This. Even though you may not be prepared to give us a report on august, just tell us were live. [laughter] we can do that. I just wanted to add to that question about each worked for the office of health in order to develop their own dash boards and epic. These are standards reports so they got to define one of the key metrics clinical and operational that they want to see and theyll be able to produce out of this multimillion dollar project that weve put forward. Those have already been established and theyll be going as time goes by and readily available to report. Thank you. I just really want to acknowledge her leadership and her perseverance and her courage moving things forward and also to acknowledge that she had a little bit to do with attracting our new talent. So i just really want to acknowledge that. As someone that came into this department with this huge epic piece, she really educated me in a way that was extremely helpful and im really excited shes going to continue to work with a team to ensure that theres success and she has not only passion for this and deep commitment but just unwavering belief this is the right thing to do and the inparticular rit e shows is inspiring to me. Commissioner grown. Thank you, next item. Item 10 is the San Francisco publichealth Emergency Preparedness and response annual update. Dr. Gurly. Good afternoon. Im just going to make a couple of opening comments before dr. Gurly speaks. Good afternoon commissioners. Director of health. Ive been with the Health Department since 1996 and after 211 it was our introduction to this world of Disaster Preparedness. We were focusing on terrorism and bio terrorism and in 2003 we deal with sars and in 2009 it was h1n1 pandemic. Having been here this long, nothing has been like its been the last couple of years. Im going to share a couple of comments. A couple things that ive realls that weve learned is we prepare for the big events by practicing on the small events. And the small events are not just things that involve just a few people but its just involved a small team of people working on things that are big. You are going to see that in a second with dr. Gurly when she talks about Climate Change and extreme weather which is the other big thing happening now. And the third thing that goes along with extreme weather is really that we learn a lot about not just human physicalology and physical infrastructure and how important it is to make sure the physical infrastructure is there not only to take care of the community but also to take care of our workers so when our workers are working own heat or air quality its a challenge to be working on that while we are actually having to work in conditions when they get too hot or the air quality is not as good. Dr. Gurly has a lot of experience and expertise in disaster response, not just locally but globally. And so, shes going to give you an update and shes taking over this new world of Disaster Preparedness and response and im excited to have her as part of our team. Thank you for the kind words. Good afternoon. Directoill be talking today abk thats been done by what i can say is a highly dedicated group of individuals. Im having trouble with my go over to view and it should say full slowe slide show. Got it. So, not only is winona a hard act to follow, but i would say a lot of the work im going to present here builds on an Amazing Foundation built by Deputy Director baba who was in this position before me. As you may be aware, publichealth Emergency Preparedness and response lives in the population of health division. It is a branch thats responsible for publichealth Emergency Preparedness and response not just for d. P. H. But for all of San Francisco. Today, well talk about how our acronym and one of the word things about Disaster Work is theres an acronym for everything. Its even worse than medicine. If i mention one without saying the full words, please dont hesitate to ask me about it. We are known as fepr. So ill talk about how fepr works with the citys Emergency Response activities. Ill talk about how our work is a really important balance of proactive and reactive responses and cover and in that ill review and well talk about the reactive forced to give you a flavor of them, theyll include commune i canal diseases, cyber i. T. Events and they activate an Emergency Operation center and an emergency and sometimes for plan events like as we sit under the umbrella, however, they have hospitals across the city, Skilled Nursing facilities which are a new development this past year, members of our dialysis clinic, private clinics and across the Broad ServiceDelivery System within d. P. M. Including San Francisco general and our Population Health division including key functions like Environmental Health and disease and especially our Emergency Medical Services authority partners. Who oversee our e. M. S. Services within the Fire Department it includes ambulatory care. How are we doing . If we gave ourselves a qualitative report card, here are some of the pluses in the areas for opportunity and both our preparedness work and our response work. We have had extensive exercise partnerships which have been deepening in the past year. Weve had to do and perform solid communication and messaging around some complex topics including receipt per rer eight or and a strong healthcare coalition. We can improve by working to improve our Community Engagement more and we have taken mini strides recently. We could also move towards more d. P. H. Involvement and training