San Francisco Department of Public Health Emergency Operation Plan Hazard Speci?c Annex Air Quality Annex Revision History Revision Date Section of Plan Revised Revised by l2120l8 initial version Gabrielle Aldern 02/20l9 Additional input Heat, Schools, N955 R. Jan Gurley San Francisco Department of Public Health Air Quality Annex Version 2 San Francisco Department of Public Health Emergency Operation Plan Hazard Speci?c Annex Air Quality Annex Table of Contents Hazard Overview ..I IV Public Health Response I Reduced Air Quality Events I DOC Activation I Health impacts I Proposed DOC Structure I Vulnerable Populations I Goals, Obiectives, and Operational Activities I Detection I Potential City-Wide impacts Additional Response l4 ll ResPonse Grid --5 VI Resources .. I5 I Response Levels Ill San Francisco Overview .. I Lead Agencies I Partner Agencies I Scale and Scope of Response I OVERVIEW NOTE: In the event of simultaneous Extreme Heat and Air Quality events, Extreme Heat response actions take precedence over Air Quality response. Please refer to the Extreme Heat Annex for more information. A. Reduced Air Quality Events Climate change is expected to increase temperatures, change precipitation patterns, increase the frequency and severity of extreme weather events, and increase sea-level rise?all of which will have signi?cant impacts on San Francisco?s environment, health, and economy. California is already experiencing the effects of climate change. One effect is that wild?res are expected to increase in frequency and the Californian ?res season is expected to last longer, resulting in higher levels of air pollution throughout much of California'. On average, San Francisco bene?ts from comparably clean air relative to other urban areas in the but the Bay Area is vulnerable to short term spikes in pollution due to increases in temperature and proximity to wild?res. From l999-20l8, l8 of the top 30 Particulate Matter (PM 2.5) pollution days in the Bay Area resulted from wild?res. Those l8 days occurred either in 20 7 due to the North Bay Fires, or 20 8 clue to the Butte Camp Fire.3 During the Butte Camp Fire AQ Event, San Francisco experienced l3 consecutive days of unhealthy or extremely unhealthy air quality, the worst air quality event on record prior to that event for the Bay Area. Reduced air quality can be caused by several major contaminants, including ozone, particulate matter (PM 2.5 or PM l0), carbon monoxide, and sulfur dioxide. Exposure to high levels of these pollutants can 1 California Environmental Health Tracking Program 2 Air Quality Draft Document written for the Climate and Health Adaptation Framework 3 Bay Area Air Quality Management District Hazard Specific Annex: Air Quality Page 1/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 cause acute and chronic health impacts. The Environmental Protection Agency (EPA) Air Quality Index (AQI) is a standardized measure of pollutant levels that describes air quality levels. The AQI measures air quality on a scale of to 500. A value above IOO is considered to be unhealthy for sensitive groups. As the AQI value increases, more groups may be at risk of health impacts. begins response when the AQI value is greater than or equal to ID for a period longer than 24 hours, and projections that the level will continue to be the same or worse for an additional four hours or more. B. Health Impacts Exposure to reduced air quality has been linked to increases in both morbidity and mortality. Pollutants with the strongest evidence for public health concern include particulate matter (PM), ozone, nitrogen monoxide, and sulfur dioxide. PM is the principal pollutant of concern from wild?re smoke for short- term exposures.4 PM is capable of penetrating deep into lung passageways and entering the bloodstream, causing cardiovascular, cerebrovascular, and respiratory impacts. Immediate short-term health impacts from AQ events may strain both emergency medical care and hospital systems. Repeated or long term exposure to unhealthy air will likely increase both morbidity and mortality of the exposed populations. Acute and chronic impacts from exposure to reduced air quality are as listed below: Acute impacts can include asthma attacks, shortness of breath, coughing, chest tightness, irritated mucus membranes, pulmonary inflammation, bronchitis, respiratory infection, and heart attacks. Acute impacts may be seen for days or weeks after an AQ emergency event. Chronic impacts can include asthma, lung cancer, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and premature death. Maternal exposure to ambient air pollution has been associated with adverse health outcomes for the fetus, such as low birth weight, pre-term birth, and small gestational age births.5 C. Vulnerable Populations While everyone may experience health impacts from AQ events, some groups are at higher risk: People with heart or lung disease Pregnant individuals Older adults Children under l4 Outdoor workers People who exercise People with diabetes People experiencing homelessness People with heart or lung disease, pregnant individuals, older adults, and children are considered at greater risk from particulate matter (PM) than other people, especially when they are physically active or work outdoors.6 Exercise and physical activity cause people to breathe faster and more deeply, causing them to take more PM into their lungs. 