY AS DESCRIBED, THREAT FOR NOT
TAKING MEDICATION. WHAT TO DO IF EXPOSED DIRECTLY OR SHOW SYMPTOMS.

EXPLAIN DISPENSING PROCEDURES/REGULATIONS AND WHO SHOULD COME/HOW TO

OBTAIN. DEFINE WHAT A POINT OF DISPENSING IS.

A list of POD site locations in St. Charles County will be distributed (TIME). The PODS will open at
(time) (date) and will remain open as needed. In order to best serve the entire community, please do not
visit the site prior to the opening. Please be aware that it is illegal to hoard or resell these free medicines,
and violators will be prosecuted.

To increase efficiency during the distribution process, one household representative will be allowed to
obtain medication for up to 10 household members who meet the above criteria. Medication will be
distributed after the representative completes a short form that provides with necessary items of
information for all household members. In order to expedite the process, please bring the following
information with you for each affected household member.
▪ Name
▪ Age
▪ Weight
▪ Any known allergies or warnings not to take antibiotics tetracycline or floxacin
▪ Is the individual a child, pregnant, or breastfeeding?

(INCLUDE BASIC INFORMATION ON AGENT/DISEASE AND EMPHASIZE THAT IT IS A

SERIOUS CONDITION AND THE NEED FOR PREVENTIVE TREATMENT). REMEMBER
(AGENT/DISEASE) (IS/IS NOT) SPREAD FROM PERSON-TO-PERSON. WHO NEEDS TO
RECEIVE MEDICATION AT THE POD SITES. WRITE HOW IMPORTANT IT IS TO TAKE THE
FULL DOSAGE ACCORDING TO PRESCRIPTION. OTHER RELEVANT INFORMATION

If you have any questions, St. Charles County has established an automated 24-hour hotline at (HOTLINE
NUMBER) or you may visit http://www.sccmo.org/394/Community-Health-the-Environment.

50
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

Update on the Distribution of Medication

In Response to {AGENT} Outbreak in St. Charles County

St. Charles County, Missouri – St. Charles County Executive Steve Ehlmann reported today that the first
(number of) hours of the (AGENT) medication distribution process have DEFINE SUCCESS RATE. He
cited the public’s cooperation as a vital component of the successful operation.

The (AGENT) Vaccination Sites opened at (time) today. Since that time, staff has vaccinated
approximately ____ people. The sites will remain open until (time or date) and will reopen at (time, date)
as needed.

All residents and visitors to the area (DEFINE WHO NEEDS TO GO) should come to their designated
site to be vaccinated against (AGENT). The vaccination will be provided at no cost; and it is prescribed as
the best prevention against (AGENT). There is enough vaccine for everyone, and our staff is working
diligently to ensure everyone is cared for in a timely fashion. Please help us by reporting to your
designated site to ensure an orderly and efficient process.

The vaccination sites are: [list sites and locations in bullet points]

To increase efficiency, one household representative will be allowed to obtain medication for up to 10
household members who meet the above criteria. Medication will be distributed after the representative
completes a short form that provides with necessary items of information for all household members. In
order to expedite the process, please bring the following information with you for each affected household
member.
▪ Name
▪ Age
▪ Weight
▪ Any known allergies or warnings not to take antibiotics tetracycline or floxacin
▪ Is the individual a child, pregnant, or breastfeeding?

INFORMATION ABOUT THE AGENT/DISEASE. EXPLAIN WHY IT’S NECESSARY TO GET

MEDICATION.

If you have any questions about (AGENT OUTBREAK), the medication dispensing site, or the
medication you receive, St. Charles County has established an automated 24-hour hotline at (HOTLINE
NUMBER) or you may visit http://www.sccmo.org/394/Community-Health-the-Environment.

FOR MORE INFORMATION, CONTACT:

Doug Bolnick, Public Information Officer, 636.949.7408

FOR IMMEDIATE RELEASE

51
DATE

SCC HEALTH INVESTIGATING {INCIDENT}

St. Charles County, Missouri – The St. Charles County Department of Community Health confirmed that
it is investigating {INCIDENT} within the community.

WHAT IS BEING DONE? ARE THERE NUMBERS TO CALL FOR THOSE INVOLVED?

“QUOTE EXPRESSING EMPATHY,” Department Director Hope Woodson said. “SECOND QUOTE
RELATED TO WHAT’S NEXT.”

IS THERE ANYTHING THAT PEOPLE NEED TO DO?

The St. Charles County Department of Community Health and the Environment is committed to the
protection and enhancement of health and the quality of life for all members of our community. Through
three divisions — Health Services, Environmental Health, and Humane Services — the department
provides a wide range of services that benefit residents and visitors. For more information, please visit
www.sccmo.org or call (636) 949-7400.

52
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

Medication Dispensing Procedures

For Care of [AGENT] Outbreak
St. Charles County, Missouri – Due to the recent cases of (agent/illness/disease), the St. Charles County
Department of Community Health and the Environment is enacting a plan to offer preventive medication
to potentially exposed persons at no charge. Those persons who will receive the medication include
(define WHO SHOULD RECEIVE THE DRUGS)
There is enough medication for everyone affected. Each potentially exposed person will have the
opportunity to receive medication. INFORMATION ON NECESSITY FOR TAKING FULL DOSAGE
AND NEED TO FOLLOW INSTRUCTIONS
If you are a resident or visitor to the area, and you and/or a family member meet the above criteria, please
(confirm with INCIDENT COMMANDER, PLANNING CHIEF AND/OR POD MANAGER the
procedures for what to bring) to the Point of Dispensing (POD) sites, located at (site) (address).

POD sites will open at (time) (date) and will remain open as needed. To best serve the entire community,
please do not visit the site prior to the opening. It is illegal to hoard or resell these free medicines, and
violators will be prosecuted.
To increase efficiency, one household representative will be allowed to obtain medication for up to 10
household members who meet the above criteria. Medication will be distributed after the representative
completes a short form that provides with necessary items of information for all household members. In
order to expedite the process, please bring the following information with you for each affected household
member.
▪ Name
▪ Age
▪ Weight
▪ Any known allergies or warnings not to take antibiotics tetracycline or floxacin
▪ Is the individual a child, pregnant, or breastfeeding?
Once you have completed the form, staff members will review it and provide you with the appropriate
medications. Please understand that household members may not all receive the same medication, but any
medications given at the dispensing site should be effective in reducing the risk of becoming ill with
(agent/illness/disease). Please carefully follow the directions that are distributed with the medication.
If you have any questions about (AGENT OUTBREAK), the medication dispensing site, or the
medication you receive, St. Charles County has established an automated 24-hour hotline at (HOTLINE
NUMBER) or you may visit http://www.sccmo.org/394/Community-Health-the-Environment.

53
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

Distribution Sites for [AGENT] Medication to Open [DAY]

St. Charles County, Missouri – In response to the recent outbreak of [AGENT] in [AREA], the St.
Charles County Department of Community Health and the Environment will open Points of Distribution
Sites (PODS) to dispense medication. PODS will open at [TIME] on [DAY], and remain open from
[HOURS] each day until all residents have received medication.

EXPLAIN WHY IT’S NECESSARY TO GET MEDICATION. [ADDITIONAL INFO HERE AS

NEEDED- INCLUDE WHO SHOULD/CAN COME; WHAT INFO NEEDED; WHAT TO DO IF
SICK].

If you are a resident or visitor to the area, and you and/or (a) family member(s) meet the above criteria,
please (EXPLAIN WHAT TO BRING) to the POD site. To increase efficiency, one household
representative will be allowed to obtain medication for up to 10 household members who meet the above
criteria. Medication will be distributed after the representative completes a short form that provides with
necessary items of information for all household members. In order to expedite the process, please bring
the following information with you for each affected household member.
▪ Name
▪ Age
▪ Weight
▪ Any known allergies or warnings not to take antibiotics tetracycline or floxacin
▪ Is the individual a child, pregnant, or breastfeeding?

POD sites will open at (time) (date) and will remain open as needed. To best serve the entire community,
please do not visit the site prior to the opening. It is illegal to hoard or resell these free medicines, and
violators will be prosecuted.

Below are the directions for each POD site in St. Charles County.

• St. Charles High School (St. Charles) – Located at 725 North Kingshighway, St. Charles, MO
63301 (approximately 1.6 miles from the intersection of First Capitol Drive and Interstate 70).
From I-70, go north on First Capitol Drive for approximately one mile, and then First Capitol will
become Kingshighway. Continue on Kingshighway for approximately 0.6 miles. The school
parking area will be on the left. WHERE WILL THE SITE BE?

• St. Charles West High School (St. Charles) – Located at 3601 Droste Road, St. Charles, MO
63301 (approximately 1.5 miles from the intersection of Zumbehl Road and Interstate 70). From I-
70, go north on Zumbehl Road for approximately .8 miles. Turn right at the stop sign and continue
on Zumbehl for an additional .6 miles. Turn right on Droste Road and continue to the school
parking area (on right). WHERE WILL THE SITE BE?
54
• Orchard Farm High School (St. Charles) – Located at 2165 Highway V, St. Charles, MO 63301
(approximately 1/8 mile from Highway 94 North). From Highway 370, go north on Highway 94
for approximately 7 miles to Highway V. Turn west on Highway V for approximately 1/8 mile
and turn right to the school parking area. The high school is the last building on the campus.
WHERE WILL THE SITE BE?

• Francis Howell North High School (St. Charles) – Located at 2549 Hackmann Road, St.
Charles, MO 63304 (approximately ½ mile from the intersection of Hackman Road and McClay
Road). From Jungermann Road, go east on McClay Road for 1.8 miles. Turn left on Hackman
Road for ½ mile and continue to the school parking area (on left). WHERE WILL THE SITE BE?

• Zion Lutheran Church (St. Charles) –Located at 3866 Harvester Road, St. Charles, MO 63304
(approximately ½ mile from the intersection of Highway 364 and Jungermann Road). From the
intersection of Highway 364 and Jungermann Road, go south on Jungermann Road to Harvester
Road/South Old Highway 94. Turn left on Harvester Road and continue for approximately ½ mile
to the church parking area (on right). WHERE WILL THE SITE BE?

• St. Peters City Hall (St. Peters) – Located at One St. Peters Centre Boulevard, St. Peters, MO
63376 (approximately 1.6 miles from the intersection of Cave Springs Road/Muegge Road and
Mexico Road). From Cave Springs Road/Muegge Road, go west on Mexico Road for
approximately 1.6 miles. Turn left into the St. Peters Centre parking area (on left). WHERE WILL
THE SITE BE?

• Francis Howell High School (Weldon Spring) – Located at 7001 Highway 94 South, St.
Charles, MO 63304 (approximately one mile from the intersection of Interstate 64/40 and
Highway 94, near the intersection of Highway 94 and Route D). From I-64, go south on Highway
94 for approximately one mile. Turn right and continue to the school parking area. WHERE
WILL THE SITE BE?

• St. Charles Community College (Cottleville) – Located at 4601 Mid Rivers Mall Drive,
Cottleville, MO 63376 (approximately two miles from the intersection of Mid Rivers Mall Drive
and Highway 364). From Highway 364 (the Page Extension), go north on Mid Rivers Mall Drive
to the campus (on left). WHERE WILL THE SITE BE?

• Fort Zumwalt South High School (O’Fallon) – Located at 8050 Mexico Road, O’Fallon, MO
63376 (approximately ½ mile from the intersection of Salt Lick Road and Mexico Road). From
Salt Lick Road/Birdie Hills Road, go west on Mexico Road for approximately ½ mile. The school
is located at the intersection of Mexico Road and Belleau Creek Road. WHERE WILL THE SITE
BE?

• Fort Zumwalt North High School (O’Fallon) – Located at 1230 Tom Ginnever Avenue,
O’Fallon, MO 63366 (approximately 1.6 miles from North Main Street in O’Fallon). From the
intersection of North Main and Tom Ginnever Avenue, go east on Tom Ginnever Ave. for
approximately 1.6 miles to school parking area (on right). WHERE WILL THE SITE BE?

• Fort Zumwalt West High School (O’Fallon) – Located at 1251 Turtle Creek Drive, O’Fallon,
MO 63366 (approximately ¼ mile from the intersection of Bryan Road and Mexico Road). From
55
 Bryan Road, go east on Mexico Road for approximately ¼ mile. Turn left on Turtle Creek Drive
to the school parking area (on left). WHERE WILL THE SITE BE?

• Wentzville Crossing Shopping Plaza (Wentzville) – Located at 1798 Mall Parkway, Wentzville,
MO 63385 (approximately one mile from the intersection of Highway 40/64 and Prospect Road).
From Highway 40/64, go east on Prospect Road. At the roundabout, take the exit onto Corporate
Parkway and continue on Corporate Parkway for approximately 0.7 miles. Turn left onto Mall
Parkway and continue to the parking area. WHERE WILL THE SITE BE?

• Holt High School (Wentzville) – Located at 600 Campus Drive, Wentzville, MO 63385
(approximately ¼ mile from the intersection of Campus Drive and West Pearce Blvd.). From
Wentzville Parkway, go east on West Pearce Blvd. At Campus Drive, turn left and continue to the
school parking area (on left). WHERE WILL THE SITE BE?

If you are unable to visit one of these POD sites, the department requests your assistance in alerting us to
your location. WHAT IS THE PROCESS AND NUMBER TO CALL? Please be prepared to provide the
names, address, ages, weight, and medical history for all individuals in your household that are unable to
visit a POD site.

If you have any questions about (AGENT OUTBREAK), the medication dispensing site, or the
medication you receive, St. Charles County has established an automated 24-hour hotline at (HOTLINE
NUMBER) or you may visit http://www.sccmo.org/394/Community-Health-the-Environment.

56
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

St. Charles County Enacting Plan to Address [AGENT]

St. Charles County, Missouri – In response to the recent outbreak of [AGENT] in [AREA], St. Charles
County Executive Steve Ehlmann has activated the Department of Community Health and the
Environment to follow its Emergency Operations Plan of established surveillance and isolation techniques
that identify the cause of the incident and provide medical treatment for all members of our community.
In addition, trained individuals and organizations participating in the response activity have received
medication and have begun preparations to administer care to the public.

Due to the recent cases of (agent/illness/disease), St. Charles County is enacting its Strategic National
Stockpile (SNS) plan to offer preventive medication to potentially exposed persons at no charge. This
process will bring enough medication to cover everyone affected in our community, and each potentially
exposed person will have the opportunity to receive medication. EXPLAIN THAT ALL INDIVIDUALS
SHOULD MAKE ARRANGEMENTS TO OBTAIN THIS MEDICATION, AS THIS IS A
POTENTIALLY DEADLY EVENT.

“In cooperation with local, state, and federal plans and regulations, our staff and partners have developed
and prepared for the response to the recent outbreak of [AGENT] in [AREA],” St. Charles County
Department of Community Health and the Environment Director NAME HERE said. “Please understand
that the County will provide the opportunity for all residents and visitors in this community to receive the
necessary [AGENT] medication.”

A collaborative effort is underway to prevent the further spread of the {AGENT} and to determine the
cause of the incident. (LIST ORGANIZATIONS INVOLVED AND A NUMBER PEOPLE CAN CALL
TO REPORT UNUSUAL ACTIVITY OR PROBLEMS).

The effort is underway as a part of the County’s SNS Response Plan, which is regularly tested by various
agencies. The SNS is a national repository of critical medical supplies and equipment designed to
supplement public health agencies in the event of a large-scale emergency. It is managed by the Centers
for Disease Control and Prevention, which works in conjunction with state and local communities. For
more information on the SNS program, please visit www.cdc.gov/phpr/stockpile.htm.

More information will be provided as the plan is further enacted. Please visit
http://www.sccmo.org/394/Community-Health-the-Environment or follow local media broadcasts for
additional information and instruction

57
FOR MORE INFORMATION, CONTACT:
Doug Bolnick, Public Information Officer, (636) 949-7408

FOR IMMEDIATE RELEASE

Month XX, 20XX

BROADCAST READ – ALERT TO {AGENT} EVENT

In response to the recent outbreak of [AGENT] in [AREA], St. Charles County Executive Steve Ehlmann

has activated the Department of Community Health and the Environment to follow its Emergency

Operations Plan of established surveillance and isolation techniques that identify the cause of the incident

and provide medical treatment for all members of our community.

Due to the recent cases of (agent/illness/disease), St. Charles County is enacting its Strategic National

Stockpile (SNS) plan to offer preventive medication to potentially exposed persons at no charge. This

process will bring enough medication to cover everyone affected in our community, and each potentially

exposed person will have the opportunity to receive medication. EXPLAIN THAT ALL INDIVIDUALS

SHOULD MAKE ARRANGEMENTS TO OBTAIN THIS MEDICATION, AS THIS IS A

POTENTIALLY DEADLY EVENT.

Please stay tuned to this station or visit http://www.sccmo.org/394/Community-Health-the-Environment

for further instructions.

58
Attachment 6:
MEDIA LIST – as of 3/1/15

NEWSPAPER
Daily
St. Louis Post-Dispatch (St. Charles Edition)
900 N. Tucker Blvd. 190 Spring Drive
St. Louis, MO 63101 St. Charles, MO 63303
Phone – (314) 340-8000 Phone – (636) 255-7201
Photo Fax – (314) 340-3103 Fax – (636) 946-8071
Gary Hairlson (Photo Assign) Fred Ehrlich (SCC Editor)
Jean Buchanan – Health editor Mark Schlinkmann (SCC Gov.)
Blythe Bernhard – Health reporter
Blythe direct phone (314-340-8129)

fehrlich@post-dispatch.com mschlinkmann@post-dispatch.com
jbuchanan@post-dispatch.com
bbernhard@post-dispatch.com photo@post-dispatch.com

Weekly
Boone Country Connection
Diane Sudbrock, Editor – boonecc2@gmail.com
1734 Schnarre Road
Foristell, MO 63348
Phone - (636) 332-3050
Fax – (636) 327-3212

Community News
Robert Huneke, Publisher – info@mycnews.com
Shannon Cothran, Editor – editor@mycnews.com
2139 Bryan Valley Commercial Drive
O’Fallon, MO 63366
Phone – (636) 379-1775
Fax – (636) 379-1632

Elsberry Democrat
Michael Short, General Manager – edgenmgr@lcs.net
106A North Third, PO Box 105
Elsberry, MO
Phone - (573) 898-2318
Fax – (573) 898-2173

59
Lincoln County Journal/Troy Free Press
Bob Simmons, Managing editor – lcjeditor@lcs.net
20 Business Park Drive
Troy, MO 63379
Phone – (636) 528-9550
Fax – (636) 528-6694

Marthasville Record
Andrea Hurley, Editor – recnews@centurytel.net
340 Depot St.
PO Box 77
Marthasville, MO 63357
Phone – (636) 433-2223

MidRivers Newsmagazine
Kate Uptergrove, Editor – editor@newsmagazinenetwork.com
Dan Fox (writer) – dfox@newsmagazinenetwork.com
Amy Armour (writer) – amyarmour@sbcglobal.net
Brian Flinchpaugh (writer) – flinchpaugh.1@netzero.com (314-732-9244)
111 Triad West Drive
O’Fallon, MO 63366
Phone – (636) 978-7983
Fax – (636) 978-7984

Newstime
Michael Short, General Manager – mshort@newstime-mo.com
Tim Hager, Editor – thager@newstime-mo.com
11102 Veterans Memorial Parkway
Lake St. Louis, MO 63367
Phone – (636) 625-3081
Fax – (636) 625-8895

Suburban Journal
Editor – goodnews@yourjournal.com
14522 S. Outer Forty Road
Town and Country, MO 63017
Phone – (314) 821-1110
Fax – (314) 821-0745

St. Charles County Business Record

Mike Trask, Editor – mike.trask@molawyersmedia.com
Richard Jackoway, Editor – richard.jackoway@molawyersmedia.com
Phone – (314) 558-3220

60
The Riverfront Times
News – Jessica Lussenhop - jessica.lussenhop@riverfronttimes.com
6358 Delmar Boulevard, Suite 200
St. Louis, MO 63130
Phone – (314) 754-5966
Fax – (314) 754-5955

Warren County Record

Tim Schmidt, Editor – erecord@centurytel.net
103 East Booneslick
Warrenton, MO 63383
Phone – (636) 456-6397
Fax – (636) 456-6150

Washington Missourian
Editor – Bill Miller – bmiller@emissourian.com
14 W. Main Street
Washington, MO 63090
Phone – 636-239-7701
Email – washnews@emissourian.com

Red Latina (Hispanic publication)

Editor – Cecilia Velasquez – contact@redlatinastl.com
4422 Woodson Road
Woodson Terrace, MO 63134
Phone – (314) 772-6362
Fax – (314) 772-8099

St. Louis Business Journal

Managing Editor – Joe Dwyer – jdwyer@bizjournals.com
Health Care Reporter – Angela Mueller – amueller@bizjournals.com
Direct Phone – (314) 421-8320
Food and Beverage Reporter - E.B. Solomont – esolomont@bizjournals.com
Direct Phone – (314) 421-8334
815 Olive Street, Suite 100
St. Louis, MO 63101
Phone – (314) 421-6200
Fax – (314) 621-5031

St. Louis Chinese American News (Chinese publication)

Editor – Tracy Wang – editor@scanews.com
8041 Olive Boulevard
St. Louis, MO 63130
Phone – (314) 432-3858
Fax – (314) 432-1217

St. Louis American Newspaper

Editorial Director – Chris King – cking@stlamerican.com
Health Editor – Sandra Jordan – sjordan@stlamerican.com
2315 Pine Street
61
St. Louis, MO 63013
Phone – (314) 533-8000
Fax – (314) 533-0038

MAGAZINE
Alive Magazine (Deadline – 2 months prior to issue date)
Executive Editor – Kelly Hamilton – kelly@alivemag.com
50 Maryland Plaza, 4th Floor
St. Louis, MO 63108
Phone – (314) 446-4059
Fax – (314) 446-4052

Crossroads (Wentzville/Lake Saint Louis focus)

Donna Huneke, Editor – editor@mycnews.com
2139 Bryan Valley Commercial Drive
O’Fallon, MO 63366
Phone – 636-379-1775

El Mundo Latino (Hispanic focus)

Editor – Rene Vences Jr. – rene@elmundolatino.us
1717 Olive Street, Suite 6R
St. Louis, MO 63103
Phone – (314) 241-0505
Fax – (314) 241-0512

FEAST
Editor – Brandi Wills – editor@feastSTL.com
14522 South Outer 40 Road
Town & Country, MO 63017
Phone – (314) 744-5744
Fax – (314) 657-3347

Healthy Planet (Deadline – 15th of each month)

J.B. Lester, Editor – info@thehealthyplanet.com
20 North Gore, #200
Webster Groves, MO 63119
Phone – (314) 962-7748
Fax – (314) 962-0728

Sauce (Deadline – 3 months prior to publishing date)

Editor – Stacy Schultz – sschultz@saucemagazine.com
1820 Chouteau Avenue
St. Louis, MO 63103
Phone – (314) 772-8004
Fax – (314) 241-8004

62
St. Louis Magazine (Deadline is 3 months prior to publication)
Margaret Schneider, Managing Editor – mbauer@stlmag.com
Jeannette Cooperman, Writer – jcooperman@stlmag.com
1600 S. Brentwood, #550
St. Louis, MO 63144
Phone – (314) 918-3000
Fax – (314) 918-3099

StreetScape
Tom Hannegan, Publisher – tom@streetscapemag.com
Judy Peters, Reporter – judy@streetscapemag.com
223 North Main St.
St. Charles, MO 63301
Phone – (636) 448-2074

Gateway Creative/Time Off Magazine

Pat Catanzaro – timeoff@gatewaycreative.net
5988 Mid Rivers Mall Drive
St. Charles, MO 63304
Phone – (636) 532-5805
Fax – (636-536-9611

RADIO
KCLC-FM (Lindenwood University)
Mike Wall – General Manager – fm891@lindenwood.edu
209 S. Kingshighway
St. Charles, MO 63301
Phone – (636) 949-4880
Fax – (636) 949-4910

KEZK-FM (Adult Contemporary)

Vic Porcelli, Morning Show Producer – vic@fresh102.com
3100 Market St.
St. Louis, MO 63103
Phone – (314) 531-0000
Fax – (314) 289-5789

KFAV-FM/KWRE-AM (Country/St. Charles County Focused)

Mike Thomas – Program Director
PO Box 220
Warrenton, MO 63383
Phone – (636) 377-2300
Fax – (636) 978-4710

KFTK-FM (Talk)
Denys Schaefer, News Director - dschaefer@stl.emmis.com
800 St. Louis Union Station, 1st Floor
St. Louis, MO 63103
63
Phone – (314) 231-9710
Fax – (314) 621-3000

KHZR-FM (Christian Broadcasting – JOY FM)

Kelly Corday, Morning News Producer – Kelly@joyfmonline.org
13358 Manchester Road, Suite 100
St. Louis, MO 63131
Phone – 314-909-8569

KIHT-FM (Top 40)

Public Relations – Kristi Carson – Kristi@stl.emmis.com
800 St. Louis Union Station, 1st Floor
St. Louis, MO 63103
Phone – (314) 231-9710
Fax – (314) 621-7053

KLOU-FM (Oldies)
Arika Parr, News Director – arikaparr@clearchannel.com
1001 Highlands Plaza Drive West, #100
St. Louis, MO 63110
Phone – (314) 333-8000

KMOX-AM (News/Talk)
John Butler, News Director – jmbutler@cbs.com
Fred Bodimer, Health Reporter – fbodimer@cbs.com
Kevin Killeen, Morning Reporter – kakilleen@cbs.com
Maria Keena – Weekend Anchor – mckeena@cbs.com
1220 Olive Street, 3rd Floor
St. Louis, MO 63103
Phone – (314) 444-3234
Fax – (314) 588-1234

KSD-FM (Country – The Bull)

Arika Parr, News Director – arikaparr@clearchannel.com
1001 Highlands Plaza Drive West, #100
St. Louis, MO 63110
Phone – (314) 333-8000

KSHE-FM (Classic Rock)

Public Relations – Kristi Carson – Kristi@stl.emmis.com
800 St. Louis Union Station, 1st Floor
St. Louis, MO 63103
Phone – (314) 621-0095
Fax – (314) 621-7053

KSLQ-FM (Adult Contemporary)

Chris Dieckhaus – News Director
Brad Hildebrand – Program/Promotions Director – brad@kslq.com
511 West 5th St.
Washington, MO 63090
64
Phone – (636) 239-6800
Fax – 1(636) 239-9735

KSLZ-FM (Top 40)

Arika Parr, News Director – arikaparr@clearchannel.com
1001 Highlands Plaza Drive West, #100
St. Louis, MO 63110
Phone – (314) 333-8000
Fax – (314) 333-8200

KTRS-AM (News/Talk)
Victoria Babu, News Director – news@ktrs.com
Colin Jeffrey, News – colin.jeffrey@ktrs.com
638 Westport Plaza
St. Louis, MO 63146
Phone – (314) 453-9704
Fax – (314) 453-9807

KWMU-FM (NPR)
Bill Raack, News Director – braack@kwmu.org
Tim Lloyd, Reporter – tlloyd@stlpublicradio.org
University of Missouri – St. Louis
One University Blvd.
St. Louis, MO 63121
Phone – (314) 516-6397

KYKY-FM (Adult Contemporary)

Courtney Landrum, Morning Show Producer – clandrum@y98.com
3100 Market St.
St. Louis, MO 63103
Phone – (314) 531-0000
Fax – (314) 531-9855

WIL-FM (Country)
Amanda Koeppe, News – akoeppe@wil92.com
11647 Olive Blvd.
St. Louis, MO 63141
Phone – (314) 983-6000
Fax – (314) 994-9421

KPVR-FM (Westplex News Talk)

Jed Finley, Program Director – westplexnews@gmail.com
30 Tower Street
Moscow Mills, MO 63362
Phone – (636) 356-9266
Fax – (636) 356-4636

65
RADIO DISNEY (Kids)
Nikki Polley, Promotions Director – Nicole.j.polley@disney.com
1978 Innerbelt Business Center Drive
St. Louis, MO 63114
Phone – (314) 428-4023
Fax – (314) 428-9119

NOAA Weather Radio (National Weather Service)

Jim Kramper, Warning Coordination Meteorologist
(james.kramper@noaa.gov) Phone - (636) 447-1876
12 Missouri Research Park Drive
St. Charles, MO 63304
Main Phone – (636) 441-8467
Fax – (636) 447-1769

TELEVISION
KMOV-TV (CBS)
One Memorial Drive
St. Louis, MO 63102
Phone – (314) 444-6333
Fax – (314) 621-4775
Email – pressrelease@kmov.com
Assignment Editor (M-F) – Bob Cyphers – bcyphers@kmov.com
Assignment Editor (Weekend) – Terry Cancila – tcancila@kmov.com
St. Charles County focused reporter – Ray Preston – rpreston@kmov.com(314) 619-1302

KPLR-TV (WB)
2250 Ball Drive
St. Louis, MO 63146
Phone – 314-213-7841
Fax – (314) 993-0922
Email – kplrnews@tvstl.com

KSDK-TV (NBC)
1000 Market St.
St. Louis, MO 63101
Phone – (314) 444-5125
Fax – (314) 444-5164
Fax – (314) 444-5364 (Show Me St. Louis)
News Tips – newstips@ksdk.com
Assignment Editor (M-F) – Dave Keiser (dkeiser@ksdk.gannett.com)
Assignment Editor (Weekend) – Brian Byrne (bbyrne@ksdk.gannett.com)
Morning Producer – Andrew Scherer (ascherer@ksdk.com)
Health Reporter – Kay Quinn – kquinn@ksdk.com)
Show Me St. Louis – Stephanie Zoller (szoller@ksdk.gannett.com)
Show Me phone - (314) 425-5319

66
KTVI-TV (FOX)
2250 Ball Drive
St. Louis, MO 63146
Phone – 314-213-7831
Fax – 314-993-0922
Email – ktvinews@tvstl.com
Assignment Editor (M-F) – Mick Bond – mick.bond@tvstl.com
Assignment Editor (Weekends) – Glen Seibold – glen.seibold@tvstl.com
Assignment Editor – Chris Pilcic – chris.pilcic@tvstl.com
Morning Producer – Angel James – angel.james@tvstl.com
Weekend Anchor – Andy Banker – andy.banker@tvstl.com

LUTV (Lindenwood University)

209 S. Kingshighway
St. Charles, MO 63301
Phone – 636-949-4513 or 636-949-4605
Station Manager – Peter Carlos – pcarlos@lindenwood.edu
News Director – Jill Falk – jfalk@lindenwood.edu

WIRE SERVICES
Associated Press
Jim Salter, News Correspondent – jsalter@ap.org
900 North Tucker Boulevard
St. Louis, MO 63101
Phone – (314) 241-2496
Fax – (314) 241-1734

UPI
Bill Greenblatt, Bureau Chief – upistl@aol.com
20 Nantucket Lane
St. Louis, MO 63132
Phone – (314) 554-1000
Fax – (314) 991-9320

OTHER
United Way 2-1-1
Regina Greer, Director – regina.greer@stl.unitedway.org
910 North 11th Street
St. Louis, MO 63101
Phone – (314) 242-1880

ST. CHARLES COUNTY STAFF/PARTNERS

SCCMO-TV
100 N. Third Street
St. Charles, MO 63301
Phone – 636-949-3790 or 636-949-7785
67
Production Manager – Jack Gamble – jgamble@sccmo.org
Production Coordinator – Ashley Lewis – alewis@sccmo.org

SCCMO WEBSITE
Nancy Teply
201 N. Second Street
St. Charles, MO 63301
Phone – 636-949-3442
Email – nteply@sccmo.org

ST. PETERS CITY TV

One St. Peters City Centre Drive/4700 Mexico Road (Studio)
St. Peters, MO 63376
Phone – 636-477-6600x227
Email – lbedian@stpetersmo.net

O’FALLON CITY TV
100 North Main Street
O’Fallon, MO 63366
Phone – 636-240-2000
Email – kenneths@ofallon.mo.us

ST. CHARLES CITY TV

200 North Second Street, Room 403
St. Charles, MO 63301
Phone – 636-949-3288
Email – cable@stcharlescity.com

Gibson Printing
Sherry Gibson, President
5903 Suemandy Road
St. Peters, MO 63376
Phone – (636) 970-6316
Email – sherry@gibsonprinting.com
NON-MEDIA CONTACTS
Augusta Chamber of Commerce
President – Robin White (636-987-2673)
PO Box 31
Augusta, MO 63332
Phone – 636-228-4005
Email – robinsnestonthekatytrail@yahoo.com

Cottleville-Weldon Spring Chamber of Commerce

President – Christa Montgomery
PO Box 685
St. Peters, MO 63376
Phone – 636-448-0403
Email – info@cwschamber.com

68
Elsberry Chamber of Commerce
President – Carla Potts
PO Box 32
Elsberry, MO 63343
Phone – (573) 898-9124
Email – secretary@elsberrycofc.org

Lake Saint Louis Community Association

Steve Probst
100 Cognac Court
Lake Saint Louis, MO 63367
Phone – 636-625-8276
Email – sprobst@lslca.com

O’Fallon Chamber of Commerce

Executive Director – Erin Williams
2145 Bryan Valley Commercial Drive
O’Fallon, MO 63366
Phone – 636-240-1818
Email – erin@ofallonchamber.org

Greater St. Charles County Chamber of Commerce

President & CEO – Scott Tate
2201 First Capitol Drive
St. Charles, MO 63301
Phone – 636-946-0633
Email – scott@gstccc.com

Troy Area Chamber of Commerce

Executive Director – Kerry Klump
543 E. Cherry Street
Troy, MO 63379
Phone – 636-462-8769
Email – Kerry@troyonthemove.com

Warrenton Chamber of Commerce

President – Scott Costello
1000 Outlet Center Drive, Atrium
Warrenton, MO 63383
Phone – 636-456-2530
Email – info@warrentoncoc.com

Western St. Charles County Chamber of Commerce

President/CEO – Tony Mathews
210 South Linn
Wentzville, MO 63385
Phone – 636-327-6914
Email – tony@wentzvillechamber.com

69
Hispanic Chamber of Commerce of Greater St. Louis
Executive Director – Jorge Riopedre
3611 South Grand Blvd., Suite 105
St. Louis, MO 63118
Phone – 314-709-0767
Email – executive@hccstl.com

Washington Chamber of Commerce

President/CEO – Mark Wessels
323 West Main Street
Washington, MO 63090
Phone – 636-239-2715
Email – mwessels@washmo.org

Union Chamber of Commerce

Executive Director - Tammy Stowe
103 South Oak Street
Union, MO 63084
Phone – 636-583-8979
Email – tammy@unionmochamber.org

OTHER
Midwestern Braille Volunteers
Loretta Bryant
325 North Kirkwood Road, Suite G
St. Louis, MO 63122
Phone – 314-966-5828
Email – mbvol@sbcglobal.net

70
Attachment 7:

Regional and State PIO Contacts

*see file maintained by PIO*

71
Attachment 8:

FOR MORE INFORMATION, CONTACT:

Hope Woodson, Department Director (636) 949-7400
Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET - ANTHRAX

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax
most commonly occurs in hoofed mammals and can also infect humans.

Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days
after exposure. The serious forms of human anthrax are inhalation anthrax, cutaneous anthrax, and
intestinal anthrax.

Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the
symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

The intestinal disease form of anthrax may follow the consumption of contaminated food and is
characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite,
vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.

Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no
need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends, or
coworkers, unless they also were also exposed to the same source of infection.

In persons exposed to anthrax, infection can be prevented with antibiotic treatment.

Early antibiotic treatment of anthrax is essential–delay lessens chances for survival. Anthrax usually is
susceptible to penicillin, doxycycline, and fluoroquinolones.

An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the
general public to prevent disease and is not available.

72
 FREQUENTLY ASKED QUESTIONS - ANTHRAX
What is Anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax
most commonly occurs in hoofed mammals and can also infect humans.

What are the symptoms of Anthrax?

Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days
after exposure. The serious forms of human anthrax are inhalation anthrax, cutaneous anthrax, and
intestinal anthrax.

Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the
symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

The intestinal disease form of anthrax may follow the consumption of contaminated food and is
characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite,
vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.

Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no
need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends, or
coworkers, unless they also were also exposed to the same source of infection.

What is the treatment for exposure to Anthrax?

In persons exposed to anthrax, infection can be prevented with antibiotic treatment.

Early antibiotic treatment of anthrax is essential–delay lessens chances for survival. Anthrax usually is
susceptible to penicillin, doxycycline, and fluoroquinolones.

An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the
general public to prevent disease and is not available.

How should I handle a suspicious package?

• Do not shake or empty the contents of any suspicious package or envelope.
• Do not carry the package or envelope, show it to others or allow others to examine it.
• Put the package or envelope down on a stable surface; do not sniff, touch, taste, or look
closely at it or at any contents which may have spilled.
• Alert others in the area about the suspicious package or envelope. Leave the area, close any
doors, and take actions to prevent others from entering the area. If possible, shut off the
ventilation system.
• Wash hands with soap and water to prevent spreading potentially infectious material to face
or skin. Seek additional instructions for exposed or potentially exposed persons.
• If at work, notify a supervisor, a security officer, or a law enforcement official. If at home,
contact the local law enforcement agency.
• If possible, create a list of persons who were in the room or area when this suspicious letter
or package was recognized and a list of persons who also may have handled this package
or letter. Give this list to both the local public health authorities and law enforcement
officials
73
 ANTHRAX FAQS
FOR HEALTHCARE WORKERS AND PROVIDERS
How is anthrax diagnosed?
Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by
measuring specific antibodies in the blood of persons with suspected cases.

In patients with symptoms compatible with anthrax, providers should confirm the diagnosis by obtaining
the appropriate laboratory specimens based on the clinical form of anthrax that is suspected (i.e.,
cutaneous, inhalational, or gastrointestinal).

What are the standard diagnostic tests used by the laboratories?

Presumptive identification to identify to genus level (Bacillus family of organisms) requires Gram stain
and colony identification.

Presumptive identification to identify to species level (B. anthracis) requires tests for motility, lysis by
gamma phage, capsule production and visualization, hemolysis, wet mount and malachite green staining
for spores.
Confirmatory identification of B. anthracis carried out by CDC may include phage lysis, capsular
staining, and direct fluorescent antibody (DFA) testing on capsule antigen and cell wall polysaccharide.

When is a nasal swab indicated?

Nasal swabs and screening may assist in epidemiologic investigations, but should not be relied upon as a
guide for prophylaxis or treatment. Epidemiologic investigation in response to threats of exposure to B.
anthracis may employ nasal swabs of potentially exposed persons as an adjunct to environmental
sampling to determine the extent of exposure.

