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City of Dubuque COVID-19 After Action Report (AAR) Summary Copyrighted September 5, 2023 City of Dubuque Action Items # 02. City Council Meeting ITEM TITLE: City of Dubuque COVID-19 AfterAction Report (AAR) Summary SUM MARY: Public Health Director Mary Rose Corrigan will present a review of the City of Dubuque COVI D-19 After Action Report SUGGESTED Receive and File; PresentationSuggested Disposition: DISPOSITION: ATTACHMENTS: Description Type MVM Memo City Manager Memo COVI D After Action Report 081523 Staff Memo COVI D After Action Report Presentation Supporting Documentation Dubuque THE CITY QF � All-Meriea Ciry DLT B E ; . � . � �� MaSt� Z�C� aYd t�Q Mt55ZSSZ Z zoa�•zoiz•�ai3 YP pp za��*zai� TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: City of Dubuque COVID-19 After Action Report (AAR) summary DATE: August 29, 2023 A City of Dubuque COVID-19 After Action Report (AAR) summary is being provided to City Council. The city's internal Emergency Preparedness Committee, worked with consultant Emergency Preparedness Consulting LLC (EPC) to gather data and departmental input for the final AAR and Improvement Plan (IP). The committee consists of: • Mary Rose Corrigan, Public Health Director • Tom Berger, Emergency Management Agency Coordinator • Jeremy Jensen, Police Chief • Amy Scheller, Frie Chief • Cori Burbach, Assistant City Manger With assistance from: • Chris Kohlmann, Information Services Manager • Abhishek Rai, City Manager's Office Fellow • Dawn March, former Environmental Sanitarian - Emergency Preparedness Planner • Mark Murphy, Environmental Sanitarian - Emergency Preparedness Planner It should be noted that the information in this report is limited to observations that are directly related to the City of Dubuque Incident Management Team and does not contain detailed information regarding actions that occurred at the Departmental level. Emergency Preparedness Consulting, LLC conducted interviews with current and former City of Dubuque employees who were heavily involved in the city's internal and community wide COVID response. Interviews were conducted via online video conferencing platforms and lasted approximately 45-60 minutes. The interviews were specifically tailored to elicit information regarding interactions within the City of Dubuque governmental structure. In addition, the City Emergency Preparedness Committee and Emergency Preparedness Consulting, LLC felt it was critical to obtain input from all city departments on their actions and experiences during the pandemic. A survey was created to collect input from staff inembers who worked for the city during the pandemic to reflect on the preparedness of each department during the COVID-19 pandemic as well as preparedness for future emergencies. Department Managers were asked to collect input from city employees who were key in responding to the pandemic emergency disruption within their department and fill out the survey. Public Health Director Mary Rose Corrigan will now present a review of the City of Dubuque COVID-19 After Action Report. � Mic ael C. Van Milligen MCVM:sv Attachment cc: Crenna Brumwell, City Attorney Cori Burbach, Assistant City Manager Mary Rose Corrigan, Public Health Director Tom Berger, Emergency Management Agency Coordinator Jeremy Jensen, Police Chief Amy Scheller, Fire Chief 2 DIJ�)UC�Ue Health Services Department THE CITY OF , , City Hall Annex 1300 Main Street All-America Ci� Dubuque,IA 52001 U L J� n�iwa,V�n�x_ii.e.,�� Office(563)589-4181 Fax(563)589-4299 °° TTY(563)589-4193 2007•2012-2013 health@cityofdubuque.org Masterpiece on the Mississippi 2�1]+tZQ1] www.cityofdubuque.org TO: Mike Van Milligen, City Manager FROM: Mary Rose Corrigan, Public Health Director Tom Berger, Emergency Management Agency Coordinator Jeremy Jensen, Police Chief Amy Scheller, Fire Chief Cori Burbach, Assistant City Manger SUBJECT: City of Dubuque COVID-19 After Action Report (AAR) summary DATE: August 15, 2023 INTRODUCTION This memorandum summarizes the City of Dubuque COVID-19 response and Improvement Plan. BACKGROUND INFORMATION The Dubuque County Incident Management Team (IMT) contracted with Emergency Preparedness Consulting (EPC) LLC, to produce the COVID-19 pandemic After Action Report (AAR) and Improvement