4 Wildfire Smoke AirNow 5 Ambient Air Pollution: Health Impacts World Health Organization 6 Spare the Air -- Hazard Specific Annex: Air Quality Page 2/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 or chronic obstructive pulmonary disease (COPD) are at increased risk because PM can aggravate these diseases. People with diabetes also may be at increased risk, possibly because they are more likely to have underlying cardiovascular disease.7 San Francisco?s p0pulation includes a large number of people experiencing homelessness. Lack of access to indoor facilities can greatly increase exposure to pollutants during AQ emergency events, putting them at increased risk for both acute and chronic health effects. D. Detection Each day, a monitor in San Francisco records concentrations of the major pollutants. These raw measurements are converted into a separate AQI value for each pollutant (ground?level ozone, particle pollution carbon monoxide, and sulfur dioxide) using standard formulas developed by EPA. The highest of these AQI values is reported as the AQI value for that day.8 The AQI is divided into 6 levels of health concern on a scale of to 500. A value above IOO is considered to be unhealthy for sensitive groups. As the AQI value increases, more groups may be at risk of health impacts. begins response when the AQI value is greater than or equal to IOI for a period longer than 24 hours, and projections that the level will continue to be the same or worse for an additional four hours or more. Please see the AQI Response Grid on Pages 5-7 for greater detail on response levels. E. Potential City-Wide Impacts Potential city-wide impacts of reduced air quality events may include: 0 Negative health impacts to thousands of exposed and/or affected persons 0 Healthcare delivery systems, including urgent and outpatient care clinics, may see a surge in patients 0 Overload of EMS and ambulance system due to increased 9 calls and emergency department surges 0 Hospitals may see increased hospitalizations due to air quality related issues 0 Social activities, day-to-day business, and school may be interrupted due to voluntary or recommended closures - Widespread public concern - Shortages of resources including N95 reSpirators, respiratory medications, air ?ltration supplies, and ventilators 0 Implementation of Continuity of Operations Plans (COOPs) Additional City-Wide Issues: Schools Parents should be encouraged to do whatever is best for their children, including keeping them home during extreme and/or prolonged air quality events. 7 Particle Pollution and Your Health AirNow 8 A Guide to Air Quality and Your Health - AirNow Hazard Specific Annex: Air Quality Page 3/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 Schools are a valuable community resource. For many children, including those from our most vulnerable communities, schools are where children get food, and have age-appropriate supervision while parents must work. For many families, there is no replacement for these resources. As a valuable community resource for children and families, DPH supports schools in their complex decision-making efforts to keep schools open, including during low staf?ng challenges. The use of air ?ltration systems and air puri?ers requires pre-planning, assessments and maintenance. The early use of air ?ltrations systems, including air puri?ers, may be important for physical education locations, such as day care centers for infants and toddlers. Universities and schools which require students to walk outdoors to classes several times during the day will need to consider the impact of student exposure to poor air quality. Universities and schools facing these challenges may wish to consider the bene?ts of changes in class locations, tele-conferencing of classes, or other interventions to minimize exposure to poor air quality. School cancellation or limitation of outdoor activities may be recommended. Please refer to existing EPA guidelines. N95 Respirators Information and guidance provided