Is there an X-ray for detecting anthrax?

A chest X-ray can be used to help diagnose inhalation anthrax in people who have symptoms. It is not
useful as a test for determining anthrax exposure or for people with no symptoms.

Can someone get anthrax from contaminated mail, equipment or clothing?

In the mail handling processing sites, B. anthracis spores may be aerosolized during the operation and
maintenance of high-speed, mail sorting machines potentially exposing workers. In addition, these spores
could get into heating, ventilating, or air conditioning (HVAC) systems.

74
Attachment 9:

FOR MORE INFORMATION, CONTACT:

Hope Woodson, Department Director (636) 949-7400
Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET - BOTULISM

Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium
botulinum.

There are three main kinds of botulism:

• Food-borne botulism occurs when a person ingests pre-formed toxin that leads to illness within a
few hours to days. Food-borne botulism is a public health emergency because the contaminated
food may still be available to other persons besides the patient.

• Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum
in their intestinal tract.

• Wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin.

With food-borne botulism, symptoms begin within 6 hours to 2 weeks (most commonly between 12 and
36 hours) after eating toxin-containing food. Symptoms of botulism include double vision, blurred vision,
drooping eyelids, slurred speech, difficulty swallowing, dry mouth, muscle weakness that always
descends through the body: first shoulders are affected, then upper arms, lower arms, thighs, calves, etc.
Paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with
breathing (mechanical ventilation) is provided.

Botulism is not spread from one person to another. Food-borne botulism can occur in all age groups.

A supply of antitoxin against botulism is maintained by CDC. The antitoxin is effective in reducing the
severity of symptoms if administered early in the course of the disease. Most patients eventually recover
after weeks to months of supportive care.

75
 FREQUENTLY ASKED QUESTIONS – BOTULISM
What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium
Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating
foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound
infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum
bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are
considered medical emergencies. Foodborne botulism can be especially dangerous because many people
can be poisoned by eating a contaminated food.

How common is botulism?

In the United States an average of 110 cases of botulism are reported each year. Of these, approximately
25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne
botulism involving two or more persons occur most years and usually caused by eating contaminated
home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent
years, but wound botulism has increased because of the use of black-tar heroin, especially in California.

What are the symptoms of botulism?

The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech,
difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed
poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle
paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of
the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36
hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

How can botulism be treated?

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a
breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks,
the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an
antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from
worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in
the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to
remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of
therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant
botulism.

76
 BOTULISM FAQS
FOR HEALTHCARE WORKERS AND PROVIDERS
What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium
Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating
foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound
infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum
bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are
considered medical emergencies. Foodborne botulism can be especially dangerous because many people
can be poisoned by eating a contaminated food.

What kind of germ is Clostridium botulinum?

Clostridium botulinum is the name of a group of bacteria commonly found in soil. These rod-shaped
organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a
dormant state until exposed to conditions that can support their growth. There are seven types of botulism
toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.

How common is botulism?

In the United States, an average of 110 cases of botulism are reported each year. Of these, approximately
25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne
botulism involving two or more persons occur most years and usually caused by eating contaminated
home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent
years, but wound botulism has increased because of the use of black-tar heroin, especially in California.

What are the symptoms of botulism?

The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech,
difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed
poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle
paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of
the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36
hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

77
How is botulism diagnosed?
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism.
However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as
Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests
may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid
examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia
gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's
serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can
also be isolated from the stool of persons with foodborne and infant botulism. These tests can be
performed at some state health department laboratories and at CDC.

How can botulism be treated?

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a
breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks,
the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an
antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from
worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in
the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to
remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of
therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant
botulism.

78
Attachment 10:

FOR MORE INFORMATION, CONTACT:

Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET – VIRAL HEMORRHAGIC FEVERS

Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct families
of viruses. Characteristically, the overall vascular system is damaged, and the body's ability to regulate
itself is impaired. These symptoms are often accompanied by hemorrhage (bleeding); however, the
bleeding is itself rarely life-threatening. While some types of hemorrhagic fever viruses can cause
relatively mild illnesses, many of these viruses cause severe, life-threatening disease.

79
 FREQUENTLY ASKED QUESTIONS
VIRAL HEMORRHAGIC FEVERS
What are viral hemorrhagic fevers?
Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct families
of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem
syndrome (multisystem in that multiple organ systems in the body are affected). Characteristically, the
overall vascular system is damaged, and the body's ability to regulate itself is impaired. These symptoms
are often accompanied by hemorrhage (bleeding); however, the bleeding is itself rarely life-threatening.
While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses
cause severe, life-threatening disease.

The Special Pathogens Branch (SPB) primarily works with hemorrhagic fever viruses that are classified
as biosafety level four (BSL-4) pathogens. A list of these viruses appears in the SPB disease information
index. The Division of Vector-Borne Infectious Diseases, also in the National Center for Infectious
Diseases, works with the non-BSL-4 viruses that cause two other hemorrhagic fevers, dengue
hemorrhagic fever and yellow fever.

What are the symptoms of viral hemorrhagic fever illnesses?

Specific signs and symptoms vary by the type of VHF, but initial signs and symptoms often include
marked fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion. Patients with severe cases
of VHF often show signs of bleeding under the skin, in internal organs, or from body orifices like the
mouth, eyes, or ears. However, although they may bleed from many sites around the body, patients rarely
die because of blood loss. Severely ill patient cases may also show shock, nervous system malfunction,
coma, delirium, and seizures. Some types of VHF are associated with renal (kidney) failure.

How are patients with viral hemorrhagic fever treated?

Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure
for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or
HFRS. Treatment with convalescent-phase plasma has been used with success in some patients with
Argentine hemorrhagic fever.

80
 VIRAL HEMORRHAGIC FEVERS FAQS
FOR HEALTHCARE WORKERS AND PROVIDERS
What are viral hemorrhagic fevers?
Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct families
of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem
syndrome (multisystem in that multiple organ systems in the body are affected). Characteristically, the
overall vascular system is damaged, and the body's ability to regulate itself is impaired. These symptoms
are often accompanied by hemorrhage (bleeding); however, the bleeding is itself rarely life-threatening.
While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses
cause severe, life-threatening disease.

The Special Pathogens Branch (SPB) primarily works with hemorrhagic fever viruses that are classified
as biosafety level four (BSL-4) pathogens. A list of these viruses appears in the SPB disease information
index. The Division of Vector-Borne Infectious Diseases, also in the National Center for Infectious
Diseases, works with the non-BSL-4 viruses that cause two other hemorrhagic fevers, dengue
hemorrhagic fever and yellow fever.

How are hemorrhagic fever viruses grouped?

VHFs are caused by viruses of four distinct families: arenaviruses, filoviruses, bunyaviruses, and
flaviviruses. Each of these families share a number of features:
• They are all RNA viruses, and all are covered, or enveloped, in a fatty (lipid) coating.
• Their survival is dependent on an animal or insect host, called the natural reservoir.
• The viruses are geographically restricted to the areas where their host species live.
• Humans are not the natural reservoir for any of these viruses. Humans are infected when they
come into contact with infected hosts. However, with some viruses, after the accidental
transmission from the host, humans can transmit the virus to one another.
• Human cases or outbreaks of hemorrhagic fevers caused by these viruses occur sporadically and
irregularly. The occurrence of outbreaks cannot be easily predicted.
• With a few noteworthy exceptions, there is no cure or established drug treatment for VHFs.

In rare cases, other viral and bacterial infections can cause a hemorrhagic fever; scrub typhus is a good
example.

What carries viruses that cause viral hemorrhagic fevers?

Viruses associated with most VHFs are zoonotic. This means that these viruses naturally reside in an
animal reservoir host or arthropod vector. They are totally dependent on their hosts for replication and
overall survival. For the most part, rodents and arthropods are the main reservoirs for viruses causing
VHFs. The multimammate rat, cotton rat, deer mouse, house mouse, and other field rodents are examples
of reservoir hosts. Arthropod ticks and mosquitoes serve as vectors for some of the illnesses. However,
the hosts of some viruses remain unknown -- Ebola and Marburg viruses are well-known examples.

Where are cases of viral hemorrhagic fever found?

Taken together, the viruses that cause VHFs are distributed over much of the globe. However, because
each virus is associated with one or more particular host species, the virus and the disease it causes are
81
usually seen only where the host species live(s). Some hosts, such as the rodent species carrying several
of the New World arenaviruses, live in geographically restricted areas. Therefore, the risk of getting
VHFs caused by these viruses is restricted to those areas. Other hosts range over continents, such as the
rodents that carry viruses which cause various forms of hantavirus pulmonary syndrome (HPS) in North
and South America, or the different set of rodents that carry viruses which cause hemorrhagic fever with
renal syndrome (HFRS) in Europe and Asia. A few hosts are distributed nearly worldwide, such as the
common rat. It can carry Seoul virus, a cause of HFRS; therefore, humans can get HFRS anywhere where
the common rat is found.

While people usually become infected only in areas where the host lives, occasionally people become
infected by a host that has been exported from its native habitat. For example, the first outbreaks of
Marburg hemorrhagic fever, in Marburg and Frankfurt, Germany, and in Yugoslavia, occurred when
laboratory workers handled imported monkeys infected with Marburg virus. Occasionally, a person
becomes infected in an area where the virus occurs naturally and then travels elsewhere. If the virus is a
type that can be transmitted further by person-to-person contact, the traveler could infect other people. For
instance, in 1996, a medical professional treating patients with Ebola hemorrhagic fever (Ebola HF) in
Gabon unknowingly became infected. When he later traveled to South Africa and was treated for Ebola
HF in a hospital, the virus was transmitted to a nurse. She became ill and died. Because more and more
people travel each year, outbreaks of these diseases are becoming an increasing threat in places where
they rarely, if ever, have been seen before.

How are hemorrhagic fever viruses transmitted?

Viruses causing hemorrhagic fever are initially transmitted to humans when the activities of infected
reservoir hosts or vectors and humans overlap. The viruses carried in rodent reservoirs are transmitted
when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents.
The viruses associated with arthropod vectors are spread most often when the vector mosquito or tick
bites a human, or when a human crushes a tick. However, some of these vectors may spread virus to
animals, livestock, for example. Humans then become infected when they care for or slaughter the
animals.

Some viruses that cause hemorrhagic fever can spread from one person to another, once an initial person
has become infected. Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses are examples.
This type of secondary transmission of the virus can occur directly, through close contact with infected
people or their body fluids. It can also occur indirectly, through contact with objects contaminated with
infected body fluids. For example, contaminated syringes and needles have played an important role in
spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.

What are the symptoms of viral hemorrhagic fever illnesses?

Specific signs and symptoms vary by the type of VHF, but initial signs and symptoms often include
marked fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion. Patients with severe cases
of VHF often show signs of bleeding under the skin, in internal organs, or from body orifices like the
mouth, eyes, or ears. However, although they may bleed from many sites around the body, patients rarely
die because of blood loss. Severely ill patient cases may also show shock, nervous system malfunction,
coma, delirium, and seizures. Some types of VHF are associated with renal (kidney) failure.

How are patients with viral hemorrhagic fever treated?

Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure
for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or
HFRS. Treatment with convalescent-phase plasma has been used with success in some patients with
Argentine hemorrhagic fever.
82
How can cases of viral hemorrhagic fever be prevented and controlled?
With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been
developed, no vaccines exist that can protect against these diseases. Therefore, prevention efforts must
concentrate on avoiding contact with host species. If prevention methods fail and a case of VHF does
occur, efforts should focus on preventing further transmission from person to person, if the virus can be
transmitted in this way.

Because many of the hosts that carry hemorrhagic fever viruses are rodents, disease prevention efforts
include:
• controlling rodent populations
• discouraging rodents from entering or living in homes or workplaces
• encouraging safe cleanup of rodent nests and droppings.

For hemorrhagic fever viruses spread by arthropod vectors, prevention efforts often focus on community-
wide insect and arthropod control. In addition, people are encouraged to use insect repellant, proper
clothing, bednets, window screens, and other insect barriers to avoid being bitten.

For those hemorrhagic fever viruses that can be transmitted from one person to another, avoiding close
physical contact with infected people and their body fluids is the most important way of controlling the
spread of disease. Barrier nursing or infection control techniques include isolating infected individuals
and wearing protective clothing. Other infection control recommendations include proper use,
disinfection, and disposal of instruments and equipment used in treating or caring for patients with VHF,
such as needles and thermometers.

In conjunction with the World Health Organization, CDC has developed practical, hospital-based
guidelines, titled “Infection Control for Viral Hemorrhagic Fevers In the African Health Care
Setting.” The manual can help health-care facilities recognize cases and prevent further hospital-based
disease transmission using locally available materials and few financial resources.

What needs to be done to address the threat of viral hemorrhagic fevers?

Scientists and researchers are challenged with developing containment, treatment, and vaccine strategies
for these diseases. Another goal is to develop immunologic and molecular tools for more rapid disease
diagnosis, and to study how the viruses are transmitted and exactly how the disease affects the body
(pathogenesis). A third goal is to understand the ecology of these viruses and their hosts in order to offer
preventive public health advice for avoiding infection.

83
Attachment 11:

FOR MORE INFORMATION, CONTACT:

Hope Woodson, Department Director (636) 949-7400
Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET – PNEUMONIC PLAGUE

Plague is an infectious disease that affects animals and humans. It is caused by the bacterium Yersinia
pestis. This bacterium is found in rodents and their fleas and occurs in many areas of the world, including
the United States.

Y. pestis is easily destroyed by sunlight and drying. Even so, when released into air, the bacterium will
survive for up to one hour, although this could vary depending on conditions.

Pneumonic plague is one of several forms of plague. Depending on circumstances, these forms may occur
separately or in combination:

• Pneumonic plague occurs when Y. pestis infects the lungs. This type of plague can spread from
person to person through the air. Transmission can take place if someone breathes in aerosolized
bacteria, which could happen in a bioterrorist attack. Pneumonic plague is also spread by breathing
in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague.
Becoming infected in this way usually requires direct and close contact with the ill person or
animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is
untreated and the bacteria spread to the lungs.
• Bubonic plague is the most common form of plague. This occurs when an infected flea bites a
person or when materials contaminated with Y. pestis enter through a break in a person's skin.
Patients develop swollen, tender lymph glands (called buboes) and fever, headache, chills, and
weakness. Bubonic plague does not spread from person to person.
• Septicemic plague occurs when plague bacteria multiply in the blood. It can be a complication of
pneumonic or bubonic plague or it can occur by itself. When it occurs alone, it is caused in the
same ways as bubonic plague; however, buboes do not develop. Patients have fever, chills,
prostration, abdominal pain, shock, and bleeding into skin and other organs. Septicemic plague
does not spread from person to person.

Symptoms and Treatment

With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing
pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The
pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early
treatment, patients may die.

Early treatment of pneumonic plague is essential. To reduce the chance of death, antibiotics must be given
within 24 hours of first symptoms. Streptomycin, gentamicin, the tetracyclines, and chloramphenicol are
all effective against pneumonic plague. A plague vaccine is not currently available for use in the United
States.

84
 FREQUENTLY ASKED QUESTIONS
PNEUMONIC PLAGUE
What is plague?
Plague is a disease caused by Yersinia pestis (Y. pestis), a bacterium found in rodents and their fleas in
many areas around the world.

Why are we concerned about pneumonic plague as a bioweapon?

Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six
days after becoming infected with the bacteria, people would develop pneumonic plague. Once people
have the disease, the bacteria can spread to others who have close contact with them. Because of the delay
between being exposed to the bacteria and becoming sick, people could travel over a large area before
becoming contagious and possibly infecting others. Controlling the disease would then be more difficult.
A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated
and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would
require advanced knowledge and technology.

Is pneumonic plague different from bubonic plague?

Yes. Both are caused by Yersinia pestis, but they are transmitted differently and their symptoms differ.
Pneumonic plague can be transmitted from person to person; bubonic plague cannot. Pneumonic plague
affects the lungs and is transmitted when a person breathes in Y. pestis particles in the air. Bubonic plague
is transmitted through the bite of an infected flea or exposure to infected material through a break in the
skin. Symptoms include swollen, tender lymph glands called buboes. Buboes are not present in
pneumonic plague. If bubonic plague is not treated, however, the bacteria can spread through the
bloodstream and infect the lungs, causing a secondary case of pneumonic plague.

What are the signs and symptoms of pneumonic plague?

Patients usually have fever, weakness, and rapidly developing pneumonia with shortness of breath, chest
pain, cough, and sometimes bloody or watery sputum. Nausea, vomiting, and abdominal pain may also
occur. Without early treatment, pneumonic plague usually leads to respiratory failure, shock, and rapid
death.

Can a person exposed to pneumonic plague avoid becoming sick?

Yes. People who have had close contact with an infected person can greatly reduce the chance of
becoming sick if they begin treatment within 7 days of their exposure. Treatment consists of taking
antibiotics for at least 7 days.

How quickly would someone get sick if exposed to plague bacteria through the air?
Someone exposed to Yersinia pestis through the air -- either from an intentional aerosol release or from
close and direct exposure to someone with plague pneumonia -- would become ill within 1 to 6 days.

Can pneumonic plague be treated?

Yes. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms.
Several types of antibiotics are effective for curing the disease and for preventing it. Available oral
medications are a tetracycline (such as doxycycline) or a fluoroquinolone (such as ciprofloxacin). For
injection or intravenous use, streptomycin or gentamicin antibiotics are used. Early in the response to a

85
bioterrorism attack, these drugs would be tested to determine which is most effective against the particular
weapon that was used.

Would enough medication be available in the event of a bioterrorism attack involving pneumonic
plague?
National and state public health officials have large supplies of drugs needed in the event of a
bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.

How is plague diagnosed?

The first step is evaluation by a health worker. If the health worker suspects pneumonic plague, samples
of the patient’s blood, sputum, or lymph node aspirate are sent to a laboratory for testing. Once the
laboratory receives the sample, preliminary results can be ready in less than two hours. Confirmation will
take longer, usually 24 to 48 hours.

Is a vaccine available to prevent pneumonic plague?

Currently, no plague vaccine is available in the United States. Research is in progress, but we are not
likely to have vaccines for several years or more.

86
 PNEUMONIC PLAGUE FAQS
FOR HEALTHCARE WORKERS AND PROVIDERS
Why are we concerned about pneumonic plague as a bioweapon?
Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six
days after becoming infected with the bacteria, people would develop pneumonic plague. Once people
have the disease, the bacteria can spread to others who have close contact with them. Because of the delay
between being exposed to the bacteria and becoming sick, people could travel over a large area before
becoming contagious and possibly infecting others. Controlling the disease would then be more difficult.
A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated
and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would
require advanced knowledge and technology.

Is pneumonic plague different from bubonic plague?

Yes. Both are caused by Yersinia pestis, but they are transmitted differently and their symptoms differ.
Pneumonic plague can be transmitted from person to person; bubonic plague cannot. Pneumonic plague
affects the lungs and is transmitted when a person breathes in Y. pestis particles in the air. Bubonic plague
is transmitted through the bite of an infected flea or exposure to infected material through a break in the
skin. Symptoms include swollen, tender lymph glands called buboes. Buboes are not present in
pneumonic plague. If bubonic plague is not treated, however, the bacteria can spread through the
bloodstream and infect the lungs, causing a secondary case of pneumonic plague.

What are the signs and symptoms of pneumonic plague?

Patients usually have fever, weakness, and rapidly developing pneumonia with shortness of breath, chest
pain, cough, and sometimes bloody or watery sputum. Nausea, vomiting, and abdominal pain may also
occur. Without early treatment, pneumonic plague usually leads to respiratory failure, shock, and rapid
death.

How do people become infected with pneumonic plague?

Pneumonic plague occurs when Yersinia pestis infects the lungs. Transmission can take place if someone
breathes in Y. pestis particles, which could happen in an aerosol release during a bioterrorism attack.
Pneumonic plague is also transmitted by breathing in Y. pestis suspended in respiratory droplets from a
person (or animal) with pneumonic plague. Respiratory droplets are spread most readily by coughing or
sneezing. Becoming infected in this way usually requires direct and close (within 6 feet) contact with the
ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is
untreated and the bacteria spread to the lungs.

Can a person exposed to pneumonic plague avoid becoming sick?

Yes. People who have had close contact with an infected person can greatly reduce the chance of
becoming sick if they begin treatment within 7 days of their exposure. Treatment consists of taking
antibiotics for at least 7 days.
How quickly would someone get sick if exposed to plague bacteria through the air?
Someone exposed to Yersinia pestis through the air—either from an intentional aerosol release or from
close and direct exposure to someone with plague pneumonia—would become ill within 1 to 6 days.

Can pneumonic plague be treated?

Yes. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms.
Several types of antibiotics are effective for curing the disease and for preventing it. Available oral
medications are a tetracycline (such as doxycycline) or a fluoroquinolone (such as ciprofloxacin). For
87
injection or intravenous use, streptomycin or gentamicin antibiotics are used. Early in the response to a
bioterrorism attack, these drugs would be tested to determine which is most effective against the particular
weapon that was used.

Would enough medication be available in the event of a bioterrorism attack involving pneumonic
plague?
National and state public health officials have large supplies of drugs needed in the event of a
bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.

What should someone do if they suspect they or others have been exposed to plague?
Get immediate medical attention. To prevent illness, a person who has been exposed to pneumonic plague
must receive antibiotic treatment without delay. If an exposed person becomes ill, antibiotics must be
administered within 24 hours of their first symptoms to reduce the risk of death. Immediately notify local
or state health departments so they can begin to investigate and control the problem right away. If
bioterrorism is suspected, the health departments will notify the CDC, FBI, and other appropriate
authorities.

How can someone reduce the risk of getting pneumonic plague from another person or giving it to
someone else?
People having direct and close contact with someone with pneumonic plague should wear tightly fitting
disposable surgical masks. Patients with the disease should be isolated and medically supervised for at
least the first 48 hours of antibiotic treatment. People who have been exposed to a contagious person can
be protected from developing plague by receiving prompt antibiotic treatment.

How is plague diagnosed?

The first step is evaluation by a health worker. If the health worker suspects pneumonic plague, samples
of the patient’s blood, sputum, or lymph node aspirate are sent to a laboratory for testing. Once the
laboratory receives the sample, preliminary results can be ready in less than two hours. Confirmation will
take longer, usually 24 to 48 hours.

How long can plague bacteria exist in the environment?

Yersinia pestis is easily destroyed by sunlight and drying. Even so, when released into air, the bacterium
will survive for up to one hour, depending on conditions.

Is a vaccine available to prevent pneumonic plague?

Currently, no plague vaccine is available in the United States. Research is in progress, but we are not
likely to have vaccines for several years or more.

88
Attachment 12:

FOR MORE INFORMATION, CONTACT:

Hope Woodson, Department Director (636) 949-7400
Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET – SMALLPOX

Smallpox is a serious, contagious, and sometimes fatal infectious disease. There is no specific treatment
for smallpox disease, and the only prevention is vaccination.

Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now
eradicated after a successful worldwide vaccination program. The last case of smallpox in the United
States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the
disease was eliminated from the world, routine vaccination against smallpox among the general public
was stopped because it was no longer necessary for prevention.

89
 FREQUENTLY ASKED QUESTIONS - SMALLPOX
What are the symptoms of smallpox?
The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash
follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off
after about three weeks, leaving a pitted scar.

If someone comes in contact with smallpox, how long does it take to show symptoms?
After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation
time is 12 to 14 days). During this time, the infected person feels fine and is not contagious.

Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many
smallpox survivors have permanent scars over large areas of their body, especially their face. Some are
left blind.

How is smallpox spread?

Smallpox normally spreads from contact with infected persons. Generally, direct and fairly prolonged
face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be
spread through direct contact with infected bodily fluids or contaminated objects such as bedding or
clothing.

How many people would have to get smallpox before it is considered an outbreak?
One confirmed case of smallpox is considered a public health emergency.

Is there any treatment for smallpox?

Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for
smallpox, but research to evaluate new antiviral agents is ongoing.

Should I get vaccinated against smallpox?

The smallpox vaccine is not available to the public at this time.

90
 SMALLPOX FAQS
FOR HEALTHCARE WORKERS AND PROVIDERS
What should I know about smallpox?
Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an
orthopoxvirus), and marked by fever and a distinctive progressive skin rash. In 1980, the disease was
declared eradicated following worldwide vaccination programs. However, in the aftermath of the
events of September and October, 2001, the U.S. government is taking precautions to be ready to deal
with a bioterrorist attack using smallpox as a weapon.

As a result of these efforts:

1) There is a detailed nationwide smallpox response plan designed to quickly vaccinate people and
contain a smallpox outbreak. This plan includes the creation of smallpox health care teams that
would respond to a smallpox emergency and the vaccination of members of these teams.
2) There is enough smallpox vaccine to vaccinate everyone who would need it in the event of an
emergency.

What are the symptoms of smallpox?

The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A
rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall
off after about three weeks, leaving a pitted scar.

Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many
smallpox survivors have permanent scars over large areas of their body, especially their face. Some are
left blind.

How is smallpox spread?

Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one
person to another. Smallpox also can be spread through direct contact with infected bodily fluids or
contaminated objects such as bedding or clothing. Indirect spread is less common. Rarely, smallpox
has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains.
Smallpox is not known to be transmitted by insects or animals.

If people had smallpox previously and survived, are they immune from the disease?
Yes. If they had smallpox before and survived, they are immune to the disease.

When are cases of smallpox infectious?

A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person
becomes most contagious with the onset of rash. The infected person is contagious until the last
smallpox scab falls off.

Is there any treatment for smallpox?

Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for
smallpox, but research to evaluate new antiviral agents is ongoing. Early results from laboratory
studies suggest that the drug cidofovir may fight against the smallpox virus; currently, studies with
animals are being done to better understand the drug’s ability to treat smallpox disease (the use of
cidofovir to treat smallpox or smallpox reactions should be evaluated and monitored by experts at NIH

91
and CDC). Patients with smallpox can benefit from supportive therapy (e.g., intravenous fluids,
medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

If a smallpox event were suspected to have occurred in a particular facility, what would be done
to protect the employees?
If a smallpox event were suspected to have occurred in a facility, response plans are in place to try to
document the presence of smallpox and rapidly initiate isolation procedures and vaccinate exposed
persons if that is deemed appropriate.

Why are we even bringing smallpox patients to the hospitals? Why not just keep them at home
where they’ve already exposed everyone?
With good infection control practices and rooms with the appropriate air handling features, we can
treat patients in the hospital without risking transmission to other patients and staff. The appropriate
care and management of smallpox patients will probably require hospitalization.

What kind of personal protective equipment (PPE, especially respiratory) would be necessary
for dealing with a smallpox patient?
Airborne and contact isolation precautions should be followed.

Does a HEPA filter remove smallpox virus? Can a makeshift isolation room be created by
bringing a portable HEPA filter into a regular private room?
Yes, HEPA filters do remove smallpox virus. HEPA filters are 99.97% efficient at removing particles
that are greater than or equal to 0.3 microns in size, but their use will not create an airborne infection
isolation room, the precautions recommended for smallpox patients.

The HEPA filter will not change the pressure relationship to the corridor unless the portable filter is set
up as a negative pressure device. Self-closing doors will help to maintain the conditions and windows
should be closed and sealed. If the HEPA filter is being used only to purify the room air, its
effectiveness will vary depending on the size of the room and output of the device. A portable HEPA
filter that produces 8 or more air changes per hour results in a 90% reduction of particles in 17 minutes
in a room with the doors and windows closed. However, to be consistent with current guidelines for
airborne infection isolation rooms, the goal should be 12 or more air changes per hour which would
produce a 90% reduction in particles in 11 minutes.

92
Once a smallpox patient has been identified, what is the response for the hospital or clinic? Do
we quarantine?
Until a case is confirmed, the recommendation would be the same as for any rash illness, such as
measles. Get the suspect patient into a negative air pressure room and gather the name and locating
information for those exposed to the patient. If they don't have a negative air pressure room, get them
to a facility that does. State and local governments have primary responsibility for isolation and/or
quarantine within their borders.

In caring for a patient with smallpox, does the vaccination status of a caregiver affect the N95
mask recommendation?
Anyone caring for a smallpox patient should wear an N95 mask.

If a health care provider has a contraindication or is at a high risk for infection, should they care
for patients infected with smallpox?
Ideally, these providers should not be in the vicinity of the patient or performing any patient care.

What are the HIPAC recommendations for health care workers who may be exposed to patients
with smallpox or plague?
For smallpox, it is advisable that caregivers use a N95 mask respirator. For plague, a standard surgical
mask is fine, and negative pressure rooms are not needed.

93
Attachment 13:

FOR MORE INFORMATION, CONTACT:

Hope Woodson, Department Director (636) 949-7400
Doug Bolnick, Public Information Officer (636) 949-7408

FACT SHEET – TULAREMIA

Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals,
especially rodents, rabbits, and hares)

People can get tularemia many different ways, such as through the bite of an infected insect or other
arthropod (usually a tick or deerfly), handling infected animal carcasses, eating or drinking contaminated
food or water, or breathing in F. tularensis.

Symptoms of tularemia could include sudden fever, chills, headaches, muscle aches, joint pain, dry cough,
progressive weakness, and pneumonia. Persons with pneumonia can develop chest pain and bloody spit
and can have trouble breathing or can sometimes stop breathing. Other symptoms of tularemia depend on
how a person was exposed to the tularemia bacteria. These symptoms can include ulcers on the skin or
mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Symptoms usually
appear 3 to 5 days after exposure to the bacteria, but can take as long as 14 days.

Tularemia is not known to be spread from person to person, so people who have tularemia do not need to
be isolated.

A vaccine for tularemia is under review by the Food and Drug Administration and is not currently
available in the United States.

94
 FREQUENTLY ASKED QUESTIONS - TULAREMIA
What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals
(especially rodents, rabbits, and hares).

How do people become infected with the tularemia bacteria?

Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies)
that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking
contaminated food or water, or by inhaling infected aerosols.

Does tularemia occur naturally in the United States?

Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported
annually in the United States, mostly in persons living in the south-central and western states. Nearly all
cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the
handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols
and from laboratory accidents.

Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be
isolated.

Can tularemia be effectively treated with antibiotics?

Yes. After potential exposure or diagnosis, early treatment is recommended with an antibiotic from the
tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, which are taken
orally, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously.
Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine
which antibiotics would be most effective.

95
 TULAREMIA FAQs
FOR HEALTCARE WORKERS AND PROVIDERS
What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals
(especially rodents, rabbits, and hares).

How do people become infected with the tularemia bacteria?

Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies)
that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking
contaminated food or water, or by inhaling infected aerosols.

Does tularemia occur naturally in the United States?

Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported
annually in the United States, mostly in persons living in the south-central and western states. Nearly all
cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the
handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols
and from laboratory accidents.

Why are we concerned about tularemia as a bioweapon?

Francisella tularensis is highly infectious: a small number of bacteria (10-50 organisms) can cause
disease. If F. tularensis were used as a bioweapon, the bacteria would likely be made airborne for
exposure by inhalation. Persons who inhale an infectious aerosol would generally experience severe
respiratory illness, including life-threatening pneumonia and systemic infection, if they were not treated.
The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a
laboratory, although manufacturing an effective aerosol weapon would require considerable
sophistication.

Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be
isolated.

How quickly would someone become sick if they were exposed to the tularemia bacteria?
The incubation period for tularemia is typically 3 to 5 days, with a range of 1 to 14 days.

What are the signs and symptoms of tularemia?

Depending on the route of exposure, the tularemia bacteria may cause skin ulcers, swollen and painful
lymph glands, inflamed eyes, sore throat, oral ulcers, or pneumonia. If the bacteria were inhaled,
symptoms would include the abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough,
and progressive weakness. Persons with pneumonia can develop chest pain, difficulty breathing, bloody
sputum, and respiratory failure. 40% or more of persons with the lung and systemic forms of the disease
may die if they are not treated with appropriate antibiotics.

What should someone do if they suspect they or others have been exposed to the tularemia
bacteria?
Seek prompt medical attention. If a person has been exposed to Francisella tularensis, treatment with
tetracycline antibiotics for 14 days after exposure may be recommended.

96
Local and state health departments should be immediately notified so an investigation and control
activities can begin quickly. If the exposure is thought to be due to criminal activity (bioterrorism), local
and state health departments will notify CDC, the FBI, and other appropriate authorities.

How is tularemia diagnosed?

When tularemia is clinically suspected, the healthcare worker will collect specimens, such as blood or
sputum, from the patient for testing in a diagnostic or reference laboratory. Laboratory test results for
tularemia may be presumptive or confirmatory.

Presumptive (preliminary) identification may take less than 2 hours, but confirmatory testing will take
longer, usually 24 to 48 hours.

Can tularemia be effectively treated with antibiotics?

Yes. After potential exposure or diagnosis, early treatment is recommended with an antibiotic from the
tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, which are taken
orally, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously.
Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine
which antibiotics would be most effective.

How long can Francisella tularensis exist in the environment?

Francisella tularensis can remain alive for weeks in water and soil.

Is there a vaccine available for tularemia?

In the past, a vaccine for tularemia has been used to protect laboratory workers, but it is currently under
review by the Food and Drug Administration.

97
 Attachment 14:

Assessing “At-Risk” Population Needs For St.

Charles County
Issue Population Need Solution Contact
Estimate*
Spanish is predominant Less than 1% Translated Interpreters on Assistance offered through 2-1-1. CDC website for
language – poor English of population Spanish-language call/at POD Site. bioterrorism agents -
comprehension (approximately signage/materials; Signs and http://emergency.cdc.gov/bioterrorism/factsheets.asp.
2,000) simple English materials See “St. Charles County Translation Needs” in Annex C
instruction for printed in folder.
signage and Spanish (Get United Way (211) – Regina Greer
staffing; through CDC (regina.greer@stl.unitedway.org) - 314.242.1880
opportunity for website). Also LAMP Translation system – 1(866) 948-7133
face-to-face or place picture St. Charles Community College ESL Translation
phone contact signage around assistance – Becky Ingraham (SCC ESL Program
with translator site. Coordinator ringraham@stchas.edu) – 636-922-8505
Lindenwood University ESL Translation assistance –
Sara Marler-Rayfield (Director smarler-
rayfield@lindenwood.edu) – 636-949-4375
St. Joachim and Ann Care Service – Miriam Mahan –
(mmahan@jacares.org) 636.441.1302
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276
Serbo-Croatian is Less than 1% Translated Interpreters on Assistance offered through 2-1-1. CDC website for
predominant language – of population language call/at POD Site. bioterrorism agents -
poor English comprehension (approximately signage/materials; Signs and http://emergency.cdc.gov/bioterrorism/factsheets.asp.
1,500) simple English materials See “St. Charles County Translation Needs” in Annex C
instruction for printed in folder.
signage and Serbian, United Way (211) – Regina Greer
staffing; Bosnian and (regina.greer@stl.unitedway.org) - 314.242.1880
opportunity for Croatian (Get LAMP Translation system – 1(866) 948-7133
face-to-face or through CDC St. Charles Community College ESL Translation
phone contact website). Also assistance – Becky Ingraham (SCC ESL Program
with translator place picture Coordinator ringraham@stchas.edu) – 636-922-8505
signage around Lindenwood University ESL Translation assistance –
site. Sara Marler-Rayfield (Director smarler-
rayfield@lindenwood.edu) – 636-949-4375
St. Joachim and Ann Care Service – Miriam Mahan –
(mmahan@jacares.org) 636.441.1302
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276

98
Other Asian speaking Less than 0.5% Translated Interpreters on Assistance offered through 2-1-1. CDC website for
(Korean, Vietnamese are of population Korean- and call. Fact sheet bioterrorism agents -
largest) (less than Vietnamese materials http://emergency.cdc.gov/bioterrorism/factsheets.asp.
1000) language printed in See “St. Charles County Translation Needs” in Annex C
materials; simple Korean and folder.
English instruction Vietnamese United Way (211) – Regina Greer
for signage and (Get through (regina.greer@stl.unitedway.org) - 314.242.1880
staffing; CDC website). LAMP Translation system – 1(866) 948-7133
opportunity for Also place St. Charles Community College ESL Translation
face-to-face or picture signage assistance – Becky Ingraham (SCC ESL Program
phone contact around site. Coordinator ringraham@stchas.edu) – 636-922-8505
with translator Lindenwood University ESL Translation assistance –
Sara Marler-Rayfield (Director smarler-
rayfield@lindenwood.edu) – 636-949-4375
St. Joachim and Ann Care Service – Miriam Mahan –
(mmahan@jacares.org) 636.441.1302
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276
Hearing Impaired 3% of Visual signage at ASL interpreters Center for Hearing and Speech – 314.968.4710
population site in prominent on call/at POD Community Council of St. Charles County – Mary
(approximately areas. Translation Site. Signs and Hutchison - (mhutchison@communitycouncilstc.org) -
7,500) of materials to materials 636.978.2277
American Sign printed and United Way (211) – Regina Greer
Language displayed at (regina.greer@stl.unitedway.org) - 314.242.1880
site. See “St. Charles County Translation Needs” in Annex C
folder.
Senior Services Task Force – Kyle Gaines (St. Charles
County Ambulance District) – 636-344-7600
(kgaines@sccad.com)
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276
Visually Impaired 1.5% of Verbal materials Website and Rehabilitation Services for the Blind – 314.877.1532
population and signage at video of the Society for the Blind and Visually Impaired –
(approximately POD sites. Braille prophylaxis 314.968.9000
3,500) translations of process. Staff Community Council of St. Charles County – Mary
materials. to read Hutchison - (mhutchison@communitycouncilstc.org) -
materials to 636.978.2277
individual and United Way (211) – Regina Greer
confirm (regina.greer@stl.unitedway.org) - 314.242.1880
comprehension. Midwestern Braille Volunteers – Loretta Bryant
Enact 24-hour (mbvol@sbcglobal.net) – 314-966-5828
phone bank ITN St. Charles – Susan Kallash-Bailey - 636-329-0888
(skb@itnstcharles.org)
Senior Services Task Force – Kyle Gaines (St. Charles
County Ambulance District) – 636-344-7600
(kgaines@sccad.com)
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276

99
Mobility Issues 4% of Delivery of Messaging St. Joachim and Ann Care Service – Miriam Mahan –
population medications to distributed (mmahan@jacares.org) 636.441.1302
(approximately home or living through care See list of long-term care centers
12,000) area. ADA centers. See list of faith-based organizations
compliant POD Establish pre- Community Council of St. Charles County – Mary
sites. event Hutchison - (mhutchison@communitycouncilstc.org) -
registration. 636.978.2277
POD sites United Way (211) – Regina Greer
reviewed for (regina.greer@stl.unitedway.org) - 314.242.1880
ADA access. Mid East Area Agency on Aging/STAR – Sarah
Enact 24-hour McDonald - 636.978.3306 (transportation@mid-
phone bank. eastaaa.org)
See ITN St. Charles – Susan Kallash-Bailey - 636-329-0888
transportation (skb@itnstcharles.org)
options below Developmental Disabilities Resource Board – Peg Capo
(pcapo@ddrb.org) – 636-939-3351x3101
Senior Services Task Force – Kyle Gaines (St. Charles
County Ambulance District) – 636-344-7600
(kgaines@sccad.com)
Community Living Inc – Barb Griffith
(bgriffith@cliservices.org) – 636-970-2800
Saint Louis Crisis Nursery – Mary Pat Smith
(marypat@crisisnurserykids.org) – 314-229-0708
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276
O’Fallon Transportation Network (Zip Care) – (314-292-
7302, ext. 380)
MO Rides (Deana Dothage) – ddothage@boonslick.org)
– (636-456-3473)

100
Unable to Comprehend 5% of Disperse Enact 24-hour St. Louis ARC – 314.569.2211
Messaging population information in a phone bank. St. Joachim and Ann Care Service – Miriam Mahan –
(approximately straightforward POD manager (mmahan@jacares.org) 636.441.1302
17,000) manner to direct these Boone Center, Inc. – Chuck Blossom -
individuals to 636.978.4300x112
“Functional Community Council of St. Charles County – Mary
Needs” Hutchison - (mhutchison@communitycouncilstc.org) -
dispensing area. 636.978.2277
Community and Children’s Resource Board of St.
Charles County – Bruce Sowatsky – 636-939-6200
(bsowatsky@sbcglobal.net)
See list of long-term care centers
See list of faith-based organizations
United Way (211) – Regina Greer
(regina.greer@stl.unitedway.org) - 314.242.1880
Youth in Need – Beth Butcher
(bbutcher@youthinneed.org) 636-757-9334
Developmental Disabilities Resource Board – Peg Capo
(pcapo@ddrb.org) – 636-939-3351x3101
Senior Services Task Force – Kyle Gaines (St. Charles
County Ambulance District) – 636-344-7600
(kgaines@sccad.com)
Community Living Inc – Barb Griffith
(bgriffith@cliservices.org) – 636-970-2800
Saint Louis Crisis Nursery – Mary Pat Smith
(marypat@crisisnurserykids.org) – 314-229-0708
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276

101
Unable to get to POD site Households Offer rides St. Joachim and Ann Care Service – Miriam Mahan –
without through (mmahan@jacares.org) 636.441.1302
vehicles are organizations ITN St. Charles – Susan Kallash-Bailey - 636-329-0888
less than 1% like St. Charles (skb@itnstcharles.org)
(around 3,500) Area Transit, OATS – 314.894.1701
Those in self- Independent SSM Senior Services – 636.947.5056
care or Transportation Mid East Area Agency on Aging/STAR – Sarah
independent Network, OATS, McDonald - 636.978.3306 (transportation@mid-
living facilities Express Medical eastaaa.org)
6% (around Transporters, Community Council of St. Charles County – Mary
18,000) Inc., STAR Hutchison - (mhutchison@communitycouncilstc.org) -
Transportation 636.978.2277
Program Youth in Need – Beth Butcher
(MidEast Area (bbutcher@youthinneed.org) 636-757-9334
Agency on Community and Children’s Resource Board of St.
Aging). Enact Charles County – Bruce Sowatsky – 636-939-6200
24-hour phone (bsowatsky@sbcglobal.net)
bank. See list of long-term care centers
See list of faith-based organizations
United Way (211) – Regina Greer
(regina.greer@stl.unitedway.org) - 314.242.1880
Developmental Disabilities Resource Board – Peg Capo
(pcapo@ddrb.org) – 636-939-3351x3101
Senior Services Task Force – Kyle Gaines (SCCAD) –
636-344-7600 (kgaines@sccad.com)
Community Living Inc – Barb Griffith
(bgriffith@cliservices.org) – 636-970-2800
Saint Louis Crisis Nursery – Mary Pat Smith
(marypat@crisisnurserykids.org) – 314-229-0708
City of St. Peters NIXLE Alert System – Tim Hickey – St.
Peters Emergency Management (636) 278-5276
O’Fallon Transportation Network (Zip Care) – (314-292-
7302, ext. 380)
MO Rides (Deana Dothage – ddothage@boonslick.org)
– (636-456-3473)

Tourists/Travelers/Homeless Varies by Disperse Spread See Media List – media and Chamber of Commerce
season information to messaging County Highway Signage – 636-949-7305
Homeless individuals staying through area Community Council of St. Charles County – Mary
population at in the county Chambers to Hutchison (mhutchison@communitycouncilstc.org) -
a given time is and/or driving reach hoteliers. 636.978.2277
less than 1% of through Utilize highway See list of faith-based organizations
total signage. Media United Way (211) – Regina Greer
population – cooperation. (regina.greer@stl.unitedway.org) - 314.242.1880
estimated Assistance from St. Joachim and Ann Care Service – Miriam Mahan –
around 1,500 community (mmahan@jacares.org) 636.441.1302
individuals. partners to Youth in Need – Beth Butcher
reach (bbutcher@youthinneed.org) 636-757-9334
homeless. Work City of St. Peters NIXLE Alert System – Tim Hickey – St.
with Fragile Peters Emergency Management (636) 278-5276
Families
coalition within
Community
Council.