Plan (IP). A presentation was given to City Council on April 17, 2023, on the overall county- wide response, led by the IMT. The contract with the consultant, EPC, included a separate component evaluating the City of Dubuque COVID -19 response operations including: • Public education regarding COVID-19 and municipal service delivery during the pandemic. • Safe workplace guidance and employee safety. • Departments' Continuity of Operations Plans. The city's internal Emergency Preparedness Committee, worked with EPC to gather data and departmental input for the final AAR and IP. The committee consists of� • Mary Rose Corrigan, Public Health Director • Tom Berger, Emergency Management Agency Coordinator • Jeremy Jensen, Police Chief • Amy Scheller, Frie Chief • Cori Burbach, Assistant City Manger With assistance from: • Chris Kohlmann, Information Services Manager • Abhishek Rai, City Manager's Office Fellow 1 • Dawn March, former Environmental Sanitarian - Emergency Preparedness Planner • Mark Murphy, Environmental Sanitarian - Emergency Preparedness Planner It should be noted that the information in this report is limited to observations that are directly related to the City of Dubuque Incident Management Team and does not contain detailed information regarding actions that occurred at the Departmental level. Emergency Preparedness Consulting, LLC conducted interviews with current and former City of Dubuque employees who were heavily involved in the city's internal and community wide COVID response. Interviews were conducted via online video conferencing platforms and lasted approximately 45-60 minutes. The interviews were specifically tailored to elicit information regarding interactions within the City of Dubuque governmental structure. In addition, the City Emergency Preparedness Committee and Emergency Preparedness Consulting, LLC felt it was critical to obtain input from all city departments on their actions and experiences during the pandemic. A survey was created to collect input from staff inembers who worked for the city during the pandemic to reflect on the preparedness of each department during the COVID-19 pandemic as well as preparedness for future emergencies. Department Managers were asked to collect input from city employees who were key in responding to the pandemic emergency disruption within their department and fill out the survey. Actions taken by the City of Dubuque were specific to the structure of city government and the following focus areas: Focus Area 1: Response Coordination and Logistics This focus area describes the observations related to the City of Dubuque incident management and logistics systems. Focus Area 2: Work Process Modifications This focus area describes the observations related to the changes in work process that were required based on the additional needs of the City of Dubuque. This focus area outlines new duties that were required of city departments, rather than those processes that were changed to maintain the essential functions described in Focus Area 4. Focus Area 3: Safe Workplace Guidance and Employee Safety This focus area describes the observations related to changes in physical working conditions, work processes, and guidelines provided to protect employees. Focus Area 4: Continuity of Operations This focus area describes the observations related to actions taken to ensure that the essential functions of City of Dubuque government operations would be maintained. This includes actions taken at the City and Departmental levels. 2 The actions taken by the City of Dubuque were specific to the structure of city government, and include the following: Primary Strengths Focus Area 1: Response Coordination and Logistics • Incident Action Plans were regularly completed for the City of Dubuque, in coordination with Dubuque County Emergency Management. A daily Department Manager meeting was more informative and productive than the weekly Incident Action Planning meetings. • Proactive planning- The Human Resources Department evaluated workforce and labor pool effectiveness. Because some duties were temporarily modified due to a lower number of employees being physically present in the workplace, consideration was given as to how some employees could be "re-assigned" to areas of need. Areas of need also