# Presentation: 064975

## Being Prepared:  Having in Place a Continuity of Operations Plan (COOP)

**Norman A. Crouch, Ph.D.**
**Director**
**Public Health Laboratory**
**Minnesota Department of Health**

**National Laboratory Training Network**
- Teleconference
- October 18, 2006

## Laboratory Role in Health Protection

-  Screening newborns for heritable and congenital disorders
-  Detecting common, rare, and emerging health threats
-  Responding to biological, chemical, and radiological emergencies
-  Diagnosing infectious diseases of public health importance
-  Monitoring environmental matrices for hazardous chemical agents

**Core Functions:**

## Laboratory Preparedness

-  Respond to natural, accidental, or intentional disasters
-  Maintain critical operations during disasters that impact:
-  Laboratory facilities
-  Laboratory staff

**Public Health Laboratories Expected to:**

## Public Health Laboratories

*“**Public health laboratories are to public health *
*what police departments are to public safety . . . *
*watching for trouble, prepared to respond.”*

**Importance:**

## Purpose of COOP

-  Assure continuation of essential laboratory functions
-  Assure laboratory can act rather than just react
-  Assure laboratory meets demands dictated by the disaster

**In Response to a  Disaster:**

## Hurricane Katrina

- Redefining Laboratory Preparedness
- at the
- Louisiana Public Health Laboratory1

- 1 Selected slides used with permission from a presentation given by Dr. Stephen Martin, Director of the Louisiana Public Health Laboratory, at the 2006 Annual Meeting of the Association of Public Health Laboratories.

## Pre-Hurricane Actions

-  Secure lab facilities and equipment within areas that may be impacted
-  Prepare to have staff available in the Emergency Operations Center
-  Prepare to move staff, supplies, and equipment to non-impacted areas
-  Permit remaining lab staff to assist with Health Department activities

## Katrina:  Friday, August 26th

## Lab Actions:  Friday, August 26th

-  Main lab in New Orleans (4th, 7th, and 8th floors of State Office Bldg)
-  Verified communications – recall lists
-  Checked equipment
-  Pagers
-  Cell phones
-  State police radios (800 MHz)
-  Secured equipment not in use (powered down, covered)
-  Arranged to return next day to secure equipment left operating
-  Allowed staff to make personal emergency plans

## Katrina:  Saturday, August 27th

## Lab Actions:  Saturday, August 27th

-  Managers and supervisors returned to New Orleans lab
-  Shut down remaining operational lab equipment
-  Removed files needed for short term operation
-  State Emergency Operations Center activated
-  Verified building security with capitol police
-  Lab secured and closed at 2 PM

## Katrina Hits:  Monday, August 29th

- Category 4 Hurricane

## Lab Actions:  Monday, August 29th

-  Lab director and assistant director at the Shreveport Regional lab
-  8 AM – lost communications
-  Land lines, cell phones, wireless internet, and pagers
-  800 MHz radios all needed for evacuation and rescue
-  1 PM – first reports of levee breaches and widespread flooding

## Lab Actions:  Monday, August 29th

-  Main New Orleans and Amite Regional lab where 100% out of service
-  No phone, water, or electricity
-  Represented 70% loss of public health lab space and equipment
-  Only about 10% of New Orleans staff checked in – most evacuated

## Post-Hurricane Expectations

-  Resume all pre-hurricane testing
-  Provide microbiological testing of all potable water supplies
-  Provide testing for enteric and respiratory pathogens 24/7 for:
-  Evacuees in shelters
-  First responders
-  Provide expanded arbovirus testing in flooded areas:
-  West Nile virus (WNV)
-  St Louis encephalitis virus (SLE)
-  Eastern equine encephalitis virus (EEE)

**LA-PHL System:**

## Immediate Post-Hurricane Issues

-  Relocate testing from the main New Orleans lab to other labs
-  Assess the status of the New Orleans and Amite labs
-  Find equipment to replace that unavailable at the New Orleans lab
-  To reestablish testing capacity
-  Especially real-time PCR and mass spectrometry
-  Replace reagents and supplies
-  Obtain CLIA, FDA, and EPA approval to move testing to other labs
-  Locate laboratory staff
-  Acquire pathology support

## Immediate Post-Hurricane Priorities

-  Reestablish microbiological testing of drinking water
-  About 2 million without potable water
-  Temperature of > 90 degrees with humidity about 90%
-  Reestablish newborn screening
-  Reestablish real-time detection of:
-  Enteric pathogens
-  Respiratory pathogens
-  Arboviral pathogens