102
Other Response Agency Disperse CERT team St. Charles County COAD – Shelia Harris Wheeler, Chair
Contacts information to leaders, MRC, (314-397-0772, cell) (scccoad@gmail.com)
county Citizens’ Corps See list of regional CERT directors
leaders/call for Council, etc. St. Charles County Citizen’s Corps Council – Dana
volunteers Send info by Puckett (636-288-5420) (danaepuckett@gmail.com)
email/phone or St. Charles County Medical Reserve Corps – Nick
other means as Kohlberg(health department)
necessary.
Have them
distribute to
further parties.

*2006-2010 American Community Survey 5-year Estimates

Updated 6/1/15

103
Attachment 15: Call Log

__ Completed
REQUEST FOR ASSISTANCE
__ Incomplete

 Incomplete
Date: _________________ Time:___________________ Tracking #:______________________

Person Taking Call: _____________________________ Title: ____________________________

Person with Request: ____________________________ Agency: _________________________

How to Contact Person: ___________________________________________________________

Description of Situation Requiring Assistance:

______________________________________________________________________________

______________________________________________________________________________

Location where assistance needed: __________________________________________________

Directions to site: ________________________________________________________________

Agency to Contact: ______________________________________________________________

How to Contact Agency: __________________________________________________________

Number of persons needing assistance: _____________________________________________

What resources are available:

___________________________________________________________________________________________
104
___________________________________________________________________________________________

___________________________________________________________________________________________

_______________________________________________________________

Information given: ______________________________________________________________

Time and date request passed on: _________________________________________________

Who received request: ___________________________________________________________

Response if known: _____________________________________________________________

105
 Attachment 16:

Important Information for Persons Taking

Ciprofloxacin
as Preventive Treatment for Anthrax
Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. You have been given this drug for protection
against possible exposure to anthrax.
If you have been given ciprofloxacin as preventive treatment for anthrax and you are also currently taking
one or more of the following medicines, it is very important that you take the appropriate actions described
in this table.

Your Current Medicine Actions to Take

If you taking another quinolone antibiotic such as: Stop taking your current drug. Contact your physician or
acrosoxacin or rosoxacin (Eradacil) cinoxacin (Cinobac) other healthcare provider for further instructions.
ciprofloxacin (Cipro, Ciloxan) gatafloxacin (Tequin)
While you are doing this, continue to take the ciprofloxacin
levofloxacin (Levaquin, Quixin) grepafloxacin (Raxar)
you have been given today exactly as prescribed unless
moxifloxacin (Avelox, ABC Pak) lomefloxacin (Maxaquin)
norfloxacin (Chibroxin, Noroxin) nadifloxacin (Acuatim) your physician or other healthcare provider tells you
ofloxacin (Floxin, Ocuflox) nalidixic acid (NegGram) differently.
oxolinic acid pefloxacin (Peflacine)
sparfloxacin (Zagam, Respipac) rufloxacin
trovafloxacin or alatrofloxacin (Trovan) temafloxacin
• tizanidine (Zanaflex) Stop taking the tizanidine (Zanaflex). Contact your
physician or other healthcare provider for further
instructions.
While you are doing this, continue to take the ciprofloxacin
exactly as prescribed unless your healthcare provider tells
you differently.
• theophylline (Theo-Dur, Slo-BID, Slo-Phyllin, Uniphyl) Temporarily decrease the dose of your current drug by 50%
• aminophylline (that is, take half as much of the drug as you have been
• oxtriphylline (Choledyl SA) taking). Contact your physician or other healthcare provider for
further instructions.
While doing this, continue to take the ciprofloxacin exactly as
prescribed unless your physician or other medical provider
tells you differently.
• probenecid (Benemid) Temporarily stop taking the probenecid (Benemid).
Contact your physician or other healthcare provider for
further instructions.
While you are doing this, continue to take the ciprofloxacin
exactly as prescribed unless your healthcare provider tells
you differently.
• warfarin (Coumadin) Begin taking the ciprofloxacin exactly as prescribed. May
enhance anticoagulant effects of warfarin. Contact your
physician or other healthcare provider for possible further
instructions regarding the warfarin (Coumadin).

If you are taking insulin or any other medicine for diabetes, be sure to carefully monitor your blood
sugar.
You have been provided a limited supply of medicine. Public health officials will inform you if you need more
medicine after you finish this supply. You may also, in the future, be switched from this medicine to a different
medicine based on new information about the anthrax organism to which you potentially have been exposed. Since
anthrax can develop quickly and be life threatening, it is very important that you take this medicine exactly as
prescribed.
106
STORAGE: Keep this medicine out of the reach of children. Store away from heat and direct light. Keep this
medicine from freezing. Ciprofloxacin oral suspension may be refrigerated (but keep it from freezing). Do not store
this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause this
medicine to not work.

DOSING INSTRUCTIONS:
• Adults: Take 1 tablet every 12 hours (once in the morning and once in the evening) unless otherwise directed.
• Children: A child’s dose depends on body weight. You will be provided special dosing instructions for
children.
• Keep taking your medicine, unless public health officials or your healthcare provider tells you to stop. If you
stop taking this medicine too soon, you may become ill.
• Take this medicine 2 hours before or after a meal with a full glass of water. Drink several glasses of water each
day while you are taking this medicine. If an upset stomach occurs, Cipro may be taken with food.
• If you miss a dose, take the missed dose as soon as possible. If it is almost time for your next regular dose, wait
until then to take your medicine, and skip the missed dose. Do not take two doses at the same time.
• This medication has been prescribed to decrease your chances of getting anthrax. Do not use it later for another
purpose or give it to someone else.

WARNINGS:
• Do not take this medicine if you have had an allergic reaction to ciprofloxacin or any of the other quinolone
medicines listed in the table on the first page.
• Health officials are currently obtaining information about which drugs will be most effective against the strain of
anthrax to which you may have been exposed. Until this information becomes available, medical experts from the
Centers for Disease Control and Prevention (CDC) recommend children, and pregnant and breast-feeding women, who
have potentially been exposed to anthrax organisms receive ciprofloxacin to prevent the life-threatening complications
of this disease. If you are currently breast-feeding and have concerns about exposing your baby to ciprofloxacin, you
may consider discarding the breast milk until you have finished the medication. If you have questions, contact your
healthcare provider.
• If this drug makes you dizzy, use caution driving doing tasks that require you to be alert. Alcohol makes the dizziness
worse.
• This medicine increases the chance of sunburn; avoid prolonged exposure to sunlight or tanning equipment. If
you have to be in the sun, make sure to use sunscreen (SPF 15 or greater) to protect your skin.

ADVERSE REACTIONS: Stop taking ciprofloxacin and call your healthcare provider or seek medical attention right
away by visiting an emergency room if you are having any of these side effects: rash or hives; swelling of face, throat, or
lips; shortness of breath or trouble breathing; seizures; or severe diarrhea. In addition, if you develop feelings of tingling,
numbness, weakness, or pain, or changes in sensation, stop taking the ciprofloxacin and immediately contact your
healthcare provider.

SIDE EFFECTS: Rare side effects may occur that usually do not need medical attention, and may go away as your
body adjusts to the medicine. These include nausea, mild diarrhea, stomach pain, dizziness, and headache. If you
experience diarrhea, add yogurt or lactobacillus to your diet. A re-hydration solution such as Pedialyte is helpful if you
have severe diarrhea.

FOOD INTERACTIONS: Avoid drinking more than one or two caffeinated beverages (coffee, tea, soft drinks) per day.
Avoid taking this medicine within 3 hours of dairy products containing large amounts of calcium such as milk, yogurt, or
cheese.

107
DRUG INTERACTIONS: Take the following drugs 2 hours after or 6 hours before ciprofloxacin: Antacids
(such as Maalox® or Mylanta®), Calcium supplements (such as Oscal®), Didanosine (such as Videx®), Iron
supplements (such as Vitron-C® or Feosol®), Sucralfate (such as Carafate®), Vitamins with mineral supplements
(such as Centrum® or Theragran-M®), or Zinc supplements.
Consult a health care professional within 3-5 days after starting ciprofloxacin for monitoring and possible dosage
change if you are taking one of the following medications: Cyclosporine (Neoral®), Foscarnet (Foscavir®),
Fosphenytoin (Cerebyx®), Mexiletine (Mexitil®), or Phenytoin (Dilantin®).
If you experience more side effects from the following medications when taken with ciprofloxacin, consult your healthcare
provider. Caffeine (Vivarin®), Clozapine (Clozaril®), Diazepam (Valium®), Glyburide (Diabeta®) Methadone (Dolophine®,
Metoprolol (Lopressor®), Propranolol (Inderal®), Olanzapine (Zyprexa®), or Ropinirole (Requip®).
Oral corticosteroids such as cortisone, hydrocortisone, prednisolone, prednisone, methylprednisolone,
triamcinolone, dexamethasone, betamethasone may increase your risk for tendon rupture. Use precaution when
exercising and report any tendon pain or inflammation to your healthcare provider.

HERBAL INTERACTIONS: Do not take fennel or dandelion within 2 hours of taking ciprofloxacin. You
may take them 2 hours after or 6 hours before ciprofloxacin.

Missouri Department of Health and Senior Services Hotline: 800-392-0272

108
Attachment 17:

Important Information for Persons Taking

Doxycycline
as Preventive Treatment for Anthrax
This drug belongs to a class of drugs called tetracycline antibiotics. You have been given this drug for
protection against possible exposure to anthrax.
If you have been given doxycycline as preventive treatment for anthrax and you are also currently taking
one or more of the following medicines, it is very important that you take the actions described in this
table.

Your Current Medicine Actions to Take

If you taking another tetracycline antibiotic Stop taking your current drug. Contact your physician or
such as: other healthcare provider for further instructions.
• demeclocycline (Declomycin)
• doxycycline (Adoxa, Bio-Tab, Doryx, While you are doing this, continue to take the doxycycline
Doxy, Monodox, Periostat, Vibra- you have been given today exactly as prescribed unless
Tabs, Vibramycin) your physician or other healthcare provider tells you
• minocycline (Arestin, Dynacin, differently.
Minocin, Vectrin)
• oxytetracycline (Terak, Terra-Cortril,
Terramycin, Urobiotic-250)
• tetracycline (Achromycin V,
Sumycin, Topicycline, Helidac)

• warfarin (Coumadin) Begin taking the doxycycline exactly as prescribed. May

• birth control pills (oral contraceptives)
enhance anticoagulant effects of warfarin. Contact your
physician or other healthcare provider for possible further
instructions regarding the warfarin (Coumadin).
Birth control pills (oral contraceptives) containing estrogen
may not work properly if you take them while you are
taking doxycycline. Unplanned pregnancies may occur.
You should use a different or additional means of birth
control while you are taking doxycycline.
Continue to take the doxycycline exactly as prescribed
unless your physician or other healthcare provider tells
you differently.

You have been provided a limited supply of medicine. Public health officials will inform you if you need more
medicine after you finish this supply. You may also, in the future, be switched from this medicine to a different
medicine based on new information about the anthrax organism to which you potentially have been exposed. Since
anthrax can develop quickly and be life threatening, it is very important that you take this medicine exactly as
prescribed.

109
DOSING INSTRUCTIONS:
o Take 1 tablet every 12 hours (once in the morning and once in the evening) unless otherwise directed.
• Keep taking your medicine, even if you feel okay, unless public health officials or your healthcare provider
tells you to stop. If you stop taking this medicine too soon, you may become ill.
• You may take your medicine with or without food or milk, but food or milk may help you avoid stomach upset.
• If you miss a dose, take the missed dose as soon as possible. If it is almost time for your next regular dose, wait
until then to take your medicine, and skip the missed dose. Do not take two doses at the same time.
• This medication has been prescribed to decrease your chances of getting anthrax. Do not use it later for another
purpose or give it to someone else.

WARNINGS:
• Do not take this medicine if you have had an allergic reaction to any of the tetracycline antibiotics listed in the
table on the first page.
• This medicine increases the chance of sunburn; avoid prolonged exposure to sunlight or tanning equipment. If
you have to be in the sun, make sure to use sunscreen (SPF 15 or greater) to protect your skin.
• Women may have vaginal yeast infections from taking this medicine. An over-the-counter vaginal, antifungal
product will help this problem.

ADVERSE REACTIONS: Stop taking doxycycline and call your doctor or seek medical attention right away by
visiting an emergency room if you are having any of these side effects: skin rash, hives, or itching; wheezing or
trouble breathing; swelling of the face, lips, or throat.

SIDE EFFECTS: Rare side effects may occur that usually do not need medical attention. These side effects may
go away as your body adjusts to the medicine. These side effects include diarrhea, upset stomach, nausea, sore
mouth or throat, sensitivity to sunlight, or itching of the mouth or vagina lasting more than 2 days. If you
experience diarrhea, consider adding yogurt or lactobacillus to your diet. A re-hydration solution such as Pedialyte
is helpful if you have severe diarrhea. Talk with your healthcare provider if any of these side effects become
bothersome.

DRUG INTERACTIONS:
This section provides information in addition to that contained on page 1. Be sure to also read the instructions on page 1.
The following medications and over-the-counter products should be taken 3 hours before or 2 hours after taking
doxycycline:
Antacids (such as Maalox® or Mylanta®) Iron supplements (such as Vitron-C® or Feosol®)
Bismuth subsalicylate (such as Pepto-Bismol®) Potassium Citrate (such as Urocit-K®)
Calcium supplements (such as Oscal®) Magnesium-containing products (such as Mag-Ox® or
Choline and magnesium salicyclates combination (such Milk of Magnesia)
as Trilisate®) Sodium bicarbonate (such as baking soda)
Cholestyramine (such as Questran®) Vitamin preparations that contain minerals (such as
Colestipol (such as Colestid®) Centrum® or Theragran-M®)
Doxycycline may affect the following medications. Consult your healthcare provider within 3-5 days if you are
currently taking any of the following medications:
Digoxin (Lanoxin®) Isotretinoin (Accutane®) Methotrexate
Dicumarol Methoxyflurane (Penthrane®) Theophylline (Theo-Dur®)
Insulin (Humulin®, Novolin®)
Oral contraceptives (birth control pills) containing estrogen may not work properly if you take them while you are
taking this medicine. Unplanned pregnancies may occur. You should use a different or additional means of birth
control while you are taking this medication. If you have questions about this, consult your healthcare provider or
pharmacist.

110
The following medications may decrease the amount of doxycycline in your body. Consult your healthcare provider
about whether you need to receive a higher dose of doxycycline:
Carbamazepine (Tegretol®) Phenobarbital Rifabutin (Mycobutin®)
Fosphenytoin (Cerebyx®) Phenytoin (Dilantin®) Rifampin (Rifadin®)

HERBAL INTERACTIONS: The herbal supplements, St John’s wort and Dong quai, should be avoided
when taking doxycycline.

STORAGE:
• Keep this medicine out of the reach of children.
• Store away from heat and direct light.
• Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places.
• Heat or moisture may cause this medicine to not work.
• Keep this medicine from freezing.
Missouri Department of Health and Senior Services Hotline: 800-392-0272

111
Attachment 18:

PHONE SCRIPT TEMPLATE:

Thank you for calling the __(RESPONDING ORGANIZATION NAME)___. Please be aware that
__ENTITY__ has declared a potential danger to our community. Law enforcement, other first responders
and area health agencies are enacting a plan to respond to this incident and to protect the well-being of
those in our region. One part of this response is to provide enough medication to provide preventative
medication to all who may be exposed to this incident at no charge to individuals.

How may I assist you?

SICK WITH SYMPTOMS

If you were recently (TIMEFRAME) near __LOCATION__ and are experiencing the following
symptoms __CONSULT http://emergency.cdc.gov/agent/agentlist.asp FOR SYMPTOMS_, please visit
your medical provider or the nearest hospital. If you are not experiencing any of these symptoms, please
obtain the free medication provided through our clinics to prevent further exposure.

OBTAINING MEDICATION
Due to this incident, the __RESPONDING ORGANIZATION_ will offer preventative medication that is
available to __DEFINE WHO MAY RECEIVE THIS MEDICATION_. Please recognize that there is
enough medication for all who may be exposed to this incident and that the medication is available at no
charge. __EXPLAIN WHY IT IS IMPORTANT TO TAKE THE FULL COURSE AND TO ASK
QUESTIONS ABOUT THE DOSAGE WHEN PICKING UP THE MEDICATION_.

In order to efficiently enact the response plan, members of our community are asked to transport
themselves to the medication distribution site as smoothly as possible. Please be advised that there may be
a wait, as these medications are being distributed to all individuals exposed to this event.

To increase efficiency, one household representative will be allowed to obtain medication for up to
__DEFINE AMOUNT OF MEDICATION A PERSON CAN PICK UP__. Please understand that various
household members may not receive the same medication but that all must take the assigned doses in full
to reduce risks for becoming ill. In some cases, certain members may be required to take additional doses
of this or other medication as a precaution. Please call us at __NUMBER__ before __DATE__ or review
__THIS WEBSITE_ to learn of future treatment needs.

Please bring to the Clinic:

• Picture identification, including information on name, age and weight for the individual picking up
the medication
• A list of medications currently being taken and any known allergies
• If you need to treat your family, you may designate a ‘head of household’ to pick up medications
for you and your family. Please bring ID’s of all household members, including names, ages &
weights. Please include a list of any medications being taken or any known allergies for each of
these individuals.

If you have the capabilities, please complete our short medication form online, print it and bring it with
you to the nearest clinic.

112
Clinics will be located at _ASK WHERE THE CALLER LIVES AND DIRECT TO CLOSEST OR
MOST CONVENIENT LOCATION_ and will be open from _HOURS___.

MEDICATION QUESTIONS
The medication distributed as a result of this incident is designed to reduce the risks of individuals
becoming ill. This preventative medication is available to all individuals at no costs, and there is plenty of
medication available for all who may be exposed.

To protect yourself and your family, it is necessary for you to take all doses of this medication exactly as
described. However, if you notice any counter-affects to these medications __DESCRIBE POSSIBLE
SYMPTOMS_, please consult with your medical provider or __OTHER ACTIONS SUGGESTED__.
For information on these medications, please review the material given to you at the time of dispensing or
visit __WEBSITE__.

AT-RISK POPULATIONS
In order to efficiently enact the response plan, members of our community are asked to transport
themselves to the medication distribution site as smoothly as possible. Please be advised that there may be
a wait, as these medications are being distributed to all individuals exposed to this event.

If you and/or family members are unable to visit one of these distribution sites, please __OUTLINE
PROCESS AND INCLUDE ALL NECESSARY INFORMATION__.

CONSULT AT-RISK ASSESSMENT TABLE FOR AGENCIES THAT MAY PROVIDE FURTHER
ASSISTANCE

WORRIED WELL
Due to this incident, the __RESPONDING ORGANIZATION_ will offer preventative medication that is
available to __DEFINE WHO MAY RECEIVE THIS MEDICATION_. Please recognize that there is
enough medication for all who may be exposed to this incident and that the medication is available at no
charge. By taking this medication you will reduce your risk for further illness, __EXPLAIN WHY IT IS
IMPORTANT TO TAKE THE FULL COURSE AND TO ASK QUESTIONS ABOUT THE DOSAGE
WHEN PICKING UP THE MEDICATION_.

The __RESPONDING ORGANIZATION_ recognizes the importance of this event. We are working with
various organizations to identify the cause of this event and to limit future exposure. _EXPLANATION
OF THIS ISSUE, WHAT IS BEING DONE AND DESCRIPTION OF TRANSMISSION/SYMPTOMS.

IF NECESSARY, SEEK FURTHER ASSISTANCE FROM SPIRITUAL/CRISIS MENTAL HEALTH

RESPONDERS.

VOLUNTEERING
A large number of individuals and organizations are preparing for this distribution of medication, but
additional volunteer support is appreciated. Staff from __RESPONDING AGENCY__ will assist and
train interested volunteers in various roles but would especially appreciate assistance from those with a
medical background. If you are interested in volunteering __WHAT IS THE PROCESS AND WHERE
SHOULD THE INDIVIDUAL GO/CALL TO VOLUNTEER__.

113
Thank you for calling. If you have no further questions, please follow local media or visit __WEBSITE__
for more information on the actions associated with this response.

114
 ANNEX D

SURVEILLANCE

Attachment 1: ESSENCE Procedures

Attachment 2: Influenza Reporting Form
Attachment 3: Distribution List for Surveillance Reports

PURPOSE
The St. Charles County DPH will maintain and enhance a syndromic, passive, and active surveillance
system for situational awareness and/or early detection of possible biological, chemical and radiological
events and the consistent reporting of all incidents.

EMERGENCY RESPONSIBILITIES
1. Hospital Surveillance
a. The Epidemiologist will view and analyze syndromic surveillance data for St. Charles
County residents and hospitals using ESSENCE. Hospitals submit real-time reports to
Missouri ESSENCE, and these reports contain chief complaint data from emergency rooms
that is analyzed to detect unexpected elevations.

b. An elevation or concern will be investigated, but it will be up to the Epidemiologist with

support from CD staff and/or the State of Missouri Senior Epidemiological Specialist or
Medical Epidemiologist to determine what needs to be investigated and the level of
investigation.

c. Elevations can be detected at the local or the State level. If it is detected at the State level,
they will call or email the findings to DPH to be investigated. In some instances collaboration
with State and other LPHA’s may be needed.

d. The DPH will be responsible for contacting the hospitals within its jurisdiction:
• SSM St. Joseph Health Center
• SSM St. Joseph Hospital – Lake St. Louis
• SSM St. Joseph Hospital – Wentzville
• Progress West
• Barnes-Jewish Hospital St. Peters

e. Communicable Disease nurses also have access to Missouri ESSENCE. The

Epidemiologist will also conduct routine monitoring of syndromic data from surrounding
counties and the State of Missouri. Missouri ESSENCE can be accessed on the web at
https://moessence.dhss.mo.gov/.

2. Over the Counter Sales

a. The Epidemiologist will view and analyze over-the-counter sales from the National Retail
Data Monitor (NRDM) using ESSENCE. The NRDM uses information from products sold
from numerous national chains including pharmacies. Missouri ESSENCE can be accessed
on the web at https://moessence.dhss.mo.gov/.

3. Mortality Surveillance
a. The Epidemiologist does not have direct access to vital records to conduct active
surveillance regarding mortality. The DPH will rely on guidance and alerts from the State
regarding unusually high levels of deaths that could indicate the presence of a public health
threat.

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4. Influenza Surveillance
a. The Epidemiologist will conduct influenza surveillance. Influenza is a reportable condition in
Missouri.

b. Every year in September, a flu reporting log is sent to hospitals, physicians, and urgent care
centers in St. Charles County by mass fax. In the case of a pandemic where influenza may
not follow typical flu seasons, a reporting log will be faxed as necessary.

c. Once reports are completed and returned, information on affected residents in St. Charles
County is entered into the DPH’s Influenza Database.

d. Information on residents from other jurisdictions is faxed to the Eastern District office to be
disseminated. During flu season, a weekly influenza report is created and sent to interested
parties within DPH.

5. STD Surveillance
a. The Epidemiologist will conduct STD surveillance. STD data is stored in WebServ, the
State’s data warehouse for reportable conditions.

b. Monthly DPH STD reports are generated from these data and disseminated to necessary
DPH staff, hospital Infection Control Staff, and the State Senior Epidemiologist.

6. Communicable Disease Surveillance

a. The Epidemiologist will conduct CD surveillance for reportable conditions (passive
surveillance).

b. Monthly DPH CD reports are generated from data on the WebSurv database and
disseminated via a distribution list that includes hospitals, first responders, regional LPHAs,
and other community stakeholders. Reports compare year-to-date CD cases from the
current year and the previous 5 years. They also compare the current month’s cases to
those of the previous 3 months.

7. Unusual Activity
a. The DPH will make immediate notification of unusual activity to the Senior Epidemiologist
and/or the Medical Epidemiologist at Eastern District. Eastern district will report all
information to the DHSS’s Division of Community and Public Health (DCPH)

b. If The Senior Epidemiologist and the Medical Epidemiologist at Eastern district are not
available, notify the DHSS’s Department Situation Room (DSR) at 800-392-0272.

c. Cindy Butler is the Senior Epidemiological Specialist and can be reached at:
• 314-877-2857 (Office)
• 314-795-3371 (Cell)
• 618-345-5601 (Home)

d. Dr. George Turabelidze is the Medical Epidemiologist and can be reached at:
• 314-877-2826 (Office)
• 314-952-6832 (Cell)
• 314-863-0428 (Home)

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ORGANIZATION
1. Surveillance
a. At the local level, the Epidemiologist will collect, maintain, and analyze surveillance data. If
the Epidemiologist is unavailable, CD nurses will conduct surveillance.

b. At the state level, the Public Health Event, Detection, and Assessment (PHEDA) program
also monitors CD and hospital surveillance data using Missouri ESSENCE and
disseminates to regional Senior Epidemiologists and LPHAs.

c. The Senior Epidemiology Specialist or Medical Epidemiologist at Eastern District shall notify
the Director of DCPH and the appropriate sections within DCPH if an aberration is detected
and verify that the necessary follow-up occurred.

2. Investigation (see Annex E)

a. At the local level, the appropriate staff within DPH will perform field investigations.

3. Epidemiology
a. At the local level, the Epidemiologist is the main person responsible for the analysis of the
syndromic surveillance data.

b. The Senior Epidemiology Specialist or Medical Epidemiologist at Eastern District shall

provide assistance in the statistical analysis of all syndromic surveillance data.

4. Technical Support
a. For technical support on the local level, please refer to Annex B annex of this plan.

5. Emergency Response
a. At the local level, the Director of DPH will be responsible for setting policy, directing, and
managing the emergency response. If the Director is unavailable, the Health Services
Division Director, will manage the emergency response.

b. At the state level, the Director of MO DHSS shall set policy, direct, and manage emergency
response with support of divisions, centers and offices within the department.

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Attachment 1: ESSENCE Procedures

Missouri Electronic Surveillance System for Early Notification of Community-based Epidemics

(ESSENCE)
Introduction
Welcome to the Missouri ESSENCE Project. The Missouri Department of Health and Senior Services
(DHSS) hopes that ESSENCE will be useful to your organization for a variety of applications. This
document is intended as a self-study guide to help you navigate through some basic functions in
ESSENCE. We encourage you to explore the system to determine the ways in which it can help you in
your job duties. Please contact the Missouri ESSENCE Project staff (ESSENCE@dhss.mo.gov) with
specific or general questions concerning the applications and capabilities of ESSENCE.
Our mission is to help state and local partners respond to adverse public health events by
providing information and tools for early event detection and situational awareness.
It should be noted that access to some features displayed in this training guide might not be available to
all individuals. For example, hospital personnel may only view data for their hospital or hospital group.
Hospitals may not “drill down” further in some data views if another facility’s data are identifiable in that
same view.

Overview
ESSENCE software takes electronic emergency department (ED) data and groups chief complaints into
syndrome categories. This information is used to determine if the number of visits is greater than
expected for that facility, county, or other geographic area based on statistical analyses. The syndrome
groups used are: Botulism-like, Fever, Gastrointestinal, Hemorrhagic, Neurological, Rash, Respiratory,
and Shock/Coma.
Some hospitals send data in near real-time while others send batches daily. Every weekday, the DHSS
Information Technology Services Division (ITSD) loads hospital records into ESSENCE, which analyzes
and displays the findings for use at the state, local, and hospital level. For this reason, today’s data are
not available in ESSENCE. The previous day’s data are available in the afternoon of the current day,
after the processing and loading are complete. The Public Health Event Detection and Assessment
(PHEDA) program, which is responsible for overseeing Missouri ESSENCE, will send out e-mail to the
user list if a significant delay is expected or if another technical issue affecting ESSENCE availability has
occurred. For this reason, it is important to keep contact information current with the PHEDA staff.
It is important to note that the data sent in near real-time form from hospitals are loaded automatically on
weekends and holidays on about the same schedule as noted above.

Applications
In general, ESSENCE is used for early event detection through the use of the Alert List feature.
ESSENCE displays the number of ED visits in each syndrome category that occurred in a given day in
either the hospital/syndrome or patient/syndrome view (detailed below). The system will “flag” a
syndrome group whose number of visits was significantly higher than the expected number based on
short-term and long-term data trends as well as day of week and holidays. The overall goal is to detect
anomalies as early as possible to identify and contain health events such as naturally occurring
outbreaks or acts of bioterrorism.
ESSENCE can be used for situational awareness to augment existing information during an ongoing
public health event. In general, the Query feature is used to track impact in terms of time, geography,
and demography.

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However, it should be noted that each ESSENCE feature is useful for a variety of applications. For
example, during cold weather, epidemiologists can conduct routine surveillance using the ESSENCE
Query feature to identify cases of hypothermia or carbon monoxide poisoning. If a rumored or known
foodborne illness outbreak has been linked to a particular county, the Alert List feature can be used to
see if a greater than expected number of cases among that counties residents have occurred at
ESSENCE hospitals.

Limitations
Users must understand the limitations of ESSENCE and its data sources to assure appropriate
interpretation, decision-making, and communication with colleagues and the general public. The Missouri
ESSENCE coverage map shows the locations of participating hospitals along with their reporting status.
The ESSENCE Reporting Rule determines which hospitals are required to send their data to DHSS for
syndromic surveillance; some rural hospitals are exempt from the Reporting Rule. Therefore, cases
related to a particular chief complaint may not be found among residents of a particular county or zip
code in ESSENCE, but this does not mean that no cases occurred in that area. Similarly, when utilizing
the Query feature to search by keyword, misspellings and variant terminology may prevent the user from
finding all of the cases related to that chief complaint included in ESSENCE.
ESSENCE data are a snapshot of the main complaints listed by the patient upon admission to the
emergency department. ESSENCE is capable of reporting discharge diagnosis for patients; however,
this information is usually not available at the time of the data transfer to DHSS, especially within the
eight syndrome groups. Outcomes like hospital or intensive care unit admission, death, or transfer to
another facility are not available in the dataset.

Getting Started
The secure website is hosted by Johns Hopkins University and can be accessed at the following site:
https://moessence.dhss.mo.gov/missouri
Logging on:
- A security certificate dialog box may appear – click yes
- You will likely see a Security Alert dialog box – click yes.
- The Enter Network Password dialog box should appear – enter your user name and password as
granted by ITSD (for instructions on obtaining this access, visit our website at
http://www.dhss.mo.gov/ESSENCE).
- The ESSENCE homepage will appear. All of the major functions of the software are accessible
using the main toolbar. We will describe each of the application tabs (e.g., Alert List, Event List,
etc.) in various depths depending upon the foreseen usefulness to the user.
- Prior to examining specific data outputs, we also suggest looking at the items on the very top of
the tool bar which describes: 1) history and background of ESSENCE and its relationship to
syndromic surveillance, 2) syndrome and subsyndrome definitions, 3) statistical methodology, 4)
the data dictionary, a glossary of common ESSENCE terms and 5) the Help section, which
contains an FAQ, additional background information, and useful links.
- The Enter Network Password dialog box should appear – enter your user name and password as
granted by ITSD (for instructions on obtaining this access, visit our website at
http://www.dhss.mo.gov/ESSENCE).
- The ESSENCE homepage will appear. All of the major functions of the software are accessible
using the main toolbar. We will describe each of the application tabs (e.g., Alert List, Event List,
etc.) in various depths depending upon the foreseen usefulness to the user.

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Prior to examining specific data outputs, we also suggest looking at the items on the very top of the tool
bar which describes: 1) history and background of ESSENCE and its relationship to syndromic
surveillance, 2) syndrome and subsyndrome definitions, 3) statistical methodology, 4) the data dictionary,
a glossary of common ESSENCE terms and 5) the Help section, which contains an FAQ, additional
background information, and useful links. The second row shows that the alert list was completely
finished updating at 2:34 pm. The third line shows that cluster detection was complete at 2:48 pm; cluster
detection is used in for Spatial Alerts and in a mapping feature. Data may be displayed in the system
before these dates and times, but they are not considered final until the system information table states it
has been updated. In summary, if the current date is the 30th of the month, to see all flagged alerts
from the previous day, the system must analyze all of the data and report the “cluster detection”
as the previous day or in this example, the 29th.
System Information is monitored daily and e-mail alerts will go out if an unusually long delay is expected.
If you observe a problem with this or any other aspect of the Missouri ESSENCE System, please hit the
“Questions or Problems?” button, which will automatically prompt you to send an e-mail to
ESSENCE@dhss.mo.gov.

ALERT LISTS
- Click on the “Alert List” icon. This feature will allow you to choose from four different alert views.
- Click on Summary Alerts: You can now see a graphical summary of syndromic alerts for the state
of Missouri as a whole or by individual reporting regions (in this instance, region = MO
Highway Patrol Region). Each asterisk (*) represents the past nine days for a given syndrome
listed chronologically with the current day being on the far right. Asterisks will appear as grey,
yellow or red (see data dictionary for explanation of the color schemes). The top tier of asterisks
provides a sense of syndromic alert activity over time and by clicking on individual asterisks, you
can further investigate the data used to generate this data point. The second tier of asterisks
shows whether any Event List entries have been posted in that region. The color schemes used
in this tier are described in the Event List section (pages 16 and 17).
- Click on Region / Syndrome: This view allows you to view alerts by county (in this instance,
region = county). You can use the sort function to strategically sort the last seven days of alerts.
To do this, click on the Region icon (this will place a 1 icon by this selection). This is good for
getting a sense of total syndromic activity in a geographic area. To further sort by a syndrome,
click on the syndrome icon (a 2 will be placed by this selection). All alerts in that region for each
syndrome will be listed for the past seven days in this graph (unless start and end dates have
been changed in the options). The region section here has been blocked for confidentiality
reasons.
- Click on Hospital / Syndrome: This view allows you to view the past 7 days of alerts by reporting
hospital. Offering additional focus (vs. Region), this method further individualizes the data. If an
elevated number of cases in a particular syndrome are reported by a hospital, a yellow or red
alert will appear and can be further investigated by selecting the time series icon.

