Functionality of Environmental Health and Incident Command System in Oregon
Nicholas Alviani
Registered Environmental Health Specialist, Lane County, Oregon
Abstract
The purpose of this research project was to analyze the use of Environmental Health (EH) Specialists in Oregon within Incident Command System (ICS) and to identify EH roles and utilization in specific Emergency Support Functions related to ICS and emergencies. The methodologies used in this research include individualized surveys sent to all environmental health program supervisors in each county in Oregon with a dedicated health department. A separate survey also was sent to all emergency management offices or contacts in each county and Tribal Nation in Oregon. Separately a phone interview was conducted for each respondent who agreed to be interviewed. The results obtained include the total amount of ICS activation by each county with a dedicated health department between the years 2014 and 2018, EH program utilization during ICS activation between the years of 2014 and 2018, and specific support functions identified by EH program emergency response. Additional qualitative data was gathered from phone interviews regarding past experiences with ICS and recommendations for future emergency responses. The research found that ICS in Oregon counties with dedicated health departments was activated in each year of the research period. EH programs were utilized in 85% of the activations. EH was utilized to support ESF 6 (Mass Care, Emergency Assistance, Housing, and Human Services) and ESF 8 – (Public Health and Medical Services). Recommendations include identification of EH roles and utilization by state agencies and ICS command staff prior to future emergencies, for EH specialists to advocate for and programs to support EH roles with continuous training, multi-agency exercises, and continual engagement with local ICS leadership.
Key words: ICS - Incident Command System, EH - Environmental Health
Functionality of Environmental Health and Incident Command System in Oregon
Background
Oregon had 1.4 times more emergency and disaster declarations between the years 2005 to 2020, than it did between the years of 1990 and 2005 (Federal Emergency Management Agency, 2020). With the number of new and reoccurring emergencies increasing in Oregon, which uses Incident Command System (ICS), are environmental health departments utilized routinely or to the fullest extent? ICS is a standardized approach to coordination of emergency response with multiple agencies. In Oregon, state agencies such as the Oregon Office of Emergency Management (OEM), local governments, and Tribal Nations collaborate during an emergency response. Any agency utilizing or applying for federal preparedness funding must be Nation Incident Management System (NIMS) compliant (Federal Emergency Management Agency, FEMA Preparedness Grans Manual, 2020).
ICS uses 15 Emergency Support Functions (ESF) to identify a government or private organization’s capabilities to provide support, resources, and services (Federal Emergency Management Agency, 2016). The Department of Health and Human Services is the ESF coordinator for ESF 8 and a supporting agency for ESF 6 (Federal Emergency Management Agency, 2016). ESF 6 - Mass Care, Emergency Assistance, Housing, and Human Services provides emergency assistance including coordination and management of organizations to provide non-congregate temporary shelters. Shelter care includes individual case management and assistance for individuals in shelters. (Federal Emergency Management Agency, Emergency Support Function #6 – Mass Care, Emergency Assistance, Housing, and Human Services Annex 2016). ESF 8 - Public Health and Medical Services provide assessment of public health, health surveillance, food safety education, vector control, and guidance on potable water (Federal Emergency Management Agency, Emergency Support Function #8 – Public Health and Medical Services Annex, 2016).
Oregon has 36 counties, 28 of which have a dedicated Environmental Health (EH) program. The remaining eight county environmental health programs are shared or contracted out by Oregon Health Authority (OHA) or neighboring counties. Environmental health programs provide guidance, information, and inspections related to food safety, potable water, vector control, pools, spas, and beaches and recreational areas including campgrounds, RV parks, and hotels (Oregon Health Authority, PE #50, 2020 and Public Health Division OARs, 2020).
Each county in Oregon has an emergency management program or resource consisting of emergency managers, services managers, disaster program managers, preparedness coordinators, and public safety directors or law enforcement officers. Emergency management offices may be located within the county emergency manager’s office, sheriff’s office, or other similar departments. There are nine Oregon Tribal Nations with similar emergency management programs.
Environmental health specialists have expertise in many fields including drinking water, food safety, vector control, septic systems, radiation, and emergency response. Environmental health specialists may be important to support functions in emergency response and may provide expertise during an emergency (Wisner, Ben, Adams, John & World Health Organization, 2002).
As new and reoccurring emergencies become more frequent, there is inadequate information on how environmental health programs are utilized for emergency support functions in Oregon.
