Advanced Practice Centers Presentation Materials - The National

Advanced Practice Centers Presentation Materials

2009 Public Health Preparedness Summit February 18-20, 2009

San Diego, CA

Introduction

This resource provides a compilation of the training sessions offered by the Advanced Practice Centers (APC) at the 2009 Public Health Preparedness Summit in San Diego. During this conference, public health preparedness practitioners from across the nation learned about some of the best practices and innovative resources developed by the Advanced Practice Centers to address the challenges faced by preparedness professionals.

APC Mission

To promote innovative and practical solutions that enhance the capabilities of all local health departments and the public health system to prepare for, respond to, and recover from public health emergencies. The seven Advanced Practice Centers include:

• Seattle-King County (WA) • Cambridge (MA) • Western New York Public Health Alliance • Twin Cities Metro (MN) • Tarrant County (TX) • Montgomery County (MD) • Santa Clara County (CA)

For more information, visit www.naccho.org/apc.

Or, contact us at:

NACCHO Advanced Practice Centers Program 1100 17th Street, NW

Suite 200 Washington, DC 20036 E-mail: [email protected]

Table of Contents

More Than Words: Powersizing Your Emergency Communications Through Comics and Pictograms Seattle-King County and Cambridge Advanced Practice Center (APC) .........................................................4 of 243 Preparing for Emergencies and Every Day: Planning With Computer Models Montgomery County APC ...........................................................................................................................................32 of 243 Tools, Training, and Technical Assistance: Supporting Health Care Providers With Business Resiliency Seattle-King County APC.............................................................................................................................................51 of 243 Cross-Jurisdictional Cross-Disciplinary Public Health Tabletops Cambridge APC .............................................................................................................................................................64 of 243 “The Greatest Hits” for Environmental Health Emergency Preparedness Twin Cities Metro APC ................................................................................................................................................76 of 243 A Critical Preparedness Triad for the Local Health Department Community Tarrant County APC.....................................................................................................................................................102 of 243 Preparing Our POD Volunteers: An Interactive Workshop for Trainers Cambridge APC .............................................................................................................................................................137 of 243 Grassroots Preparedness to Support Vulnerable/At-Risk Populations During Emergencies Cambridge APC .............................................................................................................................................................147 of 243 Emergency Preparedness: Targeting the Latino Community Montgomery County APC ...........................................................................................................................................157 of 243 Talk to Me Please! Communicating With Community Partners During a Public Health Emergency Event Santa Clara APC ...........................................................................................................................................................182 of 243 Lessons Learned From a Public Health Emergency and a POD Exercise: A Hepatitis A Experience Western New York APC .............................................................................................................................................215 of 243 Advanced Practice Center Tools and Guidance for Emergency Preparedness in Rural America Western New York APC .............................................................................................................................................235 of 243

More Than Words

Powersizing yourPowersizing your emergency communications

through pictograms and comics

Explain the value of visual images in conveying information about preparing for emergencies, emergency response, and navigating public health emergency facilities (e.g. PODS, Alternate Care Facilities).

Session Objectives

Utilize visual storytelling techniques and pictograms to enhance preparedness messaging and emergency communication.

Leverage collaboration with other jurisdictions and community partners to create and continuously improve visual messaging.

OverviewWhen Life Hands You Lemonade – Icebreaker Exercise

Open Access with Universal DesignBREAK

Communicating with Pictograms

Representing Key Concepts Visually – Activity

BREAK

Communicating with Comics

Communicating with Comics – “Jam comic” Activity

Communicating with Comics – Story Brainstorm

Conclusion and Q&A

Advanced Practices Centers = resource

Network of local health departments

Helping public health prepare for respond to and recover for, respond to, and recover from emergencies

ToolsInformed by public health experience Online & FREE

5 minutes to create a picture that willpull in customers.

When Life Hands You Lemonade

You can use “stick” figures.

Include text if you want.

Choose a spokesperson for your team.

Open Access with Universal Design

Charlie Ishikawa M S P HCharlie Ishikawa, M.S.P.H.