****Using configuration options, the user is able to manipulate the time series used for generating output,
limit the hospital, which is being examined, sex, age etc. Often times syndromes are examined in an
aggregated view for age as when the data are listed in the output, age delineation into subgroups is
easily achieved.
- Click on Spatial: The Spatial Alert List is different from the Temporal Alert Lists in that it not only
looks at a specific stratification over time, but also looks at how certain geographic areas
compare to the rest of the regions. If a cluster of zipcodes act abnormal compared to the
surrounding areas, it will be noted as a red or yellow alert.

The alert list will present information like the number of zip codes in the cluster and the total count of
cases seen that day by the zip codes in the cluster.
Functions within Each View

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After choosing one of the above ESSENCE views, you can “drill down” and display syndromic data in
very helpful ways.

Note: After opening a time series graph for the first time on a given computer, CLICK ON the “enhanced
graph (requires java 1.4.xplug-in)” link in the bottom right corner of the time series graph. This means
that a version of Java greater than 1.4 will be needed
(www.java.com/en/download/windows_ief.jsp?name=F). You will be given the choice to click “always” –
click it. This step will cover all graphics, and you will not need to complete it again.

- Time Series: Clicking on Time Series for an alert displays a graph of the number of cases over
time for the particular view and syndrome you selected. This is a good way to see how an alert
compares to baseline data and previous alerts.

- Data Details: Clicking on the Data Details icon or the data point in a time series graph will display
the individual days details. These data can be sorted using the 3-sort function. Each case record
has fields for date, admit time, zip code, age, chief complaint, medical record number, and patient
ID. All of these data are essential to evaluating alerts.

- Map View: Clicking on Map View for a given set of data details displays a new window with a
map with the color-coded syndrome cases present. You may be prompted to log-in again if it is
the first time during your ESSENCE session you have used Map View; go ahead and sign in
again. This is an easy way to generate a map for the first time using ESSENCE. Using the Map
Portal, discussed later, also provides this function with more powerful capabilities. Labeling and
other functions are user-friendlier in the Map Portal.

- Plain Text: Clicking on Plain Text yields comma delimited data detail – probably not a function
you will use much.

- Microsoft Excel: Clicking on Microsoft Excel will convert the data details chart into an Excel
spreadsheet that can be copied and pasted into an Excel file and saved to the ISDH network
drives as needed. This is helpful when you need to perform a complex sort, or to delete unwanted
data fields.

- Graphs: Each of the different graphs (i.e., time series, age groups, gender, and medical
groupings) can be saved as a .jpg or .png file. These can be helpful for investigation reports, and
communicating ESSENCE data with partners. Again note you will need to load the enhanced
graphics at least once.

Event List
We ask that all Missouri ESSENCE users who find an alert or other information in the system that they
feel warrants further attention complete an Event List entry describing their recommendations or
activities. (See Missouri ESSENCE Policies and Procedures)
Benefits of the Event List
- The best way to organize communications regarding Missouri ESSENCE findings among users

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 - As stated earlier, most flags do not require public health investigation or intervention. However,
the second tier of asterisks on the Summary Alerts page shows those flags that other Missouri
ESSENCE users have determined warrant further attention
- This provides a more accurate view of “actual” health events occurring at the state and regional
level
- Individuals can monitor this to determine if they should be on heightened alert in their jurisdiction
as well
- Provides a forum for discussing potential health events
- Provides the only way DHSS has to track how Missouri ESSENCE is used and can be improved

Creating an Original Event

- First, click on Event List icon in the menu bar. This will take you to the Missouri Event List. Here,
you can view all of the events that other Missouri ESSENCE users have commented on. To
create an original event, click Create New Event.

- Next, fill out all fields on the Create New Event page. In this case, we created an event based on
Emergency Room Data by Patient Location in St. Louis County for the GI syndrome and All Ages.
Under Category, we entered General, although the drop-down box shows other options if those
apply. To determine which Rank to use, refer to the Rank Legend and see which term and
relative rank (i.e., red, orange, etc.) best applies to your situation. Status is open in this example.
The date range here was only a two-day period.

- Description: Input what you observed and/or additional information that caused you to consider
this an “event”.

- Initial Comment: Input the initial recommendation or action you are taking; for example, contacted
X Health Department regarding a cluster at Hospital Y for follow-up.

- Click Create Event Preview and view your entry. To accept your entry, click Create Event.
Important! Once you create an event, it cannot be deleted. You will, however, have an
opportunity to edit the entry.

- Next, you will see Event Added Successfully, and you can click Return to the Event List to assure
the event has been added to the top of the list.

You have three options to add new information to the event. a. First, you can click on Edit to make
changes to a screen identical to the Create New Event screen (above). b. The second option is to click
Event Info. Here, you can add an additional comment by clicking Add Additional Comment. The options
are to add more information in the Comments Window or to add a URL to direct users to information you
feel is important. If you have posted a URL it will show up in the view that pops up when you click Event
Info. c. The third option is to reply with new comment; here you have the opportunity to update the event
ranking.

Responding to an Existing Event

- Click on Event Info next to the Event you would like to comment on.

- Click on Reply with New Comment to post your information, suggestions, or actions taken in response
to the event.

Query Portal
Clicking the Query Portal icon allows you to perform various searches of Missouri data in ESSENCE.
Your search parameters are chosen in a logical order (data source, geography, medical grouping, and
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finally chief complaint, age group, gender, and date range). Real-time data is currently not available
for your use in this or other areas of ESSENCE.

Note: to choose multiple counties or zip codes, hold the control key down and click on choices.

Matrix Portal
- Click on the Matrix Portal icon, this will allow you to create a custom report for ER data by patient
location along with a bar chart or line graph. Below is one example of a line graph, but many
different line graphs and bar charts can be created using this feature.
Note: This feature is currently not available for ER by Hospital Location and is therefore not
available for hospital staff to use.

- To create a line graph that shows all ER visits for Missouri by syndrome and date in a particular
week, first select “Emergency Room Data by Patient Location” in Datasource. Then, use your
mouse to select all syndromes and the control button to de-select “Other”, and then select all age
groups, and all regions. You can de-select “Other Region” to eliminate non-Missouri residents if
you wish. In the columns category, select Syndrome and in the rows category, select Date
Range. Under graph type, select line graph. In the start date and end date section enter the time
period of interest, here it is one full week of data. Click Change Configuration to see the product.

- At the top of the Matrix Portal page, you will see the description of everything included in the data
table below.

- Scroll down to see the Data Matrix and Line Graph. The Data Matrix shows all of the cells in
which a red or yellow alert has occurred for at least one age group. The Matrix Portal Graph is a
line graph that shows the trend in each syndrome during the week among all ages, all counties
for the state of Missouri. By clicking on a cell within the Data Matrix, you can see details on each
syndrome and date. In this example, click on Bot-Like from March 24, 2007. The Missouri Matrix
Link Portal appears and you can select among several options including: Time Series, Data
Details, Map View, and Alert List.

- By selecting the Time Series option, you can see the time series for the last three months of
available data, including the time period selected within the Matrix Portal options. By selecting
Data Details (not shown) you will get pie charts, bar charts, and the chief complaints list for the
last date entered in the Matrix Portal options, similar to any data details page. By selecting the
Map View (not shown) you will get a map for the specified syndrome and time period.

- By selecting the Alert List option, you can view which age groups flagged for Bot-Like Syndrome
on March 24, 2007. The highest alert level for any age group is red, which is why the call for this
syndrome on this date was red in the Data Matrix.

Weekly Percent
Clicking on the Weekly % icon allows you to view the percentage of syndromic cases that fall into the
Influenza-Like Illness category during a given week as a percent of total emergency department visits.
You can choose ILI from the drop-down, then choose Missouri, a single district, or “all”.

Map Portal
Clicking on Map Portal allows you create, in two steps, a statewide map depicting all data or just
alert data for all syndromes or single syndromes. The map can then be manipulated (zoom, zip
codes, etc) as necessary. This is the most powerful tool for creating maps.

The Bookmark Page feature allows the user to save searches and use the same criteria to recover
data on a daily, weekly or as-needed basis without doing the stepwise work. When saving a search,
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name the search and select the Bookmark Page icon. When accessing these criteria at a future
time, use the Bookmarks icon to recall the saved search.

Missouri ESSENCE Alert Investigation Process

Interpretation
As you have seen so far, ESSENCE software identified clusters within various syndromic and age
groups for hospitals or geographic areas and flags them red or yellow. However, the majority of
these flags do not constitute an event of public health importance. For this reason, it is up to
the user to distinguish between statistical anomalies and potential public health threats when
determining whether a follow-up, investigation, or response is warranted. The goal is to respond in a
timely manner to actual health threats and to avoid false alarms. Appendix A provides a flow chart
for the proposed alert investigation process.

View the potential event using all Missouri Alert List features:
1. View the hospital(s) that most or all patients involved in the region/syndrome alert visited to
see if the increase in cases is due to the addition of a new hospital to Missouri ESSENCE
(this occurs often) or a suspected error in the data feed coming from the hospital (rare, but
can occur). Please report any suspected data errors to us: ESSENCE@dhss.mo.gov.
2. Similarly, a significant cluster in a particular county may not show up the cases among the
view available at the Hospital/Syndrome level.
3. Summary alerts including the Event Communication tier of asterisks may show whether your
colleagues have been commenting, following up, or responding to events.
4. Spatial alerts can be viewed to determine whether the system has found spatial patterns
across jurisdictions.

Factors to Consider When Interpreting Flags:

1. Time period: The internal DHSS ESSENCE alert investigation process requires that (in the
absence of other factors or information) a region/syndrome or hospital/syndrome must flag
(red) for two days in a row for the same syndrome and hospital or region/group of regions
plus additional examination (see below) to trigger the Hospital Communications
Procedure. Users at the local and regional level may determine that an alert on one day is
worthy of follow up based on knowledge about what is “normal” for their jurisdiction.
2. Number of cases: In some situations one or two cases will flag, but do not necessarily justify
a public health response.
3. Magnitude: Consider the p-value and/or the difference between observed and expected
values.
4. Demography: Look for a pattern by age, age group, sex, or geographic area.
5. Subsyndromes or chief complaint text: Look for a pattern within the syndrome group (e.g.,
most of the cases involve vomiting) or keywords that suggest an event (e.g., food poisoning).
6. Chief complaints or subsyndromes most typically associated with non-outbreak illness such as
headache, seizure, weakness, and dizziness.
7. Knowledge of what is normal for your community or local information.
8. Increased level of awareness due to national or state events: food recall, nationwide outbreak,
increased terror alert level.

Help with Interpretation:

Please contact the Senior Epidemiologist for your region if you have questions about how to
interpret Missouri ESSENCE findings (Appendix B). If the Senior Epidemiologist or their staff are
not available, please feel free to contact us at ESSENCE@dhss.mo.gov or (573) 751-6161 to
discuss your concerns.

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Attachment 2: Influenza Reporting Log

INFLUENZA REPORTING LOG FOR

ST. CHARLES COUNTY DEPARTMENT OF PUBLIC
HEALTH

Name of Reporting Agency:

_____________________________________________________

Name Zip Age or Date Collected Test Method Result Type

DOB (ex: rapid, culture) (A, B, Unk)

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Attachment 3: Distribution List for Surveillance Reports

*see file maintained by CD Staff*

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 ANNEX E

INVESTIGATION

Attachment 1: Syndromic Surveillance Initiated Sequence

Attachment 2: Standard Operating Procedure for Investigation
Attachment 3: State Public Health Lab Specimen Collection Guidelines

PURPOSE
Investigation of an accidental or deliberate emergency chemical, biological, radiological or nuclear event
includes: identification of cases and the investigation of confirmed, probable, or suspected cases and
contacts; containment of event; and post-event surveillance.

EMERGENCY RESPONSIBILITIES
1. At the local level, the DPH maintains active and passive biological surveillance systems for the
early detection and/or situational awareness of an event.

a. DPH investigates and controls all biological events, staffs the 24-hour Duty Officer phone
line, and provides epidemiological and analytical consultation.

b. In a bioterrorism event, DPH will work with partner organizations (i.e. police, fire, DEM)
within the county to help control a biological event.

2. At the state level, DCPH provides assistance in intervention and control of biological agents,
provides assistance with the investigation of all events, and augments Regional Assessment
Teams as necessary.

a. Regional Assessment Teams-provide immediate local response to emergency situations

and provide feedback to DHSS and the affected LPHAs. The Team will consist of members
from the area Local Public Health Agencies and the state regional offices. Contact
information can be found at:
http://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/pdf/BC
DCP_district_map.pdf.

b. Public Health Event, Detection and Assessment (PHEDA) - (573) 751-6161 maintains
active and passive biological surveillance systems for the early detection of an event and
the consistent reporting of all incidents, and provides epidemiological and analytical
consultation.

c. The Section of Environmental Public Health (SEPH) - (573) 751-6111 provides

environmental, chemical, and radiological technical assistance including the investigation of
suspected events.

d. The State Health Laboratory (SPHL) - (573) 751-3334 provides laboratory services.

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ORGANIZATION
St. Charles County DPH:
1. The Health Services Division Director will oversee the investigation of confirmed, probable, or
suspected cases of a communicable disease and contacts associated with a local public health
emergency. If the Division Director is unavailable, the epidemiologist will oversee the
investigation. If the epidemiologist is unavailable, a CD nurse will lead the investigation.

2. The epidemiologist and the communicable disease nurses will be the main local investigation
team.

3. Remaining staff will take on supporting roles such as interviewing, data entry, or education.

4. A list of Missouri’s Reportable Diseases and Diseases and procedures for investigating these
cases can be found in the Missouri Communicable Disease Investigation Reference Manuel
(CDRIM) at
http://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/ A
hard copy of the CDRIM can also be found with the CD nurses.

5. For alerts identified through syndromic surveillance follow the Syndromic Surveillance Initiated
Sequence.

6. For unknown diseases, follow the Standard Operating Guidelines for Disease Investigation.

7. State Laboratory Guidelines for Specimen Collection can be found on the State Public Health
Laboratory website at http://www.health.mo.gov/lab/courierservices.php.
a. The SPHL has specific specimen collection guidelines for the six Category A bioterrorism
agents (Anthrax, Tularemia, Botulism, Plague, Smallpox and Viral Hemorrhagic Fever)
and two of the Category B agents (Ricin toxin and Brucellosis).

MO DHSS:
1. The chief of DCPH is the individual who will make section staffing decisions and will direct how
resources are utilized to assist the Regional Assessment Teams in their investigations. The chief
of DCPH will consult PHEDA as needed for technical and analytical advice.

2. The Region C Epidemiology staff (Senior Epidemiologist and Medical Epidemiologist) will play a
supportive role for LPHA’s in disease surveillance and will take primary and/or supportive role for
disease analysis, investigations and evaluation. It is the responsibility of the Regional
Epidemiology Staff to send updates directly to the DCPH or to the DCPH through the DSR (if it is
activated).

3. For a complete contact list of investigators in Region C please see the list maintained by the CD
and Emergency Preparedness programs.

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Attachment 1: Syndromic Surveillance Initiated Sequence

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Attachment 2: Standard Operating Procedures for Investigation

1. Obtain notification of suspected case

2. Are there other associated cases?

(Implement survey tool)
Is this case similar to other previously or currently
reported cases?

Yes or Unknown No

Expand investigation and look for Focus investigation around single case
associations between cases

3. Is the agent transmissible from

person to person?

Yes or Unknown No

Investigate area of exposure (if

known) to identify others who may Target area of exposure (if known) to
have been exposed identify others that may have also been
exposed to the agent.
Determine when the case was
infectious

Identify contacts for possible

secondary transmission

If person is currently infectious,

recommend practices to prevent
further transmission

If person is NOT currently infectious,

focus on previous contacts that may
now be within incubation period

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4. Conduct investigation
For all ill cases identified, obtain appropriate information:
• Complete survey tool on all persons at the affected site
• Complete disease specific investigation form for all suspect cases
• Collect clinical specimens
• Conduct environmental assessment and collect specimens
• Select comparison group (well persons) and obtain appropriate information for a risk assessment

5. Formulate a case definition

• Combine clinical characteristics, laboratory test(s) and epidemiological information into criteria for the
categorization of cases:
▪ Ill, but does not meet case definition - watch for development of signs and symptoms of the agent
and, if observed, refer to health care provider for testing and possible treatment
▪ Well, but had appropriate exposure - implement control measures which could include
prophylaxis or quarantine
▪ Well, but did not have appropriate exposure - educate individuals on agent and alert them to visit
their health care provider if they become ill
▪ Confirmed case - Implement control measures that could include testing, treatment/quarantine,
prophylaxis/quarantine of exposed contacts
▪ Suspect case - Implement control measures that could include testing, treatment/quarantine,
prophylaxis/quarantine of exposed contacts
▪ Presumptive case - Implement control measures that could include appropriate testing,
treatment/quarantine, possible prophylaxis/quarantine of exposed contacts

6. Identify cases for analysis

• Prepare a line list of relevant case information that has been gathered
• Categorize the cases according to the definition (see 5 above)
• Select the categories to be analyzed for risk factors and/or associations using EpiInfo or other suitable
statistical computer software such as SPSS

7. Analyze the cases and characterize the cases by time, place, person
• Prepare a frequency distribution of cases by location and by personal characteristics, obtain denominator
data to calculate attack rates and distributions for each-identify associations /risk factors
• Create epidemiology curve (which reflects onset time and incubation period for the agent)

8. Formulate hypothesis of the agent

Interpret available data to determine:
• Identity of most likely agent
• Likely source of agent
• Likely mode or means by which agent was transmitted

9. Select and implement control measures specific for the identified agent

10. Evaluate the control measures for efficacy

Determine if solution specified in control plan is being achieved
• Yes - consider solution achieved if additional cases are prevented
• No - identify problem(s), develop new solution, implement and evaluate

11. Prepare report of investigation

12. Distribute report to all contributors and users

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Attachment 3:

State Public Health Laboratory Specimen Collection Guidelines

Updated versions of collection guidelines can be found at the links below.

Category A Agents

Anthrax - http://www.health.mo.gov/lab/pdf/AnthraxFactSheet.pdf

Plague - http://www.health.mo.gov/lab/pdf/PlagueFactSheet.pdf

Tularemia - http://www.health.mo.gov/lab/pdf/TularemiaFactSheet.pdf

Botulism - http://www.health.mo.gov/lab/pdf/BotulinumFactSheet.pdf

Smallpox - http://www.health.mo.gov/lab/pdf/SmallpoxFactSheet.pdf

Viral Hemorrhagic Fevers - http://www.health.mo.gov/lab/pdf/VHFFactSheet.pdf

Category B Agents

Ricin Toxin - http://www.health.mo.gov/lab/pdf/RicinFactSheet.pdf

Brucellosis - http://www.health.mo.gov/lab/pdf/BrucellosisFactSheet.pdf

Information on courier drop off locations by county can be found at

http://www.health.mo.gov/lab/pdf/courierlocationsbycounty.pdf.

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 ANNEX F

PREVENTION OF SECONDARY TRANSMISSION

Attachment 1: Laundry Guidelines

Attachment 2: Symptom Information for Transmissible Diseases

PURPOSE
To prevent the secondary transmission of communicable diseases as a result of a biological incident.

The two bioterrorism agents for which secondary transmission is a primary concern are smallpox virus
and pneumonic plague. Plague is a zoonotic disease. Therefore, nonhuman sources of this illness must
be considered as a possible primary source of human cases. Furthermore, other types of plague (e.g.
bubonic) may progress to the pneumonic form.

It is essential that existing local surveillance systems be sensitive enough to provide accurate, timely
data concerning possible secondary illness.

EMERGENCY RESPONSIBILITIES
St. Charles County DPH:
1. Maintain a Standard Operating Procedure (SOP) for inoculation of medical and emergency
personnel and volunteers prior to and immediately after a communicable disease outbreak. See
Annex H

2. Maintain protocols for preparedness and prevention of secondary transmission and share with
DPH staff, medical facilities, and healthcare providers.

3. Provide the initial response to a case of secondary transmission of an infectious agent. See
Annex E.

4. If necessary, recommend isolation/quarantine to control the spread of an outbreak.

5. Disseminate information, manage resources (medications/vaccines), and provide technical

assistance. See Annex C, Annex H, Annex I, and Annex J

6. Collect daily reports of infection and secondary transmission rates from hospitals, long term care
facilities, other health care providers, and managers of sites providing mass care within an area
experiencing a communicable disease outbreak.

7. Collect basic patient information (name, age, zip, test date, test result) as necessary from
hospitals to be included in data analysis.

8. Enhance surveillance by increasing the number of participating health care providers, ensuring
that all large providers are participating, and pursuing alternative surveillance channels as
necessary.

9. Provide daily reports, noting significant trends during the course of an outbreak.

10. Assist and augment local resources in activities related to prevention of secondary transmission,
quarantine, vaccine delivery, mass prophylaxis, and surveillance.

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 11. Provide information to the public about the need for and methods of prevention of secondary
disease transmission.

MO DHSS:
1. Establish quarantine areas if required.

2. Assume primary responsibility for coordination of a response to secondary transmission of an

infectious agent when the affected area extends beyond the jurisdiction of one LPHA.

3. Assist and augment local resources in activities related to prevention of secondary transmission,
quarantine, vaccine delivery, mass prophylaxis, and surveillance.

4. The Office of Public Information (OPI) will maintain and present to the public, information about
the need for and methods of prevention of secondary disease transmission.

ORGANIZATION
1. The DPH Director will make decisions regarding staffing and operations, and will provide
quarantine/isolation recommendations to the County Executive.
a. In a smallpox incident, DPH supports the ring vaccination strategy in accordance with CDC
recommendations, as well as the use of epidemiological data to determine initial strategies
and guide future prevention and control measures.

2. The Epidemiologist will provide technical and analytical advice to the DPH Director and Health
Services Division Director.

3. The primary local investigation team will be composed of the Epidemiologist and the two CD
nurses. See Annex E for more information on investigation and quarantine/isolation.
a. Teams will be prepared to implement protocols and perform mass prophylaxis if needed.
See Annex H.

4. The Epidemiologist will submit data, reported by sentinel sites, to the district representative.
When the Epidemiologist is not available, one of the CD nurses will submit the data. See Annex D
for more information.

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 Attachment 1:

Laundry: Washing Infected Material

Although soiled linen may harbor large numbers of pathogenic microorganisms, the risk of actual disease
transmission from soiled linen is negligible. Rather than rigid rules and regulations, common-sense
hygienic practices for processing and storage of linen are recommended.

Soiled linen should be handled as little as possible and with minimum agitation to prevent gross microbial
contamination of the air and of persons handling the linen. All soiled linen should be bagged or placed in
containers at the location where it was used and should not be sorted or rinsed in the location of use.
Linen heavily contaminated with blood or other body fluids should be bagged and transported in a
manner that will prevent leakage. Soiled linen is generally sorted in the laundry before washing. Gloves
and other appropriate protective apparel should be worn by laundry personnel while sorting soiled linen.

Commercial laundry facilities often use water temperatures of at least 160°F and 50-150 ppm of chlorine
bleach to remove significant quantities of microorganisms from grossly contaminated linen. Studies have
shown that a satisfactory reduction of microbial contamination can be achieved at water temperatures
lower than 160°F if laundry chemicals suitable for low-temperature washing are used at proper
concentrations. In the home, normal washing and drying cycles including "hot" or "cold" cycles are
adequate to ensure patient safety. Instructions of the manufacturers of the machine and the detergent or
wash additive should be followed closely.

Commercial dry cleaning of fabrics soiled with blood also render these items free of the risk of pathogen
transmission.

Clean linen should be handled, transported, and stored by methods that will ensure its cleanliness.

Source: CDC (2011) http://www.cdc.gov/HAI/prevent/laundry.html

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 Attachment 2:

Symptom Information for Transmissible Diseases

Disease Symptoms

Initial: sudden onset of high fever (104oF), malaise, headache,

prostration, severe backache, occasional abdominal pain and vomiting
Smallpox 1
After 2-4 days: deep-seated rash progressing from macules to scabs
that fall off after 3-4 weeks

Initial: Nonspecific (fever, headache, chills, malaise, myalgia, sore

throat, nausea, prostration)
Pneumonic Plague 1
- secondary involvement of lungs can lead to pneumonia,
mediastinitis, or pleural effusion

Initial: marked fever, fatigue, dizziness, muscle aches, loss of strength,

and exhaustion
VHFs 2
- Patients with severe cases of VHF often show signs of
bleeding under the skin, in internal organs, or from body
orifices like the mouth, eyes, or ears.

Use the case definition to determine the disease's symptoms.

Other

References

1. APHA (2008). Control of Communicable Diseases Manual. Washington, D.C.: American Public
Health Association.

2. CDC (2013). Viral hemorrhagic fevers. CDC.gov. Centers for Disease Control and Prevention.
Retrieved Dec. 7, 2015, from http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm

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 ANNEX G

ISOLATION AND QUARANTINE

Attachment 1: Protocol for Voluntary Isolation and Quarantine

Attachment 2: Information Packet for Isolation and Quarantine
Attachment 3: Legal Authorities for Isolation and Quarantine

PURPOSE
With the possibility of an influenza pandemic, the warnings about bioterrorism threats, and the existence
of emerging infectious diseases such as MERS-CoV, the DPH recognizes the need for measures to
address the isolation and quarantine (I & Q) of communicable diseases.

During past outbreaks, health officials first offered timely post-exposure prophylaxis (PEP) to susceptible
persons who had close contact with a person infected with a contagious disease, such as measles.
However, when PEP vaccination was refused, quarantine was used to reduce the risk of further
transmission to a vulnerable population.

An essential public health tool, although rarely used in the last half century in the United States,
quarantine is often confused with isolation, which is the restriction of movement of persons who are
known to be infected with a communicable disease and who often are symptomatic. Quarantine reduces
the risk of exposure to disease by separating and restricting the movement of persons who are not yet ill
but who have been exposed to an infectious agent and might become infectious. It is more difficult to
implement than isolation because the persons under quarantine are not symptomatic and thus have
greater difficulty understanding the need for staying at home when compared with ill persons who need
to be isolated.

The purpose of this annex is to provide guidance during a public health emergency and/or biological
incident that may require I & Q measures within our county to protect lives and to further prevent spread
of a life-threatening disease. Specifically, the purpose of the plan is to:
• Establish the decision making criteria used by local health officials to determine when I &Q are
necessary to minimize health impact of a disease outbreak
• Identify authorities, roles, and responsibilities of DPH and partner agencies in the event of
disease outbreak requiring I & Q of one or more individuals
• Describe procedures and decision algorithms for accomplishing I & Q of large numbers of
individuals
• Describe specific procedures for supporting home-based I & Q of large numbers of individuals
• Define role and responsibilities for DPH employees, healthcare partners, and response agencies
during an outbreak requiring I & Q
• Describe how communications and coordination will occur between DPH, regional and state
partners during such an event
• Assist response partners with limiting the spread of infectious diseases, illnesses, and death

LEGAL CONSIDERATIONS
Authority to order I & Q is not inherent in St. Charles County ordinances. The DPH Director only has the
authority to recommend isolation or quarantine of an individual or group.

**Any involuntary isolation or quarantine must come by court order.

DPH has no authority to involuntarily detain individuals.**

EMERGENCY RESPONSIBILITIES
St. Charles County DPH:
1. Act as lead agency in the management of communicable disease outbreak.

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 2. DPH Director, Epidemiologist, and CD team will assess the public health threat, evaluate
potential consequences based on established criteria, and determine whether isolation and/or
quarantine are necessary in any given outbreak situation.

3. DPH Director may recommend the I & Q of individuals as a protective action to limit the spread of
infectious agents or contaminants.

4. When possible, seek the cooperation and compliance of infected or exposed individuals in
abiding by I & Q requests. Under specific circumstances, DPH may immediately seek a court
order to detain infected or exposed individuals and place them in isolation or quarantine.

5. In all cases where I & Q is considered, DPH will address the basic needs of individuals placed in
I& Q including, but not limited to: food, shelter, medical care, communication with family
members, and disease related information.

6. Act as lead clinical and administrative manager of any non-hospital isolation or quarantine
facilities that are established.

County and Municipal Law Enforcement:

1. Assist with service of Notice of Civil Involuntary Detention to clients, if necessary.

2. With assistance from St. Charles County Ambulance District, provide escort for individuals
requiring transportation for purposes of involuntary isolation and quarantine if necessary.

3. Execute arrest warrants related to I & Q cases.

St. Charles County Ambulance District

1. Assist law enforcement with transportation of isolated and/or quarantined individuals.

Prosecuting Attorney’s Office, together with the County Counselor’s Office:

1. Coordinate with DPH and law enforcement to serve Notice of Civil Involuntary Detention.

Community Organizations:
1. American Red Cross and other social services will provide food, shelter, and emergency needs.

2. Provide access to mental health services and other psychological support.

a. Activation of these resources can be coordinated with DEM, or by calling The Crider
Center’s Crisis Response Team at 1-866-384-1254.

b. As our region’s administrative agent for the Missouri Department of Mental Health, Crider
can also assist with coordination of supplemental resources if necessary.

ORGANIZATION
1. DPH will be the lead agency in coordination of the local health and medical response to an
outbreak requiring isolation or quarantine of individuals.
a. DPH may activate the Public Health EOC (HEOC) to coordinate the county-wide public
health and medical response during an outbreak.

b. DPH will work in conjunction with the County’s EOC.

2. Determination of Need for Isolation and Quarantine

a. The CD nurses, Epidemiologist, and Division Director(s) of DPH will recommend the need
for isolation and/or quarantine as strategies to control a disease outbreak.
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 b. The DPH Director will recommend the use of isolation and/or quarantine to the County
Executive.

c. The DPH Director will activate the Public Health IC and will act as or identify the Incident
Commander.

d. DPH will seek voluntary compliance with requests for isolation and quarantine. However, if
deemed necessary, a request for a court order for involuntary detention for the purposes of
isolation and quarantine will be made if the conditions are as follows:
• There is a reason to believe that the individual or group is, or is suspected to be,
infected with, exposed to, or contaminated with a communicable disease or chemical,
biological or radiological agent that could spread to or contaminate others if remedial
action is not taken.

• There is a reason to believe that the individual or group would pose a serious and
imminent risk to the health and safety of other if not isolated or quarantined.

• Seeking voluntary compliance would create a risk of serious harm.

3. Communications
a. DPH will:
• Act as lead agency in St Charles County for public education and messaging. See
ANNEX C.

• Provide necessary information to health care providers.

• Provide necessary information to the general public.

• Identify a call center if necessary.

• Coordinate with the State PIO and regional health departments to develop common
health messages and educational materials.

• Maintain I&Q fact sheets

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Attachment 1:
Protocol for Voluntary Isolation and Quarantine

Epidemiology/CD Investigators will:

1. Initiate contact with the individual or group suspected of being infected or exposed.

2. Determine whether interpretation services are needed to facilitate communication. If so,

coordinate this issue with available service organizations.

3. Document information related to cases and contacts including dates and times of all verbal and
written communications.

4. Verbally communicate the following information to the individual or group:

a. Explain the circumstances regarding the infection or exposure, the nature and
characteristics of the illness, and the potential for infection of others.
(Provide written material when available.)

b. Request that the individual or group isolate or quarantine themselves.

• Explain the process for I&Q
• What is expected of each individual.
• How Public Health will support their needs.
• How long they must remain under isolation or quarantine.

c. If necessary, explain that the DPH Director has authority to petition the court ex parte for an
order authorizing involuntary detention if the individual or group does not comply with the
request for isolation or quarantine.

5. If an individual is a patient in a hospital, make contact with hospital staff as well as the patient to
ensure that appropriate measures for hospital-based isolation and infection control are adhered
to, if indicated.

6. Complete a written request for voluntary compliance with isolation or quarantine instructions,
including:
a. The location and dates of isolation or quarantine
b. Suspected disease
c. Medical basis for isolation or quarantine
d. Relevant patient information.

(Make necessary copies for all agencies who may be assisting)

7. Make reasonable efforts to obtain the cooperation and compliance of the individual or group with
the request for isolation or quarantine. Document efforts on a standardized form and enter into a
database.

8. Alert the DPH Director to situations where a person or group indicates an unwillingness to
comply.

9. Recommend to DPH Director whether involuntary detention should be initiated.

10. Contact the identified individual to evaluate the suitability of their residence for isolation or
quarantine.

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 a. Determine whether evaluation can be implemented using a telephone questionnaire or if an
in-person interview is necessary.

11. Immediately deliver an information packet to the individual placed in isolation or quarantine.
Provide appropriate instructions and training, if needed, regarding:
a. Packet contents
b. Public Health expectations
c. Infection control measures

[NOTE: patients isolated within health care facilities may only require an information packet; the
health care facility may address training needs and infection control issues for the patient].

12. Develop a schedule of daily check-in calls for each individual under isolation or quarantine.

13. Verify that the individual is at a specified location and monitor their health status.

14. Continue conducting daily check-in calls with each individual until they are released from isolation
or quarantine.

[NOTE: If repeated attempts to locate individuals subject to isolation or quarantine, including

telephone calls and site visits, are unsuccessful, coordinate with the Public Health Incident
Commander and local authorities regarding the need to pursue involuntary detention].

15. Follow up with referral agencies regarding requests for assistance.

16. Coordinate with hospital discharge planners to provide DPH with appropriate notice regarding the
discharge of isolated patients.

17. Ensure that patients are aware of the continuing requirements of isolation and appropriate
infection control measures.

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Attachment 2: Information Packet for Isolation and Quarantine

What you need to know about...Isolation and Quarantine

What are emergency isolations and quarantines?

When people are sick or exposed to others who are sick, they may need to be separated from the
general public during a health emergency. Both isolation and quarantine are common public health tools
used to contain illnesses that spread from person to person.

What is isolation?
Isolation refers to the separation of people who have a specific infectious illness from those who are
healthy.

What is quarantine?
Quarantine refers to the separation and restriction of movement of people who have been exposed to an
infectious agent but who are not sick or showing symptoms.

What kinds of illnesses could prompt isolations and quarantines?

Any outbreak of a serious, highly contagious illness such as pandemic flu, plague or smallpox could
cause isolations and quarantines. A terrorist attack involving radiation or chemicals also could trigger
isolations and quarantines.

Are emergency isolations and quarantines mandatory?

At this time, the St. Charles County Department of Public Health can request for individuals or groups to
voluntarily isolate or quarantine themselves. However, if these requests are not complied with, and the
situation presents a risk to public health, a court order may be obtained that would require involuntary
isolation and/or quarantine.

Who enforces isolations and quarantines?

Isolations and quarantines are overseen, and in some cases enforced, by the public health officials, law
enforcement, transportation authorities and health care providers.

Where would I be isolated or quarantined?

Often, isolations and quarantines take place in your own home, as long as the residence is suitable for
prolonged occupancy. If persons are already in a hospital or other healthcare institution, isolation may be
continued at that location. In some cases, arrangements can be made to house isolated or quarantined
individuals in temporary residences to ensure their health and safety, and that of their families during this
period of time.

How will I receive medical care or food if I am separated from other people?
Access to medical care, food, water, telephone, electricity and medicines must be considered in every
isolation and quarantine situation. In emergency situations, public health officials will work with
community agencies and other partner organizations to ensure that clients have necessary supplies and
medical care.

Will my family and friends be allowed to get in touch with me?

Yes. If you are isolated or quarantined it is important that you have access to a telephone. But for the
safety of the public and your family, it is best to keep some family members such as infants and the
elderly away from you if you are sick or have been exposed to a communicable disease.

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How do I know if I need to be isolated or quarantined?
If you have symptoms of a highly contagious disease, or feel that you’ve been exposed, contact your
doctor or the St. Charles County Department of Public Health at 636-949-7319. In emergency situations,
people will be given direct instructions if they should be isolated or quarantined.

What is the public health system doing about the possibility of emergency isolations and
quarantines in Missouri?
Local, state and federal public health agencies are working with local health care providers, hospitals,
emergency response teams, laboratories, veterinarians and others to prepare for large outbreaks and
disasters of all types. If bioterrorism is suspected, public health officials will notify the Centers for Disease
Control and Prevention (CDC), the Federal Bureau of Investigation (FBI), and other appropriate
authorities.

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 Disease Information Sheet

(insert disease fact sheet for given situation)

See following locations for possible fact sheets:

Annex C

www.cdc.gov

http://health.mo.gov/living/healthcondiseases/communicable/index.php

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 Steps to Prevent the Spread of [INSERT DISEASE]
in Your Home and Community

If you are confirmed to have, or being evaluated for, [INSERT DISEASE], you should follow the
prevention steps below until a healthcare provider or local or state health department says you can return
to your normal activities:

Prevention Steps for Patients

Stay home
You should restrict activities outside your home, except for getting medical care. Do not go to work,
school, or public areas, and do not use public transportation or taxis.

Separate yourself from other people in your home

As much as possible, you should stay in a different room from other people in your home. Also, you
should use a separate bathroom, if available.

Call ahead before visiting your doctor

Before your medical appointment, call the healthcare provider and tell them that you have, or are being
evaluated for [INSERT DISEASE]. This will help the healthcare provider’s office take steps to keep other
people from getting infected.

Wear a facemask
You should wear a facemask when you are in the same room with other people and when you visit a
healthcare provider. If you cannot wear a facemask, the people who live with you should wear one while
they are in the same room with you.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into
your sleeve. Throw used tissues in a lined trash can, and immediately wash your hands with soap and
water.

Wash your hands

Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand
sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your
eyes, nose, and mouth with unwashed hands.

Avoid sharing household items

You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with
other people in your home. After using these items, you should wash them thoroughly with soap and
water.

Monitor your symptoms

Seek prompt medical attention if your illness is worsening [INSERT SYMPTOMS IF
APPLICABLE]. Before going to your medical appointment, call the healthcare provider and tell them that
you have, or are being evaluated for [INSERT DISEASE]. This will help the healthcare provider’s office
take steps to keep other people from getting infected. Ask your healthcare provider to call the local or
state health department.