in these disaster issues and our numerous activations and responses do impact planning because we have the same small group of people to do both activities. In terms of our responses we had strong response activity across a broad range of areas giving us a lot of experience in areas to prepare for the big event. Those experiences foster a city wide team and deep connections. However, we could improve by expanding our response experience within our own department and having a small team carrying a large number of responses means they suffer burnout and get stretched thin and one of our goals is to unite what we call the planning response cycle which means you dont just respond to an event like a cyber terrorism threat but you can change your plan so that the next time it happens its better and you are activities get improved every single cycle. So how are some of the ways weve done the things i just mentioned . In terms of preparing, last fall we had a large city wide medical needs disaster shelter exercise. It was done at saint marys cathedral and involved a large number of partners at the local state and federal level including n. G. O. S like the American Red Cross and the salvation army. It was a really successful event looking at what it takes to put together a very large shelter focused on medical needs. We also did last fall a large state wide medical Health Exercise is what we call it and we chose to focus it and the state tells us what to do and we did it for i for in flew ends as impacted by influenza epidemic. We had 75 participants and we have both the tabletop where we talk through the problem and how we Work Together and then we do what is called a functional exercise where we pretend its actually happening. We included all of our local hospitals and had a focus on managing scarce resources such as receipt per eightors or anti viral medications. In preparing in terms of our Community Training and information, we had training for psychological first aid and training for 300 participants. We moved into continuity of operations training, in other words, if you only have your minimum staff, what are you going to keep going in an urgent setting and we focused in on our methadone providers and there were 18 different clinics participating. We have a critical partners list which say list of agencies that serve our most vulnerable communities in San Francisco. We engage with them frequently. So we were training the trainers and we worked with media, especially big shout out to our Public Information officers here in the d. P. H. And we had an extreme weather media workshop where over 15 bay area media tv radio and electronic representatives attended. We have our healthcare coalition, which in nights are hospital and other Healthcare Facilities across the city and this year we launched a a quarterly bulletin and we also won a Natural Association of seeing county Health OfficersNational Award for a Promising Program in their Model Program division because of our meth tone Disaster Workgroup. Where we have pulled together all of our medication assistant treatment clinics and they have actually begun to decide how they would distribute scarce resources in a disaster situation and how they would communicate effectively with each other about people who maybe in desperate need of these medications. We have also worked to expand the training and exercising within d. P. H. And we developed 18 training over 146 participants. One thing to keep in mind is this is happening while people have full time jobs and are often over stretched so its quite a commitment for our department. Now were going to move to what kind of emergencies we have responded to and these are just some examples. As a snapshot, to speak to what the doctor mentioned, in all of 2018, we had 12 total full activations that means we declared that theres an emergency. We organize ourselves in an instant command structure and we do all the documentation from beginning to end including our q. I. Processes for what happened and how it should be improved. That was 87 days of activation and 2018 representing about a quarter of the days of the year and a little over a third of the work days of the year but we work during the weekend also. So, however so far in 2019, weve had 15 full activations having 12 last year with the same group of people. What things do we see . Weve had two different u. C. Labor activations where we activate to make sure theres no negative impacts to our hospitals and medical a search that might happen and monitor whether or not theres an event that could be impacted during a labor action. We also had a kaiser labor action and then you may remember the day where there were multiple bitcoin bomb threats sent across the city include something of our own facilities but we manage it city wide and not just for d. P. H. And our i. T. Department and its been in the directors report a chiller failure when we had an i. T. Shut down for a day. We have activated for a t. B. Contact investigation which was 60 days of planning and 16 days of operations to identify exposures and get them tested and treated in a very effective manner and we were activated for a prolonged period of time to prevent the hepatitis a epidemic coming up the coast towards San Francisco. That was five months total of 2017 and 30 days in january of 2018. Im sure all of you remember the beaut campfire where they were activated for 14 Straight Days and then we had our extreme heat activation recently of four days where our e. M. S. System was