included the hospitals, who were experiencing extreme workforce shortages. • Supply Chain Management- Multiple stakeholders advised that the City of Dubuque was extremely proactive in determining what supplies were needed by individual departments. Departments were asked to inform the City of Dubuque IMT of anticipated supplies once per week. • Departmental Briefings- Multiple stakeholders advised that their individual departments held regularly scheduled briefings to share information. These meetings were also used to discuss how information that was disseminated from the City of Dubuque IMT affected the departments. For the first several weeks of the pandemic, a daily call among the city Leadership was held to share information, (from the IMT and other sources) request assistance and share how departments were adjusting their work and what other changes were being made. These briefings became less frequent as the pandemic progressed and the department managers standing weekly meeting and the weekly ICS meeting continued. • In addition to the leadership calls, a second call was held to convey information to city employees. The frequency of these calls also decreased as the pandemic progressed. Many city departments also held internal departmental briefings. Focus Area 2: Work Process Modifications • The Fire Department was asked to assist with multiple requests that would normally be considered outside of the scope of the department. This included assisting with drive-through vaccination sites and other vaccine clinics, transporting COVID-19 patients from medical facilities to the shelter, and assisting with delivering food to those that were housed in the shelter. • The City Information Services Department oversaw and facilitated the internet access at the Kennedy Mall and Grand River Center PODs (Point of Distribution), and acquired software for the vaccination POD at the Grand River Center • The Finance Department created different purchasing codes to account for COVID related expenses. Also, several non-standard "specialty items" needed to be purchased (such as disinfection equipment for EMS and the library), and standard purchasing processes were used to do so. 3 Focus Area 3: Safe Workplace Guidance and Employee Safety • Since some employees initially still needed to be physically present in the office, departments immediately implemented social distancing in common areas. These type of accommodations for social distancing and safe work environments were adjusted throughout the pandemic. CDC (Centers for Disease Control and Prevention) guidance was used to create cleaning protocols for city facilities. As the pandemic progressed, additional workplace modifications were also implemented, such as plastic barriers. A Safe Workplace Guidance document for city employees was compiled, shared, and updated on a regular basis. Thermometers, masks, and cleaning supplies were made available. • Police Department policies were adjusted so that response, in-person trips were handled by telephone, rather than an officer going to the scene. Whenever possible, officers who needed to meet in person to discuss cases did so outside. Officers also requested that complainants meet outside rather than entering residences or businesses or homes. Officers noted they also made fewer traffic stops for low level offenses. • Fire Department processes were modified. When someone called to request EMS (Emergency Medical Services), the dispatch protocol was modified to ask questions that screened for potential COVID-19 symptoms or exposure. When responding to private residences, one medic would enter the building rather than the entire crew. If EMS was requested from a healthcare facility (such as a long- term care facility), staff was asked to bring the patient to the door if possible. • The City Attorney's Office drafted public health emergency language and met regularly to determine if any changes needed to be made to the City Public Health Emergency Declarations based on the impact of the State and Federal Declarations. This invaluable interpretation of ever changing State and Federal Proclamations was shared with the county IMT and the Dubuque County leadership. • Prior to the COVID-19 pandemic, the Human Resources Department was exploring alternative work arrangements