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Prevention Steps for Caregivers and Household Members
If you live with, or provide care at home for, a person confirmed to have, or being evaluated for, [INSERT
DISEASE], you should:

Make sure that you understand and can help the person follow the healthcare provider's
instructions for medication and care.
You should help the person with basic needs in the home and provide support for getting groceries,
prescriptions, and other personal needs.

Have only people in the home who are essential for providing care for the person.
Other household members should stay in another home or place of residence. If this is not possible, they
should stay in another room, or be separated from the person as much as possible. Use a separate
bathroom, if available.

Restrict visitors who do not have an essential need to be in the home.

Keep elderly people and those who have compromised immune systems or certain health conditions
away from the person. This includes people with chronic heart, lung or kidney conditions, and diabetes.

Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an
opened window, weather permitting.

Wash your hands often and thoroughly with soap and water.
You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are
not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Wear a disposable facemask, gown, and gloves when you touch or have contact with the
person’s blood, body fluids and/or secretions, such as sweat, saliva, sputum, nasal mucus,
vomit, urine, or diarrhea.
Throw out disposable facemasks, gowns, and gloves after using them. Do not reuse.

Wash your hands immediately after removing your facemask, gown, and gloves.

Avoid sharing household items.

You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with
a person who is confirmed to have, or being evaluated for, [INSERT DISEASE].

After the person uses these items, you should wash them thoroughly (see below):
o Immediately remove and wash clothes or bedding that have blood, body fluids and/or secretions
or excretions on them.
o Wear disposable gloves while handling soiled items. Wash your hands immediately after
removing your gloves.
o Read and follow directions on labels of laundry or clothing items and detergent. In general, wash
and dry with the warmest temperatures recommended on the clothing label.

Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures,
toilets, phones, keyboards, tablets, and bedside tables, every day.
Also, clean any surfaces that may have blood, body fluids and/or secretions or excretions on them.
o Read label of cleaning products and follow recommendations provided on product labels. Labels
contain instructions for safe and effective use of the cleaning product including precautions you
should take when applying the product, such as wearing gloves or aprons and making sure you
have good ventilation during use of the product.

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 o Use a diluted bleach solution or a household disinfectant with a label that says “EPA-approved.”
To make a bleach solution at home, add 1 tablespoon of bleach to 1 quart (4 cups) of water. For
a larger supply, add ¼ cup of bleach to 1 gallon (16 cups) of water.

Place all used gloves, gowns, facemasks, and other contaminated items in a lined container
before disposing them with other household waste.
Wash your hands immediately after handling these items.

Monitor the person’s symptoms.

Be especially mindful of [INSERT SYMTPOMS IF APPLICABLE]

If they are getting sicker, call his or her medical provider and tell him or her that the person has, or is
being evaluated for, [INSERT DISEASE]. This will help the healthcare provider’s office take steps to keep
other people from getting infected. Ask the healthcare provider to call the local or state health
department.

Caregivers and household members who do not follow precautions when in close contact with a person
who is confirmed to have, or being evaluated for [INSERT DISEASE], are considered “close contacts”
and should monitor their health. Follow the prevention steps for close contacts below:

Prevention Steps for Close Contacts

If you have had close contact with someone who is confirmed to have, or being evaluated for [INSERT
DISEASE], you should:

Monitor your health starting from the day you were first exposed to the person and continue for
14 days after you were last exposed to the person.
Watch for these signs and symptoms:
[INSERT APPLICABLE SYMPTOMS]

If you develop symptoms, follow the prevention steps described above on page 1 of this packet,
and call your healthcare provider as soon as possible.
Before going to your medical appointment, call the healthcare provider and tell them about your possible
exposure to [INSERT DISEASE]. This will help the healthcare provider’s office take steps to keep other
people from getting infected. Ask your healthcare provider to call the local or state health department.

If you do not have any symptoms, you can continue with your daily activities, such as going to
work, school, or other public areas.
You are not considered to be at risk for [INSERT DISEASE] infection if you have not had close contact
with someone who is confirmed to have, or being evaluated for [INSERT DISEASE]. The CDC advises
that people follow prevention steps to help reduce their risk of getting infected with [INSERT DISEASE].
For more information, visit [INSERT WEB PAGE IF NECESSARY] or call the St. Charles County
Department of Public Health Communicable Disease Program at 636-949-7319.

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Attachment 3:

Legal Authorities for Isolation and Quarantine

A. Federal Legal Authorities

Public Health Service Act

Section 319(a) of the Public Health Service (PHS) Act (42 U.S.C. 427d)
‘‘SEC. 319. PUBLIC HEALTH EMERGENCIES.
‘‘(a) EMERGENCIES.—If the Secretary determines, after consultation with such public health officials as
may be necessary, that—
‘‘(1) a disease or disorder presents a public health emergency;
or
‘‘(2) a public health emergency, including significant outbreaks of infectious diseases or
bioterrorist attacks, otherwise exists, the Secretary may take such action as may be
appropriate to respond to the public health emergency, including making grants and
entering into contracts and conducting and supporting investigations into the cause,
treatment, or prevention of a disease or disorder as described in paragraphs (1) and (2).

Section 361 of the Public Health Service (PHS) Act

PART G—QUARANTINE AND INSPECTION CONTROL OF COMMUNICABLE DISEASES
SEC. 361. [264] (a) The Surgeon General, with the approval of the Secretary is authorized to make and
enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or
spread of communicable diseases from foreign countries into the States or possessions, or from one
State or possession into any other State or possession. For purposes of carrying out and enforcing such
regulations, the Surgeon General may provide for such inspection, fumigation, disinfection, sanitation,
pest extermination, destruction of animals or articles found to be so infected or contaminated as to be
sources of dangerous infection to human beings, and other measures, as in his judgment may be
necessary.

(b) Regulations prescribed under this section shall not provide for the apprehension, detention, or
conditional release of individuals except for the purpose of preventing the introduction, transmission, or
spread of such communicable diseases as may be specified from time to time in Executive orders of the
President upon the recommendation of the National Advisory Health Council and the Surgeon General.

(c) Except as provided in subsection (d), regulations prescribed under this section, insofar as they
provide for the apprehension, detention, examination, or conditional release of individuals, shall be
applicable only to individuals coming into a State or possession from a foreign country or a possession.

(d) On recommendation of the National Advisory Health Council, regulations prescribed under this
section may provide for the apprehension and examination of any individual reasonably believed to be
infected with a communicable disease in a communicable stage and (1) to be moving or about to move
from a State to another State; or (2) to be a probable source of infection to individuals who, while infected
with such disease in a communicable stage, will be moving from a State to another State. Such
regulations may provide that if upon examination any such individual is found to be infected, he may be
detained for such time and in such manner as may be reasonably necessary. For purposes of this
subsection, the term ‘‘State’’ includes, in addition to the several States, only the District of Columbia.

Section 311 of the Public Health Service (PHS) Act

PART B—FEDERAL-STATE COOPERATION
IN GENERAL

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SEC. 311. [243] (a) The Secretary is authorized to accept from State and local authorities any assistance
in the enforcement of quarantine regulations made pursuant to this Act which such authorities may be
able and willing to provide. The Secretary shall also assist States and their political subdivisions in the
prevention and suppression of communicable diseases and with respect to other public health matters,
shall cooperate with and aid State and local authorities in the enforcement of their quarantine and other
health regulations, and shall advise the several States on matters relating to the preservation and
improvement of the public health.

(b) The Secretary shall encourage cooperative activities between the States with respect to
comprehensive and continuing planning as to their current and future health needs, the establishment
and maintenance of adequate public health services, and otherwise carrying out the public health
activities. The Secretary is also authorized to train personnel for State and local health work.
The Secretary may charge only private entities reasonable fees for the training of their personnel under
the preceding sentence.

(c)(1) The Secretary is authorized to develop (and may take such action as may be necessary to
implement) a plan under which personnel, equipment, medical supplies, and other resources of the
Service and other agencies under the jurisdiction of the Secretary may be effectively used to control
epidemics of any disease or condition and to meet other health emergencies or problems. The Secretary
may enter into agreements providing for the cooperative planning between the Service and public and
private community health programs and agencies to cope with health problems (including epidemics and
health emergencies).
(2) The Secretary may, at the request of the appropriate State or local authority, extend temporary (not in
excess of six months) assistance to States or localities in meeting health emergencies of such a nature
as to warrant Federal assistance. The Secretary may require such reimbursement of the United States
for assistance provided under this paragraph as he may determine to be reasonable under the
circumstances. Any reimbursement so paid shall be credited to the applicable appropriation for the
Service for the year in which such reimbursement is received.

B. State Legal Authorities

Rules of Missouri Department of Health and Senior Services

Division 20 - Division of Community and Public Health
Chapter 20 - Communicable Diseases
19 CSR 20-20.040 “Measures for the Control of Communicable, Environmental and
Occupational Diseases”
http://www.sos.mo.gov/adrules/csr/current/19csr/19c20-20.pdf

PURPOSE: This rule defines investigative and control measures for reportable diseases and establishes
who is responsible for them. Editor's Note: The following material is incorporated into this rule by
reference: 1) Morbidity and Mortality Weekly Report (Atlanta: Centers for Disease Control). In
accordance with section 536.031(4), RSMo, the full text of material incorporated by reference will be
made available to any interested person at the Office of the Secretary of State and the headquarters of
the adopting state agency.

(1) In controlling the diseases and findings listed in 19 CSR 20-20.020, the director shall comply with the
methods of control section of one (1) of the two (2) books listed in 19 CSR 20-20.030(2)(B) or the
recommendations of the Immunization Practices Advisory Committee (ACIP) published by the Centers
for Disease Control in the Morbidity and Mortality Weekly Report listed in 19 CSR 20- 20.030(2)(B). The
director shall use the legal means necessary to control, investigate, or both, any disease or condition
listed in 19 CSR 20-20.020 which is a threat to the public health.

149
(2) It shall be the duty of the local health authority, the director of the Department of Health or the
director’s designated representative on receiving a report of a communicable, environmental or
occupational disease to—
(A) Inspect any premises that they have reasonable grounds to believe are in a condition conducive
to the spread of any communicable disease;
(B) Confer with the physician, laboratory or person making the report;
(C) Collect for laboratory analysis any samples or specimens that may be necessary to confirm the
diagnosis or presence of the disease or biological, chemical or physical agents and to determine
the source of the infection, epidemic or exposure. Health program representatives and other
personnel employed by the Department of Health, after training and certification to perform
venipuncture, and after specific authorization from a physician, are authorized to perform
venipuncture utilizing procedures within the scope of the training they have been given. The
content and scope of this training shall be established by the Department of Health. Training shall
be provided by a physician or his/her designee and the certificate shall be signed by the
physician. Nothing in this rule shall limit the authority of local public health departments to
establish their own training policies, with or without certification, or to limit their voluntary
participation in the certification program developed by the Department of Health, nor shall it apply
to venipuncture for other purposes;
(D) Make a complete epidemiological, environmental or occupational industrial hygiene investigation
and record of the findings on a communicable disease or exposure report form;
(E) Establish and maintain quarantine, isolation or other measures as required;
(F) Provide the opportunity to be immunized to all contacts of persons suffering from those diseases
for which there is a reliable and approved means of immunization;
(G) Establish appropriate control measures which may include isolation, quarantine, disinfection,
immunization, closure of establishment and other measures considered appropriate by medical
experts for the protection of public health;
(H) Establish, as the local health authority, whenever a case of unrecognized illness is reported or
otherwise brought to the attention of the local health authority or the Department of Health and
investigation presents symptoms of a communicable disease, but sufficient time has not elapsed
to render a positive diagnosis, after consultation with the director or his/her designated
representative, the control measures applicable in actual cases of the suspected communicable
disease, until a positive diagnosis can be established. If a disease proves to be
noncommunicable, the temporary control measures shall be terminated at once;
(I) Assume direct responsibility as director of health to make necessary investigation and
immediately institute appropriate control measures necessary for the protection of the public
health in occurrence of outbreaks or unusual clusters of illness involving more than one (1)
county or a general regional area; and
(J) Investigate, as the local health authority, the disease within the local jurisdiction with assistance
from the director of the Department of Health or his/her designated representative when any
outbreak or unusual occurrence of a reportable disease is identified through reports required by
19 CSR 20- 20.020. If, in the judgment of the director, the disease outbreak or unusual
occurrence constitutes a medical emergency, the director may assume direct responsibility for
the investigation.

(3) It shall be the duty of the local health authority, upon identification of a case of a reportable disease or
upon receipt of a report of that disease, to take actions and measures as may be necessary according to
any policies which have been or may be established by the director of the Department of Health, within
the provisions of section (2) and subsections (2)(A)–(J) of this rule.
(A) When the local health authority is notified of a reportable disease or has reason to suspect the
existence of a reportable disease within the local jurisdiction, the local health authority, either in
person or through a designated representative, shall make an investigation as is necessary and
immediately institute appropriate control measures as set forth in section (2) and subsections
(2)(A)–(J) of this rule.

150
 (B) The local health authority shall use every reasonable means to determine the presence of a
communicable disease or the source of any disease listed in 19 CSR 20- 20.020 or of any
epidemic disease of unknown cause. In the performance of this duty, the local health authority
shall examine or cause to be examined any person reasonably suspected of being infected or of
being a source or contact of infection and any person who refuses examination shall be
quarantined or isolated.
(C) Control measures implemented by the local health authority shall be at least as stringent as those
established by the director of the Department of Health and shall be subject to review and
alteration by the director. If the local health authority fails to carry out appropriate control
measures, the director or his/her designated representative shall take steps necessary to protect
the public health.

(4) It shall be the duty of the attending physician, immediately upon diagnosing a case of a reportable
communicable disease, to give detailed instructions to the patient, members of the household and
attendants regarding proper control measures. When a person dies while infected with a communicable
disease, it shall be the duty of the attending physician to learn immediately who is to prepare the body for
burial or cremation and then notify the funeral director, embalmer or other responsible person regarding
the communicable disease the deceased had at the time of death. A tag shall also be affixed to the body
providing the name of the communicable disease likely to have been present at the time of death.

(5) Every practitioner of the healing arts and every person in charge of any medical care facility shall
permit the director of the Department of Health or the director’s designated representative to examine
and review any medical records which are in the practitioner’s or person’s possession or to which the
practitioner or person has access, upon request of the director or the director’s designated representative
in the course of investigation of reportable diseases in 19 CSR 20-20.020.

AUTHORITY: sections 192.006 and 192.020, RSMo 2000.* This rule was previously filed as 13 CSR 50-
101.050. Original rule filed July 15, 1948, effective Sept. 13, 1948. Rescinded and readopted: Filed Dec.
11, 1981, effective May 13, 1982. Amended: Filed Sept. 16, 1982, effective Jan. 14, 1983. Amended:
Filed March 21, 1984, effective July 15, 1984. Amended: Filed June 2, 1988, effective Aug. 25, 1988.
Amended: Filed Nov. 15, 1989, effective Feb. 11, 1990. Amended: Filed Aug. 14, 1992, effective April 8,
1993. Amended: Filed Sept. 15, 1995, effective April 30, 1996. Emergency amendment filed June 13,
2002, effective July 1, 2002, expires Dec. 27, 2002. Amended: Filed June 13, 2002, effective Nov. 30,
2002.
*Original authority: 192.006.1., RSMo 1993, amended 1995 and 192.020, RSMo 1939, amended 1945,
1951.

Rules of Missouri Department of Health and Senior Services

Division 20 - Division of Community and Public Health
Chapter 20 - Communicable Diseases

19 CSR 20-20.050 “Quarantine or Isolation Practices and Closing of Schools and Places of Public
and Private Assembly”
http://www.sos.mo.gov/adrules/csr/current/19csr/19c20-20.pdf

PURPOSE: This rule provides for the isolation or quarantine of persons and animals with a
communicable disease and their contacts; it also authorizes the closing of schools and places of public
and private assembly.

(1) The local health authority, the director of the Department of Health or the director’s designated
representative shall require isolation of a patient or animal with a communicable disease, quarantine of
contacts, concurrent and terminal disinfection, or modified forms of these procedures necessary for the

151
protection of the public health. The isolation of a patient, animal or contact shall be carried out according
to the methods of control in 19 CSR 20-20.040(1).

(2) No person or animal infected with or suspected of having a communicable disease listed in 19 CSR
20-20.020(1)–(3) or any contact of a disease subject to quarantine or isolation shall move or be moved
from one (1) health jurisdiction to another, unless necessary for medical care, without notice to and
consent from the local health authority, the director of the Department of Health or the director’s
designated representative. If a person is moved for the reason of medical care, the health authority who
ordered the isolation or quarantine shall be notified within seventy-two (72) hours.

(3) The local health authority, the director of the Department of Health or the director’s designated
representative is empowered to close any public or private school or other place of public or private
assembly when, in the opinion of the local health authority, the director of the Department of Health or
the director’s designated representative, the closing is necessary to protect the public health. Any school
or other place of public or private assembly that is ordered closed shall not reopen until permitted by
whomever ordered the closure.

AUTHORITY: section 192.020, RSMo 1994.* This rule was previously filed as 13 CSR 50-101.061.
Original rule filed Dec. 11, 1981, effective May 13, 1982. *Original authority: 192.020, RSMo 1939,
amended 1945, 1951.

Missouri Revised Statutes Chapter 44 Civil Defense Section 44.100

Emergency powers of governor.
http://www.moga.mo.gov/statutes/C000-099/0440000100.HTM

1. The emergency powers of the governor shall be as follows:

(1) The provisions of this section shall be operative only during the existence of a state of emergency
(referred to in this section as "emergency"). The existence of an emergency may be proclaimed by the
governor or by resolution of the legislature, if the governor in his proclamation, or the legislature in its
resolution, finds that a natural or man-made disaster of major proportions has actually occurred within
this state, and that the safety and welfare of the inhabitants of this state require an invocation of the
provisions of this section.

(2) Any emergency, whether proclaimed by the governor or by the legislature, shall terminate upon the
proclamation thereof by the governor, or the passage by the legislature, of a resolution terminating such
emergency.

(3) During the period that the state of emergency exists or continues, the governor shall:
(a) Enforce and put into operation all plans, rules and regulations relating to disasters and
emergency management of resources adopted under this law and to assume direct operational control of
all emergency forces and volunteers in the state;
(b) Take action and give directions to state and local law enforcement officers and agencies as
may be reasonable and necessary for the purpose of securing compliance with the provisions of this law
and with the orders, rules and regulations made pursuant thereof;
(c) Seize, take or requisition to the extent necessary to bring about the most effective protection
of the public:
a. Any means of transportation, other than railroads and railroad equipment and fuel, and
all fuel necessary for the propulsion thereof;
b. Any communication system or part thereof necessary to the prompt and efficient
functioning of the emergency management of the state;
c. All stocks of fuel;
d. Facilities for housing, feeding and hospitalization of persons, including buildings and
plants;
152
 (d) Control, restrict and regulate by rationing, freezing, use of quotas, prohibitions on shipments,
price fixing, allocation or other means the use, sale or distribution of food, feed, fuel, clothing and other
commodities, materials, goods or services;
(e) Prescribe and direct activities in connection with but not limited to use, conservation, salvage
and prevention of waste of materials, services and facilities, including production, transportation, power
and communication facilities, training and supply of labor, utilization of industrial plants, health and
medical care, nutrition, housing, including the use of existing and private facilities, rehabilitation,
education, welfare, child care, recreation, consumer protection and other essential civil needs;
(f) To use or distribute all or any of this property among the inhabitants of the state in any area
adversely affected by a natural or man-made disaster and to account to the state treasurer for any funds
received thereof;
(g) To waive or suspend the operation of any statutory requirement or administrative rule
regarding the licensing, certification or issuance of permits evidencing professional, mechanical or other
skills;
(h) In accordance with rules or regulations, to provide that all law enforcement authorities and
other emergency response workers and agencies of other states who may be within this state at the
request of the governor or pursuant to state or local mutual-aid agreements or compacts shall have the
same authority and possess the same powers, duties, rights, privileges and immunities as are possessed
by like law enforcement authorities and emergency response workers and agencies of this state;
(i) To perform and exercise such other functions, powers and duties as may be necessary to
promote and secure the safety and protection of the civilian population.

2. When any property is seized, taken or requisitioned under this section, the circuit court of the county in
which the property was taken may on the application of the owner thereof or on the application of the
governor in cases where numerous claims may be filed, appoint three disinterested commissioners in the
manner provided by section 523.040, RSMo, to assess the damages which the owners may have
sustained by reason of the appropriation thereof. Upon the application the amount due because of the
seizure of property shall be determined in the manner provided in chapter 523, RSMo, for the
determination of damages in case of the exercise of the power of eminent domain.
(L. 1951 p. 536 § 26.230, Reenacted L. 1953 p. 553, Reenacted L. 1955 p. 607, A.L. 1961 p. 483, A.L.
1967 p. 122, A.L. 1998 S.B. 743)

Missouri Revised Statutes Chapter 77 Third Class Cities Section 77.530

Powers of council, quarantine, condemnation, police power outside city.
http://www.moga.mo.gov/statutes/C000-099/0770000530.HTM

The council may make regulations and pass ordinances for the prevention of the introduction of
contagious diseases into the city, and for the abatement of the same, and may make quarantine laws
and enforce the same within five miles of the city. The council may purchase or condemn and hold for
the city, within or without the city limits, within ten miles there/from, all necessary lands for hospital
purposes, waterworks, sewer carriage and outfall, and erect, establish and regulate hospitals,
workhouses, poorhouses, police stations, fire stations and provide for the government and support of the
same, and make regulations to secure the general health of the city, and to prevent and remove
nuisances; provided, however, that the condemnation of any property outside of the city limits shall be
regulated in all respects as the condemnation of property or railroad purposes is regulated by law; and
provided further, that the police jurisdiction of the city shall extend over such lands and property to the
same extent as over public cemeteries, as provided in this chapter.
(RSMo 1939 § 6953, A.L. 1998 H.B. 1352) Prior revisions: 1929 § 6807; 1919 § 8294; 1909 § 9231
CROSS REFERENCES: Hospital, established, adoption for tax, board of trustees to govern, RSMo
96.150 to 96.228. Parks, city may acquire, tax to maintain, RSMo 90.010

153
Missouri Revised Statutes Chapter 192 Department of Health and Senior Services Section 192.020
To safeguard the health of the people of Missouri--certain diseases to be included on
communicable or infectious disease list.
http://www.moga.mo.gov/statutes/chapters/chap192.htm

1. It shall be the general duty and responsibility of the department of health and senior services to
safeguard the health of the people in the state and all its subdivisions. It shall make a study of the
causes and prevention of diseases. It shall designate those diseases which are infectious, contagious,
communicable or dangerous in their nature and shall make and enforce adequate orders, findings, rules
and regulations to prevent the spread of such diseases and to determine the prevalence of such
diseases within the state. It shall have power and authority, with approval of the director of the
department, to make such orders, findings, rules and regulations as will prevent the entrance of
infectious, contagious and communicable diseases into the state.

2. The department of health and senior services shall include in its list of communicable or infectious
diseases which must be reported to the department methicillin-resistant staphylococcus aureus (MRSA)
and vancomycin-resistant enterococcus (VRE).
(RSMo 1939 §§ 9735, 9736, A.L. 1945 p. 945 § 14, A.L. 1951 p. 784, A.L. 2004 S.B. 1279) Prior
revisions: 1929 §§ 9015, 9016; 1919 §§ 5772, 5773; 1909 § 6653)

Missouri Revised Statues Chapter 192 Department of Health and Senior Services Section 192.320
Violation of law or quarantine--penalty.
http://www.moga.mo.gov/statutes/C100-199/1920000320.HTM

Any person or persons violating any of the provisions of sections 192.010, 192.020 to 192.490, 192.600
to 192.620 or who shall leave any pesthouse, or isolation hospital, or quarantined house or place without
the consent of the health officer having jurisdiction, or who evades or breaks quarantine or knowingly
conceals a case of contagious, infectious, or communicable disease, or who removes, destroys,
obstructs from view, or tears down any quarantine card, cloth or notice posted by the attending physician
or by the health officer, or by direction of a proper health officer, shall be deemed guilty of a class A
misdemeanor.
(RSMo 1939 § 9750, A.L. 1951 p. 784, A.L. 1961 p. 463, A.L. 1978 S.B. 509) Prior revisions: 1929 §
9030; 1919 § 5786

Missouri Revised Statutes Chapter 192 Department of Health and Senior Services Section 192.460
Emergency orders--compliance required--hearing.
http://www.moga.mo.gov/statutes/C100-199/1920000460.HTM

Whenever the department of health and senior services finds that an emergency exists requiring
immediate action to protect the public health or welfare, it may issue an order reciting the existence of an
emergency and requiring that such action be taken as it deems necessary to meet the emergency. The
order shall be effective immediately. Any person to whom the order is directed shall comply therewith
immediately, but on application to the department shall be afforded a hearing within ten days. On the
basis of the hearing the department shall continue such order in effect, revoke it, or modify it.
(L. 1963 p. 359 § 7)

154
 ANNEX H

MASS PROPHYLAXIS

Attachment 1: SNS Request Form

Attachment 2: Requesting the SNS Algorithm
Attachment 3: SNS Pick Up Authorization Letter
Attachment 4: Consent to Preventative Treatment Form
Attachment 5: Chain of Custody/Transfer of Medication Form
Attachment 6: Dispensing Information Form
Attachment 7: Pharmacies in SCC
Attachment 8: Nursing Homes/LTC Facilities in SCC

PURPOSE
Should there be a major natural disaster, disease outbreak, or terrorist attack, local and state
jurisdictions will likely deplete their supplies of pharmaceuticals and other medical equipment very
quickly. Anticipating this situation, the United States Congress maintains a massive stockpile of
pharmaceuticals, vaccines, medical supplies, equipment, and other items to augment local supplies of
critical medical items. The stockpile, managed by the U.S. Department of Homeland security, in
coordination with the CDC, is known as the Strategic National Stockpile (SNS).

The purpose of this annex is to provide a plan for requesting, receiving, and distributing life-saving
pharmaceuticals and medical supplies in the event of a biological, chemical, radiological, or nuclear
incident to reduce morbidity and mortality with or without the activation of the SNS. These guidelines
establish the framework to distribute pharmaceuticals to the approximately 395,000 residents of St.
Charles County in a coordinated and efficient manner. The determination of the need for mass
prophylaxis will be made by officials from St. Charles County DPH and DEM in collaboration with other
local, state, and federal partners. This effort will be accomplished by establishing both open and closed
point of dispensing clinics (PODs) throughout the County, and by using alternate means of dispensing
medication.

The purpose of a POD is to:

• Provide preventive medications and basic information to the community.
• Divert asymptomatic persons away from area hospitals to prevent over-crowding.
• Conserve health and first responder infrastructure.
• Protect first responders and allow them to maintain high levels of emergency response.

ASSUMPTIONS
1. DPH will be assisted in this effort by many other agencies throughout the county and region,
including but not limited to:
a. Regional LPHAs
b. Other St. Charles County departments
c. American Red Cross
d. St. Louis Area Regional Response System (STARRS)
e. Municipal police departments
f. EMS
g. Hospitals
h. Disaster Medical Assistance Team (DMAT)
i. MO National Guard
j. MO DHSS
k. SEMA
l. FEMA
m. CDC

155
 2. Hospitals will be overwhelmed in the case of a bioterrorism incident. It will be critical to divert
asymptomatic patients requiring prophylaxis to other sites.

3. SEMA will be the lead agency in requesting and receiving supplies from the SNS. Technical
advisors from the CDC will accompany SNS shipments and will advise local and state authorities
on the management of SNS assets.

4. Depending on the scope of the incident, 1 – 6 locations in St. Charles County will serve as open
PODs.

5. POD locations and instructions for completion of electronic dispensing forms will be announced to
the public during press releases.

6. Transportation will be available to distribute medications, vaccines, and supplies to each POD.

7. First responders need to be treated with priority, and will be provided with sufficient doses for
their families as well.

8. The personnel, services, supplies, and equipment required to provide mass prophylaxis will be
available on short notice and exclusively committed to this task until it is completed.

9. The extent to which these guidelines are applicable will vary according to the nature and size of
the event.

ORGANIZATION
1. The DPH Director is responsible for activating the procedures for providing pharmaceutical and
medical supplies in a local public health emergency.

2. Upon evidence provided by local surveillance and/or exhaustion of all local resources, the DPH
Director will be responsible for contacting DEM to activate the requesting of SNS materiel through
SEMA.

3. SEMA, in collaboration with DPH, will determine the appropriate request from the CDC SNS
program depending on the incident and the suspected or confirmed agent.

4. The Director of SEMA in consultation with MO DHSS, the local jurisdiction, and other necessary
partners shall determine whether the Governor should be advised to request activation of the
SNS.

5. Prior to SNS arrival, or in the event of a local public health incident which does not require the
assistance of the SNS, prophylaxis will be distributed in the following order:
a. First responders – those required to respond directly to the incident (public health, fire, law
enforcement, EMS, etc.)

b. Individuals directly exposed to the agent (if this population is known)

c. Those whom came in direct contact with those individuals exposed to the agent (if this
population is known)

EMERGENCY RESPONSIBILITIES
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 St. Charles County DPH:
1. Execute Local Public Health Emergency Operations Plan.
2. Contact necessary County officials.
3. Contact and assign all necessary staff and volunteers.
4. Activate open PODs and/or alternative forms of dispensing.
5. Activate closed PODs if necessary.
6. Establish a meeting location for DPH staff to be briefed on the situation.
7. Prepare to receive SNS by convening staff via emergency phone chain.
8. Develop plan to provide prophylaxis for other necessary first responders.
9. Track SNS supplies via coordination with DEM and SEMA.
10. Provide mental and behavioral health services to County employees through the County
Employee Assistance Program.
11. Coordinate with DEM to request additional personnel necessary for a mass prophylaxis
campaign.
12. Coordinate with DEM to request mental health providers via statewide mutual aid.

DPH Director:
1. Establish Public Health IC.
2. Appoint command staff.
3. Designate liaison to the County EOC.
4. Alert County officials regarding the situation.
5. Maintain contact with MO DHSS, the St. Charles County Executive and all supportive
departments.
6. Determine the need for prophylaxis based on epidemiological data and recommendations.
7. Review standing orders for the appropriate type and amount of prophylaxis.
8. Set eligibility criteria for receiving prophylaxis or referral for clinical evaluation.
a. Eligibility will be based on the following factors:
• Type of prophylaxis necessary
• Time, location, and duration of exposure
• Symptoms
• Location of residence or workplace

DPH will make an initial determination as to how many persons will require immediate prophylaxis based on
the eligibility criteria, and how that will be accomplished. As situations evolve, estimates may need to be
revised.

Level 1--Less than 100: Local hospitals and physicians will offer necessary prophylaxis. DPH will issue
public health recommendations.

Level 2--Between 101 and 1000: DPH Director will seek advice from state officials regarding deployment of
state resources or vendor managed inventory. DPH will issue public health recommendations.

Level 3--Over
Health 1000: DPH
Services DirectorDirector:
Division will consider requesting that state officials seek deployment of the SNS.
DPH will prepare a sufficient number of PODs to provide prophylaxis and issue public health
recommendations. 157
 1. Serve as Operations Section Chief.
2. Lead the Epidemiological/CD investigation or appoint a designee to do so.
3. Maintain contact with all nursing staff.
4. Assist in opening POD(s).
5. Alert Closed PODs and hospitals.
6. Send out information to all employees.

Public Health Emergency Planner:

1. Serve as Planning Section Chief.
2. Open PODs and ensure adequate resourcing for operation.
3. Maintain contact with the Missouri SNS Program Manager(s) as needed.
4. Locate supplies and resources and plan for their deployment.
5. Provide the list of authorized staff to sign for the SNS from SEMA.
6. Assure that DPH employees (and their families) have received prophylaxes from local cache.
7. Manage and update information regarding the situation, documentation, resources, and
demobilization.

Epidemiologist:
1. Maintain contact with state and regional epidemiologists.
2. Serve on or lead surveillance and investigation team(s), at the discretion of the Health Services
Division Director.
3. Alert hospitals and other healthcare providers regarding possible patient surge.
4. Maintain contact with Infection Control staff at hospitals.
5. If necessary, provide just-in-time training for staff or volunteers to assist in surveillance and/or
investigation.

Public Information Officer:

1. Activate Annex C.
2. Maintain contact with regional and state PIOs.
3. Maintain contact with all agency PIOs involved in the emergency.
4. Create public information messaging for identified target audience(s).
5. Coordinate relations with media.
6. Assist in set up of Joint Information Center if necessary.

St. Charles County DEM:

1. Activate County EOC or deploy Mobile Command Unit.
2. Assist in the requesting and location of emergency resources and supplies.
3. Provide logistical support to ensure resources are deployed appropriately.
4. Act as liaison between County and SEMA and FEMA.
5. Assist in communication efforts, including activation of ARES and other volunteer groups if
necessary.
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 6. Assist in transportation of SNS supplies to PODs and treatment centers.

Region C LPHA’s:
1. Coordinate efforts of affected LPHAs and provide mutual aid if necessary and available.
2. Coordinate messaging via the Joint Information System.
3. Post updates to WebEOC and/or other communication platforms to maintain situational
awareness.

St. Charles County Humane Services Division:

1. Provide drivers and vehicles for the transportation of pharmaceutical supplies to the PODs if
necessary.
2. Provide staff to help operate POD if necessary.
3. Provide exclusive use of shared radio repeater frequency for communications.
4. Assist in repackaging of pharmaceuticals if necessary.
5. Provide advice to the public regarding pet safety during the incident.

St. Charles County Police Department:

1. Assist the Missouri State Highway Patrol (MSHP) with SNS transport when necessary and if
available.
2. Provide armed security for the DPH transportation of supplies within the County.
3. Assist with traffic control to allow for expedited transport of supplies, if necessary.
4. If necessary, provide security for the DPH building.
5. Provide security for personnel and volunteers traveling to and from PODs, when available.
6. Provide security for Open POD locations in unincorporated St. Charles County, unless otherwise
coordinated with other jurisdictions.
7. When necessary, seize property in the interest of public safety.
8. Follow applicable local, state, and federal laws concerning use of force.

Municipal Police Departments:

1. Provide security for Open PODs within given jurisdiction.
2. Provide security for personnel and volunteers traveling to and from PODs, when available.
3. Assist with traffic control and/or transportation of supplies, if necessary and available.
4. Follow applicable local, state, and federal laws concerning use of force.

[Note: Assigned individuals are responsible for the security plan for each POD. A crowd control &
security plan has been developed by and is housed within the respective local Police Departments.]
Contact information for each jurisdiction is included in the Open POD Contact List.

Note: Other agencies such as the MO Dept. of Natural Resources, MO Dept. of Conservation, etc. may
be able to provide officers to provide armed security at POD sites. Officers should have Peace Officer
Standards and Training (POST) certification and have arresting power in the event that individuals
become unruly.

St. Charles County Ambulance District:

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 1. If possible, assist in the delivery of medication to home-bound patients identified through MO
DHSS and other community/service organizations.
2. Dispense medication if allowed by the Governor in a declared emergency.
3. Remain on standby if numerous PODs are activated.
4. Should there be less than 5 active PODs, stage an ambulance at each site to expedite necessary
medical treatment.

Fire Departments:
1. Provide direction in HAZMAT services, if necessary.
2. Assist EMS through mutual aid.

Hospitals:
1. Hospitals will request SNS materiel through directly from the State of Missouri, but are required to
notify LPHAs involved in the response in order to maintain adequate situational awareness.
Hospitals will distribute SNS materiel within and between their own facilities, with support from
other organizations if necessary.
2. Centerpointe Hospital and Crider Health Center will contact DPH as part of the closed POD
procedure to request SNS.
3. Dispense or administer prophylaxis to their staff internally.
4. Provide care to those presenting with suspected or confirmed symptoms of a given condition.
5. Activate internal surge procedures to manage increased patient census.

St. Charles County Highway Department:

1. Provide vehicle assets for transportation of personnel and equipment to and from PODs as
necessary.
2. Provide EOC with County road data which may impact the movement of POD
equipment/personnel.

Medical Reserve Corps and/or CERT Teams:

1. Provide assistance in staffing PODs.
2. Provide assistance to local municipalities and/or DPH as needed for various tasks.

Community Organizations:
1. American Red Cross and other social services will provide food, shelter, and emergency needs.

2. Provide access to mental health services and other psychological support.

a. The Crider Center’s Crisis Response Team can be reached at 1-(866)384-1254.

i. As our region’s administrative agent for the Missouri Department of Mental Health,
Crider can also assist with coordination of supplemental resources if necessary.

b. The Department of Mental Health can be reached at (573)751-4122.

c. Behavioral Health Response can also be reached to provide resources by calling

(636)642-0642, 1-(855)-642-0642, or (314)469-6644.

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 d. Communication with these agencies should be maintained via coordination with DEM or
via the DPH Liaison Officer, unless otherwise notified.

***Mental health services and crisis counseling should be only be provided by personnel with
appropriate training and licensure as determined by the Missouri Department of Mental Health
or other appropriate licensing entities***

Private Sector Organizations

1. Serve as Closed PODs if designated to do so.
2. Provide PPE and other supplies for staff and volunteers when appropriate and available.
3. Assist in coordination of donations and/or food service for staff and volunteers.
4. Provide facilities for use by DPH or other response agencies when appropriate and available.

STRATEGIC NATIONAL STOCKPILE (SNS)

Authorized DPH SNS Coordinator:

Primary
DPH Director

Alternate
Public Health Emergency Planner

Authorized as alternates, by the DPH Director, to coordinate SNS:

Health Services Division Director
Regional Public Health Emergency Planner
DEM Operations Officer

The SNS consists of multiple, large caches of medication, vaccines, medical supplies, and medical
equipment stored in strategic locations around the U.S.
SNS cargo containers come in two sizes to fit the curvature of a wide-bodied jet. Both containers have a
base 43 inches by 60.5 inches. The tall container is 80 inches high. The short container is 64 inches. The
heaviest container weighs approximately 1,400 pounds.
Assets can arrive by air or ground in two shipment phases:
1. 12-hour Push Package (broad spectrum if agent is unknown):
a. A 12-hour Push Package is a 50-ton cache of pharmaceuticals and medical supplies
designed to provide rapid delivery of a broad spectrum of assets for an ill-defined threat.
The 12-hour Push Package can be delivered to a receipt, stage, and store (RSS)
warehouse within 12 hours of the federal decision to do so. This formulary, combined with
technical assistance from the project area’s program services consultant, can assist state
and local SNS planners in streamlining the staging and reordering process.

b. The Push Package Product Catalog is updated as products are added or removed.

c. The catalog is organized by color codes that correspond with the colors of the product list
on each cargo container in the 12-hour Push Package.

d. See the catalog for a complete list of items available. Depending on reordering availability,
the products pictured in this catalog may vary based on brand and packaging. The product

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 description also may indicate additional sizes not pictured in the catalog but are included in
the 12-hour Push Package.