significantly impacted as were many of our facilities and within d. P. H. I just like to say thank you all of the work that i just mentioned and shared with you is actually the very hard work from this very small group of people who deserve a big shout out. Thank you for your time today Public Comment. I have not received questions. Its in the hands of the commission. Any questions or comments . Thank you. Commissioner. All right. Thank you. Curious, where do the Community DisasterResponse Teams come in . For many years there have been discussions and parliament began in china town with the 1989 earthquake. The mission created something and not sure whether that is still around. You talk about critical partners but what is now the mechanism to use these and are we still doing trainings or anything like that as part of the over all programs . Yes, thank you for the question. So, we work closely with the Fire Department. At the time, nert, the neighborhood Emergency Response teams live within the Fire Department. They have a great group there that does the training and the organization. When we activate, we coordinate through them. Our Community Group and our Community Work tends to focus heavily on the publichealth as aspect of disaster. In that sense, we have been very involved in our medical health core, volunteer responses and we sent volunteers out to the beaut campfire for for example, from that group. That group of living within nerts upset and with the state is deeply a part of the work that we do right now. In addition, were working to develop specific Agency Collaborations around Emergency Responses that are somewhat neighborhood specific. During the recent heatwave, we worked with Senior Centers and meals on wheels to define Wellness Checks and how we were reaching out to the most vulnerable. I dont know if that fully answers your question but i would be happy to get back to you with more information. Im interested in understanding whether its in the first part doing all nerd training but communities were, like i said, specifically english and chinatown were creating kind of a multi task agency so that if with you needed publichealth sponsor they needed transportation, or they needed food or something in two areas they could mobilize internally some of the already existing nonprofit and have that work. I didnt know if that was till continuing or it is only nerd that is still part of the legacy that remains from the 89 earthquake. I would be happy to get back to you with more on that. Right now its nert. Theres a coalition in the bay view where we have joined them to do some exercises that sound exactly like that. Theres a plan within the department of Emergency Management to expand those. Its community resilience, its a capability called esf16. I mention it because we are willing and active participants in those efforts. We dont own them. I think it is in the area where we hope to improve on going forward. Because within our large city wide plan, if a big disaster happened, those organizations would exist within a battalion chiefs district. And that is how it would be organized. So, that has not been exercised in a while and im not sure, other than the one i mentioned in the bay view, how many are still active and separate from the nert program. Well, yeah. This is sort of a 30year warning that never gets any traction all the way from the very top when the admiral used to head Emergency Services here to what looks like a great response from publichealth is not integrated with the rest of the local community. I find this is a little distressing that each one of these great plans dont include the community or. It may be my lack of communication. I feel like that sort of hub is what we call it and lives under department of Emergency Management and we try to jump in. Thats why im offering to get back to you and i can find more information and i would be happy to share with you how its more formally structured and where it might be missing and where our hubs are in terms of development weve participated in the short time is in bay view. Right. And so, one time, the Chinatown Health Center for example was part of these response zoos if you are not really aware of what else is going on within that because its been going on for all these years, everyone thinks its a great idea to have neighbors involved but it seems sufficient infrastructure and resources to really allow the neighborhoods to blossom and i was asking, what is the status of this now because eventually, when we say you are on your own for 70 hours and there are people who cant be on their own and this is where some of the neighborhoods were going to try to take that up and we have a plan to take care of that have but it might be there and you are just the opportunity to ask about it. I fully appreciate it and i do want to make sure i that i that china town Health Center say great champion and theyre involved in this work. Just not feeling comfortable speaking for them about how embedded they are in the rest of their neighborhoods for this but we will definitely take this as a charge to improve and i appreciate it. Thank you green. On the next level in terms of the hospitals, i wonder if in the future you can give us more details about whether theres standardtation in a major emergency. How quickly can they react and how do we know which hospitals have which services, verdicts, if there were this great need what are we doing as a community to use the best resources of our hospital systems. Sure, we are in close touch with them.