such as remote working, flexible hours, etc. Many of the city's policies were being updated to begin implementing these policies. Because the city was already exploring these options, the Human Resources Department had a model from which to being implementing these measures when necessary. These new policies, along with the use of temporary and permanent technology, allowed for adjusted working hours and start times, implementing innovative work models like, 50% in the office and 50°/o out of the office and conducting virtual meetings among staff and with the public. • A variety of City personnel staffed the "Sleeves Up" vaccine information line and assisted with the PODs and public information outreach such as placing door hangers and providing other information. • Human Resources also worked throughout the pandemic to modify policies related to testing, sick leave, and other OSHA (Occupation Safety and Health Administration) guidelines. • Virtual meetings increased productivity and decreased waste. Staff became proficient/familiar with a variety of virtual meeting platforms. 4 Focus Area 4: Continuity of Operations • The City Attorney's office (and other departments) immediately began considering flexible work arrangement policies. This included looking at job functions/duties and whether these duties could be maintained if employees worked remotely. A core group began this process and presented their findings to Leadership for approval. • The City Attorney also immediately began evaluating how city functions could be maintained remotely while still adhering to state law regarding transparency. This included a process for holding all public meetings virtually while ensuring that there was a process in place to ensure public access and comment. Court proceedings that were normally held in-person were transitioned to virtual meetings. • The Information Services Department took measures to ensure that city employees had the technology functionality to work remotely. Many computers (approximately 180) that were due to be replaced were instead "recycled" and provided to employees for home use. This required additional consideration to ensure that cybersecurity was being maintained. Telephone communication required using "recycled" mobile phones and additional licensing to leverage the existing communications technology. • The Information Services Department did not have a robust system to track and resolve IT help desk issues. The department created a "ticketing system" for tracking IT support and implemented remote access so that help desk personnel could remotely access computers to assist users. Because some employees would normally need to print receipts in their workplace, printers were provided to employees for home use if necessary. • The Information Services Department also developed the technology infrastructure and processes for holding public meetings remotely. • The Human Resources Department advised that prior to the pandemic, all city employment applications were completed online. The city had considered transitioning to virtual interviews prior to the pandemic, with the goal of ensuring that applicants could be interviewed with the fewest barriers possible. This was implemented during the pandemic. • To circumvent the possibility of certain types of supply shortages, protocols were implemented to purchase a higher number of items than usual. An example given was that if the department ordered a larger number of gloves than usual for a fixed time period (several months), the supplier guaranteed that they would receive the gloves as ordered. • In early March 2020, the Health Services Department implemented its Continuity of Operations Plan (COOP) and delegated activities to other departments. For example, nuisance control duties were transitioned to the Housing Department. Routine environmental health regulatory inspections were temporarily suspended, which allowed the department to focus almost entirely on COVID response, both internally with the city organization and as part of the Dubuque County IMT. Health Services Department staff served as technical advisors to the City Manager's Office and all City of Dubuque operations. Other departments updated and began implementing their departmental COOPs. • The City Public Information