***Vaccines for anthrax and smallpox, and botulism antitoxin are not included in a push
package, but can be shipped separately as required.***

2. Managed Inventory (MI);

a. Allows for response with correct asset(s) when threat is known
b. Makes up 97% of SNS materiel
c. Some is managed by the SNS directly, while other assets are managed by contracted
vendors

d. In addition to items included in a push package, VMI also includes:

• Other antibiotics
• Antibiotic suspension
• Emergency medications
• Antivirals
• Nerve agent antidotes (CHEMPACKS)
• Radiation countermeasures
• Burn and blast items
• Vaccines and antitoxins
• IV administration tools
• Respiratory support
• PPE
• Ventilators
• Suction machines
• Other ancillary supplies
e. Use of MI will typically begin within 24–36 hours once a state identifies the threat

3. Population treatment capacity:

a. Entire resources of the federal SNS Program will protect 12 million people with a full 60-day
regimen against anthrax (anthrax requires longer treatment period than plague and
tularemia)

b. Treatment options will be available for more than 1.1 million people who are symptomatic of
anthrax infection

c. Protect at least 12 million people against tularemia and plague and treat those with
symptoms.

4. 12-Hour Push Package or MI:

a. The SNS Program may decide to ship only MI materiel if the agent is apparent from the
beginning of an emergency;

b. Missouri may receive a Push Package, MI, or a combination of the two; SNS materiel will
continue to arrive for as long as it is needed.

5. Assessment of Threats:
a. CDC scientists work closely with the intelligence community to assess the probability of
various biological and chemical threats

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 b. As threats are analyzed, protocols are created for therapeutic treatment and prophylaxis;
these protocols determine which drugs and other supplies are maintained in the SNS.

Justification to Request the SNS

The following criteria can be used to request the SNS:
1. Overt release of a chemical or biological agent
2. Claim of release by intelligence or law enforcement
3. Indication from intelligence or law enforcement of a likely attack
4. Clinical or epidemiological indications
5. Large number of ill persons with similar disease or syndrome
6. Large number of unexplained disease, syndrome, or deaths
7. Unusual illness in a population
8. Higher than normal morbidity and mortality from a common disease or syndrome
9. Failure of a common disease to respond to unusual therapy
10. Single case of disease from an uncommon agent
11. Multiple unusual or unexplained disease entities in the same patient
12. Disease with unusual geographic or seasonal distribution
13. Multiple atypical presentation of disease agents
14. Similar genetic type in agents isolated from temporally or spatially distinct sources
15. Endemic disease or unexplained increase in incidence
16. Simultaneous clusters of similar illness in non-contiguous areas
17. Atypical aerosol, food, water transmission
18. 3 people presenting the same symptoms near the same time
19. Deaths or illness among animals that precedes or accompanies human death
20. Illnesses in people not exposed to common vent systems
21. Laboratory results
22. Unexplainable increase in emergency medical service requests
23. Unexplained increase in antibiotic prescriptions or over-the-counter medication use

***Requests can be made by following the supplied algorithm.***

Requesting the SNS

The following information must be submitted to the DSR at the time of request:
1. Number of first responders (and their families) provided prophylaxis
2. Number of individuals currently showing symptoms or ill
3. Projected needs considering the population, including transients, and possible number infected
versus non-infected individuals
4. Number of current casualties
5. Location of dispensing site(s) that will be opened
6. Name and location of the hospital(s) involved in the event

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 7. Hospital capacity at the time of the event, including ICU beds and ventilator needs
8. Local resources identified, including pharmacy distributors, oxygen availability, other nearby
hospitals, transport capacity, and local alternative care centers
9. Security measures at the dispensing sites
10. Copy of signed physician standing orders
11. Number of individuals treated before local resources were exhausted

***DPH should send the initial request through local DEM, who will forward it to SEMA to be
signed by the Governor or his/her designee.***

If DPH receives an apportioned amount of courses, an immediate resupply request will follow until
coverage of the total population or initial request is obtained.

The Operations Section Chief will receive hourly updates from PODs on medical countermeasure supply
levels. Once the initial request for countermeasures is fulfilled, inventory management will be utilized by
reviewing throughput and distribution time frame analysis data from all POD locations.

Exhaustion of Resources
Local supply of antibiotics
1. DPH currently manages a cache of 2,000 courses of ciprofloxacin for St. Charles County
employees.
2. Other local sources will include pharmacies and hospitals.
3. Local resources may be prioritized to ensure that first responders and their families receive
prophylaxis first. This may include allowing them to go through open POD locations, ideally
before the general public is allowed to start arriving. Critical disciplines are identified below (in no
particular order):
a. Law Enforcement
b. Emergency Medical Services
c. Fire Service
d. Public Health
e. Emergency Management
f. Public Works
g. County/Municipal Government

***If also providing prophylaxis to family members of personnel in these disciplines, the number of
courses and/or doses is estimated at roughly 6,000 – 8,000***

***St. Charles County DPH will provide prophylaxis to internal and County staff. Unless otherwise
covered in a Closed POD or other agreement, other agencies should plan to provide prophylaxis to staff
based on internal protocols.***

4. In collaboration with local health care providers and pharmacists, DPH will determine when local
resources will be exhausted, prompting the need to request assistance from other jurisdictions.
a. DPH will request assistance from regional and/or statewide LPHAs by submitting a resource
request to SCC DEM
b. If local resources are exhausted, DPH will request assistance from MO DHSS or SEMA by
submitting a request to SCC DEM
c. If state-level resources are exhausted, DPH will request the activation of federal SNS assets
by submitting a resource request to SCC DEM

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 i. This request will be sent to SEMA before being signed by the governor or his/her
designee, and then forwarded to DHHS

5. The Operations Section Chief will receive hourly updates on antibiotic supply levels from PODs.

6. The Operations Section Chief and Planning Section Chief will consult with the Distribution
Manager on reordering needs.

7. POD Managers will notify the Operations Section Chief if, at any time, inventory drops below
5,000 courses.

Releasing the SNS

The CDC will assess the following before releasing the SNS to the state:
1. Number of current casualties and/or possible exposures

2. Projected needs considering the population, including transients, and possible infections versus
non-infections

3. Presence of an identifiable, coordinated SNS annex to the state/local bioterrorism response plan

4. Hospital capacity at the time of the event, including ICU beds and ventilator needs

5. State resources identified, including pharmacy distributors, oxygen availability, other nearby
hospitals, and in-state alternative care centers

6. Local resources, e.g., pharmacy distribution, oxygen availability and transport capacity

7. State plan for managing the SNS

Management of the SNS

St. Charles County DPH:
1. Track distribution of SNS assets during an incident until unused stock is returned to CDC.

2. Maintain proper documentation throughout the incident.

3. Dispatch personnel to the County EOC during an incident to maintain situational awareness
related to SNS needs.

4. Train staff and volunteers to understand SNS management and protocols.

5. Initiate public information, including:

a. Activation of Mass Prophylaxis plan
b. Location of open POD locations and operating timelines
c. Appropriate use of website(s)
d. Ensure hotline phone lines are activated if necessary
e. Receive and distribute health alerts, as issued by MO DHSS

6. Coordinate with local service organizations to ensure contact with high risk and special needs
populations.

7. In conjunction with state and federal agencies, determine when prophylaxis is no longer needed.
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 8. Determine credentialing process of POD staff, including identification and training needs

St. Charles County DEM

1. Manage resource requests, including the request for activation of SNS.

2. Assist DPH in documenting activities throughout each operational period.

3. Provide logistical support for personnel and other resources needed to support POD operations.

4. Assist in activation and management of volunteers as needed.

Controlling SNS Inventory

WebEOC
The primary method to order and track SNS inventory will be via a dedicated WebEOC board. DPH
personnel will have access and will input the necessary data to inform SEMA of inventory being
requested.

Items to have available when ordering:

- Number of courses needed for each Open POD
- Number of courses needed for each Closed POD
- Number of courses needed for each Hospital (hospitals should be submitting their own orders,
but having this number available is important for situational awareness and in case hospitals
need assistance in placing SNS orders)
- Preferred order of delivery from RSS to PODs or hospitals (helps determine order of loading)

Menus will be available to make orders specifically for Open PODs, Closed PODs, hospitals, etc.

SEMA will review requests from LPHAs across the state and/or region and allocate resources as best as
possible based on populations affected.

Excel spreadsheet
If WebEOC is not available at the time of an incident, a secondary method will be an Excel spreadsheet.

An initial Excel spreadsheet will be provided by SEMA to DPH, displaying quantities that are available for
order. DPH will then generate its own spreadsheet indicating the quantities being requested for each
POD location. This spreadsheet should be returned to the SNS Program Coordinator at SEMA who will
allocate assets and prepare them for shipment.

Other
If no electronic means are available, orders will be placed via phone or radio, and tracked with pen and
paper.

In either case, the Planning Section will track orders and current inventory levels at each POD.

Overall management and supervision of the SNS inventory (after delivery from CDC) is the responsibility
of the SEMA SNS Program Manager.

Chain of Custody

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Individuals who are authorized to receive SNS materiel (below) will use the Strategic National Stockpile
Materiel Chain of Custody Form. This form must be filled out with necessary information before being
signed by both the party releasing the materiel and the party receiving it.

Chain of custody within PODs will be maintained by placing a label from medication bottles on the form
that each individual will turn in when receiving their medication. This will ensure DPH’s ability to track the
type and lot number that each individual received.

The following individuals are authorized to sign for the SNS materiel:
1. County Executive (or designee)
2. DPH Director (or designee)
3. DPH Assistant Director
4. Health Services Division Director
5. Environmental Health Division Director
6. Public Health Emergency Planner
7. Regional Public Health Emergency Planner

Controlled substances will be signed for by DEA-authorized individuals from local hospitals.

Inventory Tracking at PODs

1. POD Managers are required to provide hourly reports regarding inventory levels.

2. The preferred method will be to use the SNS POD Inventory Reporting Worksheet, which has
been adopted from Franklin County, MO.

3. If electronic means are not available, a paper version will be used.

***POD Managers will be directed to notify the Operations Section Chief if, at any time, overall inventory
levels fall below 5,000 courses.***

Recovery of Materiel, Equipment and Supplies

Upon the decision to demobilize one or multiple POD sites, excess medication, supplies, and equipment
will need to be picked up and returned to their appropriate locations.

SNS medication and other materiel will be returned to the RSS to be returned to the custody of SEMA,
before being returned to CDC. This can be accomplished by loading supplies onto trailers, or if space
permits, regular County vehicles will suffice. This materiel should be accompanied by security in the form
of County or Municipal Police.

DPH supplies and equipment should be returned to supply cages and returned to storage within the DPH
building.

DPH trailers should be returned to1211 Lindenwood Ave., St. Charles, MO 63301. Trailers should be
locked.

DPH vehicles should be returned to the DPH parking lot. Other vehicles can be returned to their
appropriate location or temporarily parked on DPH property.

Biological waste, most likely vaccine sharps, will be transported by the vendor with which DPH contracts
with for normal disposal. These vendors possess the permits, vehicles, and protocols necessary to
transport material of this nature.

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RSS Site
State RSS Responsibility
1. The RSS site for SNS supplies and materials, is selected, managed and secured by SEMA.

2. SEMA is tasked with providing staff to receive assets, fill orders from LPHAs and other agencies,
and prepare orders for shipment to the Local Delivery Site (LDS).

3. The primary RSS location for the St. Louis region is the Family Arena, located at 2002 Arena
Pkwy, St Charles, MO 63303.

Notification to LPHAs, Hospitals, and EMS Providers

Local public health agencies, hospitals, and EMS providers involved in the incident will be notified of the
location of the RSS site from the DSR (notification can be e-mail, phone or FAX).

Information will include:

1. LPHA request for medication form
2. Hospital request for medication and supply form
3. Address and directions to the RSS site and/or ADS
4. Directions to the staging area at the site
5. Documentation needed at distribution site
6. Etiquette for the RSS site

DPH RSS Responsibility

The St. Charles County Executive or DPH Director, or other appointed liaison, will release the name(s) of
the driver(s) who are authorized to pick up supplies from the RSS site. Other information that will need to
be provided:
1. Letter authorizing pick up
2. Number of vehicles deployed to site/description
3. Badge information

SNS Distribution
Distribution Manager: DPH Administrative Assistant
Alternate: Lead Animal Control Officer

Upon activation of the SNS in St. Charles County, DPH staff and volunteers will be notified by use of the
confidential phone chain and Show-Me Response, respectively. All personnel will report to the DPH
building, unless otherwise indicated.

Drivers will be told to report to the Distribution Manager at the HEOC for detailed instructions and to meet
with their escorts from the St. Charles County Police Department. Drivers will be assigned vehicles and
given GPS navigation units or written directions for that vehicle, along with county radios for
communication. If GPS units are unavailable, maps will be given to drivers with plotted routes. Radios
will be tuned to channels designated at the time of the incident. Unless otherwise indicated, drivers
are not to be without their escort at any time, until released.

Drivers will pick up all Emergency Preparedness trailers from the DEM parking lot, located at 1211
Lindenwood Ave., St. Charles, MO 63301, and deliver the operational supplies to the designated POD.

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Once trailers are unloaded, the drivers will then drive the trailers to the LDS site to be loaded with SNS
materiel.

DPH vehicles will be the primary source of transportation. Secondary assets may be requested from the
Division of Humane Services, followed by tertiary sources including the St. Charles County Highway
Department or DEM.

Vehicles used for the transport of medical supplies must be shielded from the elements, so vehicle
availability may vary based on the nature of the resources needing transport. All vehicles will be fueled at
the County-operated gas pumps, unless otherwise indicated. See the vehicle list for vehicles readily
available to the DPH.

Drivers will sign for all SNS materiel that is loaded into their vehicle or trailer. They will also keep track of
lot numbers and expiration dates of the SNS materiel for which they are signing. Once delivered, the
POD Manager will sign for custody of the SNS materiel from the driver.

If there is a mechanical issue or breakdown of a vehicle, the driver must notify the Distribution Manager
immediately. The Distribution Manager will notify the Logistics Section Chief, who will coordinate the
vehicle’s recovery with the Finance & Administration Section Chief and/or Planning Section Chief. If there
is SNS remaining in the disabled vehicle, additional vehicles will be dispatched to secure those items.
The disabled vehicle will not be towed with SNS materiel still on board.

Once deliveries are completed, drivers and their escorts will return to the HEOC. At this point, the drivers
will either remain with the Logistics Section, or be released to another section requiring additional
manpower. If, at any time, the drivers are needed by the Distribution Manager, the drivers will be
excused from their current assignment and report back to the HEOC.

If materials should need to be transported by other means, the following resources may be available:

Air Transport:
St. Charles County Police Dept. Emergency Service Helicopter
Air-Evac Lifeteam
ARCH Air Medical Services

Boat:
St. Charles County DEM

SNS Distribution Routes

DPH is responsible for delivering medication and other supplies from the RSS to each POD location.
Below are expected drive times based on the fastest suggested routes via Google Maps. These routes
should be used unless otherwise directed, or if road conditions necessitate alternate routes. Sites are
listed in the suggested order of delivery, if a single vehicle contains materiel designated for all sites.

Drive times may differ during an incident as stops may be made consecutively, rather than separate
vehicles driving to each location.

RSS to St. Charles West HS: 12 minutes

RSS to St. Charles Community College: 13 minutes

RSS to Fort Zumwalt West HS: 19 minutes

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RSS to Wentzville Holt HS: 25 minutes

RSS to Francis Howell HS: 15 minutes

RSS to Francis Howell North HS: 5 minutes

***Approximate time for 1 vehicle to travel from RSS to these sites in this order: 95 minutes***

LIABILITY PROTECTION
1. Missouri Statute – 19 CSR 20-44.010
a. Covers medical and non-medical volunteers under a Governor-declared emergency

b. States that volunteers who have received the State-sponsored POD training are allowed to
dispense medical countermeasures within the scope of a Governor-declared emergency

c. Defines volunteer as an individual who is not being compensated for their work

d. Provides liability protection from damages, except for willful misconduct or neglect

2. Public Readiness and Emergency Preparedness (PREP) Act

a. Covers all personnel involved in the manufacturing, distribution, dispensing, or
administration of medical countermeasures under a PREP Act declaration by the Secretary
of Health and Human Services

b. In Missouri, volunteers that have received the State-sponsored POD training are allowed to
dispense medical countermeasures within the scope of a PREP Act declaration

c. Personnel do not have to be volunteers

d. Provides liability protection from damages, except for willful misconduct or neglect

e. Persons who experience adverse reactions from medications may seek compensation
through the Health Resources and Services Administration, but POD workers and their
agencies may not be sued (except in claims of willful misconduct or neglect)

3. Medical providers crossing state lines

a. PREP Act declaration may provide liability for medical providers crossing state lines to
provide care

b. Governor of state receiving medical providers must issue an order indicating that medical
professionals who are licensed in other states are permitted to provide care for a given
period of time relevant to the disaster

DISPENSING METHODS
Open PODs
Open PODs are locations within St. Charles County that will be operated by DPH and will be open to
everyone who lives or works in the County. Open POD(s) are meant to allow for mass dispensing to the
entire County population in a short timeframe, if the need should arise.

DPH has chosen 6 sites that could be used as open PODs. Once one or multiple POD(s) are activated
by the DPH Director, deployment of resources needed to set up each location will be deployed as quickly
as possible. If designated sites are unavailable for activation, the Planning Section Chief will request the
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use of other suitable facilities. These requests will be made in coordination with school districts and
DEM.

Set-up is estimated to be within 4 – 12 hours, depending on the number of locations being activated. The
POD Activation Checklist provides more details on the process required to initiate a response of this
nature.

Staff and volunteers will be activated via a call-down roster. Job action sheets for each POD position will
be distributed by the POD Manger assigned to each POD. Just-in-time training (JITT) will be provided as
personnel are assigned their duties.
- POD Manager will provide JITT to Team Leaders
- Team Leaders will provide JITT to staff/volunteers

Spontaneous volunteers will be turned away if they show up to a POD, and informed to report to a
volunteer reception center.

Security for each POD will be provided by municipal and/or County law enforcement, supplemented by
other agencies as necessary.

Each POD will operate under the standing orders signed and approved by the DPH Director.

There are two possible models for POD operation, which will be determined by the type and scope of the
given incident:

1. Medical
a. Basic vital signs, height/weight measurements, and a medical history will be collected (to
some extent) for each person as part of a more thorough exam.

b. This model can be used for incidents of smaller scales and/or events that allow for more
thorough planning.

c. LEVEL 1 (1-100 patients) or LEVEL 2 (101-1000 patients) activation will fit the criteria
for Medical POD operation.

2. Non-Medical
a. This model is meant to get individuals through the POD with necessary medication and
information as quickly as possible in mass dispensing scenarios.

b. Basic demographic information and limited health information (medication allergies, weight,
pregnancy, etc.) will be collected for each person.

c. Health information will be reviewed quickly to ensure correct dispensing decisions are
made, but there will be limited time to ask questions or be seen by medical professionals.

d. LEVEL 2 (101-1000 patients) activation with less than 24 hours of lead time or ANY
LEVEL 3 (1000+ patients) activation will fit the criteria for non-medical POD operation.

Open POD Operations

Setup
Each POD Manager will be provided with a Setup Checklist and a POD layout that will guide them
through the necessary steps to get the POD to an operational level. They will also be provided with a
table indicating the necessary PPE that should be used for POD workers.

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Currently identified open POD sites have tables, chairs, and some office supplies that are necessary for
POD operations. However, the majority of supplies and equipment will be supplied by DPH. See POD
inventory for more detailed information as to what is necessary for POD operation.

Supplies are housed in prepared, portable cages within the DPH building and will be transported by
trailer to sites that are being activated in a time of emergency.

When setup is complete, the POD Manager will brief staff on the situation and safety concerns, and
provide JITT to incoming section managers prior to the POD opening. Those managers will then brief
their staff prior to the shift starting.

Operations
A Registered Nurse employed by DPH or another licensed medical professional will be on staff at each
POD. The ICS chart and duty assignments located in the POD folder will be utilized. The assignments
are a best possible scenario; however, substitutions may be required.

POD Managers must communicate with the Operations Section Chief in the HEOC on an hourly basis to
identify supply levels and note any issues that may arise.

The POD Manager at each POD will have final decision-making authority for their location. However, the
decision to transition to medical or non-medical dispensing, or to demobilize and close the POD, must
come from the Incident Commander.

The following list identifies basic rules for all PODs. However, the POD Manager can waive any of the
requirements as he/she feels necessary to protect the public health. Direct orders may come from the
HEOC and/or Incident Commander that may adjust any of the rules as necessary:

1. Medical Model
a. Every person receiving medication must be present to be assessed by a medical
professional.
b. Dispensing form (electronic or paper form) must be completed for each person receiving
medication.
c. Consent forms must be filled out for all vaccinations.
d. Identification must be presented to receive medication (some exceptions can be made at
the discretion of the POD Manager).
e. Dispensing of medication must be in accordance with applicable laws and current standing
orders.
f. Any person under the age of 16 will not be allowed to receive medication without a parent or
guardian present (some exceptions can be made at the discretion of the POD Manager).

2. Non-Medical Model
a. Head-of-household pick-up will be utilized (a family member can pick up a maximum of 10
courses).
b. Any person under the age of 16 will not be allowed to receive medication without a parent or
guardian present (some exceptions can be made at the discretion of the POD Manager).
c. Dispensing form (electronic or paper form) must be completed for each person receiving
medication, meaning that the person picking up medication must be able to provide basic
health information such as age, weight, and medication allergies.

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 d. Dispensing of medication must be in accordance with applicable laws and current standing
orders.
e. Symptomatic people will be referred for clinical evaluation as quickly as possible. If
necessary, EMS will be called to transport patient to a local hospital.

**Operations may begin in a medical model and transition to a non-medical model, based on direction
from the Incident Commander.**

***In order to transition from a medical model to a non-medical model, public information should be
distributed highlighting the use of head-of-household model (when applicable). Staff should also be
instructed that not every individual needs to be present, and that identification is no longer needed to
receive medication.***

When using either POD model, proper PPE must be provided to staff. The level of PPE required will vary
based on the agent of concern. At a minimum staff should be provided gloves and respirators to allow for
a baseline level of protection.
Staff will be fit-tested annually and receive N95 respirators for personal use, while gloves and other PPE
will be provided at the time of the incident. Training with other types of PPE will be provided as
necessary and available.
If the local supply of PPE is not adequate at any time during an incident, DPH will contact DEM to
request resources from others throughout the county, region, and the state.
Electronic Dispensing
Electronic means of dispensing may be appropriate to reduce the public’s time spent inside the POD.

DPH will use Dispense Assist

- Allows individuals to fill out and print medication vouchers that can make the dispensing decision
in place of a human screener.
- Dispensers are able to scan a QR code into an Excel document in order to maintain
documentation of patient information.

*In the event that electronic means are not appropriate or feasible, paper forms can be used.*

Closed PODs
A Closed POD is a location that is operated by a private business or organization to dispense medication
to a specific population (i.e., its employees and their families, and potentially clients). Closed PODs are
not open to the public and are kept extremely confidential for their safety.

Tools for a closed POD are prepackaged and should be provided upon recruitment:
1. Closed Dispensing Guide
2. MOU
3. Planning template
4. Sample floor plan
5. POD supply checklist

It is DPH’s responsibility to ensure closed POD partners are aware of their responsibilities and are ready
to dispense to their employees. This is accomplished by regular engagement via trainings and exercises.
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To the extent possible, DPH will maintain record of the medication needs for each Closed POD in order
to expedite the process of delivering mass prophylaxis. These records will be maintained by the Public
Health Emergency Planner and will be kept confidential.

Vulnerable Populations:
St. Charles County residents who are unable to make it to a POD, or send a head-of-household
representative for medication, may need delivery of medication. Residents or organizations who serve
them will call a designated 800 number and report the need for delivery or alternate dispensing methods.

Various organizations have the capability to reach populations consisting of those who don’t speak
English; who have mobility concerns; who have physical or cognitive disabilities; etc. These will be the
primary links to allow these residents to receive necessary information and medical countermeasures.

Drive-Thru Clinic:
The drive-thru process would allow for patients to enter by car into a fixed location and receive
prophylaxis while staying in their car. DPH has 1 site identified as a possible host for drive-thru clinics.

Demobilization
As it becomes evident that PODs do not need to remain open, for a variety of reasons, the POD
Manager will be contacted by the Operations Section Chief to inform him/her that the POD will be
closing, followed by any pertinent instructions. The POD Manager will then complete the Demobilization
Checklist while maintaining normal operations as necessary until closing.

Information leading to this decision will primarily result from coordination between the Operations and
Planning Sections, who will have been tracking the situation and resources throughout the incident.

***As a general rule, if the number of unique people entering the POD drops below 100 per hour, for two
consecutive hours, the demobilization process will be triggered.***

The Logistics Section will break down and move all equipment to a designated area. The POD Manager
is still responsible for SNS accountability until it is released back to the Distribution Manager.

The POD Manager must be sure that SNS is still provided with security to those already inside the POD
during this phase of the operation.

Biological waste, most likely vaccine sharps, will be transported by the vendor with which DPH contracts
with for normal disposal. These vendors possess the permits, vehicles, and protocols necessary to
transport material of this nature.

DPH Incident Command

DPH IC will be activated by the DPH Director or his/her appointed designee. IC will be set up for all
emergencies, regardless of scale, although some positions will not be filled for minor incidents.

IC Structure for DPH is pre-defined. Pre-assigned, trained individuals are located within the department
and meet all requirements for ICS. DPH will set up the HEOC in the Executive Conference Room. The
room is equipped with the following items for functioning as the HEOC:

1. MOSWIN Radio
2. Local cache of radios (stored at DEM)
3. White board
4. Video conferencing equipment

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 5. TV for media monitoring
6. Phone line for conference calls
7. Emergency phone line and data ports
8. IC folders and job descriptions
9. IC placards and identification vests

Training and Exercises

The Public Health Emergency Planner is responsible for ensuring that that all DPH personnel are trained
and have exercised their specific roles for a mass prophylaxis event. This can be measured by
completion and monitoring of a Multiyear Training and Exercise Plan. This document identifies training
needs and establishes a desired timeframe to have the necessary courses completed.

HSEEP training is strongly encouraged for this position in order to successfully complete After-Action
Reviews (AARs) and Improvement Plans (IPs). When the Public Health Emergency Planner is
unavailable, the Regional Public Health Emergency Planner will maintain training practices for the
department.

If possible, the Public Health Emergency Planner should obtain the Master Exercise Practitioner
certification, as well.

DPH participates in local, regional, and statewide exercises on a regular basis in order to test capabilities
and make improvements to existing plans. Hot Washes should be conducted immediately following each
exercise to obtain feedback from participants, in addition to what is collected from participant feedback
forms. AARs are collected and submitted within 60 days of an exercise. IPs must be submitted 180 days
of an exercise.

Regular drills pertinent to this plan are the staff call down drills and the satellite call down drills. These
are conducted monthly to determine correct contact info and average time to muster adequate staff for
incidents. Individuals that fail to respond to these drills within the time limits are contacted to ensure
appropriate contact information and knowledge of emergency responsibilities.

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Attachment 1:
SNS Request Form

County: _______________________________

Estimated population affected:

Number of citizens treated with local resources:________________________

Number of First Responders treated with local resources

(including family members): _________________________

Projected needs:________________________________

Number of citizens currently ill or symptomatic: __________________________

Possible number infected: ___________________

Possible number non-infected: ______________________

Number of current casualties: __________________________________

Location of OPEN POD(s) that will be opened:

1.
2.
3.
4.
5.
6.

Location of CLOSED POD(s) that will be opened:

1.
2.
3.
4.
5.
6.
7.
8.

176
9.
10.

Name and location of hospital(s) involved:

1.
2.
3.
4.
5.
6.

Current hospital capacity, including ICU beds and ventilator

needs:______________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
______________________________________________________

Local Resources Identified:

Pharmacy distributors:
Oxygen availability:
Nearby hospitals/healthcare facilities:
Transport capacity:
Alternative care centers:
Other:

Security Measures at Dispensing Site(s):

St Charles County Department of Public Health Official

Title
_______________
Date

Signed Copy of Standing Orders (attached to this document)

177
Attachment 2:
SNS Request Algorithm

178
Attachment 3: Draft SNS Pick-up Authorization Letter

_mm__/_dd_/__yyyy__

I, [COUNTY OFFICIAL] , direct [INSERT INDIVIDUAL(s) NAMES], acting as an agent of

[COUNTY AGENCY] ,to take custody of SNS materiel, of which responsibilities for
management, distribution, and dispensing are hereby charged to the St. Charles County Department of
Public Health until such resources are returned to the Centers for Disease Control and Prevention.

_____________________________
[COUNTY OFFICIAL] Witness
[TITLE] [COUNTY OFFICIAL]
[DEPARTMENT] [TITLE]
[DEPARTMENT]

179
Attachment 4:

Consent to Preventative Treatment

I understand that it is important to take the medication exactly as prescribed for the full duration of
treatment. I have been advised of the possible risks, complications, and anticipated benefits of the
recommended treatment and the possible consequences of not taking preventive treatment. If I am
picking up medication for other members of my household, I will explain the possible risks and
complications to them.

I certify that this form has been fully explained to me, that I have read it, or have had it read to me, and
that I understand its contents.

Signature of household representative: _____________________________________

Date: ______________

If applicable, signature of translator: ________________________________________

Date: _____________

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 Attachment 5:

STRATEGIC NATIONAL STOCKPILE MATERIEL CHAIN OF CUSTODY FORM

SITE: ______________________________________

MATERIEL/Rx LOT EXPIRATION AMOUNT RELEASED RELEASED BY DATE/ RECEIVED RECEIVED BY

# DATE (BOTTLES, BY (SIGNATURE) TIME BY (SIGNATURE)
BOXES, (PRINT (PRINT
CASE, PILLS) NAME) NAME)
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM

181
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM
X __/__/____ X
__:__
AM/PM

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Attachment 6:

Dispensing Information Form

The paper dispensing information form can be found in Emergency Preparedness documents.

Guidance on electronic forms via Dispense Assist will be distributed at the time of the incident.

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Attachment 7:

Pharmacies in St. Charles County

*see file maintained by the Emergency Preparedness Program*

184
Attachment 8:

Nursing Homes/LTC Facilities in St. Charles County

*see file maintained by Public Information*

185
 ANNEX I

MASS PATIENT CARE

Attachment 1: Human Services Partners

Attachment 2: RHCC Shelter Medical Support Annex

PURPOSE
The impact of a Mass Casualty Event (MCE) of a significant magnitude will likely overwhelm hospitals
and other traditional venues for health care services, and may render many facilities inoperable. This
scenario could necessitate the establishment of alternate care sites (ACS), mass dispensing clinics,
mass shelters or functional needs shelters for the provision of care and services that would normally
be provided in an inpatient facility.

In the aftermath of the September 11, 2001 attacks, a more concerted focus was placed on the
definition and development of public health and medical surge capacity. A distinction was drawn
between health care facility surge capacity and community surge capacity, with the understanding that
community surge capacity strategies were focused on the creation of out-of-hospital solutions to the
delivery of health care and other services.

This understanding led to the emergence of a new definition of ACS, one that included a location for
the delivery of medical care that occurs outside the acute hospital setting for patients who, under
normal circumstances, would be treated as inpatients. In addition, the ACS has come to be viewed as
a site to provide event-specific management of unique considerations that might arise in the context of
catastrophic MCEs, including the delivery of chronic care; the distribution of vaccines or medical
countermeasures; or the quarantine, cohorting, or sequestration of potentially infected patients in the
context of an easily transmissible infectious disease.

In addition to ACS, the need may arrive for mass shelters to serve the general public and those with
various functional needs.

EMERGENCY RESPONSIBILITIES1
St. Charles County DPH
1. Activate pre-determined public health roles (population monitoring, environmental health and
safety assessments, accessibility for populations with functional needs, and need for
decontamination) needed in the mass care response in coordination with mass care and
health partners.

2. Coordinate with response partners to utilize pre-existing jurisdictional risk assessments,

environmental data, and health demographic data to identify population health needs in the
area impacted by the incident.

3. Coordinate with response partners to complete a facility-specific environmental health and

safety assessment of the selected or potential congregate locations.

4. Coordinate with partner agencies to assure food and water safety inspections at congregate
locations.

5. Coordinate with partners to assure health screening of the population registering at

congregate locations.

6. Coordinate with healthcare partners to assure medical and mental/behavioral health services
are accessible at or through congregate locations.
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 7. Coordinate with providers to facilitate access to medication and assistive devices for
individuals impacted by the incident.

8. Coordinate with jurisdictional HAZMAT resources or other lead agency to assure provision of
population monitoring and decontamination services, including the establishment of tracking
systems of contaminated or possibly contaminated individuals who may enter congregate
locations, if applicable. See Annex K for more information regarding incidents of this nature.

9. Disseminate accessible information regarding available mass care health services to the
public.

10. Coordinate with Division of Humane Services and other agencies to accommodate and
provide care for service animals within general shelter populations.

11. Coordinate with EMS, DEM, local, state, tribal, and federal health agencies, state hospital
associations, social services, and participating nongovernmental organizations to return
individuals displaced by the incident to their pre-incident medical environment (for example,
prior medical care provider, skilled nursing facility, or place of residence) or other applicable
medical setting during and after the incident.

ORGANIZATION
Alternate Care Sites
There are many different models and categories of ACSs. An ACS may be best suited to function as
primary triage sites, providing limited supportive care, offering alternative isolation locations to
infectious-disease patients, and serving as recovery clinics to assist in expediting the discharge of
patients from hospitals.

Hospitals will be the lead agencies for determining the need for and location of ACSs in the St Louis
Region. St. Charles County DPH and DEM, along with regional counterparts, will have a supportive
role by providing staff, supplies, and/or medical countermeasures if they are available.

Mass Dispensing Sites and Vaccination Clinics

DPH will be the lead agency for planning and executing mass dispensing clinics, also known as points
of dispensing (PODs).

Annex H of this Public Health EOP addresses the planning, setup, and execution of PODs.

Shelters
For this annex, shelters are defined as a means of providing protective shelter, temporary lodging,
emergency feeding, clothing, and/or medical care to persons who are forced to leave their homes due
to an emergency, disaster, or precautionary evacuation.

For St Charles County, the American Red Cross will be the point of contact in charge of coordinating
activation of shelters within the County. As indicated above, DPH will provide supportive services to
ensure shelters meet the needs of those in need.

Access and Functional Needs Sheltering

Access and Functional Needs (AFN) is a broad term used to describe someone who may have
additional needs before, during and after an incident in functional areas, including but not limited to:
maintaining independence, communication, transportation, supervision, and medical care.

187
Whenever possible, individuals with AFN will be cared for within “general population” shelters.
Individuals with AFN typically have physical or mental conditions that require more extensive
medical/nursing oversight. Family members are often primary caregivers who understand these
individuals’ needs, so allowing them to remain together increases the chances that these individuals
will receive the care they need. The goal within any shelter is to devote a portion of the space to
families and individuals with AFN, who may require additional space and resources to remain
comfortable and safe.

Individuals with AFN may also need to be sustained with more medical resources and individual care
than can typically be provided in a general shelter. Hospitals, school districts, and other community
agencies may provide guidance and resources that can assist public health and other disciplines care
for these individuals.

When possible, nurses or other medical staff should be designated to caring for these individuals, at
least for a portion of their shift. The provision of care in shelters reduces surge demands on hospitals
where, in times of emergencies, services and care are demanded by patients with more urgent
medical needs.

See Annex X for more detailed considerations and resources that are available to assist jurisdictions
with planning efforts related to AFN populations.

Sheltering of Registered Sex Offenders

Federal law requires that sex offenders be provided emergency human services. In order to protect
children and other members of the general population, this can be accomplished in one of three ways:

1. Shelter these individuals in a designated facility, separated from the general population

2. Shelter these individuals in the same building, but in a separate area of that building

3. Shelter these individuals in the general population after providing the general population with
knowledge of their presence

Reunification
The American Red Cross will be in charge of providing reunification services, especially for
reunification of children with adults.

The State of Missouri has a plan for provision of emergency human services, including reunification.
Assistance can be requested via local DEM.

The National Center for Missing and Exploited Children is the national lead for this function, and they
may provide support if necessary and available.

Private sector partners such as airlines, amusement parks, and Amtrak have systems in place to
manage these situations on a daily basis. These partners may be an asset in planning and/or
response if such assistance is necessary.

References

1. (2011). RHCC Shelter Medical Support Annex, pp. 18-19.

188
Attachment 1:

Human Services Partners

American Red Cross of Eastern Missouri

http://www.redcross.org/local/missouri/eastern-missouri

Shelters Currently Open

http://www.redcross.org/get-help/disaster-relief-and-recovery/find-an-open-shelter

ARC 24-hour phone: (314)516-2700

Salvation Army – Midland Division

http://stlsalvationarmy.org/about-us/

314-646-3000

St. Charles County COAD

http://www.communitycouncilstc.org/disasteremergency-planning-coad

All assistance should officially be requested via DEM

189
Attachment 2:

RHCC Shelter Medical Support Annex

This document contains information related to shelter needs from activation to demobilization.

Especially relevant locations within the document are listed below:

• Pp. 18-19: Role of Public Health

• Pg. 22: Shelter Medical Support Group Personnel Contact List
• Pg. 23: Shelter Medical Support Group Shift Schedule
• Pp. 24-25: Shelter Medical Team Staffing Guidelines
• Pp. 26-27: Shelter Medical Station Layout Recommendations
• Pp. 28-30: Initial Medical Assessment Form
• Pp. 31-34: Durable Medical Supplies
• Pp. 36-51: Consumable Medical Supplies
• Pp. 52-53: Medications

190
 ANNEX J

MASS FATALITY

Attachment 1: Medical Examiner’s Office

Attachment 2: Local Mass Fatality Resources
Attachment 3: Mass Fatality Planning Toolkit
Attachment 4: SCC Funeral Homes

PURPOSE
A mass fatality incident is defined as an occurrence of multiple deaths that overwhelms the usual
routine capabilities of local resources. Natural disasters, terrorist attacks, and accidents such as plane
crashes have the potential to produce catastrophic numbers of fatalities. Attacks using weapons of
mass destruction (WMD) have the potential to create extraordinary numbers of fatalities and may
present concerns related to biological, chemical, and/or radiological materials.

A variety of response organizations will be required to respond in order to effectively manage a mass
fatality incident. The purpose of this annex is to describe the various ways in which the St. Charles
County DPH will provide support in the management of large-scale incidents, if necessary.