in this plan regarding N95 respirators is based on available knowledge and may change at any time. Masks and N95 respirators are not a replacement for staying indoors. N95 respirators are not designed for children. N95 respirators are ineffective with facial hair. N95 respirators, properly ?tted, increase the work of the cardiovascular system and can be dangerous for some people. If an N95 respirator makes a person feel worse, they should not use it. There are not suf?cient data to support the bene?t of prolonged use of N95 respirators in wild?re smoke air quality events. People who have adequate air quality at home should not leave their home to ?nd an N95 respirator. For staff who must work outdoors, or for unsheltered people who remain outdoors, N95 respirators may be helpful. However, over time N95 respirators will become damp (due to the breath) and harder to breathe through as particles are trapped in it. In general, N95 respirators may need to be replaced after 8 hours of total use (depending on the amount of wild?re smoke in the air), or when damp or damaged or soiled, or when the work of breathing through it increases. N95 re5pirators may be provided to unsheltered individuals. Unsheltered people always have a choice whether or not to use offered N95 respirators. Cancellation of Outdoor Events Outdoor activities can include farmer?s markets, outdoor sporting events, neighborhood clean-ups, parades, and festivals. Outdoor events may involve hundreds or thousands of participants and require Hazard Specific Annex: Air Quality Page 4/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 varying levels of physical activity. Outdoor activities may involve varying target age groups children?s events). The cancellation of outdoor events can be a complex process and can have unintended impacts, including adverse economic impacts. In addition, the cancellation of a permit for an event may not mean that the event does not occur. Participants may not receive noti?cation of the cancellation or may choose to attend despite a permit cancellation. ln coordination with DEM, San Francisco DPH will message warnings and advice for event organizers to cancel or consider canceling outdoor activities. EPA guidance will be used to message the risks of outdoor activities. Human Resources In the event of an extreme and/or prolonged air quality event, staff will likely be counseled to remain indoors (see activation grid). Communication for City workers regarding sheltering in place should be optimally sent to all staff. The Department of Emergency Management and the Department of Public Health encourage the creation of Continuity of Operations Plans (COOPs) for businesses, contracted organizations, and City Departments. Critical outdoor workers, as de?ned by a Department?s or organization?s COOP, should be provided the option to wear N95 respirators while outdoors. If an N95 respirator makes an employee feel worse, the employee should not wear an N95 respirator. II. AQI RESPONSE GRID NOTE: In the event of simultaneous Extreme Heat and Air Quality events, Extreme Heat response actions take precedence over Air Quality response. Please refer to the Extreme Heat Annex for more information. Heat and air quality When heat and air quality events co-occur, there are at least three major considerations: Heat protocols take precedence. Studies have shown that heat remains a high risk for rapid increases in death rates. Whenever air quality issues happen at the same time as a temperature of 85 degrees or higher, the Heat Emergency Plan and Response takes precedence. 2. Messaging must change. Air quality messaging must change when the temperature is 85 degrees or higher. Messages to the population that people should stay indoors because of air quality, without cooling available to people, could result in increased deaths, particularly among vulnerable populations. 3. Cleaner Air Centers may need to change. In a co-occurring heat and air quality event, cooling shelters will replace cleaner air centers. Sending populations to a cleaner air center that is not also a cooling center could result in increased deaths, particularly among vulnerable populations. The San Francisco Department of Emergency Management (DEM) Duty Of?cer is the designated individual to receive, monitor and communicate Bay Area Air Quality Management District (BAAQMD) and National Weather Service (NWS) announcements and temperature forecasts for the City and County of San Francisco. The DPH Public Health Emergency Preparedness and Response (PHEPR) section will also receive alerts to maintain situational awareness. Hazard Specific Annex: Air Quality Page 5/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex - Version 2 In accordance with the DPH DOC Activation and Notification Protocol, DPH will follow a tiered-level response for Air Quality events. Activation and Noti?cation for the Air Quality Annex and checklist is initiated based on NWS alert type and air quality forecast. The following color grid lists the tiered response based on the EPA Air Quality Index. Please note that temperature issues may affect response, requiring a higher level of activation and response activities: Hazard Specific Annex: Air Quality Page 6/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 Air Quality Index Value and Level of Health Concern* Response Level DPH Communications DPH Response Actions Other Agency Response Actions Cleaner Air Centers and Wellness Checks Moderate Likely notify ISC, Critical Partner List PIO will consider posting info. on website 8: social media -Consider - Assess 911 call volume; notify ambulance partners - Assess hospital ED status - Consider N-95 reSpirator staging DEM consider coordination call with DPH, HSH, HAS, SFUSD, PlOs, NWS, BAAQMD and others ?aim: wildfire situation' MEDIUM All of the above, plus: - Consider notifying Independent Senior Disabled Housing - Consider notifying Healthcare partners ?Consider or regional messaging or talking points ?Consider providing guidance to agencies with outdoor workers EMS, police, Parks Rec) All of the above, plus: may be activated -Consider distribution of N-955 at DPH sites for vulnerable populations? ?Begin EMS trends tracking ?Consider healthcare facility calls -Consider call center protocol -Begin Medical Respite and Sobering surge protocol All of the above, plus: -DEM IMT likely activated EOC may be activated will likely: use Alert SF, inform Mayor?s Office, consider Policy call, consider promoting and reviewing COOP plans to determine non? essential services, and consider DHR recommendation for non-essential outdoor workers to remain indoors -HSH will likely implement air quality protocol for unsheltered people ?Per EPA guidance, SFUSD will likely decrease student outdoor activities All of the above, plus: -Review and consider publicizing libraries, grocery stores and malls that have HVAC -Consider recommending closure of outdoor exercise facilities, such as pools -Consider recommending extending hours for city- owned community spaces such as Parks and Rec, libraries, and others. Very Unhealthy 201 to 300 (Purple) Respond if >24 hours or in a sustained or worsening wildfire sltuation* HIGH All of the above, plus: -Consider collaboration with for press release/media response ?Consider health advisory messaging around risks of outdoor events - nclude cleaner air center locations in messaging All of the above, plus: -DPH DOC activated ?Standard EMS protocols for surge apply ?Consider regular healthcare facility calls All of the above, plus: -EOC likely activated -DEM likely to coordinate Board of Supervisors call -Consider expansion of N-95 distribution -Consider recommending free transit options All of the above, plus: -Consider activating cleaner air centers Hazardous 301 to 500 (Maroon) Respond if >24 hours or in a sustained or worsening wildfire VERY HIGH situation* All of the above, plus: -Consider regional calls/ messages - Consider WEA, with actionable message All of the above, plus: ?Consider recommending voluntary self-evacuation All of the above, plus: -Consider check-ins via calls and/or physical checks by agencies serving vulnerable populations Hazard Specific Annex: Air Quality Page 7/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 over Air Quality response. Please refer to the Extreme Heat Annex for more information. 2) Assumption made that with any increase in response, previous actions continue to be implemented and 3) there are time sensitive considerations actions may be based on forecast; multiple days in any one category; extreme heat and/or judgment based on other factors). 4) Further Heat/Temperature considerations may exist (response may change if poor air quality in addition to heat and/or power outages for example). 