Office provided daily updates to city staff on the daily "all employee webinars" held Monday through Friday for the first year or more in the pandemic. (The calls eventually shifted to three times a week and, eventually, once a week.) Those updates included daily new COVID case counts, deaths, 5 hospitalization levels, and IMT and/or CDC guidance for mitigation. When vaccines became available, these updates to City staff included the latest information on vaccination guidance as provided by the IMT and/or CDC. COVID-related guidance was also relayed to City employees through SPIRIT Times, the employee newsletter distributed every two weeks with payroll. Posters with COVID mitigation and vaccination guidance were also produced and distributed to departments for display in break areas and departmental office areas throughout the organization. Employees were also encouraged to subscribe to receive COVID updates from the IMT via email and/or text. Primary Challenges: Focus Area 1: Response Coordination and Logistics • The Incident Action Planning (IAP) and daily Department Manger meetings were informative, however, the two meetings created confusion, duplication, and lack of engagement at the weekly IAP meetings, where documentation of planning and activities took place. Likewise, early in the response there did not appear to be a well-defined Incident Command System in place. Although the city ICS became more developed throughout the response, it caused some confusion. • The Police Department experienced many questions regarding how various public health countermeasures (i.e., city mask ordinance) would be enforced. Although this process is within the scope of the Police Department's duties, there was not a clearly defined policy for doing so. Focus Area 2: Work Process Modifications • Although it is not unusual for the Information Services department to create infrastructure for various departments, this is normally done in a pre-planned process. Additionally, software needed for vaccination clinics would be done by determining system needs, creating a Request for Proposal, evaluating the proposals, and choosing a vendor. Due to a limited number of vendors that produce this software and a large number of jurisdictions that were also attempting to purchase similar software, the time frame for selecting a company was very compressed. • The Dubuque Fire Department was asked to assist with multiple requests that would normally be considered outside of the scope of the department. These proved to be both challenging and successful. • Managers and supervisors did not have the tools or processes to track productivity of those working from home. Some departments reported working from home was a disruption. • Maintaining morale and motivation was also voiced as a need, especially for those working remotely. Focus Area 3: Safe Workplace Guidance and Employee Safety • The Police Department modification of workplace practices was particularly challenging since they share space with the Dubuque County Sheriff's Office, who modified their processes differently than the Police Department. 6 • The Fire Department's close physical environment and long work shifts created several challenges. For example, it was almost impossible for employees to wear masks for their entire shift, since part of the shift included sleeping. • Interpreting relevant guidelines was also challenging for the Fire Department. While most City of Dubuque employees' health falls under the COVID protocols identified by OSHA or the CDC, EMS personnel are considered healthcare workers. Separate guidance or mandates issued for healthcare workers sometimes conflicted with Safe Workplace Guidance established for all other employees, leading to the need to interpret both and make judgements based on specific circumstances on a regular basis. • The division between non-essential and essential employees and their different work environments was challenging from a departmental work production standpoint and from an employee health and safety viewpoint. • Although Human Resources worked throughout the pandemic to modify policies related to testing, sick leave, and other OSHA guidelines, this proved to be challenging due to the frequent modifications in guidelines that were created in various federal