Cambridge Advanced Practice Center for Emergency Preparedness

Public Health Emergency

Population Vulnerability

Physical disabilityCognitive disabilityLanguage barrier (e.g., English, literacy)Conditional impairmentsConditional impairments

Mental noiseEnvironmental barriersTrust Knowledge barriers

The Key: Service Design

Universal Design

Equitable useFlexibility in useSimple and intuitivePerceptible informationPerceptible informationTolerance for errorLow physical effortSize and space for approach and use

• Information:• Station experience • Sequence• Personal health

Risk Communication

• Personal health information

• Message Delivery:• Receive• Understand• Personally Applicable

Mass Communication

Communicate through trusted

Identify station purpose with a g

sourcesp ppicture

Simple one-wordstation description

Provide language translation

Behavioral Health?

Interpersonal Communication

Provide Directions

“Please go to the blue Children area.”

I need water

Re-cap

Service design and accessCommunicating in the presence of riskUniversally designed communication Mass communication: SignageInter-personal communication: Pocket Communicator

Thank you

Access Umbrella IncAccess Umbrella, Inc.CauseMedia

Garrett Simonsen & Bryan Hall

www.cambridgepublicheatlh.org

The Power of Pictograms

Di YDiane Young

Public Health – Seattle & King County

The Power of Pictograms

NeedAiding

Communication

DevelopmentStarting and

Getting There

UseOptimizing Your

Pictograms

NeedAiding

Communication

Symbols Evolve

1500 1800 2009

Pictograms—literal representation of object, place, action—tend to communicate more intuitively. What you see, is what you get.

Symbols are generally abstract or arbitrary, may deal more with a concept, increasing the need to teach viewer.

Exceptions and Cultural Differences

Improving Health Literacy

Health and safety risks

Level of fear and anxietyLevel of fear and anxiety

Likelihood of seeking/using services

Compliance to treatment plan

Pictograms Outweigh . . .

DevelopmentStarting and

Getting There

Alternate Care Facility (ACF)Health Care Center

Integrating

Risk Comm Plan

Key Web Site & Print

Reduce Help Staff Carry Out

Opportunities

Messages Print Materials

Staff Scripts/ Actions

Pictograms/ Signage

Anxiety Carry Out Duties

Earn Public’s

ConfidenceSave Lives

Planning

Assess Needs Establish Resources

Set Timeline Plan Backup

Building on Previous POD Work

ACF: multiple activities/purposes; escorted; overnight stays; largeinterior/exterior spaces; many signs/pictograms

Researching Solutions

Hablamos Juntos; Society for Environmental

Graphic Design; AIGA

Focus groups: pre-, during, post-design

phases(see Resources handout)

p ases

Cambridge Advanced Practice Center

Belyea, Signage Advisory Team, other internal and

external partners

Creating and Refining

indentifying/directing (wayfinding); instructing; reassuring

Type

primary; secondary; tertiary (exterior)primary; secondary; tertiary (exterior)Priorities

visual shorthand, culturally aware, text/image relationship

Content

size, color, contrast, consistency, font, “feel”Design

Primary: 3 “Step” Signs

Stages of Refinement

Stages of Refinement

Versatile/Modular

UseOptimizing Your

Pictograms

Support FormatsWhat other activities at POD/ACF further carry out pictogram/signage messages? (A single mode will not satisfy all ( g ycommunication needs.)

Brochures, fact sheets, maps, Web site, ad campaigns, media releases, other

Service Animals

In groups:In groups:1. Determine the message(s)2. Describe the pictogram3. (Optional) Sketch your pictogram

Service Animals

Why Comics Work

Meredith Li-VollmerMeredith Li Vollmer

Public Health – Seattle & King County

More than superheroes & funny pages

Graphic Novels

Persepolis (2003)

Ghost World (2001)

MangaManga

Yakitate!! Japan (2003)

Underground Comix

International Success

Manhua (China) Manhwa (Korea) Fotonovelas (Latin Am.)

Why comics work

Comics asComics as communication tools

g C

omic

s (1

993)

McC

loud

, Und

erst

andi

n

And don’t forget…

… symbols!

*@#%!

Activity

meaning through picturesmeaning through pictures

Words can…

…reinforce the meaning of the picture

Pictures can…

…make the words more vivid.