5) Response language in messaging may be combined with predicted shifts and fluctuations in AQI Vulnerable Pop ulations- people with respiratory/cardiac diseases (COPD, asthma, coronary artery disease, history of myocardial infarction for example), people with diabetes, the elderly, pregnant individuals, unsheltered individuals; although children considered vulnerable population, N955 not designed for children A. Response Levels It is assumed that with any increase in response, the actions of previous response levels will continue to be implemented. Some actions may be dependent on time-sensitive considerations, such as the forecast, multiple days in one category, extreme heat, and judgement based on other factors. [5 1.x .3 lf.l.: {I?T'i'n?l I 'll Ii RESPONSE LEVEL: MEDIUM Respond if within this range for >24 hours or in a sustained or worsening wild?re situation DPH DOC and City EOC will be activated. Actions may include the following: - .ilv" I I run. May consider convening DPH Incident Management Team. DPH incident Management Team includes, but is not limited to, the following DPH entities: 0 Director of Health Deputy Director of Health 0 Health Of?cer 0 Communications Director 0 Director of Security 0 PHEPR Director 0 EMS Administrator - PHEPR PHEPR will likely notify Integrated Steering Committee of air quality and potential for DOC activation if AQI worsens. 0 PHEPR and DPH PIO will consider posting AQI health information on DPH website and DPH social media 0 PHEPR PHEPR will likely disseminate AQI health information (multilingual) to vulnerable population partners agencies via the Critical Partners List PHEPR Assess Hospital Emergency Departments? status by Reddinet monitoring a EMSA Designee to assess EMS 9] volume; notify private ambulance company partners of potential increase in activity due to respiratory or cardiac issues Hazard Speci?c Annex: Air Quality Page 8/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 PHEPR Leadership - OSH Consider N95 respirator staging DEM Consider coordinating call with DPH, HSH, SFUSD, PlOs, NWS, BAAQMD and others. . I. i'il-WUW) RESPONSE LEVEL: MEDIUM I HIGH Respond if within this range for >24 hours or in a sustained or worsening wild?re situation DPH DOC and City EOC may be activated. Actions may include the followingCity I Mp Health Of?cer Coordinate through ABAHO to ensure consistent regional messaging, recommendations, and talking points PHEPR Consider notifying Independent Senior Disabled Housing, and Healthcare Partners Consider activation of Department Operations Center based on forecast, expected resource needs, etc. - DEM Consider policy call PHEPR Consider distribution of N95 respirators and donning information at DPH sites for CCSF employees and vulnerable pepulations Track EMS trends in respiratory and cardiac patients. Implement additional ambulances as needed based on call volume. 0 PHEPR Monitor hospital/clinic rates of cardiopulmonary patients through ReddiNet polling or hosPital calls - PHEPR Encourage healthcare partners to consider mass texts to respiratory patients regarding emergency inhalers and health information PHEPR Consider healthcare facility calls - Consider providing guidance to agencies with outdoor workers EMSA, SFPD, SFFD, MTA, Rec Parks) 0 ?Call Centers Consider encouraging Call Centers to distribute mass texts to respiratory patients regarding emergency inhalers and health information. Consider 3 Call Center protocol to include scripts and/or messaging on website 0 -Medical Respite and Sobering Center Begin surge protocol expanding availability for clients by providing additional chairs/mats Hazard Specific Annex: Air Quality Page 9/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 PH EPR Recreation and Parks Consider recommending closure of outdoor recreation and exercise facilities, such as pools. Consider recommending extending public community center hours for additional shelter-in- place options Coordinate planning with 3 to provide scripts or messaging on 3l website, and for healthcare Call Center as needed (see above). HSA HSA to consider review and publication of libraries, grocery stores, and malls that have HVAC systems 0 Key DPH personnel will participate on all CCSF or Policy Group conference calls 0 DEM DEM will likely send out AlertSF noti?cation with Air Quality guidance and health information; inform Mayor?s Of?ce; consider policy call 0 HSH HSH will likely implement air quality protocol, begin wellness checks, and distribute water and N95 respirators to homeless population SFUSD Per EPA guidance, SFUSD to consider decreasing student outdoor activities 0 DHR Consider issuing recommendation for non- essential outdoor workers to remain indoors. Consider promoting and reviewing COOPs to determine non-essential services. PurplelVery Unhealthy (AQI 20 -300) RESPONSE LEVEL: HIGH Respond if within this range for >24 hours or in a sustained or worsening wild?re situation DPH DOC and City EOC will likely be activated. Actions may include the following: Responsible Branch. and/or Supporting City Department Actions Consider collaboration with for press DOC . DEM release or other media response Consider health . advisory messaging around risks of outdoor events I include cleaner air center locations in DPH messages to the public and to critical partners that reach vulnerable populations 0 DOC DPH