agencies without notice. • Implementing the vaccination requirement for city employees was challenging due to employee understanding of the vaccine and vaccination process, also confidentiality and creating a system for documenting and interpreting if the vaccines employees received were compliant with the policy. Focus Area 4: Continuity of Operations • Although efforts were being made to develop Continuity of Operations Plans for every city department prior to the pandemic, several departments had not yet completed them. Those departments that had not yet completed their plans did so in an accelerated manner due to the workplace and work process modifications needed during the pandemic. • The Information Services Department advised that ensuring that all city departments had the resources necessary for working virtually was a monumental challenge. They advised that although it was assumed that most employees had computers at home, it was quickly determined that many did not. • Human Resources determined that after transitioning to virtual interviews during the pandemic, the primary concern was ensuring that applicants who may not have access to technology to conduct the interview process, were not placed at a disadvantage. • In the early stages of the pandemic, employees were allowed to take leave if they or their family member had been diagnosed with COVID-19 without using their accrued sick or vacation time off. This was modified during the course of the pandemic as federal guidance changed and caused confusion among employees. • Moving to paperless processes along with check processing required new methods and workarounds. • Office/at-home work adjustments included staff members had to pick up mail and make deliveries to employee's houses; internal controls were broken or were not strictly adhered to; dependency on one staff person in the office to receive city mail and packages; not having a contactless process for verifying driver's licenses and issuing permits; public expectation of in-person services at city buildings etc.) � • Misinformation about the pandemic and vaccinations at the local, regional, and national levels created challenges not only for the Public Information Office but also with and among city employees and with the public. Looking ahead The second phase of the AAR is creating an Improvement Plan (IP) to address the challenges and limitations experienced during the COVID-19 response. Improvement Item 1: Department Level After-Action Reporting Focus Area 1: Response Coordination and Logistics Each Department is encouraged to develop an After-Action Report and Improvement Plan that highlights the strengths and areas for improvement that were observed during the COVID-19 response in their individual department. Improvement Item 2: Incident Action Planning, Incident Command and Continuity of Operations. Focus Area 1: Response Coordination and Logistics Recommendations: Ensure that a process is in place to develop a comprehensive Incident Action Plan and Continuation of Essential City Services including: • Development of templates for Incident Action Plan and EOC Action Plan for use by the City of Dubuque IMT • Ensuring that all members of the City of Dubuque IMT have had appropriate training in the use of the "Planning P" Incident Action Planning Process • Ensure that the Incident Command Structure is clearly developed and communicated to all Department managers. Improvement Item 3: Healthcare Surge Capacity Planning Focus Area 1: Response Coordination and Logistics Recommendations: The City of Dubuque must have a process to provide surge capacity for medical, housing, or other services when the demand is greater than available resources. Improvement Item 4: Reassignment of City Employees & HR Policy Modifications Focus Area 1: Response Coordination and Logistics Recommendations: Explore the potential for reassigning city employees to assist city operations outside their department or normal duties as well as with community stakeholders such as healthcare during times of extreme need. This might occur when the duties of city employees are limited due to an infectious disease outbreak such as COVID-19. This should include: s • Identification of employee groups that could potentially be reassigned based on the emergency. • Determining