Problem Statement
The extent to which environmental health programs in counties with dedicated health departments are utilized in Incident Command Systems in Oregon is currently unknown.
Research Questions
1. What percentage of counties in Oregon with dedicated health departments activated ICS from 2014 to 2018?
2. What percentage of counties with dedicated health departments utilized the environmental health programs in ICS activation from 2014 to 2018?
3. What emergency support functions were provided by environmental health programs which activated ICS from 2014 to 2018?
4. What are the contributions made by environmental health programs that were utilized in ICS from 2014 to 2018?
5. If environmental health was not utilized during an ICS activation, including ESF #6 or ESF #8, why were they not used?
Methodology
To understand the preliminary information available, a review was conducted of annual reports and website data from the Federal Emergency Management Agency (FEMA) and emergency disaster declarations, the Oregon Health Authority, and the Oregon OEM regarding declarations, and the Oregon Comprehensive Emergency Management Plan. Local county ICS usage and emergency operations plans also were reviewed.
A survey was sent to all environmental health supervisors with dedicated EH programs and emergency managers in all counties and Tribal Nations in Oregon. The survey asked questions addressing when ICS was implemented and how EH programs were used in emergencies during the research period. Respondents also were asked if they would be willing to participate in a phone interview.
Respondents who opted for a phone interview were contacted and ensured anonymity. The interviews consisted of questions designed to elicit additional qualitative data about the involvement of EH programs in specific emergency situations, such as the role of the EH staff members. Interviews were recorded and transcribed for analysis.
Data from the surveys was entered into a Microsoft Excel spreadsheet for analysis. The data from the phone interview transcripts was analyzed for common themes and trends.
Results
Nine out of 28 environmental health supervisors (32%) responded to the questionnaire, while one out of 36 (2%) of county emergency management office representatives responded. Notable factors that may have contributed to a low response rate and limited data pool were the Covid-19 pandemic response and unprecedented wildfires which severely affected multiple counties in Oregon and overwhelmed local public health departments and emergency management offices.
Figure 1 shows 50% of responding environmental health programs had their health department activate ICS during the years 2014-2018. Figure 2 shows that 2017 saw the greatest number of ICS activation by health departments due to multiple wildfire and flooding emergencies.
Figure 1
ICS Activation 2014-2018
Figure 2
Years ICS Activated
Figure 3 shows the rate at which EH was utilized in ICS during 2014 to 2018. EH was utilized in ICS response 50% of the time. Figure 4 shows total EH program usage per year among nine responding EH programs. The years 2014, 2015, and 2017 were those during which county health departments most frequently activated ICS. When relating the data for EH usage to ICS activation during the years 2014 to 2018, environmental health programs were utilized during 12 of 14 (85%) ICS activations.
Figure 3
EH Utilized in ICS 2014-2018
Figure 4
Years EH utilized in ICS Activation
Interviews were conducted with environmental health supervisors and emergency managers who responded to the survey and agreed to an interview. Five interviews were conducted with environmental health supervisors, while one interview was conducted with an emergency manager. The interviews included questions about how EH was utilized and why EH was not utilized in ICS activations. The most common terms for how environmental health programs were used include: food safety, outbreak control, training, facility help, water quality, winter storm response, and wildfire response. These terms encompass the roles ESF 6 (Mass Care, Emergency Assistance, Housing, and Human Services) and ESF 8 – (Public Health and Medical Services). The most notable reasons why EH programs were not included in ICS activations are as follows:
· Emergency operation centers may not understand environmental health knowledge or training related to emergency response.
· Environmental health may not be needed for specific ICS activations.
· Some agencies had little institutional memory of, or even if, ICS was activated in the years in question.
· Some administrations had differing views of whether to activate ICS or not.
Five interviewees and one survey respondent who was not interviewed noted the importance of training and participating in exercises prior to emergencies, and the resulting positive impact on environmental health response during emergencies.
Conclusions
ICS in health departments were activated each year in Oregon, between 2014 and 2018, and EH programs were used about 85% the time during that same period of time. Response data on ICS activation demonstrates that ICS activation and emergency response are common during the periods of time reviewed in Oregon.
EH programs are utilized often when ICS is activated by local health departments, generally due to EH programs in Oregon existing within the local health department program structure.
EH programs primarily supported functions for ESF #6 and ESF #8, which includes; drinking water, food safety and shelter inspections (related to wildfires and winter storm events). Contributions by environmental health specialists include, food safety education, outbreak control, training, facility help, water quality, winter storm response, and wildfire response. These two ideas tie together the roles and contributions of EH during emergency response and should be areas of focus regarding future activation.
