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

• Saline County is supported by two hospitals located in Marshall and Sweet Springs (see Appendix 2 to this Annex). Residents also rely on hospitals located in Sedalia, Columbia, Boonville, Lexington, Carrollton and Warrensburg and other locations. All of these hospitals have developed emergency plans in accordance with State and Federal regulations. Such plans are tested and exercised regularly.

• Public health for Saline County is the responsibility of the Saline County Public Health Office located in Marshall. They address problems such as communicable disease, environmental sanitation problems, bio-terrorism, contamination of food and water, and other health matters. The Saline County Health Department has developed an emergency response plan to deal with these public health emergencies. That plan compliments this emergency operations plan.

• Ambulance service for Saline County is provided through 3 districts located at Marshall, Slater and Sweet Springs (see Appendix 2 to this Annex). The ambulance services are all dispatched through the county E-911 Facility:

Slater Ambulance District No. 1

Sweet Springs Ambulance Dist. No. 2

Saline County Ambulance District No. 3, located in Marshall.

• Should the local medical organization become overtaxed or rendered inoperable, resources are available from the state and surrounding counties to help alleviate the situation.

• Depending upon the emergency, Saline County may have a limited capability in decontaminating injured individuals that have been contaminated. Injured individuals would be taken to Fitzgibbon Memorial Hospital located in Marshall for decontamination, treatment and care.

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

• First responder emergency medical care will be supplied by the ambulance districts and support, if needed, will come from the fire and rescue services.

• All medical units responding to an emergency call will be dispatched as described above in the Situation and Assumptions section.

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

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

• Review the identified hazards (Basic Plan, Situation and Assumptions) to determine all the types of disasters that could occur in the county. Provide realistic training for the types of situations that could arise (such as hazardous materials incidents}. EMS personnel will be trained to a minimum at the hazardous material first responder awareness level.

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

• Develop Emergency Mortuary Plans and coordinate these plans with the Missouri Funeral Directors Association and the Emergency Management Coordinator (See Appendix 4 to this Annex).

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

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

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

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

• Identify medical facilities that have the capability to decontaminate injured individuals that have been contaminated.

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

• Participate in tests and exercises of the Saline County Emergency Operations Plan.

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

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

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

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

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

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

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

• Provide public health information to the Public Information Officer for dissemination to the public.

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

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

The organizational chart for the health and medical services is shown in Appendix 1 to this Annex.

• Coordination of the Health and Medical services in Saline County will be the responsibility of the Administrator of the Saline County Public Health Office.

• Emergency mortuary procedures will be the responsibility of the Saline County Coroner.

• The Administrator of the Saline County Public Health Office will be responsible for public health matters, to include health education.

• The Ambulance Services (Saline County Ambulance District #3, Slater Ambulance District #1 and Sweet Springs Ambulance District #2) will be responsible for initial triage, emergency medical treatment and patient transport. Helicopter evacuation is possible from certain locations as documented in the Appendix and supporting photographs and descriptions.

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

• Crisis counseling for disaster victims and emergency workers can be provided by the local medical services and the Missouri Department of Mental Health.

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

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

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

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

• The line of succession for the Saline County Health & Medical Coordinator will be through the Administrator of the Saline County Public Health Office

• The line of succession for each operating health and medical agency/organization will be as explained in departmental SOG.

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

Deaths

Injuries

Inoculations given

Blood supply

Incidence of disease

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

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

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

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

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