a process by which employees are offered or assigned alternative assignments. • Determining a policy for employee compensation while working in alternative assignments • Determine sample agreements for community organizations utilizing city staff. • Staffing impacts of additional benefits/requirements/assignments for employees Improvement Item 5: Enforcement of Public Health and Emergency Specific Countermeasures Focus Area 2: Work Process Modifications Recommendations: Ensure that the process for developing and enforcing public health/employee safety countermeasures are clearly outlined. (ex. social distancing) This should include enforcement actions for local, county, state and federal measures. Improvement Item 6: Information Services Department Preplanning Focus Area 2: Work Process Modifications Focus Area 4: Continuity of Operations Recommendations: Ensure that the Continuity of Operations Plan for Information Services considers alternate scenarios that would require Information Services and technology support. This should include: • Working from alternative locations, including those that may not have existing infrastructure. • Support for off-site facilities that could be used for vaccination clinics or surge capacity facilities. Improvement Item 7: Communication to Employees and Community Focus Area 2: Work Process Modifications Focus Area 4: Continuity of Operations Recommendations: To provide consistent communication methods and formats throughout the incident. 9 Conclusion The areas outlined in this AAR and IP will be used to assist departments with workplace preparedness improvements, determine budget needs and priorities, provide an agenda for the City's Preparedness Committee for planning, training, exercising and updating plans, capabilities and employee competencies for preparedness specific acuities, and improving overall city employee and operational performance. A heartfelt thank-you to all the city staff and community partners who went above and beyond their normal duties to meet the needs of Dubuque during the pandemic. Thank you to the Mayor and City Council and City Manager Mike Van Milligen for the ongoing support, confidence, and direction. It is truly appreciated! 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M�� I � �O�O �;_q� n `��i� � :_��`�w`�,��Y� ' �' y� . � � 9 '� V �'v�. �� ;�'W �M � Media conference announcing Dubuque County COVID-19 death - �` �.�--�.. �� -� COVID- I 9 PUBLIC INFORMATION & OVTREACH � �'� °�. ��,: ; Du bu ue Cou nt COVI D -19 U dates q Y p • 586 COVID Updates issued between March 18, 2020, and Jan. 25, 2023. • Daily updates for first 13 months, then 3 times per week, then weekly. • Sent to nearly 1 , 100 recipient by email and text • All updates posted to social media � . , . ._. _ ; ,� � . . •. . . z% + s � �' - -- - - - �� 560 � ' `� . � � 434 49i5 ,, 315 37Q a295 :� . . �w� `.�'��:..`"� x+� �rt 257 =� ,�.� ir �� I��I �_; _ ' _ JI LII _� � � � � � � � � � � COVID- 19 PUBLIC INFORMATION & OVTREACH � , ., , , ��es , E�� - �1,- ■ ■ � �;`t�� ' :.�� e++n+a��a.e�oru� Cam a � ns & Mater� als � - ;�� -� p J �� FS �� . . . v�,. G �, _ � �,�. • Direct mail, countywide CodeRED �,, -o • �� - ._ . � . hone calls advertisin in count � --' `� �� . � �.�� e�;�.: p � J Y �. � .�_...�. - . . . J� print publications and on county �a�o�B�a��G° a '�- ' - _. �: �.: � aea�:�n��a ,�'''. radio stations, billboards �. ' - � � �� 6BSLBO�uere yryrnafam....Wn am.e ��: �'.. throughout the county, posters and NEED A COVID-19 TEST? y�;� 6�� ; flyers distributed throughout the � � � �� - - FAEE AT-HOME COVIO-19 TEST PflUYl0EN5: " ;�i; ■ ■ �E��P��.hak.o v.w e=m..m.�e•aM� ea�6eaM11Rs • . '. . /�41f5rnP BB3-� ..e. c o u n ty, a n d s o c i a l m e d i a. ��j�==��.��x��kA�� '��.��..u,�;��a��.m a�k.�� ,'�`�.de . 1 1 • � � • ��.�� Y.r« + P�„�.��.a..r��.��. .�n��., � i � � � � � � m.. � � ' ` � � I ��,o,...��.»�..... ..� �.` � . I �.�.w��.��,�,�� .� \ FAEE IN-PERSON C0410-19 TESTlN6 OPT[ONS: x..9a..�-�, f -��4�r�.4i�i��e�uea�.�umoe�aein , - -x M��a��«.mn M cu M�a u K Mdu4 n.sp'mmRr��aN i n.