DOC activated - EMSAIMHOAC Standard EMS protocols for surge apply 0 DOC Regular healthcare facility calls, as needed 0 Consider expansion of N95 distribution 0 EOC Consider staf?ng EOC ESF 8 if requested 0 DOC Commander/Health Of?cer DPH will participate on all CC?E_Board of Hazard Specific Annex: Air Quality Page 10/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 Supervisors conference calls DOC Commander/Health Of?cer Health Of?cer to consider issuing public health advisory and/or recommendations regarding purple/very unhealthy air quality to help inform decision-making concerning the cancellation of permitted or non-permitted outdoor events SFMTA Consider recommending free transit Options DEM Consider activating cleaner air centers Maroon/Hazardous (AQI 30 -500) RESPONSE LEVEL: VERY HIGH Re5pond if within this range for >24 hours or in a sustained or worsening wild?re situation DPH DOC and City EOC will likely: be activated. Actions may include the following: Responsible City Department and/or Actions Branch DOC/Health Of?cer Consider regional call to discuss uni?ed messages - DEM - JIC DOC/Health Of?cer Consider WEA with actionable message 0 DEM - - Health Of?cer Consider recommending voluntary self-evacuation Consider check-ins via calls and/or physical checks, HSA via DAAS, meal delivery services and/or critical . c305 partners/agencies serving vulnerable populations II SAN FRANCISCO RESPONSE OVERVIEW A. Lead Response Agencies In an air quality event, DPH will be the lead response agency and activities will be coordinated through the DPH Department Operations Center (DOC) in coordination with the City Emergency Operations Center (EOC), if activated. If other events are also occurring Extreme Heat or Power outage), DPH may share uni?ed command with other partners. Department Responsibilities during an Air Quality Event DPH - Assess medical impact of air quality event 0 Inform city agencies. medical community, responders, and the public of appropriate health precautions 0 Provide informational messages for, and outreach to, community-based organizations and the public to protect and promote health 0 Coordinate with health care partners regarding medical surge related to air quality 0 Coordinate with EMSA regarding system surge related to air quality Hazard Specific Annex: Air Quality Page 1 1/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 Coordinated distribution of N95 respirators B. Partner Agencies City County of San Francisco During a reduced air quality event, support may be required from other city agencies. These may include: DepartmentlAgencyIOrganization Responsibilities Human Services Agency (HSA) 0 Work with DPH to coordinate communication and events related to air quality 0 Identify locations of cleaner air centers 0 Communication with clients especially via the Department of Aging and Adult Services 0 Perform check-in by calls or physical visits for vulnerable populations Department of Emergency 0 Coordinate citywide calls and assist in dissemination of Management (DEM) public information 0 Send public alerts 0 Act as liaison between The National Weather Service and CCSF agencies 0 Coordinate city wide response Support may also be required from additional City departments, agencies, and local organizations, including: Fire Department El Animal Care 8: Control El Small Business Assoc. El Police Department El 3-l-l El Neighborhood 1] Department of Public Works Mayor?s Of?ce on Emergency Response El Public Utilities Commission Disability Teams (NERT) 1] Recreation Parks Dept. El SF Uni?ed School District Medical Reserve SF CARD Community Agencies El Other local CBOs Corps/Disaster Responding to Disaster Healthcare Volunteers RegionallState/Federal Agencies Coordination with regional, state, and federal agencies may initially occur via the EOC. Close ongoing communication and coordination may occur through the DOC. Key agencies may include: Local Health Departments Bay Area Air Quality Management District California Department of Public Health (CDPH) The Centers for Disease Control and Prevention (CDC) California Emergency Medical Service Authority (EMSA) California Office of Emergency Services National Weather Service (NWS)National Oceanic and Atmospheric Administration (NOAA) . Scale and Scope of the Response Hazard Specific Annex: Air Quality Page 12/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 The scale and scope of the response will depend on the duration and severity of the air quality event, which could be a few days to several weeks. Key factors that could impact the scale and scope of the response include: Access to health care Ability to receive and understand educational/prevention information regarding air