Together, words and pictures…

…can amplify a message…

…or convey an idea that neither could convey alone

Comics at their best

• Involve readers in stories

• Encourage identification with characters

Fun Home (2005)

Developing a Comic

Making No Ordinary FluMaking No Ordinary Flu

Audience Research

Key messages

The time frame for a pandemic Aspects of the 1918 pandemic, to demonstrate that this has happened beforeWh t i l di t i l k likWhat social distancing may look like Changes to healthcare How you can prepare

Messages for “mental rehearsal”

Conveying specific spec cinformation

Making pandemic flu compellingcompelling

Activity

“Jam Comic”Jam Comic

Pre-testing

Final Version

Illustrated guideto an alternate care facilitycare facility

Drawn comic books Fotonovelas or comic book software (Comic Life, Comic Book Creator)

Comics on the cheap

A t ( t h lP f i l i ti t

More Expensive Cheaper

Community partners or medical interpreters

Amateurs (art schools, community colleges, high schools)

Professional comics artists (comic book stores, comic conventions, internet search)Professional printing ‘zines on the copier,

web comicsTranslation agency

Story Brainstorm!

How could comics help you do outreach?What do want the public to know? How could you tell a story about it?Wh t ld d d i t th t i ?What would draw readers into the topic?

Conclusion

Thank you!Charlie Ishikawa

[email protected](617) 665-3759

Meredith [email protected]

(206) 263-8704(206) 263 8704

Diane [email protected]

(206) 263-8702

Cambridge Advanced Practice Center for Emergency Preparednesshttp://www.cambridgepublichealth.org/services/emergency-preparedness/

Public Health – Seattle & King County Advanced Practice Centerhttp://www.advancedpracticetoolkits.com/index.htm

Preparing for Emergencies and Every Day: Planning with Computer Models

Montgomery County MD

Planning with Computer Models 1

Montgomery County, MD, Advanced Practice Center for Public Health Emergency Preparedness and Response and University of MarylandFebruary 18, 2009San Diego, California

Introduction: APCs

The NACCHO Advanced Practice Centers (APC) Program is a network of local health departments that exist to serve the public health community, developing resources and training


y, p g gmaterials.The program’s mission is to promote innovative and practical solutions that enhance the capabilities of all local health departments and the public health system to prepare for, respond to, and recover from public health emergencies.

Montgomery County, MD APC for Public Health Emergency Preparedness and

ResponseTo be a resource in emergency response capabilities for local public health agencies, especially those who are also planning on a multi-jurisdictional area; To collect appropriate tools that other local


To collect appropriate tools that other local public health agencies in the National Capital Region have developed for dissemination; and To create and develop toolkits, technologies, and other materials that have been evaluated and tested in Montgomery County, into formats that can be easily replicated and used by other local public health agencies.

Overview of Workshop

Introduce Computer ModelingIntroduce CRI Scenario

Build Clinic Planning Model


Continue CRI ScenarioPlan medication distributionUse electronic screening

Other uses of modelsConcluding remarks

Objectives

At the end of this session, participants will be able to:

1. Define the term “computer models.”2 Id tif t th d h ll t


2. Identify strengths and challenges to using computer models for local public health departments.

3. Describe at least two examples of how computer models can be integrated into local public health.

Introduction: Computer Modeling


Models come in many varieties.


Defining “Model”

A model represents a system or process.A computer model is a computer program that evaluates the performance


of a given system based on data about that system.

Includes spreadsheets, specialized software, simulation programs, web-based applications, and others.

Planning with Computer Models . . .

. . . is like using tax preparation software:Requires collecting important dataEvaluates your specific situation


Automates calculation of critical valuesAllows rapid recalculation after changes and correctionsRequires some time to learn it

Models for POD planning

Operational Assessments for SNS Readiness suggest using a POD planning model.

RAND ki 571


RAND working paper 571,

http://www.bt.cdc.gov/cotper/coopagreement/08/pdf/WorkingPaper-Drills.pdf

Available models:BERMRealOPTClinic Planning Model Generator

Model comparison

Model: BERM RealOpt CPMG

Platform: Web browser Java program Excel spreadsheet

Model type: Simulation Simulation Mathematical


Model type: Simulation Simulation, optimization

Mathematical equations

POD design: Fixed Flexible Flexible

Access: Go to URL Request from developers

Download from website

Weill Cornell Bioterrorism and Epidemic Outbreak Response Model (BERM)

Developed by the Cornell Institute for Disease and Disaster Preparedness(available at www.simfluenza.org)Features:


Features:Estimates staffing needed to meet dispensing requirementsUses simulation to determine and graph queue lengths at each station (greeting, triage, evaluation, dispensing)Web-based tool

RealOPT

Available from the Center for Operations Research in Medicine and Health Care at Georgia TechFeatures:


Features:Includes simulation and optimization modules to determine staffing that optimizes performance in user-defined scenariosIncludes graph drawing tool for layoutImplemented in Java

Clinic Planning Model Generator (CPMG)

Collaboration between University of Maryland and Montgomery County, Maryland


Features:Spreadsheet-based program that builds a customized POD planning spreadsheet modelEstimates POD capacity and queueingRequires Microsoft Excel 2003

CPMG Development

The planning models use data collected from time studies of mass dispensing and vaccination exercises in Maryland, Vi i i d N J


Virginia, and New JerseyWe developed the spreadsheets based on input from public health planners around the country.