�www�xrntl�wnFom �� u�+eN � �oMn.s�� j�� . COYIa-19 AAPIO TEST UPTIONS: � �� ,�� '��"" ��,��`u I ` � mpooaMyo�tiv�ds�u Ww�+.u5kavand.uim�.ns. »YALCINFSAR£NDTYETAVAIU9IFFDRT!lEdENERAi PIAA!lCCC � �.. �. �� , � II' � � ` � i Mary Rose Corrigan , Public Health Director Tom Berger, Dubuque County EMA Coordinator Jeremy Jensen , Police Chief Amy Scheller, Fire Chief Mark Murphy, Environmental Sanitarian/PH Emergency Preparedness Planner Cori Burbach , Assistant City Manager ��IrRVr GI-�� r �� Department Level After-Action IncidentAction Planning, Incident Reporting Command and COOPs Recommendation : Departments Focus Area 1 : Response conduct individual AARs and Coordination and Logistics Improvement Plans _ Recommendations: Ensure �� , process to develop I ncident Action �� Plan and Continuation of Essential ,F City Services Y � �! r�..�!!��l "� IJ ' .°��yy�..ss � A'�!�� R+��_ ��+f�Y�� .r�._ • ,:��?..•' '�Spe'�-' v�� '�-`-t��t i . _ - r� _ _ �i�rA' _ac ' I��..,� .� R� � � �'`xLL� ys• •iy�` V•� -. `'+4Mt�'!��1� j€riF�� -.aR�� ` ♦ �. - .. �'�, _ �� a+ ��W -.r , , _. . '_ .� "..t-`--. . � '.� �� _ - _ " ' � 6 RiyYT 41 � � ^t` {. � R1�'-�_��~ ��yfE"1:��'��.:1 f_ r _ � . •. 3'�I � �'f � ��' ...z��;3��;'�NT-��T� �� _i' �� __'� ��i" � ' � ��-� "� y ''� �� _ - ' , . _ -_ _v � ' �.•.; � �� i�� y.ri :�,na;i 1 - ♦ �1�'�'T'__ . ��N..�'^"s - t I : �� .`�'��-'�-�+. � - �,�*. '� , , � 1 .�.� � ' �r 4 � ' � . � _ - � � � �� - ' �� HEALTHCARE � � � R � � � � .� � � �� ; . � i . ' � � � a . SURGE CAPACITY � � �{�� _ . � � ; � , �. � ,:: ,�: :� , . �� ; P LAN N I N G r + �s � � � � � � �. � � � � ' � �'� � � Focus Area 1 : Response �` � �� Coordination and Lo istics � . �; g .� � �_� �'�! � � � . .,�' ,� `I4 �' - ,R _ i Recommendations: Proce - `� - - � '�'- � ��- � ss to provide surge capacity ��-- � � � - �- for medical, housing or other . � �' - services when the demand is �� ,' � �� greater than available � ` � ,�,,,,,,.� resou rces. _ ;,,�;'� .,:�_ - - -- - .r +...►f a_fr� -_. �Y' a.�.�� . -. ,. . . •,�.-�� I ' .� 'Y'i- �:Y'_� � ... . �'+" . _ .. ' �. _ '_`�� •�!1'. � .:�:r � � �.-h 4` :S 1 _ •�� .<� ... Y _ { . . - ... ' . . . .. � �y; . � . . . � � ' � . . . . .'«' ' .'' . • ��' " _�TV - . . ,�.. .. _ -��.?. � �.�V �- � • �I` ' � • '" ��x �1`� ` �� `� +,.`. � . :.s�r. , T • � .�d�. ,4 .I. � :i " . �y 1,•��SJ'_�"�i!F - � � ' ' . ��. RG/y771V1�11�IL1�1 1 Vr �rl 1 i GI�IrLV i LG7 breckerridge Focus Area 1 : Res onse Coordination and �� - p , � �.: � ,� ' i`i - � � � f ` � _ � Logistics �� ` � € �a �, ; ,, // A /�` / 1 - � • Recommendations: Human - �� ' , � � �. �l�:� Resou rces Pol icy � �� Explore the potential for � .�==��- �� y' � � ,�:; L �� .� _ r ; reassigning city employees =�' � � � �� .. � _ i t. ��rVRVG1Y1G1Y 1 vr rvv`�v nr�`� n r�� GIYIGRVGIYV 1 �r�v�r�v COUNTERMEASURES Focus Area 2 : Work Process Modifications Recommendations: Ensure process for developing and enforcing public health/employee safety countermeasures ��t� ��n�n�� . �� T�r� � � � � nnQ �r� �.a�a �� r �hin �h� � � b�� Q�� '� � xh�n i� pu�l�t, wiL� �a�� =��11r�;� ' ' �� .�iY.�i r . ... _ _ . • . .. � �� ,; � ��.�la��,��1�1 � , � rrt�r �� v � � _ � � • ��- -- - " Y � - �" U u � - Focus Area 2 . Work Process � - - _ � � Modifications �" -� � - - - _ � Focus Area 4: Conti n u it of _ , � � '=� � s T� � y � ��___ __ Operations ' � �� '- - � Ensure Information Services and � �: __� -, �r� _ � � �e �� departmental COOPs consider �� r '� �- �� - ��,:. � _ � alternate scenarios re uirin �`� � ( `� `��`�� q g ,PAT�ENT �.. � � � ICHECK-IN .. HERE technology support -= N _ � -- � `� - ; �d . �e, _ � :,. ;; I pArrfNr : _ � -� `f ,'�HFLKlk - � �� . HF�E - � � � - � �� .�i --__ � , � , � / _ �`z"�_��f�� • L.VI`�11`�1 V IV IL.A 1 IVIV EMPLOYEES AND COMMUNITY Focus Area 2 : Work Process � Modifications Focus Area 4: Continuity of _ � '�` � ,� � �, Operations , � `�' � f � �- � � �w,, - t � - _�� :� Recommendations : To provide � - �� -�� - �� .�,� -� consistent communication �'� �� ~ � � � �. '�- —� �% �� methods and formats throughout �. ,� _ the incident. '��_ �tE_ �� . :� � L,��, � �-� � - . i4 � =s-�._ � , \ ._,�y�.._ � , �_-'�:�j' � � �� . _ ��``� _ r . � � � � � COVID-19 New Hospital Admissions and COVID-19 Nucleic Acid Amplification Test(NAAT)Percent Positivity,by Week,in The United States, Reported to CDC n -140k ) � ' � 3 120k I 3 1100k n � • 8Dk : A � � i � - 60k , II j40k �I r T ��q ._. �I� � �� j20k � . _ . 0 Jan 11,'20 Aug 15,'20 Mar 20,'21 Oct 23,'21 May 28,'22 Dec 31,'22 Jul 22,'23 � Jan��,'ZO JW 22,'23 � � . • �