EMERGENCY RESPONSIBILITIES
St. Charles County DPH
DPH does not have the manpower, resources, or expertise to serve as the lead agency in the
management of a mass fatality incident. Furthermore, in many scenarios, there may not be a
significant public health threat that requires a large DPH response. For these reasons, DPH will act as
a supporting agency that can provide assistance in large-scale incidents, particularly those that are
related to biological agents and/or communicable disease threats to the overall community.

DPH will:

1. In coordination with other state and federal officials, use information on the known agent
causing death to determine the appropriate handling and burial of bodies.

2. Provide responders and the general public (when appropriate) with information related to
handling remains of deceased individuals.

3. Provide available staff and resources to assist with Family Assistance Center (FAC)
operations.

4. Assist in coordination of services for family reunification, victim identification, and

mental/behavioral health for responders, victims, and their families.

5. Assist ARC and other community organizations with activation of shelters, if needed for
service to victims’ families and/or displaced members of the public.

St. Charles County Medical Examiner’s Office

1. Evaluate scene and overall situation including number of fatalities, condition of bodies,
possible cause(s) of death, resource needs for processing of remains.

2. Assist in recovery of remains.

3. Identify and process remains of deceased individuals.

191
 4. Assist with collection of antemortem and postmortem data to allow for family reunification
and/or victim identification.

Law Enforcement
1. Scene security and perimeter control.

2. Evidence collection and processing.

Fire/EMS
1. Perform search and rescue if possible.

2. Triage surviving victims on scene.

3. Provide care/and or transport of those in need of immediate medical attention.

ORGANIZATION
1. At the local level, the incident will be managed by law enforcement, fire/HAZMAT personnel,
the medical examiner’s office, or a combination of these agencies in a unified command
structure.
a. Support will be provided by DPH, DEM, volunteer organizations, and other agencies that
are identified at the time of the incident.
b. DEM maintains a supply of mass fatality equipment that can be quickly deployed to
provide assistance with field operations.

2. At the state level, there are multiple resources that can be requested when local resources
become overwhelmed.
a. The Missouri Disaster Response System (MoDRS)
• State portable morgue
• Missouri Mortuary Response Team (MOMORT)
• Partnerships with MSHP, MO National Guard, and the Kansas City Mortuary
Operational Response Group (KCRMORG)

b. Victim Information Center

• Asset available to assist families with identification and/or reunification.
• Team of 3 professionals will be assigned to each family from the time they present an
individual who is missing to reunification or identification of a body.
i. Behavioral Health Specialist
ii. Nurse – assists family with antemortem data collection
iii. Spiritual Care – typically a chaplain
iv. *MSHP Officer* – will replace nurse after data collection

c. Homeland Response Force – element within MO National Guard specialized for mass
fatality and other types of incidents

d. SEMA is the agency through which the above and other resources can be requested.

e. The Missouri Funeral Directors and Embalmers Association maintains the Missouri
Funeral Directors Association Disaster Response Team (MFDADRT) .

192
3. At the federal level, FEMA maintains the Disaster Mortuary Operation Response Team
(DMORT).
a. An evaluation team will be deployed to help evaluate the personnel and equipment that
may be necessary to manage the incident. The team can typically have individuals on
scene within 8 to 12 hours of being requested.

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Attachment 1:

Medical Examiner’s Office

1650 Boone’s Lick Rd.

St. Charles, MO 63301
Phone: (636)949-1878
Fax: (636)949-1847
Death Reporting Line: (636)949-1849

Mary Case, M.D.

(636)925-1647 (home)
(314)315-0189 (cell)
Chief Medical Examiner
macase@sccmo.org

Kathleen Diebold Hargrave, M.A., D-ABMDI

Chief Forensic Investigator
(636)949-7400 x5415 (office)
(314)323-3001 (home)
(314)346-3034 (cell)
khargrave@sccmo.org

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Attachment 2:
Local Mass Fatality Resources

Equipment Managed by St. Charles County Division of Emergency Management

• Body bags (adult, child, infant)
• Autopsy saws
• Gloves
• N95 respirators
• Metal detector
• Evidence kits
• Embalming machine
• Shoe covers
• Stretchers
• Tents (open and enclosed)
• Fire extinguishers
• Gas cans
• Lighting equipment
• Aspirator
• Portable x-ray machines
• Bleach
• Tool kits
• Taps
• Toughbook laptops
• Cameras
• Biohazard bags
• Morgue tables
• Two trailers (one with capacity of 20 bodies and cooling capabilities)

Inventory was completed in collaboration with St. Charles County DEM and the St. Charles County
Medical Examiner’s Office.

For a complete inventory of these resources, contact DEM at (636)949-3023.

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Attachment 3:
Mass Fatality Planning Toolkit
This document was created by the Texas Department of State Health Services and contains useful
resources that can be used in a time of mass fatality emergency.

Especially relevant locations within the document are listed below:

• Pp. 22-23: PPE for the Safe Handling of Human Remains
• P. 24-25: Infection Control and the Decontamination of Human Remains
• P. 26: The Body Process Pathway
• P. 27: Recovery Site Report
• P. 28: Recovery Site Field Log
• P. 30: Decedent Tracking Sheet
• Pp. 33-35: Decedent ID Form
• P. 37: Post-processing Storage Log
• P. 41: Info Sheet for Survivors of a Traumatic Event
• P. 42: Info Sheet for Disaster Response Workers
• Pp. 43-51: FAC Assessment Considerations
• P. 52: Religious Preferences Regarding Final Disposition
• Pp. 53-56: Antemortem Interview Form
• Pp. 57-58: Call Center Script
• P. 59: Call Center Intake Form
• P. 61: Remains Released Authorization Form
• P. 62: Remains Released for Final Disposition Log

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Attachment 4:
St. Charles County Funeral Homes

Alternative/Lonning Funeral Services

2115 Parkway Dr.
St. Peters, MO 63376
(636)498-5300

Baue Funeral Homes

620 Jefferson St.
St. Charles, MO 63301
(636)940-1000

311 Wood St.

O’Fallon, MO 63366
(636)240-2242

3950 West Clay St.

St. Charles, MO 63301
(636)940-1000

Newcomer Funeral Home

837 Mid Rivers Mall Dr.
St. Peters, MO 63376
(636)875-1200

Paul Funeral Home

240 N. Kingshighway St.
St. Charles, MO 63301
(636)724-0283

Pitman Funeral Home

1545 Wentzville Pkwy.
Wentzville, MO 63385
(636)327-6600

Stygar Mid-Rivers/Hutchens
5987 Mid Rivers Mall Dr.
Cottleville, MO 63304
(636)936-1300

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 ANNEX K

RADIOLOGICAL, NUCLEAR, & CHEMICAL INCIDENTS

Attachment 1: Radiological, Nuclear, Chemical Resources

Attachment 2: Region C CHEMPACK Locations (FOUO)

PURPOSE
Radiological, nuclear, and chemical incidents have the potential to cause widespread panic in the
event of an accidental or intentional release of these materials. Local infrastructure must be prepared
to respond to those who are directly affected, as well as those who believe they or their belongings
have been exposed. Whether or not the incident is on a small or large scale, the lack of knowledge
among the general public regarding radiological, nuclear, and chemical substances will likely
contribute to an increase in perceived severity, which will further strain local resources.

This annex will outline the functions of DPH and collaborating partners in an emergency of this nature.

***St. Charles County DEM, together with the St. Charles County HAZMAT
team, will be the lead agency in a radiological, nuclear or chemical incident.
The St. Charles County DPH will serve as a support to their response.***

EMD: Cpl. Chris Hunt Phone: (636) 949-3023

HAZMAT Team Leader: Chief Tom Vineyard Phone: (636) 272-3493

EMERGENCY RESPONSBILITIES
St. Charles County DPH
DPH does not have the manpower, resources, or expertise to serve as the lead agency in the
management of a radiological, nuclear, or chemical incident. Furthermore, in many scenarios, there
may not be a significant public health threat that requires a large DPH response. For these reasons,
DPH will act as a supporting agency that can provide assistance in large-scale incidents.

DPH will:

1. In coordination with other state and federal officials, use information on the known
substance(s) to determine the presence of a public health threat.

2. Provide responders and the general public (when appropriate) with information regarding
health effects related to exposure to the substance(s) in question.

3. Provide available staff and resources to assist with shelter and/or Community Reception
Center (CRC) operations.

4. Assist in coordination of services for family reunification, victim identification, and

mental/behavioral health for responders, victims, and their families.

5. Assist ARC and other community organizations with activation of shelters, if needed for
service to victims’ families and/or displaced members of the public.

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 6. If necessary, coordinate with DEM and hospitals to establish ACSs, particularly for populations
with functional needs.

7. If necessary, coordinate with DEM to initiate deployment of emergency medical supplies, the
SNS, and/or CHEMPACK.

8. In conjunction with MO DHSS, conduct damage assessments of affected restaurants, day care
centers, nursing homes, hospitals, public water and sewer systems and give
recommendations regarding embargo of food, water and milk supplies that were affected by
the incident.

Law Enforcement
1. Scene security and perimeter control.

2. Evidence collection and processing.

Fire/EMS
1. Perform search and rescue if necessary.

2. Triage victims if necessary.

3. Provide care/and or transport of those in need of immediate medical attention.

DEM/HAZMAT Team
1. Determine the nature of materials that were released and potential environmental and/or
health concerns.

2. Establish IAP to mitigate effects of hazardous materials.

3. Coordinate with local, state, and federal partners to effectively utilize available resources.

4. Determine need for mass decontamination and establish location(s) for public to go.

a. SSM & BJC have the capability to establish sites where needed.

b. St. Louis Regional Radiological Response MRC has equipment and volunteers that can
assist with CRC operations, including population monitoring in radiological incidents.

ORGANIZATION

1. At the local level, law enforcement and/or fire departments will likely be the first agencies
notified of a radiological, nuclear, or chemical incident.
a. If necessary, these agencies will request services of the HAZMAT Team, which will
then take command of the situation.

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 b. If DPH is the first agency to become aware of an incident, personnel will notify DEM to
initiate proper emergency response.

c. DEM will coordinate with HAZMAT to request resources and provide technical
assistance, while also alerting other community stakeholders.

2. At the state level, MO DHSS, MO Department of Natural Resources (MDNR), SEMA, and
others will be notified if the situation evolves to the point that local resources are inadequate.
a. The state lead for chemical incidents is MDNR. MDNR should be notified of the
incident via the 24-hour Environmental Emergency Hotline at (573)634-2436.

b. MO DHSS can be notified via the DSR at 1-800-392-0272.

c. EPA can be notified via the EPA Region 7 Emergency Response Line at
(913)281-0991 or National Response Center at 1-800-424-8802.

d. SEMA will be contacted through St. Charles County DEM.

3. At the federal level, the CDC, EPA, FEMA, USDA and others may be notified by state officials,
depending on the nature and scope of the incident.

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Attachment 1:
Radiological, Nuclear, Chemical Resources

1. Environmental Protection Agency (EPA)

http://www.epa.gov

a. Coordinator for Emergency Support Function #10, Oil and Hazardous Materials
Response Annex.
b. US EPA Region 7 http://www.epa.gov/aboutepa/epa-region-7-midwest
c. 24-hour EPA Region 7 Emergency Response Line: (913) 281-0991
d. 24-hour National Response Center: 1-800-424-8802

2. Missouri Department of Natural Resources (MDNR)

http://dnr.mo.gov/env/esp/esp-eer.htm

a. State lead for Annex N – Hazardous Materials of the Missouri State EOP.
b. 24-hour Environmental Emergency Hotline: (573) 634-2436

3. Chemical Risk Mapping Project

Bureau of Environmental Epidemiology
Division of Community and Public Health
Missouri Department of Health and Senior Services

Maps for each county showing the fixed chemical facilities and an emergency planning zone
buffer around each of these facilities. Hospitals, day care centers, nursing homes, and
elementary and secondary schools are identified that are located within these buffer zones.
Reports provide information including, chemical type and quantity, addresses, and 24-hour
emergency contact numbers. Addresses and phone numbers are provided for the sites located
within the buffer zones.

4. Environmental Health Operational Guidelines

Bureau of Environmental Health and Safety
Division of Community and Public Health
Missouri Department of Health and Senior Services

http://www.health.mo.gov/atoz/ehog/pdf/ehogmanual.pdf

Provides procedures for inspections and embargo actions.

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Attachment 2:
Region C CHEMPACK Locations (FOUO)

Barnes Jewish Hospital

216 S. Kingswighway Blvd.
St. Louis, MO 63110

Missouri Baptist Medical Center

3015 N. Ballas Rd.
Creve Coeur, MO 63131

St. Louis Children’s Hospital

1 Children’s Place
St. Louis, MO 63110

SSM St. Louis University Hospital

3635 Vista Ave.
St. Louis, MO 63110

SSM St. Mary’s Health Center

6420 Clayton Rd.
Richmond Heights, MO 63117

St. Anthony’s Medical Center

10010 Kennerly Rd.
St. Louis, MO 63128

Mercy Hospital St. Louis

615 S. New Ballas Rd.
St. Louis, MO 63141

A map of these locations is also available. Distribution of these locations is FOUO

and must be approved by MO SEMA and/or DSNS.

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 ANNEX L

ENVIRONMENTAL HEALTH & PROTECTION

Attachment 1: Environmental Health Staff Contact Information

Attachment 2: Environmental Vendor List
Attachment 3: Environmental Emergency Shelter Evaluation Form
Attachment 4: Environmental Emergency Job Action Sheet
Attachment 5: Missouri Rapid Response Team Request Form

PURPOSE
Complications affecting the health of the community including disease; sanitation problems;
contamination of food, water, people, animals, areas, and structures; mass care; and mass causalities
are all scenarios in which environmental health may become a concern. These concerns may arise
due to various types of incidents:

• Naturally occurring emergencies such as floods, tornadoes, and winter storms

• Large chemical releases or attacks
• Outbreaks of communicable disease including pandemic influenza
• Biological terrorism
• Chemical releases or attacks
• Radiological incidents
• Nuclear detonations

Circumstances of the emergency event will determine the nature and extent of intervention required
by environmental staff.

The Environmental Health Division within DPH serves all of St. Charles County except municipalities
that manage their own environmental health agencies (i.e., City of St. Peters).

This annex will provide guidance and instruction for DPH Environmental Health staff for all emergency
events that warrant an environmental public health response. It is intended to enable Environmental
Health staff to act in a coordinated fashion with other emergency responders, both internal and
external to DPH.

EMERGENCY RESPONSIBILITIES
St. Charles County DPH
Environmental Health Division
Charged with improving, protecting, and promoting the health and the well-being of people in St.
Charles County, with a particular focus on protecting the environment and reducing environmental
health hazards.

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In the event of a public health or environmental health disaster or emergency, the Division will:
1. Provide support and advice related to environmental hazards to law enforcement, fire,
HAZMAT, EMS and other responders.

2. Provide information and risk analysis regarding the potential health effects of the
environmental hazard, continuing through the recovery phase of the emergency response
effort.

3. Provide public information support as necessary.

4. Act to reduce hazards’ impact on the public’s health using regulatory functions (e.g., closing
food establishments after natural disaster or chemical spill).

5. Inspect public entities that may have been affected by the incident, including:
a. Restaurants
b. Public swimming pools
c. Daycare centers
d. Lodging establishments

6. Inspect mass care shelters that may need to provide food and water to the public.

7. Inspect damaged buildings that may present a hazard to surrounding residents or wildlife.

8. Ensure correct practices for solid waste disposal (especially in HAZMAT incidents).

9. Assist with investigations of food- and waterborne disease outbreaks in coordination with the
CD program.

10. Provide sampling and consultation regarding air and water quality.

11. Ensure appropriate and adequate functioning of sanitation facilities.

12. Implement actions to prevent or control vectors such as flies, mosquitoes, rodents and other
pests.

13. Coordinate with Humane Services Division to ensure proper disposal of dead animals.

Humane Services Division

1. Advise veterinarians and meat inspectors on the disposition of animal carcasses.

2. Advise local veterinarians, pet owners, and livestock owners during a response involving an
animal disease outbreak.

3. Coordinate animal rescue and sheltering.

Emergency Preparedness Program

1. Coordinate individual programs and activation of mass care shelters, if necessary, in
collaboration with other DPH programs and County agencies.

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St. Charles County DEM
1. Coordinate requests for and acquisition of resources via local mutual aid or state assistance.

2. Assist with remediation practices as allowable based on the type of substance in question.

MDNR
1. Serve as lead agency in response to any oil or hazardous material (with the exception of
agricultural chemicals) spills or releases.

2. Serve as lead state agency in debris/waste management and environmental contamination

situations.

3. Provide MDNR contractors, if necessary, to assist with cleanup or evidence collection.

4. In a chemical event, provide support and advice to law enforcement, fire, EMS and other
responders regarding hazardous chemicals, debris removal/disposal, and long-term cleanup.

5. Assist or lead the debris removal process including sorting, transfer, and disposal if the
amount of debris generated exceeds capabilities of local resources.

6. Identify and remediate concerns among wildlife affected by environmental hazard(s).

7. Assist with radiological monitoring of individuals and vehicles as necessary.

8. Assist with decontamination of vehicles and equipment as necessary.

9. Provide technical assistance for debris clearance on state waterways and in forested areas.

Missouri Dept. of Agriculture (MDA)

1. Serve as lead agency in response involving agricultural chemicals.

2. Recommend protective/remedial actions following a spill or intentional release.

3. Assure safety of the food supply during a human, animal, or plant disease outbreak.

4. Coordinate disposal of livestock carcasses if necessary.

MO DHSS
1. Provide guidance on protective actions to state and local authorities in areas affected by
incidents involving hazardous materials (chemical, radiological, or biological).

2. Provide advice and technical assistance for the delivery of health protection services and
critical medical services to medical providers in areas affected by incidents involving
hazardous materials.

3. Assess long-term health implications of an incident involving human exposure to hazardous

materials.

4. SPHL will make its laboratory capabilities available 24/7 for the analysis and identification of
potentially hazardous materials during a potential WMD event, natural disaster, or other public
health emergency.

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 5. In conjunction with local health agencies, determine the safety of water supply.

6. Assist local agencies with identification and management of adulterated and distressed foods
in hospitality establishments (e.g., restaurants, bars, hotels, shelters).

7. Assist local agencies with cleanup activities for re-occupancy of homes and lodging
establishments.

8. Deploy the Missouri Rapid Response Team (MRRT) if necessary

a. MRRT is designed to assist local agencies with complex, multi-jurisdictional
contamination incidents or foodborne outbreaks
b. Consists of personnel from FDA, MO DHSS, and MDA
c. Combines epidemiology, environmental health, and laboratory services
d. Can expedite testing of samples with assistance from FDA
e. Can arrive on scene in approximately 24 – 48 hours with a maximum of 4 individuals
f. Can provide remote assistance as necessary
g. Requesting procedures:
i. DEM
ii. MO DHSS Senior Epidemiologist for the Eastern District
iii. MO DHSS Environmental Public Health Specialist V for Region C
iv. MO DHSS, Center for Local Public Health Services

MODOT
1. Ensure that HAZMAT transportation regulations are complied with and enforced.

2. Lead debris removal on interstates and state highways.

3. Issue necessary transport permits.

SEMA
1. Assist local efforts with HAZMAT assessment and response teams, when necessary and
available.

2. Ensure that operations and documentation meet requirements for federal assistance,
particularly with debris removal and HAZMAT remediation.

3. Provide investigative support to identify source of HAZMAT spill or release.

ORGANIZATION
At the local level, DPH and DEM will have primary control over environmental incidents as they have
the expertise to respond to the majority of hazards within the County. However, major spills or
intentional releases of hazardous materials will likely require assistance from state and/or federal
partners.

At the state level, the agencies mentioned above will provide guidance and resources for incidents
large enough to overwhelm local capabilities. Many incidents will affect multiple jurisdictions, so
coordination of assistance will primarily occur via MO DHSS and SEMA.

At the federal level, agencies such as the CDC, EPA, USDA, and DHS will manage long-term public
monitoring; collection and processing of data and evidence; and long-term health effects of the
incident. These activities will continue until such time when state and local agencies can resume
command of the situation.
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ENVIRONMENTAL HEALTH EMERGENCY FUNCTIONS

FOOD SAFETY
DPH epidemiologists and environmental public health staff will work with MO DHSS, MDA, and local
officials to identify which food supplies have been affected by the incident and ensure a safe food
distribution system. This may include regular inspection of retail food service establishments,
education of food-service staff, and public education. Epidemiologists and environmental staff will
coordinate these efforts with the appropriate agencies responsible for grocery stores and meat
packing plants such as the MDA and USDA.

The role of DPH professionals while investigating a foodborne disease outbreak varies widely
according to the nature of the incident. The investigation may include an environmental evaluation of
the food facility suspected as the source of the outbreak. MO DHSS may play either a supporting or
lead role in the investigation depending on the severity of the outbreak or if the situation crosses
governmental jurisdictions.

MO DHSS or other governing agencies will be responsible for public notification regarding any
identified contaminated facilities and the work plan for resolution of the problem.

In the event of an incident, staff may be asked to help with the following activities:
• Contacting licensed food service facilities to assess operational status.
• Ensuring that licensed food service facilities can provide for hand-washing, ware-washing,
safe water, and refrigeration (e.g., with generators or dry ice).
• Providing information to the public and businesses regarding food safety topics such as
salvaging, sorting and proper disposal.
• Assuring that mass care sites comply with best practices for safe and hygienic food
preparation and service.
• Providing information/recommendations to help manage donations of food.

Assessment
1. Inspect food preparation and retail facilities, including mass shelter and mass care sites.
2. Qualitatively assess the impact of the incident on food in the area near the incident.
3. Identify basic food safety issues such as proper food temperatures, food storage, cross-
contamination, cleaning and sanitizing, hand washing, and personal hygiene.
4. Develop a sampling plan and coordinate sampling and analysis of food, water or other
materials as necessary.
5. Determine the fitness of foods for consumption and identification of potential problems related
to food contamination (e.g., radiation, chemical, bacterial, and viral).

Intervention
1. Assist other disaster response agencies with food transport, storage, and distribution logistics.
2. Assist with sorting, condemnation, and disposal of contaminated food at commercial
establishments.
3. Determine corrective actions and make recommendations to facility managers, homeowners,
and authorities.
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Communication/Education
1. Provide the public and businesses with information regarding the protection of perishable
foods, as well as proper preparation, storage, and disposal of foods under emergency
conditions.
2. Provide local and state personnel with food service information and data regarding number of
food handling establishments, retail food stores, mass feeding centers, mobile kitchens, and
food distributors.

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DRINKING WATER SAFETY
In a major disaster, the public water supply system (treatment plants, storage and pumping facilities,
and distribution pipelines) could be damaged, interrupted or contaminated. Environmental public
health staff will work with St. Charles County DEM, MO DHSS and local public water operators
regarding disruption of water supplies. MO DHSS or other governing agencies will be responsible for
public notification of any identified contaminated facilities and the work plan for resolution of the
problem.

The role of DPH professionals while investigating a waterborne disease outbreak varies widely
according to the nature of the event. MO DHSS may play either a supporting or lead role in the
investigation depending on the severity of the outbreak or if the situation crosses governmental
jurisdictions.

In the event of an incident, staff may be asked to help with the following activities:
• Ensuring that safe, potable water will be available to the general public and to highly-
susceptible populations (hospitals, nursing homes).
• Preventing outbreaks of water-borne diseases such as E. coli, salmonella, typhoid, cholera,
dysentery, and infectious hepatitis.
• Providing information to the public regarding water safety and supply.
• Providing technical assistance and guidance to food service establishments.

Assessment
1. Recognize the multiple pathways of exposure:
a. Ingestion and aspiration of water
b. Dermal absorption (during cleanup and bathing)
c. Consumption of food contaminated by water during preparation
d. Consumption of food contaminated by water indirectly via the food chain
2. Prepare a sampling plan and perform field analysis of drinking water for pH, disinfectant
residuals, and microbiological contamination.
3. Coordinate sampling and analysis for other parameters of state, local or US EPA regulations,
as necessary.
4. Qualitatively assess the impact of the incident on water resources in the area near the
incident.
5. Inspect water treatment, storage and distribution systems.
6. Conduct public health assessments of community drinking water systems and private wells,
including at mass shelter and mass care sites.
7. Conduct security assessments of community drinking water systems.
8. Conduct damage assessments of community drinking water systems and private water wells
during or following a disaster.
9. Document public water system damage.

Intervention
1. Prioritize special needs of susceptible populations most at risk for health effects from
dehydration, waterborne disease, and water contamination.

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 2. Ensure an alternate water supply for all community needs.
3. Coordinate delivery by water haulers; coordinate bottled water distribution.
4. Determine corrective actions and make recommendations to water operators, facility
managers, homeowners, and authorities.
5. Remove and dispose of contaminated water and standing water from residential areas and
industrial facilities.
6. Assist in the emergency restoration or replacement of facilities for treatment, storage and
distribution.
7. Assist in the disinfection of distribution systems, storage tanks, and water-hauling tankers.
8. In case of suspected waterborne disease outbreak, follow established investigation protocols.

Communication/Education
1. Communicate with public water utilities about extent of damage.
2. Notify the public about the condition of water and actions to take.
3. Notify the public about availability and location of potable water.
4. Disseminate information about water needs and rationing.
5. Educate the public on water disinfection and storage.
6. Educate the public about well testing and disinfection.

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WASTEWATER
Sewer lines can become flooded or damaged in a disaster. In this case, human waste containing fecal
matter may be released into the environment. This waste may contain a range of disease-causing
microorganisms including viruses, bacteria, and eggs or larvae of parasites. Microorganisms such as
E. coli, salmonella, typhoid and cholera may be contained in human feces, and may enter the human
body through contaminated food, water, cooking utensils, and by contact with contaminated objects.

• In the event of an incident, DPH professionals may be asked to help with the following
activities: Assuring proper management and disposal of human waste.
• Preventing human exposure to and the spread of disease-causing microorganisms.
• Preventing contamination of domestic water supplies.
• Preventing the degradation of surface and groundwater quality.
Assessment
1. Prepare a sampling plan and perform field analysis of wastewater for chemical and biological
contamination.
2. Conduct surveys and/or damage assessments of wastewater systems, including private on-
site systems, and temporary or emergency systems for disaster-stricken areas.
3. Assess the impacts of wastewater on groundwater, surface water, drinking water supplies, and
recreational waters.
4. Coordinate sampling and analysis for other parameters of state, local or US EPA regulations,
as necessary.
5. Conduct surveys or assessments of facilities and practices regarding hygiene and disposal of
human excreta in disaster-stricken areas, mass shelters, or mass care sites.
6. Sample and test surface waters and effluents for indicator organisms, pathogens, chemicals,
etc.

Intervention
1. Determine corrective actions and make recommendations to water operators, facility
managers, homeowners, and authorities.
2. In case of a suspected waterborne disease outbreak, follow established investigation
protocols.
3. Coordinate the placement and/or construction of alternative wastewater management systems
(e.g., chemical toilets, pit privies, etc.) if necessary.
4. Monitor alternative system maintenance.

Communication/Education
1. Provide public information regarding proper emergency sewage disposal methods.
2. Provide public information related to the prevention of disease.
3. Post hazard warnings.
4. Promote healthy behaviors related to interaction with wastewater.

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SOLID WASTE MANAGEMENT
In the event of a natural disaster or act of terrorism, the infrastructure that routinely deals with the
storage, collection, and disposal of solid waste may be interrupted anywhere from a few days to
several months. Disaster situations often result in large volumes of solid waste that overburden the
waste management infrastructure, and present the following potential public health concerns:
• Insect and rodent harborage
• Disease caused by environmental agents (such as mold)
• Chemical contamination.
The disposal of medical waste from health care facilities may be disrupted in the event of a disaster,
while both the demand for medical services and the generation of medical waste are likely to
increase. The resulting medical wastes must be handled and disposed of carefully to eliminate
potential hazard to the public.

DPH staff may be asked to help with the following activities:

• Determining the extent of damage to the system.
• Ensuring the community has the proper guidance regarding safe operations and recovery from
damage sustained.
• Communicating with the public about safe practices and the prevention of secondary public
health problems associated with a disrupted waste management system.

Assessment
1. Check with appropriate contacts to determine extent of solid waste management system
disruption.
2. Conduct surveys or assessments of facilities and practices regarding solid waste and solid
waste management in disaster-stricken areas, mass shelters, or mass care sites.
3. Develop a sampling plan and coordinate sampling and analysis of materials, if necessary.

Intervention
1. Ensure that solid waste is properly and promptly stored, collected, and disposed of to prevent
vector nuisances (flies and rodents), odor problems, or the potential contamination of food and
water supplies.
2. Serve as liaison with functioning facilities and collection services to try and ensure continuity of
solid waste management services.
3. Work with appropriate contacts to publicize the availability of emergency disposal and or
transfer sites.
4. Provide regulatory oversight and technical assistance as needed.
5. Serve as a liaison between disaster site cleanup operations, waste haulers, and disposal
facilities.
6. Monitor for hazardous wastes and disease vectors.
7. Determine corrective action and make recommendations to facility managers, the public, and
authorities.
8. Verify that facilities receiving medical waste are operational and can continue to accept and
treat waste on site.
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 9. Determine the availability of medical waste transporters.
10. Inspect medical waste facilities.

Communication/Education
1. Provide information and guidance to businesses and the public about changes in the solid
waste management system resulting from the disaster.
2. Provide information for healthcare facilities about the management of medical wastes.
3. Provide public information about separation, storage, collection, and sites available for the
disposal of solid waste.
4. Provide public information regarding disease prevention, vector control, and safety.
5. Promote healthy behaviors related to potential interaction with untreated solid waste.

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HAZARDOUS WASTE MANAGEMENT
Following a major disaster, the unplanned release of hazardous material into the environment that
poses a threat to human health and safety is likely to occur. A hazardous waste is any refuse, sludge,
or other waste material that is capable of (a) causing or significantly contributing to an increase in
mortality or an increase in serious irreversible, or incapacitating reversible illness; or (b) posing a
substantial present or potential hazard to human health or the environment when improperly treated,
stored, transported, or disposed of, or otherwise managed.

Categories of hazardous waste materials include, but are not limited to:
• Explosives
• Flammables
• Oxidizers
• Poisons
• Irritants
• Corrosives

St. Charles County DEM, local HAZMAT teams, and DPH Environmental Health staff, as appropriate,
will coordinate with MO DHSS, MDA, and MODOT for removal and disposal of contaminated
materials. In instances where city sewage/treatment is involved, local officials and public waste water
system operators will be included in the planning and operations. Local hospital emergency
departments, EMS, and fire/rescue decontamination procedures will be followed.

In the event of an incident, staff may be asked to help with the following activities:
• Advising for health and safety precautions at an incident site if hazardous wastes are present.
• Identifying vulnerable populations that may be affected by the incident.
• Assisting in implementation of procedures to assess and mitigate a hazardous waste incident.

Assessment
1. Determine if hazardous waste generators are the source of the disaster or could be affected
by the disaster.
2. Perform health hazard assessments of hazardous waste or material releases to identify
possible health hazards.

Intervention
1. Provide technical consultation, training, and planning assistance to incident commander,
emergency responders, public health officials and others regarding:
a. Impacts of decisions or activities on public health
b. Sampling techniques and strategies
c. Re-entry into contaminated areas
d. Long-term monitoring of the environment
e. Long-term monitoring of the population exposed to the hazard
2. Assist in determining whether illnesses, diseases, or complaints may be attributable to
exposure.
3. Conduct environmental sampling.
4. Monitor how the waste is disposed of to ensure it complies with regulations.

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 5. Potentially provide oversight and direction for the overall hazardous waste incident response
and cleanup.

Communication/Education
1. Provide public information on the health effects of toxic substances.
2. Provide public information to minimize risk of exposure.
3. Provide public information and assistance regarding the disposal of household hazardous
wastes.

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HOUSEHOLD HAZARDOUS WASTE
St. Charles operates a household hazardous waste collection program. Following a disaster, the
public will require information on how to manage household hazardous waste.

In the event of an incident, DPH staff may be asked to help with the following:
• Determining the extent of the problem
• Identifying specific community needs for information and education
• Ensuring proper educational materials are disseminated

Assessment
1. Assess nature of program disruption and determine timeline for reestablished service.

Intervention
1. Work with existing contractors to assess their capacity to manage increased volumes of
household hazardous waste.
2. Evaluate options for providing alternative household hazardous waste collection service to the
public.
3. Discourage washing or disposing of hazardous materials into the sewers, drains or soil.
4. Inspect household hazardous waste drop-off facilities.

Communication/Education
1. Provide information about waste collection changes/alternatives for homeowners.

INDOOR ENVIRONMENTS
The DPH Environmental Health program, in conjunction with MO DHSS and MDNR, is responsible for
the mitigation of contaminated and otherwise damaged buildings and living spaces.

Issues in the indoor environment include:

• Radon
• Mold
• Lead
• Carbon monoxide
• Asbestos

Assessment
1. Conduct surveys or assessments of homes and facilities, including mass shelter and care
sites.
2. Develop a sampling plan and coordinate sampling and analysis of materials, if necessary.

Intervention
1. Determine corrective action and make recommendations to facility managers, the public, and
authorities.

Communication/Education

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1. Educate the public about the dangers associated with the use of generators and carbon
monoxide poisoning.
2. Promote healthy behaviors related to indoor hazards.

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ANIMAL WASTE REMOVAL
The DPH Environmental Health program will work with the Division of Humane Services to assure
animal waste is removed safely. This will be done in consultation with MDA and the state veterinarian
at MO DHSS.

Assessment
1. Conduct surveys or assessments of facilities and practices regarding pet and animal wastes,
including remains, in disaster-stricken areas, mass shelters, or mass care sites.
2. Develop a sampling plan and coordinate sampling and analysis of materials, if necessary.

Intervention
1. Determine corrective action and make recommendations to facility managers, the public, and
authorities.
2. Consult partners to ensure proper removal and disposal of animal waste.

Communication/Education
1. Provide direction on safe handling and disposal practices related to animal carcasses and
animal waste.
2. Promote healthy behaviors related to interaction with animal waste.

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LODGING/MASS CARE SHELTERS
This function provides congregate shelter facilities and food services to victims who have been
displaced by a disaster. Mass care shelters will be operated in conjunction with American Red Cross
(ARC) primarily.

The ARC has been designated by Congress to provide emergency housing, feeding, and first aid to
displaced persons in disaster situations. Mass care services are initiated upon notification of an
impending disaster or immediately following a disaster.

Mass care assistance is provided through a combination of the following three elements:
• Congregate or individual temporary shelters
• Fixed or mobile feeding operations
• Direct distribution of relief supplies

In the event of an incident, DPH staff may be asked to ensure that emergency shelters are safe for
human occupation and food distribution.

Assessment
1. Assist with the inspection of mass care sites.
2. Assist building officials and structural engineers in determining the habitability of pre-identified
shelters.
3. Evaluate shelter facilities for:
a. Potable water
b. Emergency disposal of sewage and solid waste
c. Food sanitation
d. Safety
e. Vector control
f. Personal hygiene

Intervention
1. Assist other responding agencies in the planning and development of temporary housing sites.
2. Provide housing sanitation guidance and oversight in disaster aftermath.
3. Identify and address problems related to pest infestations, other living requirements (e.g.,
lighting, temperature, solid/liquid waste disposal, sleeping arrangements, personal hygiene),
and infectious medical waste storage, transportation, and disposal.

Communication/Education
1. Advise decision makers regarding public health concerns in emergency shelters.

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VECTOR CONTROL
Disasters frequently create conditions that result in population increases of insects and rodents. In this
situation, the chance of disease transmission increases sharply. For example, floods and heavy rains
will create new mosquito breeding sites in disaster rubble or standing water. If sewage systems are
disrupted and riverbanks are disturbed, rodents will leave these areas and head for other sources of
food and harborage. In addition to disease hazards, insects and rodents can also contribute to
psychological stress by being a major nuisance to residents and responders.

In the event of an incident, DPH staff may be asked to help with the following activities:
• Ensuring elimination of public health nuisances, including breeding sites for rodents, flies, and
mosquitoes
• Providing information to the public regarding rodent and pest extermination
• Coordinating emergency corrective measures against vectors that cause public health
problems
• Controlling spread of infectious diseases that may be spread by vectors
o See the St. Charles County DPH Zika Action Plan

Assessment
1. Assist in conducting environmental-related disease investigations related to water, pest, or
other disease vectors.
2. Assess conditions in the disaster area regarding standing water, uncollected and exposed
solid waste, food waste, and/or damaged sewer systems that may promote vector populations.
3. Monitor for disease vectors.
4. Collect vectors for laboratory analysis.
5. Survey potential vector breeding sites.

Intervention
1. Provide assistance and oversight related to implementation of vector control measures.
2. Perform field surveys to identify hazards related to potentially vector-borne outbreaks.
3. Work with private and public refuse haulers to reinstate regular collection or arrange for
special collections.
4. Contact mosquito control agencies in neighboring jurisdictions about assistance in application
of vector-control measures in the affected area.

Communication/Education
1. Provide public information regarding vector-borne disease control measures.

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PUBLIC POOLS AND RECREATIONAL WATERS
Environmental Health staff will work with County epidemiologists, MO DHSS and MDA to ensure
water safety. Water includes recreation sites and other water that could cause disease, such as
swimming pools and beaches.

Assessment
1. Understand the challenges associated with evaluating water-related diseases with exposure to
chemical agents in floodwater:
a. Petroleum from damaged refineries
b. Chemical contamination from HAZMAT spills
c. Gasoline from damaged gas stations
d. Chemical releases from flooded automobiles
e. Hazardous waste sites in region
f. Industrial facilities with lead, mercury, hexavalent chromium, arsenic, benzene, or
pesticides
2. Test water quality.

Intervention
1. Assure the removal and disposal of contaminated and standing water.

Communication/Education
1. Provide guidance to facility managers, the public, and authorities about safety concerns in
public pools and other bodies of water.

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CHEMICAL, BIOLOGICAL, RADIOLOGICAL HAZARDS
The two main strategies for minimizing illness, injury, and death due to chemical, biological, and
radiological hazards are early detection and intervention.

In the case of abatement being necessary for a known, intentional biological or chemical
contamination incident, DPH will coordinate with the County DEM, the County HAZMAT team, MO
DHSS, MDA, and federal agencies to determine the appropriate course of action dependent upon the
type of contamination. In the event of a criminal investigation, the removal of these materials will be
coordinated with the investigating agency. The County Chief of Police or a designated law
enforcement official will act as the liaison between public health and the criminal justice system
officials conducting the investigations.