Personal TestimonyHow many patients per hour?How large of a facility is needed?How much staff is needed?How do you determine most efficient


yflow pattern for your POD?Needed another planning tool that engaged technology in a efficient wayTime Study Baseline data Creation of Model

Viewing and editing the model


Model ScopePlanning, not a training toolOnly takes into account essential station staffIncluded, but not predicted:


SecurityRunnersTranslatorsData EntryLogistics

Model ScopeOne of many tools for planning

Not the silver bullet of POD planningBasic computer skills needed

Microsoft Office Excel


Unexpected situationsLost children, media, health emergencies

Human factorDoesn’t predict supplies neededNumbers in model based on a limited data set

How can the model help you?

Self-select stationsDecrease bottlenecks/congestionPredicts essential staffing


gCompare arrival patterns

Buses vs. individualPre-Event and during an eventUser-friendly

How can the model help you?

Evaluation tool of POD plansCost-effectiveVersatility of model


ySeasonal flu clinics-not always for a crisis

Field tested and research based

User Guide Information

User Guide can be used for single use or “Train the Trainer” presentation


For the most updated version of the User Guide and Model go to:

Institute for Systems Research, University of Maryland

www.isr.umd.edu/Labs/CIM/projects/clinic/

Patient Waiting in PODs

Waiting occurs when systems with variability operate near capacity.


p yExcessive waiting provides an opportunity to improve POD design.

Waiting for screening station June 21, 2004

Clinic Planning Model Generator Demonstration

(CRI Scenario)


(CRI Scenario)

CRI Background

The Cities Readiness Initiative (CRI) is a federally funded effort to prepare major US cities and metropolitan areas to ff ti l d t l l


effectively respond to a large scale bioterrorism event by dispensing antibiotics to their entire identified population within 48 hours of the decision to do so.

CRI ScenarioThere has been an aerosolized Anthrax attack in Anywhere, USA. It has a population of 500,000 residents. There are 65 elementary schools that will be used to distribute oral medication. Household Representatives will be asked to walk to the nearest elementary school. Anywhere’s Local Health Department is given 24 hours to


Local Health Department is given 24 hours to distribute the medication, requiring two 12 hour shifts. Problem: Determine the number of staff needed to deliver medications to 500,000. Use two stations Greeting and Delivery.Go to CPMG

Example: Input Data

Size of population to be treated: 500,000

Time for treatment (days): 1


Hours of operation per day: 24

Number of PODs: 65

Worksheets

Greeting

500,000

1

24

65


100 %

100 %

Dispensing

Exit

Greeting

Dispensing

Dispensing

Exit

1

2

Model creationLaunch the CPMG (enable macros) and enter setup information


Model creationSelect stations in clinicSelect ‘OK’ and save clinic


Model creation

Enter station names…….and routing data



Navigate to Main page





Viewing and editing the clinic


What if?What happens if weadd a person to the station with the highest utilization?


Add 1 to number of dispensing staff:

Adding 1 to dispensing impactsPOD performance:

POD capacity:343 to 400 patients per hourTime in POD:

What if?


5.35 mins to 1.83 minsPatients in POD:29 to 10Waiting time at dispensing:3.78 mins to 0.26 minsQueue length at dispensing:20 to 1

Medication Distribution Model


CRI Scenario: Medication Distribution

Medication flow:Strategic National Stockpile (SNS) and Vendor Managed Inventory (VMI)


State Receipt, Store, and Stage (RSS) facilityLocal Distribution Center (LDC)Points of Dispensing (PODs)

Multiple shipments to RSS require good plans to get medication to PODs on-time

CRI Scenario: Medication Distribution

Slack = how early are deliveries to PODs?

More slack is better: more robust plan that h dl di ti


can handle disruptionsSynchronizing operations is key to increasing slack.