Interviewees and respondents suggested environmental health utilization was generally related to the nature of the emergency; therefore, if the emergency did not require ESF 6 or ESF 8, then environmental health programs would not be used. In addition, if members of the emergency operations center do not understand the roles and abilities of environmental health specialist staff, then environmental health programs may not be used. When determining utilization of EH specialists and programs, these determining factors should be applied and used to analyze how ICS coordinates and responds to emergencies in order to appropriately integrate EH programs.
Recommendations
The recommendations from this study indicate Oregon Health Authority and incident command staff should use historical information to consider environmental health usage for future emergencies. Historical information could include; EH usage in the state, usage by county, environmental health education and training related to specific emergency response, and national responses by EH specialists.
Additionally, EH specialists should advocate for their roles in ESF #6 and ESF #8 in ICS, when activated, prior to future emergencies. Methods for advocating could include; more incident command system training, conducting emergency preparedness exercises with other entities, and continual engagement during any coordination efforts. These methods could result in better trained staff, better response performance and timing, and increased contact and/or communication with management and emergency operation centers.
Acknowledgments
Collaboration between Counties, the State of Oregon, emergency managers, and environmental health specialist and supervisors in Oregon was crucial to the findings and results of this article, and I thank you all. To my Fellows in Cohort IX with International Food Protection Training Institute, who helped and encouraged me throughout this process, thank you. Thank you to all Mentors and the IFPTI Fellowship Program, for your support and expertise.
References
Federal Emergency Management Agency. (2021, February 25). Data visualization: Disaster declarations for states and counties. Retrieved from: https://www.fema.gov/data-visualization-disaster-declarations-states-and-counties
Federal Emergency Management Agency. (2016, June). Emergency Support Function #6 – Mass Care, Emergency Assistance, Housing, and Human Services Annex. Retrieved from: https://www.fema.gov/sites/default/files/2020-07/fema_ESF_6_Mass-Care.pdf
Federal Emergency Management Agency. (2016, June). Emergency Support Function #8 – Public Health and Medical Services Annex. Retrieved from: https://www.fema.gov/sites/default/files/2020-07/fema_ESF_8_Public-Health-Medical.pdf
Federal Emergency Management Agency. (2020, February) FEMA Preparedness Grans Manual 2020. Retrieved from: http://lapd-assets.lapdonline.org/assets/pdf/FEMA_PreparednessGrantsManual_21320_1605_508c.pdf
Oregon Health Authority. (2020). Laws and rules governing the public health division. Retrieved from: https://www.oregon.gov/oha/PH/rulesregulations/Pages/index.aspx
Oregon Health Authority. (2020, July) Program Element #50: Safe Drinking Water Program. Retrieved from: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/LOCALHEALTHDEPARTMENTRESOURCES/Documents/pe/PE-50-SDW.pdf
State of Oregon Office of Emergency Management. (2015, February 3). Oregon state emergency comprehensive emergency management plan. Emergency operations plan. ESF 6 – Mass Care. Retrieved from: https://www.oregon.gov/oem/Documents/2015_OR_EOP_ESF_06_mass_care.pdf
State of Oregon Office of Emergency Management (2014, December 1). Oregon state emergency comprehensive emergency management plan. Emergency operations plan - ESF 8 – health and medical. Retrieved from: https://www.oregon.gov/oem/Documents/2015_OR_EOP_ESF_08_health_medical.pdf
Wisner, Ben, Adams, John & World Health Organization. (2002). Environmental health in emergencies and disasters: a practical guide / edited by B. Wisner, J. Adams. World Health Organization. https://apps.who.int/iris/handle/10665/42561
Author Note
Nicholas Alviani, Registered Environmental Health Specialist
Lane County Environmental Health
This research was conducted as part of the International Food Protection Training Institute’s Fellowship in Food Protection, Cohort IX
Correspondence concerning this article should be addressed to:
Nicholas Alviani, Lane County Environmental Health
151 West 7th St, Suite 430 Eugene Oregon 97401
Nicholas.Alviani@lanecountyor.gov
*Funding for this statement, publication, press release, etc., was made possible, in part, by the Food and Drug Administration through grant 5U18FD005964 and the Association of Food and Drug Officials. Views expressed in written materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does any mention of trade names, commercial practices, or organization imply endorsement by the United States Government.