quality emergencies Underlying health conditions in the population mental illness, chronic health conditions) Source of pollution (wild?re, vehicle emissions, etc.) Temperature Signi?cant morbidity and/or mortality Infrastructure issues, such as loss of power Ill PUBLIC HEALTH RESPONSE OVERVIEW A. DPH DOC Activation NOTE: In the event of simultaneous Extreme Heat and Air Quality events, Extreme Heat response actions take precedence over Air Quality response. Please refer to the Extreme Heat Annex for more information. The DPH DOC will likely be actiVated when the A0 Event requires a response that exceeds (or has the potential to exceed) the management capacity of DPH designated staff and meets at least one of the following criteria: 0 PurpleNery Unhealthy AQI expected for >24 hours or in a sustained or worsening wild?re situation I High pro?le public health situation or event 0 Assessment by DPH that health systems are impacted, requiring city support and DPH can support Refer to the DPH DOC Activation Noti?cation Protocol for speci?c activation noti?cation steps. B. Proposed DOC Structure It is recommended that the DOC Functions checked in the table below be activated immediately. See the guidance below regarding additional functions to consider activating: Activate Activate Function Immediately Function Immediately Hazard Specific Annex: Air Quality Page 13/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 COMMAND Containment Branch 0 DOC Commander 0 Community Mitigation Group 0 Information Of?cer 0 Restriction, Exclusion, Clearance Group 0 Safety Of?cer 0 Mass Prephylaxis Group - Liaison Of?cer i/ IsolatiOn Quarantine Group POLICY GROUP 1/ Medical Branch PLANS SECTION oHospital Coordination Group 0 Situation Status Unit - LTCF Group 0 Resource Status Unit 0 Alternate Care Group 0 Documentation Unit Outpatient Group consider* 0 Technical SpecialistUnit 0 Pharmacy Group 0 Demobilization Unit oPre-Hospital Care Transport Liaison OPERATIONS SECTION oMass Fatalities Liaison considerk Information Guidance oMass Care 8: Shelter Liaison consider* Branch - Inquiries Group Epidemiology, consider* Surveillance, 8: Data Branch 0 Content Group 0 Investigation Group 0 Dissemination Group Surveillance Group Environmental Health consider* a Data Group Branch 0 Hazmat Group Lab Branch 0 Food Group 0 Lab Testing Group - Sanitation Group a Lab Receiving/Documentation Group 0 Water Group consider* LOGISTICS SECTION x/ Community Outreach 0 Personnel Unit consider* Branch 0 Prevention Group consider* oSuppIies Unit v? Re5ponse Group 0 Facilities Unit consider* oCommunication Equipment Unit 0 Info Technology Unit FINANCE SECTION Consider activation depending on scale, scoPe and Speci?c circumstances of event. C. Operational Goals 0 Assess the situation and threat 0 Determine strategies to mitigate the threat and protect and promote health 0 Coordinate closely with regional, state, and federal partners Hazard Specific Annex: Air Quality Page 14/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 D. Operational Objectives and Activities Objectives and DOC Lead Activities Provide information and guidance Information and Guidance Branch 0 Provide guidance to city of?cials, responders, and the public on the situation, prevention, treatment, and when to seek health care. 0 Provide information to the public regarding Cleaner Air Centers Disseminate information 8: educate Community Outreach Branch 0 Implement outreach and education strategies in community, with focus on most vulnerable neighborhoods and populations Assess and provide technical expertise Policy Group/Situation Status Unit Assess AQI and temperature forecasts for City County of San Francisco 0 Provide guidance on N95 respirators and/or air puri?ers and/or air ?ltration Support provision of medical care Medical Branch 0 Monitor hospitals, primary care sites, and EMS for surge Respond to requests for information, resources, and logistical support from medical providers. 0 If hospital and/or other facility surge plans have been activated and cannot meet population medical needs, activate alternate care sites. Data collection 0 Collect and analyze data on EMS, hospitals, staff response hours, volunteer Data Group deployments, etc. Facilitate deployment of a If air quality event is due to a disaster in a neighboring region, facilitate mutual personnel aid deployment of City personnel and volunteers to the affected region. Personnel unit I Providejust-in-Time Training to deployed personnel 0 Ensure tracking of responder safety and health Distribute N95 Respirators Supplies Unit 0 Based on N95 guidance, distribute cache to designated groups IV ADDITIONAL RESPONSE CONSIDERATIONS The DPH Emergency Operations Plan (EOP) is the primary functional response guide for all DPH emergency response activities. However, because of the unique nature of an air quality event, the following modi?cations and/or considerations should be considered and applied when necessary to the approPriate Operational section of the EOP. A. Command Staff 0 The Safety Of?cer should provide safety recommendations to employees who work outdoors and personnel deployed to areas impacted by disaster. B. Policy Group 0 The Policy Group should consider writing/approving policies related N95 respirators and alternatives for children and other groups for whom respirators are not intended and/or are dangerous to use. 0 As much as possible, policies should be similar across the City and County of San Francisco, as well as the region. The group will work with other City Departments and regional policy groups such as the Association of Bay Area Health Of?cials (ABAHO) to develop consistent guidelines. 0 Policy Group should consider the following critical issues: Hazard Specific Annex: Air Quality Page 15/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 D. 0 Possible reassignment of City employees who work outdoors 0 Activation of Continuity of Operations Plans (COOP) 0 Recommendations regarding cancellation of outdoor events and activities Plans Section No additions to the core EOP. Operations Section Information 8: Guidance Branch If the AQ event is occurring regionally and/or affects the region, information and guidance should be coordinated regionally. Consider that the p0pulations most vulnerable to reduced AQ events will have limited access to healthcare and indoor shelters Vulnerable populations will need continued care and outreach. This outreach and care may potentially expose caregivers to poor air quality (Home visits, Homeless Outreach Team. Primary Care Clinics and HOSpitals). Consider this group of caregivers when providing guidance. Medical Branch Monitor hospitals, primary care sites, and EMS for surge Respond to requests for information, resources, and logistical support from medical providers. If hospital and/or other facility surge plans have been activated and cannot meet population medical needs, activate alternate care sites. Data Group IV Compile data collected during response, including hours worked by staff, number of respirators distributed, number of respiratory admissions to EDs, etc. Logistics Additional resource needs for this event may include HEPA ?lters, ventilators, N95 respirators, respiratory medications, and other air ?ltration resources. Finance Maintain tracking of costs incurred by deployment of city personnel/mutual aid and acquiring resources (N-95 respirators), as well as other costs. RESOURCES A. Glossary 8: Acronyms AQI: Air Quality Index. A standardized measure of pollutant levels that describes air quality levels. Developed by the EPA. Cleaner Air Center: An indoor location that is available for public congregation in which the air may be better quality than outdoor air. Cleaner Air Centers may or may not have ?ltration systems. See the Community Cleaner Air Shelter Guidance for more information. Hazard Specific Annex: Air Quality Page 16/18 Last Update 2/2019 San Francisco Department of Public Health Air Quality Annex Version 2 BAAQMD: Bay Area Air Quality Management District Community Cleaner Air Shelter: See Cleaner Air Center COOP: Continuity of Operations Plan DOC: Department Operations Center EMSA: Emergency Medical Systems Agency EOC: Emergency Operations Center EPA: Environmental Protection Agency DEM: Department of Emergency Management HSA: Human Services Agency Incident Management Team Integrated Steering Committee NW5: National Weather Service Primary Care Call Center PHEPR: Public Health Emergency Preparedness and Response Branch PM: Particulate Matter Reduced Air Quality: The condition in which pollutants negatively impact the ambient air quality, with the potential to cause adverse health effects in the exposed population. I San Francisco Department of Public Health B. Messaging Templates 0 Messaging templates can be found here: S:\Activations\20l8\l .O3_Butte Camp Fire\2. Templates 0 Multilingual messaging can be found here: S:\Community Planning\Climate Health Preparedness\Air Quality C. Protocols The following protocols can be found in the Drive: (development in process) a. Call Center Protocol b. Surge Protocol c. Clinic Surge Protocol d. Community Wellness Check Protocol D. Community Cleaner Air Shelter Guidance Found Here: S:\Emergency Plans Ubrary\EOP\3. Hazard Speci?c Annexes\D. Environmental Health Hazards\Air Quality\Community Cleaner Air Shelter Guidance_0 l. l4. 9 Hazard Specific Annex: Air Quality Page 17/18 Last Update 2/2019