CRI Scenario: Medication Distribution Planning

Inputs:TimeframeShipments to RSS: time, quantity


PODs: location, demandVehicles: number, capacity

Output:Routes for vehiclesDelivery schedule with quantities

Medication Distribution Planning Process



Routing:Uses TourSolver (cdcstockpilerouting.c2logix.com) to

t hi l t


generate vehicle routesScheduling:

Uses tested rules to schedule deliveries and determine best quantities


Go through CRI example


eMedCheckElectronic Patient Screening


CRI Scenario: Patient Screening







Demonstrate eMedCheck


Planning with Computer Models . . .

. . . can be used for more routine operations:

Tuberculosis screening at high schools


Seasonal flu clinicsOther immunization clinics

Objectives

At the end of this session, participants will be able to:

1. Define the term “computer models.”2 Id tif t th d h ll t


2. Identify strengths and challenges to using computer models for local public health departments.

3. Describe at least two examples of how computer models can be integrated into local public health.

Concluding Remarks

We encourage you to use these tools and provide feedback to use so that we can continue to improve them and d l f l


develop useful new ones.

A Final Thought

Modeling should create a conversation, not answer a question.


Contact InformationFor more information about the Montgomery County Advanced Practice Center (APC) and tools please refer to the following website:

http://www.montgomerycountymd.gov/apc


Or contact:Kay Aaby, APC Program [email protected]. Jeffrey Herrmann, University of Maryland [email protected]

Questions


Public Health Preparedness Summit 2009 – San Diego, California

Tools, Training, and Technical Assistance: Supporting Healthcare Providers with BusinessSupporting Healthcare Providers with Business Resiliency

Michelle McDanielPublic Health – Seattle & King County

Stephanie TijerinaSea Mar Community Health Centers

February 19, 2009

Overview

APC & King County Healthcare Coalition Issue to addressBusiness Resiliency Project

GrantsG

Workshop

Tools

Evaluation

Preparedness in practice – Sea Mar Challenges and lessons learned

Advanced Practices Centers = resource

Network of local health departments

Helping public health prepare for, respond to, and recover from emergencies

Toolsinformed by public health experience Online & FREE

King County Healthcare Coalition

A network of healthcare organizations & providers committed to coordinating their emergency preparedness and response activities.

Purpose: develop & maintain a comprehensive system that assures coordination, effective communications, and optimal use of available health resources in preparation for and in response to emergencies and disasters.

“Non-Hospital” Healthcare Providers

Mental healthSubstance abuseNursing homes

Home careHome healthPalliative careg

Boarding homesAdult family homesPoison centers

PediatricAmbulatory careBlood centersDialysis

The Issues To Address

“Healthcare system” is not limited to hospitals.

Must have continuity of care within the continuum of care to:

reduce mental/physical decline and need for higher level of care for the people non-hospital healthcare providers serve,

avoid surge on EMS and hospitals.

Non-hospital healthcare providers critical in a community-wide event.

Disaster’s Impact on Healthcare

Wind/Rainstorm 2006Nursing home evacuation

Rainstorm 2007Near flooding of mental

health residential facility

Earthquake Scenario

You are the CEO at Healthy-R-U, a healthcare organization with multiple sites and services throughout the county.

A 6.8 quake has struck. Major damage is visible in all areas of the County Phones (landlines and cell) are jammed Power of the County. Phones (landlines and cell) are jammed. Power is out throughout much of the region, including your site.

Upon conducting an initial assessment of the outpatient clinic you are at, some staff and clients appear to be injured. Within 5 blocks of your location, Healthy-R-U has three more sites: 1) a nursing home, 2) a dental clinic, and 3) a pharmacy.

Earthquake Scenario

What would be your top priorities in this situation?What are your biggest concerns?What preparedness activities could have been done to make the response easier & more effective?make the response easier & more effective?With phones being jammed, what are other ways you could communicate between sites? To EMS? To loved ones?How would you handle a surge of injured community members coming in for care?

Business Resiliency Project

Funded by Assistant Secretary for Preparedness and Response (ASPR)

Goals:1. To strengthen the capacity and capabilities of non-

hospital healthcare agencies that support at-risk and vulnerable populations through continuity of operations workshops and organizational enhancement funding.

2. To strengthen coordination across sectors.

Business Resiliency Project

Filled gaps:Lack of funding – reimbursed preparedness supplies, staff time, training, etc.