## September 5th:  View from Lab

- New Orleans

## Assistance to the LA-PHL

-  Iowa PHL – newborn screening
-  Texas PHL – tuberculosis  and drinking water testing
-  Arkansas PHL – drinking water testing
-  Alabama PHL – LRN/bioterrorism testing
-  USEPA Houston lab – trace metal testing for drinking water
-  USEPA mobile labs – drinking water testing
-  LSU clinical labs – variety of clinical testing and pathology services
-  FDA mobile labs from Arkansas – water testing to reopen fisheries
-  Others

## Evaluation of Pre-Hurricane Plan

-  Communications were disrupted or failed
-  Staffing issues resulted from many displaced, homeless employees
-  Support from FEMA and EMAC was hard to access
-  Not enough redundancy for critical services, especially communications
-  Time frame of the plan was too short, only one week
-  US Postal Service ceased to function in affected areas

## Lessons Learned from Katrina Event

-  Need to have short term and long term plan
-  Need to assure effective, reliable communication systems
-  Need to assure emergency power is adequate and sustainable
-  Need to back up critical laboratory records
-  Need to have senior lab staff report immediately to a secure location

## Elements of a COOP 

- Elements of a COOP

## Purpose of COOP

-  Threat to or incapacitation of the laboratory facility
-  Need to relocate selected lab personnel or functions
-  Need to assure continuation of lab’s essential functions

**Pre-Plan to Address:**

## Objectives of COOP

-  Ensure continuity of essential lab functions during crises
-  Protect essential facilities, equipment, records, and other assets
-  Reduce or mitigate disruptions to lab operations
-  Prevent loss of life and minimize damage
-  Achieve timely and orderly reconstitution of normal operations
-  Ensure and validate COOP readiness through training/exercising

## Elements of COOP Planning

* *Assess lab vulnerability
-  Define trigger for activating plan
-  Establish incident command structure
-  Identify recovery teams
-  Determine essential lab functions
-  Identify alternative lab site
-  Pre-arrange assistance from other labs
-  Pre-position supplies and workstations
-  Create a “Go Pack”

## Planning:  Lab Vulnerability

* *Scenarios which could threaten or incapacitate the lab
-  Assess the lab’s vulnerability for each (e.g., security)
-  Level of risk for any threat is used to guide planning

- Air handling failure	Snow and ice	Hazardous chemical release
- Bomb threat	External sabotage	Sewer failure
- Explosion		Electrical failure	Steam failure
- Civil disturbance	Computer failure	Severe storm
- Fire		Telephone failure	Mischief
- Earthquake		Flooding		Accreditation loss
- Hurricane		Labor dispute	Epidemic disease
- Tornado		Workplace violence	Terrorist attack
- Severe wind	No state budget	Hazardous biological release

## Planning:  Triggers for Activation

* *External or internal event closes lab to normal activities
-  Area closed to business because of catastrophic event
-  Action to take based is on COOP team assessment of situation
-  Need to pre-establish trigger points based on lab vulnerability

## Planning:  Incident Management

- Capability/Capacity Assessment

- Safety

- Incident Manager

- Planning

- Logistics

- Finance

- Liaison

- Sample Recovery

- Facility

- Results Recovery

- Operations

- Capability/Capacity
- Assessment

- Sample Receiving

- Facility

- Staffing

- Supplies/Equipment

- Communications

- IT Support

- Pre-identify key staff

## Planning:  Recovery Teams

* *Pre-identify special COOP teams as needed
-  Each team responsible for a specific aspect of recovery
-  Examples:
-  Management team
-  Facility evacuation team
-  Relocation team
-  Alternate site preparation team
-  Operations, communications, and computer team
-  Administration and logistics planning team
-  Salvage and recovery team
-  Security coordination team

## Planning:  Essential Lab Functions

-  Must _*maintain*_ in house or at an alternate site
-  Could _*outsource*_ to another lab
-  Should _*suspend*_ for duration of emergency

**Categories of Function to Consider:**

- Essential

## Planning:  Essential Lab Functions

* *List the overarching goals of the lab
-  Provide guidance and testing to control _*infectious disease*_
-  Provide guidance and testing to support _*environmental health*_
-  Provide guidance and testing to support _*maternal and child health*_
-  For each goal, list _ALL_ of the lab functions

## Planning:  Essential Lab Functions

-  Categorize each lab function based on the impact if _NOT_ continued
-  Tier 1 – highest priority
-  Tier 2 – medium priority
-  Tier 3 – lowest priority
-  Tier 4 – non-essential

## Planning:  Essential Lab Functions

-  Rank order essential functions based on _TIME_ operation can go without
-  AAA
-  AA
-  A
-  B
-  C
-  D

- Criticality Codes

## Planning:  Essential Lab Functions

-  Delineate _tasks_ required to accomplish each function identified
-  Delineate _resources_ required to accomplish each task identified