Biological agents are viruses or bacteria that produce infection or intoxication, such as anthrax,
plague, tularemia, botulism, smallpox, ricin toxin, etc. Most biological agents do not survive or persist
long in the environment and are easily disinfected or inactivated.

A bioterrorism attack is the deliberate release of viruses, bacteria, or other agents used to cause
illness or death in people, animals, or plants. These agents are typically found in nature, but it is
possible that they could be weaponized to increase their ability to cause disease, make them resistant
to current medicines, or to increase their ability to be spread into the environment. Biological agents
can be spread through the air, water, or in food. Terrorists may use biological agents because they
can be extremely difficult to detect and do not cause illness for several hours to several days. Some
agents, like the smallpox virus, can be spread from person to person and some, like anthrax, cannot.

A chemical emergency occurs when a hazardous chemical has been released and the release has
the potential for harming people's health. Typical chemical agents of concern include:
• Ammonia
• Arsenic
• Benzene
• Chlorine
• Cyanide
• Formaldehyde
• Mercury
• mustard gas
• Sarin gas

Chemical releases that endanger the safety and health of the general public can be caused by an
accidental industrial release from a facility, a transport-related release, or by the deliberate use of
industrial chemicals or chemical warfare agents. Chemicals enter the body through the skin, eyes,
lungs or digestive tract. The rate of absorption varies with different chemicals, and is affected by the
concentration and the length of time the chemical is in contact with the body, the air temperature,
humidity and the person’s age.

There are several ways in which a person can become overexposed to radiation. In peacetime, the
more likely ways are accidents in nuclear power plants or research institutions dealing with radioactive
materials, transportation accidents, and undue exposure to radioactive waste or radioactive sources
used in industry, medicine and research laboratories. Recently, the threat of terrorist acts that involve

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nuclear facilities, a dirty bomb, or the theft of radioactive substances, has become more prominent.
The primary concern with a radiological agent is exposure and spreading of the contamination.

In the event of a biological, chemical or radiological incident, DPH staff may be asked to participate in
the following:
• Population monitoring
• Mass dispensing operations (PODs)
• Data collection
• Education of the public and external agencies

Assessment
1. Conduct environmental-related disease, injury, illness or exposure investigations.
2. Monitor the extent of the casualties and alert and activate health-care facilities.
3. Perform field surveys to identify environmental hazards related to the health threat.
4. Conduct interviews to establish causal factors related to people, place and time.
5. Prepare a sampling plan and coordinate sampling and lab analysis of food, water or other
materials if necessary.
6. Collect soil, water and or food samples.
7. Contact regulated entities in the affected area to determine if regular operations have been
disrupted.

Intervention
1. Work with appropriate emergency responders and governmental agencies to ensure the safety
of the general public.
2. Determine prevention and mitigation strategies and make recommendations to the public,
health care professionals, and authorities.
3. Monitor workers’ health and safety.
4. Ensure the availability of immediate medical treatment for those who require it.
5. Ensure safe shelters and healthy food and water supplies.
6. Recommend disease control and prevention measures.

Communication/Education
1. Inform the public about the incident, measures being taken to contain the release, the health
effects of exposure, and what the public can do to protect themselves.
2. Provide emergency departments with information about the nature of the chemical and any
precautions to be taken.
3. Explain contamination and how to decontaminate casualties, staff and equipment.
4. Provide information and technical guidance to the public and others regarding clean-up and
decontamination.

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Attachment 1:
Environmental Health Staff Contact Information

*see file maintained by DPH staff*

224
Attachment 2:
Environmental Vendor List

*see file maintained by the Environmental Health Division*

225
Attachment 3:

Environmental Emergency Shelter Evaluation Form

*see form in Emergency Preparedness folder*

226
Attachment 4:

Environmental Emergency Job Action Sheet

*see file in Emergency Preparedness Folder*

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 ANNEX M

VOLUNTEER MANAGEMENT

Attachment 1: Phone Bank Setup Procedures

Attachment 2: Phone Bank Script

PURPOSE
The purpose of this annex is to describe how DPH will manage and retain volunteers during and
following a major health disaster.

DPH will rely primarily on local Medical Reserve Corps (MRC) and Community Emergency Response
Team (CERT) organizations for volunteer support, but the American Red Cross and spontaneous
volunteers may also become resources during an emergency.

Public Health emergencies that could require the use of volunteer responders:
• Winter storms
• Floods
• Fires
• Tornadoes
• Earthquakes
• Bioterrorism incidents
• Hazardous material incidents

PRE-INCIDENT ACTIVITIES
Recruitment:
DPH houses the Mid Rivers MRC unit, which allows for the recruitment of volunteers via various
activities. Community events, guest lectures, and collaboration with other organizations allow staff to
network and promote the unit in an effort to increase membership. Once potential volunteers are
identified, they have multiple options to apply:

1) St. Charles County website: http://www.sccmo.org/695/Volunteer-Organizations-Activities

2) Mid Rivers MRC Unit Application
3) Show-Me Response: www.showmeresponse.org

All volunteers are required to complete ICS 100, 200, 700, and 800, and are required to be affiliated
with the Mid Rivers MRC on Show-Me Response.

Credentialing
The Mid Rivers MRC relies on the Show-Me Response database for credentialing of professional
volunteers. The system automatically verifies licenses for nurses and other medical professionals via
the Board of Professional Registration, and an alert is visible to the Unit Coordinator when a
volunteer’s license expires.

Health professionals are provided with an Emergency Credential Level (ECL) when their license is
confirmed by Show-Me Response.
- ECL 3: License is in good standing
- ECL 2: Health professional in outpatient setting
- ECL 1: Health professional in inpatient setting

DPH may keep copies of volunteers’ license if the volunteer is willing to provide such documentation.

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Badging
Volunteers will be provided with a badge directly from DPH. The Elliot Event Manager System will be
used to input volunteers’ information, which will be converted to a badge with photo identification.

Each volunteer can receive a badge in approximately 5 -10 minutes, provided the system is
functioning properly.

Training
Initial training requirements can be completed online.
Ideally, the unit conducts in-person training on a quarterly basis. Training primarily consists of content
related to MCM functions, but varies based on the needs and preferences of the unit.

Completion of all training is tracked with digital and paper-based databases that are maintained by
DPH Emergency Preparedness staff. Activities are also tracked at the unit level by the national MRC
organization. In order for a unit to remain in good standing, an activity must be conducted each
quarter.

EMERGENCY RESPONSIBILITIES
St. Charles County DPH
The Public Health Emergency Planner will have the primary responsibility of acquiring, managing, and
retaining volunteers for the department’s emergency operations. Since volunteers are an essential
part of the mass prophylaxis plan, MRC volunteers will be included in exercises as often as possible.

The Public Health Emergency Planner will also be responsible for notifying volunteers upon the
decision to activate in response to MCM incidents or other emergencies. The primary method of
contact will be via Show-Me Response, which allows for messages to be sent via email, phone call,
and text. Templates are currently established, but novel messages can also be created as needed.

*During non-emergency situations, phone calls and texts via the Show-Me Response system have a
cost associated with them. This cost will be waived when notifying volunteers during a Governor-
declared emergency*

An alternate method will be to use the MRC database to access volunteers’ contact information and
notify them manually.

Volunteers will be told to report to the DPH building unless the building is uninhabitable or another
location would allow for more efficient deployment.

Volunteers may be grouped in Show-Me Response based on function (trained dispensers), ECL level,
or other categories as deemed appropriate to allow for more efficient deployment.

St. Charles County DEM

DEM will be responsible for processing requests for volunteers if local CERT teams need to be
activated. DEM will work with emergency managers from local municipalities to activate their
respective teams and fulfill necessary resources.

A request to DEM should be as specific as possible regarding the type of volunteer needed, based on
training level, professional background, etc. These may include, but are not limited to:
- Trained dispensers
- Public health nurses (RN)
- Direct patient care providers (RN, CNP, Physician Assistant, Physician, etc.)
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 - Mental/behavioral health providers
- Non-medical personnel (general laborers, data entry, clerical, etc.)

SPONTANEOUS VOLUNTEERS
1. Phone Bank
a. The Public Health Emergency Planner will manage a clearinghouse for people who want
to volunteer. Once staff and a facility safety are secured, an 800 number and additional
phone lines can be activated, with the Department of Information Systems, to handle
large volumes of calls.

2. Volunteer Reception Center

a. In some cases, the Public Health Emergency Planner may set up and manage a
Volunteer Reception Center (VRC) instead of or in addition to the phone bank. The VRC
is not dependent on phones and is therefore an option when phones are not working. If a
VRC is deemed necessary, the tentative location will be the large conference in the DPH
building. If a larger or more centrally located space is required, a new venue will be
secured with assistance of local agencies.

3. Volunteer Database
a. It is important to track volunteer information before they are allowed to act under the
direction of DPH. At the very least, DPH needs to have adequate contact information and
documentation of any necessary licenses, particularly for medical personnel. A call
tracking sheet will be provided to each person staffing the phone bank and/or VRC to
ensure DPH monitors availability of volunteers with various skills.

4. Responding Agency Needs

a. Various types of agencies will have different needs during a response to a particular
emergency. Some may be known prior to activation and others may emerge as gaps are
identified during the response. A database will be managed that records needs of local
agencies, in an effort to link qualified volunteers to their efforts. Agencies should be
directed to make formal requests for assistance through DEM, unless other procedures
are determined at the time of the emergency. Once DEM receives a request, DPH can
assist in providing volunteers who have reported availability and relevant skills.

STAFFING POLICIES AND PROCEDURES

1. During normal business hours
a. All employees on site at the time of the disaster are expected to assist with the
implementation of a phone bank or VRC, if deemed necessary. As soon as they are able,
those not on-site are expected to report to the Public Health Emergency Planner to
determine where they are needed.

2. Outside normal business hours

a. DPH Director, or designee, will determine what steps are to be taken to respond to the
emergency. The Public Health Emergency Planner will contact other employees as
needed to provide adequate staffing for the phone bank or VRC. Employees are
expected to respond to requests as quickly as time allows.

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 3. Volunteers
a. Volunteers will be accepted to help with phone bank or VRC operations if they are
needed. Priority will be given to those who are members of MRC or CERT teams as they
have been trained and vetted. If these volunteers are unavailable or assigned elsewhere,
spontaneous volunteers who have adequate skills and availability will be recruited.

4. Staffing shifts and breaks

a. The maximum shift for any employee or volunteer is 12 hours. Each worker will receive
and must take at least one 10-minute break every two hours. If any employee is asked to
work more than 12 hours in a 24-hour time period, policies regarding overtime for exempt
and non-exempt employees will apply. All decisions regarding overtime work (beyond 8
hours per day or 40 hours per week) must be approved in advance by the DPH Director
or his/her designee.

5. Procedures
a. No person works alone (minimum of two staff must be onsite at all times).
b. The VRC will not open to the public until two staff members are present.
c. The last two people in the VRC will be responsible for lock up and shut down
procedures.
d. If the VRC is open longer than 8.5 hours per day, staff must be scheduled in overlapping
shifts.
e. A rest area, away from the other activities, will be designated.
f. Each employee and volunteer will sign in and out each day so that an accurate record of
hours can be maintained.
g. DPH staff may be requested to deploy outside of St. Charles County. These may or may
not be deployed as volunteers (not being compensated), at the discretion of the DPH
Director.

VOLUNTEER SERVICES

All volunteers who are deployed as agents of DPH will be provided the same services as could be
expected by DPH employees:

• Access to mental health services

• Food and water while on shift (procured by DPH or provided by community organizations)
• Shelter and sleeping quarters (when necessary)

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Attachment 1:
Phone Bank Setup Procedures
1. Set up in room or area where additional phone lines can be activated (preferably one large
room).

2. Activate 800 number and/or additional phone lines if necessary.

3. Make sure volunteer database is operational.

4. Get volunteer intake forms ready.

5. Send representative to EOC if activated (to assist with fulfilling requests from outside
agencies).

6. Distribute guidance and script for phone bank operators.

7. Designate one or more persons to take volunteer calls. Have personnel on stand-by in case
call volume increases significantly.

8. Try to anticipate volume of calls so additional lines can be added before they are absolutely
necessary.

9. Notify EOC, other relevant agencies, and media when ready to receive calls.

10. Schedule personnel to operate phone bank for future operational period(s) (include time to
provide training).

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Attachment 2:

Phone Bank Script

Answer the call:

You’ve reached the (name of event) volunteer hotline. This is (your name). How can I help you?

If calling to volunteer:

1. May I get your name?

2. What is your home address?
3. What is the best phone number to reach you?
4. Do you have any abilities or work experience related to the medical field?
5. Do you have any clerical and or data entry experience?
6. Do you have any abilities or work experience related to general labor?
7. Do you have any other abilities or work experience that you think may be useful
to us?

If calling to make a donation:

1. May I have the name of the donor?

2. What item(s) are available to be donated?
3. In what quantities are the item(s) being donated?
4. How will the items be donated?
 The donor can deliver or arrange for delivery of the items to the Donation Center?
 The St Charles County Health Department must arrange for the items to be picked up?
Pick Up Address ___________________________________________________________

If calling for information:

INSERT INFORMATION BASED ON SCENARIO – see fact sheets for possible info

Finish the Call:

Thank you for calling. Is there anything else I can assist you with today?

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 ANNEX N

RECOVERY

PURPOSE
The purpose of this annex is to outline activities that will help the community recover from and
mitigate effects of a natural or man-made public health emergency.

The extent of recovery efforts that are necessary will vary based on the extent to which the population
and/or significant infrastructure are affected. These factors will likely be decided by the nature of the
event (i.e. natural disaster vs. deliberate terrorist attack).

EMERGENCY RESPONSIBILITIES
St. Charles County DPH
1. Perform immediate activities necessary to save lives
2. Perform surveillance to ensure proper identification and treatment of relevant agent(s)
3. Provide vaccinations for residents and responders potentially exposed to infectious agents
4. Provide environmental supplies and inspections to assess safety of well water, restaurants,
etc.
5. Assist with damage assessments for homes, public health facilities, equipment, and supplies
6. Assist in the inspection and maintenance of temporary shelter facilities
7. Assist in coordination of mental health services for victims, responders, and families
8. Provide guidance to responders and the public to ensure protective measures are observed

St. Charles County DEM

1. Track resource requests related to needs for public health services and/or supplies
2. Assist in location of facilities that can be used to provide public health services
3. Assist in documentation of economic impact of public health emergencies

ORGANIZATION
At the local level, St. Charles County DPH and DEM are the two primary agencies who will lead
recovery efforts in response to a public health emergency. Through their own capabilities and through
collaboration with local partners, these agencies have the ability to provide health and medical
services, assistance with temporary shelter sites, and coordination of wrap-around services for those
affected.

At the state level, SEMA and MO DHSS, along with other partners, will provide resources,
coordination, and guidance to assist local recovery efforts.

At the federal level, FEMA and CDC are the primary agencies who will be able to provide aid and
technical assistance to enhance state and local recovery efforts.

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 ANNEX P

PANDEMIC FLU

Attachment 1: Priority Groups for Vaccination

Attachment 2: Flu Resources
Attachment 3: Hospital Infection Control Staff
Attachment 4: Active Surveillance Resources

PURPOSE
The purpose of this annex is to reduce the health and economic impacts of illnesses and fatalities due
to an influenza pandemic.

BACKGROUND
An influenza pandemic is a global outbreak of a new influenza virus that emerges in the human
population, causes serious illness, and then spreads easily from person to person worldwide.

Pandemics are different from seasonal outbreaks or “epidemics” of influenza. Seasonal outbreaks are
caused by subtypes of the influenza virus that already circulate among people, whereas pandemic
outbreaks are caused by new subtypes, by subtypes that have never circulated among humans, or by
subtypes that have not circulated among humans for a long time. Past influenza pandemics have led
to high levels of illness, death, social disruption, and economic loss.

Three conditions must be met to classify an outbreak as a pandemic:

1. New influenza virus subtype must emerge (new to humans)
2. Subtype must infect humans and cause serious illness
3. Subtype must spread easily and spread must be sustained among humans

Influenza virus infects the respiratory tract and causes symptoms that include:
1. Rapid onset of fever
2. Chills
3. Sore throat
4. Runny nose
5. Headache
6. Non-productive cough
7. Body aches

Influenza is a highly contagious illness and can be spread easily from one person to another. It is
spread through contact with droplets from the nose and throat of an infected person during coughing
and sneezing. The time period between exposure and the onset of illness is usually one to five days.
Two types of influenza viruses cause disease in humans - type A and type B. Influenza A viruses are
composed of two major antigenic structures essential to vaccines and immunity: hemagglutinin (H)
and neuraminidase (N). The structure of these two components defines the virus sub-type. A minor
change caused by mutation (antigenic drift) results in the emergence of a new strain within a sub-
type. Drifts can occur in both type A and B influenza viruses. A major change caused by genetic
recombination (antigenic shift) results in the emergence of a novel sub-type (i.e., never before
occurred in humans) associated with influenza pandemics. This shift occurs with influenza type A
235
viruses. Influenza A viruses are unique because they can infect both humans and animals and cause
more severe illness. Antigenic shifts in influenza A viruses have been the cause of at least three
pandemics in the 20th century.

Pandemic influenza is a unique public health emergency that affects the community at large. The
impact of the next pandemic could have a devastating effect on the health and well-being of the
American public. The Centers for Disease Control and Prevention (CDC) estimates that, in the United
States alone, up to 200 million people will be infected, 50 million people will require outpatient care,
two million people will be hospitalized, and between 100,000 and 500,000 persons will die.

Effective preventive and therapeutic measures, including vaccines and antiviral agents, will likely be in
short supply, as may some antibiotics to treat secondary infections. Healthcare workers and other first
responders will likely be at an elevated risk of exposure and illness compared to the general
population, further impeding access to care.

Widespread illness in the community will also increase the likelihood of sudden and potentially
significant shortages of personnel who provide other essential community services.

Pandemic influenza is considered to be a relatively high-probability event, yet it remains unknown

when the next pandemic will occur. Most experts believe that there will be between one and six
months between the identification of a novel influenza subtype and the time that widespread
outbreaks begin to occur in the U.S. Outbreaks are expected to occur simultaneously throughout
much of the U.S., preventing relocation of human and material resources. The effect of influenza on
individual communities will be relatively prolonged (six to eight weeks) when compared to most other
natural disasters. Due to the prolonged nature of a pandemic influenza event, the World Health
Organization (WHO) has defined phases of a pandemic in order to facilitate coordinated plans.

PANDEMIC PHASES

These phases are designed to enhance planning efforts by marking important milestones in the
progression of a pandemic. They will likely overlap in their timing and may not always occur in
numerical order.

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In general, phases 1-3 are preparedness phases, when officials should be monitoring surveillance
data and readying assets to respond if necessary. Phases 4-6 generally indicate a need for an
organized response. The following table illustrates each phase in greater detail.

Pandemic Phase Characteristics Actions to Be Taken

Phase 1
Normal surveillance procedures
Phase 2
Normal surveillance procedures
Phase 3
*Elevated risk for community-level
outbreaks*
Enhanced surveillance procedures
No viruses circulating among Normal operations
animals have been reported to
cause infections in humans.
An animal influenza virus Normal operations
circulating among domesticated or
wild animals is known to have
caused infection in humans, and is
therefore considered a potential
pandemic threat.
An animal or human-animal Sustained DPH operations with
influenza reassortant virus has increased preventative steps taken
caused sporadic cases or small for staff
clusters of disease in people, but
has not resulted in human-to- Consider need for mass
human transmission sufficient to prophylaxis
sustain community-level outbreaks.
Enhanced public information to
Limited human-to-human educate on transmission prevention
transmission may occur under
some circumstances, for example,
when there is close contact
between an infected person and an
unprotected caregiver.

However, limited transmission

under such restricted
circumstances does not indicate
that the virus has gained the level
of transmissibility among humans
necessary to cause a pandemic.
Verified human-to-human If outbreaks have occurred in St.
transmission of an animal or Louis Metro Area
human-animal influenza Provide/encourage masks for
reassortant virus able to cause clients of DPH and other County
“community-level outbreaks”. offices

Phase 4
*Elevated risk for pandemic*
Active surveillance
The ability to cause sustained
disease outbreaks in a community
marks a significant upwards shift in
the risk of a pandemic.
Any country that suspects or has
verified such an event should
urgently consult with WHO so that
the situation can be jointly
assessed and a decision made by
the affected country if
implementation of a rapid
pandemic containment operation is
warranted.
Require masks for staff with direct
client interaction
Enhanced public information to
educate on increased risk of
widespread illness
If outbreaks have occurred
outside of St. Louis Metro Area
Provide/encourage masks for
clients of DPH and other County
offices

237
 Phase 4 indicates a significant
increase in risk of a pandemic but
does not necessarily mean that a
pandemic is a forgone conclusion.
Human-to-human spread of the
virus into at least two countries in
one WHO region (see figure
below).
Phase 5
While most countries will not be
*Pandemic imminent* affected at this stage, the
declaration of Phase 5 is a strong
Active surveillance signal that a pandemic is imminent
and that the time to finalize the
organization, communication, and
implementation of the planned
mitigation measures is short.
Community level outbreaks in at
Phase 6 least one other country in a
different WHO region in addition to
*Pandemic under way* the criteria defined in Phase 5
(above).
Active surveillance
Designation of this phase will
indicate that a global pandemic is
under way.
Pandemic disease levels in most
countries with adequate
surveillance will have dropped
Post-peak below peak observed levels.
Active surveillance The post-peak period signifies that
pandemic activity appears to be
decreasing; however, it is uncertain
if additional waves will occur and
countries will need to be prepared
for a second wave.
Provide/encourage masks for staff
with direct client interaction
Enhanced public information to
educate on transmission prevention
If U.S. is affected
See Phase 6 (below) for actions to
contain pandemic
If U.S. is not affected
Require masks for all staff and
clients of DPH and other County
offices
Deny access to services for those
with flu-like symptoms
Consider closing DPH and other
County offices for non-essential
services
Educate public on possible
pandemic containment measures
DPH and other County offices
closed for nonessential services
Require masks for all staff and
clients of DPH and other County
offices
Actively coordinate pandemic
containment measures with local,
state, and federal partners
- Social distancing (school
closures, cancellation of large
community events, etc.)
- Isolation and/or quarantine
- Cordon Sanitaire (limit access
to a defined area)
Evaluate ability to reopen County
offices
Continue active surveillance
procedures
Evaluate response
Prepare for second wave of
disease
Continue educating public on
transmission prevention
238

Post-pandemic
Active surveillance, returning to
normal procedures
Influenza disease activity will have
returned to levels normally seen for
seasonal influenza. It is expected
that the pandemic virus will behave
as a seasonal influenza A virus.
Reopen County offices, begin
return to normal operations
Revise EOPs
Educate public on current situation
Enhance recovery efforts

Conduct AAR on overall response

Source: WHO. (2009). Pandemic Influenza Preparedness and Response: A WHO Guidance Document.

Source: WHO. (2009). Pandemic Influenza Preparedness and Response: A WHO Guidance Document.

PLANNING ASSUMPTIONS
Pandemic preparedness planning is based on assumptions regarding the evolution and impacts of a
pandemic. While pandemics might differ drastically based on variations in severity of infections and
the virulence of the influenza viruses that caused the pandemics, the major influenza pandemics of
the 20th century (1918, 1969, 2009) shared similar characteristics. Our assumptions are derived from
these characteristics as they provide a foundation on which to base our planning efforts, while
allowing flexibility to respond to novel situations in the future.

St. Charles County will operate with the following assumptions in mind:
1. Coordination between local, state, and federal partners will be ongoing prior to, during, and
after the occurrence of an influenza pandemic.
2. Children tend to have the highest rates of illness, while the elderly and immune-compromised
populations usually have the highest mortality rates.
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 3. Geographical spread will be rapid and virtually all communities will experience outbreaks.
4. Vaccines may not initially cover a novel influenza subtype, but work will be undergone to
develop and mass produce an effective formulation.
a. It will take approximately 6-8 months after the virus is identified before the vaccine is
available for distribution. Ongoing vaccine research may influence vaccine availability.
b. Once a pandemic has been declared as imminent, LPHAs will have approximately 1-6
months to plan for vaccine delivery and administration.
c. Vaccine produced during the first month will be purchased by either the federal or state
governments and distributed to local agencies. This vaccine supply will be used to
vaccinate priority groups. Priority classifications for high risk or essential personnel may
differ at the time of a pandemic depending on the epidemiological characteristics of the
virus. Decisions to target certain groups may be necessary based on recommendation
from CDC and MO DHSS epidemiologists. See Attachment 1 below for more information.
d. The CDC will develop a standard vaccine information statement that details the risks and
benefits of the disease and the vaccine used for a pandemic.
5. Antivirals will be provided in limited quantities.
a. When large amounts of antiviral agents are available through manufacturers or the SNS,
they will be distributed in one of three ways:
• Private purchase system that providers use today
• Delivered to mass dispensing sites
• Distribution through the activation of the SNS managed inventory program. See
Annex H for more details.
6. Susceptibility to the pandemic influenza subtype will be universal.
7. The clinical disease attack rate will be approximately 30% in the overall population.
8. Of those who become ill with influenza, approximately 50% will seek outpatient medical care.
9. The typical incubation period for influenza averages 2 days. It is assumed that this would be
the same for a novel strain that is transmitted between people via respiratory secretions.
10. In an affected community, a pandemic outbreak will last approximately 6 to 8 weeks.
11. At least two to three pandemic disease waves are likely.
12. Following the pandemic, the new viral subtype is likely to continue circulating and to contribute
to seasonal influenza.

EMERGENCY RESPONSIBILITIES
St. Charles County DPH
1. Notify and educate County Executive on situation’s potential impact on the community.
2. Coordinate with local, regional, state, and federal partners to determine common operating
picture.
3. Assess need for vaccine and prophylaxis supplies.
4. Conduct surveillance and disease investigation.

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 5. Notify local hospitals, physicians, urgent care centers, schools and other partners of potential
for widespread influenza and educate personnel on protective measures.
6. Ensure coordination of laboratory procedures between hospitals and SPHL.
7. Issue press releases to media.
8. Participate in JIC operations.
9. Issue educational materials to inform public of protective measures
10. Inform public if/when containment measures (social distancing, I&Q, etc.) are enforced. See
Annex G.
11. Open PODs if mass prophylaxis is indicated. See Annex H.
12. Mobilize volunteers to staff PODs perform other necessary functions.
13. Maintain Continuity of Operations
a. Employees of DPH will be asked to report to work during a pandemic situation.
b. Active Surveillance will be conducted on all employee households. All illnesses should
be reported immediately to the Health Services Division Director or DPH Director.
c. Prior to the start of the business day, all employees will be briefed on the status of the
emergency situation. Further updates will be given as necessary.
d. Sanitarians should be briefed often to ensure food establishments, child care facilities,
and other community venues are aware of the situation and following recommended
guidance.
e. Employees’ attendance of attend outside meetings will be done on a case-by-case basis.

St. Charles County DEM

1. Organize EOC operations.
2. Coordinate fulfillment of resource requests.
3. Coordinate requests to the state level as necessary.

ORGANIZATION
At the local level, St. Charles County DPH and DEM are the two primary agencies who will lead
recovery efforts in response to a pandemic. Through their own capabilities and through collaboration
with local partners, these agencies have the ability to provide health and medical services and
coordination of wrap-around services for those affected.

At the state level, SEMA and MO DHSS, along with other partners, will provide resources,
coordination, and guidance to assist local response and recovery efforts.

At the federal level, FEMA and CDC are the primary agencies who will be able to provide aid and
technical assistance to enhance state and local response and recovery efforts.

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Attachment 1:
Priority Groups for Vaccination

Targeted Recipient Groups

In view of the likely vaccine shortage, the United States Public Health Service, in conjunction with
various advisory committees has formulated draft recommendations for a rank-order list of high
priority target groups for vaccination.

The order of these groups is based on a number of factors including the need to maintain those
elements of community infrastructure that are essential to carrying out the pandemic response plan.
Other factors include limiting mortality among high-risk groups, the reduction of morbidity in the
general population, and the minimization of social disruption and economic losses. The draft rank-
order list is subject to change – potentially on short notice - depending on the epidemiological and
clinical features exhibited by the actual pandemic strain. Plans based on these draft recommendations
should contain a great deal of flexibility in order to be responsive both to the final recommendations
and changing conditions during the pandemic.

Rank-Order List of High-Risk Groups (subject to change)

1. Health-care workers and public health personnel involved in the distribution of vaccine

2. Persons responsible for community safety and security (e.g., police, firefighters, paramedics,
military personnel, National Guard, EMS personnel, etc.)

3. Other highly skilled persons who provide essential community services whose absence would
either pose a significant hazard to public safety (e.g., nuclear power workers) or severely
disrupt the pandemic response effort (e.g., persons who operated regional
telecommunications or electric utility grids). Members of these groups are likely to vary widely
from community to community and are highly influenced by local circumstances.

4. Persons traditionally considered being at increased risk of severe influenza illness and
mortality, as currently defined by the Advisory Committee on Immunization Practices

5. Persons of any age with high-risk medical conditions

6. Pregnant women

7. Persons in nursing homes and other long-term care facilities

8. Persons age 65 or older without identified high-risk medical conditions

9. Infants between the ages of 6 to 23 months, if supported by epidemiological and clinical data

10. Persons who, in the judgment of state and local health officials, provide critical community
services (e.g., utility workers, funeral services personnel, persons involved in the transport of
essential goods such as food).

11. Household contacts of persons with high-risk medical conditions and household contacts of
persons in the first three groups

12. Pre-school age children (especially those attending day-care-centers)

13. Healthy persons between the ages of 18 and 64

14. Healthy school-age children (the population least likely to have severe illness)

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Attachment 2:
Flu Resources

National Institute of Allergy and Infectious Diseases – “Is it a cold or the flu?”
https://www.niaid.nih.gov/topics/Flu/Documents/sick.pdf

CDC – Flu
http://www.cdc.gov/flu/

U.S. DHHS – Flu

http://www.flu.gov/

Flu FAQs
http://www.cdc.gov/flu/faq/

OSHA – Pandemic Flu FAQs for Healthcare Workers and Employees

https://www.osha.gov/SLTC/pandemicinfluenza/pandemic_health.html

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Attachment 3:

Hospital Infection Control Staff

***see file maintained by CD staff***

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Attachment 4:

Active Surveillance Resources

Influenza Reporting Log

Influenza Distribution List

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 ANNEX Q

PUBLIC HEALTH MUTUAL AID

Attachment 1: Missouri Systems Concept of Operational Planning for Emergencies

(MoSCOPE)
Attachment 2: LPHA Mutual Aid Resource Request
Attachment 3: Personal Supply Checklist
Attachment 4: Schedule of Reimbursement Rates

INTRODUCTION
In times of natural or man-made disasters, local resources may become overwhelmed. In these times,
agencies in various disciplines such as the fire service, law enforcement, emergency medical
services, and public health may request additional personnel, equipment, or supplies from partners
outside their jurisdiction.

This system of providing mutual aid across jurisdictional boundaries is authorized by Missouri State
Statute, and automatically covers agencies within the State of Missouri, unless they wish to opt-out.
St. Charles County has chosen to participate and is therefore eligible to request and receive mutual
aid.

Discipline-specific mutual aid plans exist within the Missouri Systems Concept of Operational
Planning for Emergencies (MoSCOPE). As of September, 2016, the public health annex is under
development (LPHAs are still covered by state statute).

EMERGENCY RESPONSIBILITIES
St. Charles County DPH:
1. Anticipate need for additional personnel, equipment, or supplies

2. Request mutual aid through SEMA via DEM

3. Be as specific as possible when request personnel, equipment, or supplies

4. Ensure both requesting and receiving parties are aware of which agency is responsible for
compensating staff who are deployed on mutual aid

5. Call deployed staff members back to St. Charles County at any time as the situation dictates

6. Track hours worked by staff received and/or deployed

ORGANIZATION
Mutual aid is organized based on the following tenets, regardless of which agency(s) are requesting
or receiving mutual aid:

1. Deployed personnel’s certifications, workman’s compensation, licensure, and other credentials

follow them to the receiving jurisdiction within the State of Missouri

2. Resources lent out on mutual aid need to be self sufficient

a. Personnel and equipment should be equipped with everything necessary to perform
their duties
b. Receiving jurisdiction will not necessarily have resources to supply to incoming
personnel
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3. Any mutual aid deployment should be considered an unreimbursed deployment unless an
agreement is made between the requesting and receiving jurisdictions (before, during, or after
an incident)

4. Resources lent out on mutual aid can be called back to their home jurisdiction at any time as
necessary

5. Resources should NEVER self-deploy

a. Self-deployment creates logistical hardships and WILL NOT be reimbursed by FEMA

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 ANNEX X

ACCESS AND FUNCTIONAL NEEDS SHELTERING

Attachment 1: Key AFN Planning Resources

INTRODUCTION
Access and Functional Needs (AFN) is a broad term used to describe someone who may have
additional needs before, during and after an incident in functional areas, including but not limited to:
maintaining independence, communication, transportation, supervision, and medical care.

Whenever possible, individuals with AFN will be cared for within “general population” shelters.
Individuals with AFN typically have physical or mental conditions that require more extensive
medical/nursing oversight. Family members are often primary caregivers who understand these
individuals’ needs, so allowing them to remain together increases the chances that these individuals
will receive the care they need. The goal within any shelter is to devote a portion of the space to
families and individuals with AFN, who may require additional space and resources to remain
comfortable and safe.

Individuals with AFN may also need to be sustained with more medical resources and individual care
than can typically be provided in a general shelter. Hospitals, school districts, and other community
agencies may provide guidance and resources that can assist public health and other disciplines care
for these individuals.

When possible, nurses or other medical staff should be designated to caring for these individuals, at
least for a portion of their shift. The provision of care in shelters reduces surge demands on hospitals
where, in times of emergencies, services and care are demanded by patients with more urgent
medical needs.

EMERGENCY RESPONSIBILITIES1
St. Charles County DPH
1. Activate pre-determined public health roles (population monitoring, environmental health and
safety assessments, accessibility for populations with functional needs, and need for
decontamination) needed in the mass care response in coordination with mass care and
health partners.

2. Coordinate with response partners to utilize pre-existing jurisdictional risk assessments,

environmental data, and health demographic data to identify population health needs in the
area impacted by the incident.

3. Coordinate with response partners to complete a facility-specific environmental health and

safety assessment of the selected or potential congregate locations.

4. Coordinate with partner agencies to assure food and water safety inspections at congregate
locations.

5. Coordinate with partners to assure health screening of the population registering at

congregate locations.

6. Coordinate with healthcare partners to assure medical and mental/behavioral health services
are accessible at or through congregate locations.

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 7. Coordinate with providers to facilitate access to medication and assistive devices for
individuals impacted by the incident.

8. Coordinate with jurisdictional HAZMAT resources or other lead agency to assure provision of
population monitoring and decontamination services, including the establishment of tracking
systems of contaminated or possibly contaminated individuals who may enter congregate
locations, if applicable. See Annex K for more information regarding incidents of this nature.

9. Disseminate accessible information regarding available mass care health services to the
public.

10. Coordinate with Division of Humane Services and other agencies to accommodate and
provide care for service animals within general shelter populations.

11. Coordinate with EMS, DEM, local, state, tribal, and federal health agencies, state hospital
associations, social services, and participating nongovernmental organizations to return
individuals displaced by the incident to their pre-incident medical environment (for example,
prior medical care provider, skilled nursing facility, or place of residence) or other applicable
medical setting during and after the incident.

References

1. (2011). RHCC Shelter Medical Support Annex, pp. 18-19.

ORGANIZATION

At the local level, the American Red Cross will be the primary agency responsible for activating and
staffing shelters. DPH and DEM will support their efforts by providing staff, medical resources,
guidance, and inspection of facilities when possible.

At the state level, MO DHSS and SEMA will be the lead agencies to provide support and resources to
supplement local efforts. SEMA houses Functional Assessment Support (FAST) which can be
activated to assist in identifying and resolving needs for AFN clients.

- These resources should be requested via DEM.

At the federal level, DHHS and FEMA will be the primary agencies that can provide guidance and
resources to support local and state efforts. Federal assets include the National Disaster Medical
System (NDMS) which can be activated to provide staff, guidance, and resources to provide
additional care for displaced residents.

- These resources should be requested by SEMA via DEM.

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Attachment 1:

Key AFN Planning Resources

1. Medicare Information by County

a. DHHS emPOWER Map (Medicare electric dependency)
http://www.phe.gov/empowermap/Pages/default.aspx

b. Medicare Chronic Diseases by County

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/Dashboard/Chronic-Conditions-County/CC_County_Dashboard.html

c. Mapping Medicare Disparities by County

https://data.cms.gov/mapping-medicare-disparities

2. Pediatric Resources
a. City of St. Charles School District
i. http://stcharles1.schoolwires.net/Page/79

b. Fort Zumwalt School District

i. http://www.fz.k12.mo.us/about_us/departments/special_education

c. Francis Howell School District

i. http://www.fhsdschools.org/departments/special_education

d. Orchard Farm School District

i. http://www.ofsd.k12.mo.us/district/student_services/special_education

e. Wentzville School District

i. http://wentzville.k12.mo.us/mod/page/view.php?id=2477

f. Number and Capacity of Childcare Facilities – St. Charles County

https://webapp01.dhss.mo.gov/childcaresearch/searchengine.aspx

g. Childcare Emergency Preparedness

http://health.mo.gov/safety/childcare/emergency.php

h. Childcare Inclusion Services Professionals

http://health.mo.gov/safety/childcare/pdf/inclusionservicesmap.pdf

i. Pediatric Resources – DHHS TRACIE

https://asprtracie.hhs.gov/technical-resources/31/Pediatric/0

3. State of Missouri Resources

a. Functional Assessment Support Teams
i. Collaborate and assess resource needs of individuals in all post-disaster settings, but
especially in general population shelters.
b. Missouri Emergency Human Services
http://sema.dps.mo.gov/programs/emergency-human-services.php

c. Should be requested through DEM

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4. Federal Resources
a. FEMA Guidance on Integrating AFN
http://sema.dps.mo.gov/docs/programs/Planning-Disaster-Recovery/LEOP-Planning-
Documents/fnssfinalguidance20101031.pdf

b. National Disaster Medical System - DHSS

http://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx

c. National Commission on Children in Disasters

http://archive.ahrq.gov/prep/nccdreport/nccdreport.pdf

d. National Advisory Committee on Children in Disasters

http://www.phe.gov/Preparedness/legal/boards/naccd/Pages/default.aspx

e. HSPD 21
http://georgewbush-whitehouse.archives.gov/news/releases/2007/10/20071018-
10.html

f. Should be requested by SEMA through DEM

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