Lack of time – developed easy-to-use tools, customized workshop for non-hospital healthcare providers, offered tips to avoid overwhelm and perception of “not enough time!”

Lack of expertise – offered 1:1 technical assistance after attending workshop

Grants Awarded

Awarded 9 providers “large” grant via RFP process

Large Grant: Funded projects designed to assist the King County region in becoming better prepared and ready to respond to the needs of at-risk populations during times of disaster. Projects awarded were designed to regionally benefit at-risk populations rather than one individual organization or treatment provider.

Could not exceed $24,000

Large Grants Examples

Northwest Kidney Centers

Establishment of an emergency call center

Aging & Disability Services

Increase preparedness level of home care services system

Grants Awarded

Awarded 127 providers “small” grant via RFP process

Small Grant: Funded non-hospital healthcare agencies serving King County to develop and enhance their resiliency in an emergency. The goal of the funding is to support healthcare organizations’ ability to maintain service delivery during an emergency event.

Could not exceed $2,499

Preparedness in Practice

Sea Mar Community Health Centers47 facilities specialized in Ambulatory Care, Behavioral Health Services (inpatient and outpatient), Home Care, Home Health and Nursing p ), , gHome servicesThe majority of the patients, clients and residents served are the underserved and most vulnerable populations in WA

Sea Mar Community Health Centers

Challenges in preparing Sea Mar: Massive, complex community health system High turnover ratesLocation - located in 10 different counties and have 0 vdifferent resources available to health centersLimited resources available to facilitate and prepare 47 sites in 10 different countiesJoint Commission accredited and required to meet specific standards

Joint Commission

Joint Commission Emergency Preparedness StandardsRequired to have…

Hazard Vulnerability Analysis per County (updated annually)Community Response Plan - involving city, county and regional resourcesOrganization Emergency Management Plan describing recovery stages, actions, and individual responsibilities

Two disaster drills annually that enable the organization to practice communication strategies

Drills that exercise communication, resources, security, staff, utilities and patients Evaluate the responses of the exercises, identify the deficiencies and opportunities for improvement

Source: Joint Commission, Comprehensive accreditation manual for ambulatory care 2009

Tool

Business Resiliency Assessment Tools (BRAT)

Required completion of both short & long form

Purpose:1. Obtain critical information about provider’s preparedness

level, resources and contacts.

2. Increase provider’s awareness of their level of preparedness and resiliency.

3. Create awareness of important preparedness and response considerations.

Tools

Business Resiliency Workshops

5 Workshops 72 Hours of Instruction3 Locations in King County3 Locations in King CountyOver 150 Participants

Representing 101agencies

Objectives:

Id tif th l f th Ki

Business Resiliency Workshop

Day 1: Fundamentals of Business Resiliency

1. Identify the value of the King County Healthcare Coalition.

2. Examine roles of emergency management and the value of the incident command system.

3. Identify the types of hazards in our region and how they may impact your organization’s ability to protect your staff and serve your patients/clients.


Day 1 objectives continued:

4. Outline infrastructure vulnerabilities and describe impacts to your organization.

5 Describe the importance of personal and family 5. Describe the importance of personal and family preparedness and ways to increase your personal preparedness level.

6. Outline methods to increase organizational preparedness and business resiliency.

Tool

Business Resiliency Workbook12 sections: information, forms and step-by-step instructions

Grant recipients required to complete 5 sections

Essential services/critical functionsPersonnelEmergency supply cachesAgency go-kitsIncident command system

Available online in interactive PDF form


Objectives:1. Describe the local response

Day 2: Business Resiliency in Practice

system.

2. Identify how your organization can access information and request resources during an emergency.

3. Demonstrate the regional and organizational preparedness efforts coordinated by the King County Healthcare Coalition.

4. Identify the benefits and function of the Incident Command System (ICS).

Tools

Workshop Participant Manual & CD-ROM

AgendaWorkshop ContentpExercisesKey ContactsResources

Tools

Benefits gained…

BR Workbook helped improve emergency management plans at each site

Have implemented workbook as a mandatory tool to help standardize emergency management plansWorkbook was a tool to help improve current plansHelpful, user friendly tool

Benefits gained…

Workshop provided:Review of emergency management systemCritical infrastructure panel presentationsImportance of a personal preparedness planBreak out session which provided the interaction with other healthcare agencies Materials free of costHelpful tools for managers

Grant funds helped us to implement & standardize emergency preparedness supplies ordered for all 47 sites (i.e. patient transporters, flashlights, whistles, purification tablets).