## Planning:  Identify Alternative Lab Site

-  Does the alternative lab have the required certifications
-  Does the alternative lab have necessary security
-  Is the alternative lab LRN and Select Agent approved
-  What will be the financial arrangement
-  Will there be liability issues to address
-  Will the alternative lab retain or return tested samples
-  What are the risks in using a particular lab

**Issues to Consider:**

## Planning:  Identify Alternative Lab Site

* *What essential tests need to be outsourced
-  What methods of testing will the alternative lab use
-  How will the results be reported by the alternative lab
-  What will be the expected turn-around times for results
-  Is the alternative lab’s capacity for the testing sufficient
-  How will the specimens or samples be transported
-  What are the advantages/disadvantages of particular labs

**Issues to Consider:**

## Planning: Identify Alternative Lab Site

* *Consider local reference labs for essential diagnostic testing
-  Create a database for each possible alternative lab
-  Contact information
-  Capabilities
-  Capacities

## Planning:  Arrangements for Assistance

-  Pre-arrange assistance through formal documents:
-  Memoranda of Understanding (MOU)
-  Short term assistance
-  May provide defined services
-  Perhaps no funds involved
-  Memoranda of Agreement (MOA)
-  Long term assistance
-  Will provide defined services
-  Funding agreed upon

## Planning:  Arrangements for Assistance

-  Pre-arrange assistance through formal documents:
-  Contracts
-  Routine assistance
-  Long term
-  Funding established
-  Emergency Management Assistance Compact (EMAC )

## Planning:  Supplies and Workstations

-  Determine number of workstations needed for off-site
-  Create an inventory for each station accessible off-site
-  Computer, printer, fax machine
-  Phone
-  Internet access
-  Paper, pens, etc.
-  Workstation-specific materials such as:
-  Packaging and shipping supplies
-  Forms
-  Barcode reader, etc.

## Planning:  “Go Pack”

-  Have pack located at an off-site location1
-  Hard copy of the COOP
-  Electronic copy of the COOP on a jump drive
-  Copy of relevant standard operating procedures
-  Contact information for all special COOP staff
-  Contact information for all non-COOP staff

- 1 May also be maintained on an external website

## Operations for COOP

* *Phase 1:  Activation and relocation
-  Phase 2:  Alternate facility operations
-  Phase 3:  Recovery and reconstitution

## Phase 1:  Activation and Relocation

-  COOP should include all activation and relocation procedures
-  First determine extent of emergency and _level_ of activation needed
-  Decision to activate made by special lab COOP team base on:
-  Lab capabilities remaining
-  Length of time lab is expected to be down
-  What safety and security issues exist
-  Conduct internal and external notifications
-  Internal:  COOP and non-COOP staff
-  External:  Health Officer, clients, couriers, alternative labs, etc.

## Phase 1:  Activation and Relocation

-  Devolution:
-  COOP must consider worst-case scenario
-  If COOP leadership team is incapacitated
-  Plan for transferring all essential functions to a different site

## Phase 2:  Alternate Facility Operations

-  Determine essential function capabilities/capacities needed
-  Identify appropriate alternate site from COOP database
-  Activate pre-determined arrangements for assistance from site
-  Assure vital files, records, and databases are secure and usable
-  Determine what testing is complete and needs to be reported
-  Notify submitters about samples being tested before event happened
-  If testing can be completed
-  If samples will be referred to an alternate lab for testing
-  Implement mechanism for reporting test results by alternative lab

## Phase 3:  Recovery and Reconstitution

-  Returning to the original facility, if possible
-  Replacement of the original facility, when necessary
-  Develop a formal _After Action Report_ to assess COOP

## Conclusions

-  COOP is a critical document to assure essential functions
-  Many examples of past need
-  Our _*public health labs need to be prepared*_
-  APHL Board of Directors
-  Need for all public health laboratories to develop a COOP
-  Emergency Preparedness and Response Committee charge
-  Guidelines for COOP development will be forthcoming

## Current Status of COOP

-  Laboratory has a COOP in place	19
-  Laboratory is part of state COOP	14
-  Laboratory has _no COOP_		_17_            (34%)

**State Public Health Laboratories:**

- 50

- Public Health Laboratory Issues in Brief:
- Bioterrorism Capacity, May 2006

## Post Teleconference Information	

- Participants need to go to  _[www.cdc.gov/phtnonline](http://www.cdc.gov/phtnonline)_  to register, complete an evaluation and print a CEU certificate.
- Course verification code: **COOP**
- CA and FL CEUs are available and can be requested on the evaluation form.
- CEUs are available until November 15, 2006.