Project Evaluation

Evaluation components

Pre- and post-workshop surveys

Follow up survey (W b b d)Follow-up survey (Web-based)

Tools for tracking/monitoring grants, workshop participants, technical assistance, deliverables

Project Evaluation: Pre- and post-workshop surveys

Usefulness – workshops (% of responses)

Day Excellent Very

Good Good Fair Poor

1 (n=160) 36% 49% 13% 3% Overall usefulness to you and your agency 2 (n=153) 44% 47% 8% 1%

(% of responses) Strongly

Agree Agree Disagree Strongly

Disagree

I will be able to apply the workshop information to my job. (n=147)

65% 33% 1% 1%


Knowledge and Skills

Participants rated their pre- and post- level of confidence in 12 knowledge and skills areas related to the workshop objectives using a 11-point scale (0 = “not confident at all,” 10

“ l t l fid t ” = “completely confident.”

All 12 areas showed a significant increase in confidence across all four workshops (p=<.005).


In the event of a disaster or emergency I am confident…

I can describe the importance of personal and family preparedness and list 3 ways to increase my level of personal preparedness.I have a basic understanding of the regional emergency response I have a basic understanding of the regional emergency response system.

I can describe the role of the Public Health - Seattle & King County during an emergency.

I can list at least 3 strategies that my organization could use to make preparedness "do-able."

I can explain the importance of regularly exercising my organization's disaster response plans.

Project Evaluation: Follow-up survey

Satisfaction – program components (% of valid responses)

Component n= Excellent Very Good

Good Fair Poor

Grant request for proposals/ application process

62 31% 35% 24% 8% 2%

process

Quality of the technical assistance you received

62 42% 35% 20% 3%

Resource materials and tools provided

62 50% 40% 8% 2%

Expense reimbursement process

62 22% 34% 21% 17% 5%

Grant deliverable requirements

59 24% 44% 22% 5% 5%

Project Evaluation: Follow-up survey

Learnings gained by participants

The complexity of business resiliency planning N thi t l k t i i f di tNew things to look at in preparing for a disasterHow government response systems operateTools and resources availableOptions for community support during a crisis

Project Challenges/Lessons Learned

Marketing – direct communication essential

Wide variation in provider’s resources. Examples:

Ad lt F il H ith t I t t d/ FAX Adult Family Homes without Internet access and/or FAX Unable to commit to a two day workshop.

Wide variation in provider’s preparedness levels & understanding

Mixing of providers of large and small operations

ESL issuesDiscovered additional barrier: Executive By-In

To access project tools…

htt // ki t /h lth i /h lth/http://www.kingcounty.gov/healthservices/health/preparedness/hccoalition/ambulatory.aspx

Discussion

Q i ?Questions?

Cross-Jurisdiction Cross-DisciplinaryExercisingg

We can collaborate!

Partners in Public Health PreparednessBrookline (MA) Public Health Department

Cambridge Advanced Practice Center for PublicCambridge Advanced Practice Center for Public Health Preparedness

Harvard School of Public Health Center for Public Health Preparedness

~ 3000 Local Public Health Agencies in US

12% of them are in Massachusetts12% of them are in Massachusetts

351 cities and towns

351 local health agencies

PH Emergency Preparedness Regions

Region 4b

Local Needs – Local perspective

Local Health Departments in MA and in Region 4b are very small, and in some cases have no paid staff. Local health department emergency preparedness

dneeds:Staff/People resourcesTrainingResources (e.g., guides for developing plans)Stuff (supplies)SustainabilityFunding

Local Needs –Advanced Practice Center Role

“Learning lab”

“Scary bugs”

Demonstrating value of collaboration

Product development

Technical assistance

HSPH-CPHP Exercise ProgramOriginated from community needs

Limitations of didactic sessionsLimited opportunities for trainingpp gNeed to integrate PH into the response communityNeed to educate response community about PH threats

HSPH-CPHP Exercise ProgramCommunity needs (continued)

Challenges in assembling multiple communitiesNeed for vertical integrationgDifficulty in gathering appropriate cadre of evaluators Need for concrete, valid feedback

HSPH-CPHP Exercise Program: Design

Multi-jurisdictionalMulti-disciplinaryPublic health focused

HSPH-CPHP Exercise Program:Scope

Designed and led >35 exercisesDiscussion-based (tabletop)Operations-based (full-scale, functional, drill)

Reached over 4,000 participants from more than 200 municipalities in MA and MEAverage exercise > 100 participants

Collaboration History

Brookline- CollaborationsThe Brookline Public Health Department (BPHD) has worked collaboratively (informally) with other communities for many years.Region 4b/APC has formalized and helped to coordinate the working relationship with other localcoordinate the working relationship with other local communities.Region 4b identifies needs and gaps and the APC develops resources to assist with helping with needs and filling gaps.The BPHD has worked with the Harvard School of Public Health on exercises and drills.

Cambridge APC Regional ProjectsPublic Health Mutual Aid Agreement Pandemic influenza exercisesEmergency Dispensing Site TrainingsEmergency Dispensing Site TrainingsPocket CommunicatorEmergency Preparedness Begins at HomeMaster the DisasterMAVEN Functional Exercise

HSPH-CPHP Regional ProjectsPandemic influenza exercisesMass dispensing exercisesSurge care facility exerciseSurge care facility exerciseMRC notification programsMAVEN

Impact of Collaboration

Local Perspective –Impact of Working Together

Regional Coordinator has given local health departments assistance with staffing by providing regional liaisons, assistance with MRC recruitment, development and day to day operationsFunding for trainings, local allocations and special projectsSupplies - Signs, EP at Home, vests, communication equipmentResources– APC provides technical assistanceTraining materials developed –EDS, All-Hazards planExercises–Pandemic Flu, PEER, LENS, TAR and soon to be implemented MAVEN

Local Perspective -Lessons Learned

Collaboration is essential for successful work in Emergency Preparedness. Using the APC and academic centers as resources and partners has assisted local health departments with the p pability to save money and not duplicate work that has already been done.Working with other health departments, the APC and HSPH-CPHP has given locals the opportunity to do more than we ever could independently.

Impact of Collaboration –Advanced Practice Center

Growing ability to work across community boundariesIncreasing participation of communities at all levelscommunities at all levelsBroad recognition of public health role in preparednessNew collaboration partners and ideas Products and Practices for local health departments

HSPH-CPHP Exercise Program: Observed Benefits

Identify gaps and redundancies in community planningBuild and strengthen relationshipsBuild and strengthen relationshipsUnderscore roles and assets specific to PHOpportunity to engage broad range of partners to increase reach and ensure standard preparedness training

Evaluation in the HSPH-CPHP Exercise Program

Evolved over timeUse of trained evaluators

Evaluator training ongoingChecklists

Delphi process used to identify domains

Self-assessment tools for table participantsWeb-based surveysReview of electronic records

HSPH-CPHP Exercise Program: Evaluation Results

Content analysis of after action reports has identified a number of recurrent systems challenges including:

Lack of understanding ofLack of understanding of individual and agency roles and responsibilitiesInconsistent coordination among responders, especially between disciplines

HSPH-CPHP Exercise Program: Evaluation Results (continued)

Limited communications capabilities, especially with regards to sharing information about health risksSignificantly limited integration of public health expertise into the response community’s decisionexpertise into the response community s decision makingInsufficient knowledge of the capabilities and assets of responding partners

Biddinger PD, Cadigan RO, Auerbach BS, Burstein JL, Savoia E, Stoto M, Koh H. Using Exercises to Identify Systems-Level Preparedness Challenges. Public Health Reports 2008

Challenges

Ongoing Challenges –Local

Decreasing funding

M nicipal b dget c tsMunicipal budget cuts

Increasing need to demonstrate measurable results

Ongoing Challenges –Advanced Practice Center

Working with HSEEP requirements

Contin ed capacit b ildingContinued capacity building

Sustaining practices

Ongoing Challenges –HSPH

What’s the proper unit of measurement?

Given the fragmented t t f bli h lthstructure of public health

(city, county, region, state, multi-state metropolitan area, nation)Health department vs. “community”

Ongoing Challenges (continued)Who decides appropriate standards?

Balancing risks, efficacy of interventions, and other opportunities for public healthU i i d l h kliUse expert opinion to develop checklist

Who judges when standards are met?Need for subjective, but reliable, measures of higher order capabilitiesCreate corps of trained peer evaluators

Further Opportunities for Academic-Local Partnerships

Examine the key factors determining the quality and fidelity of PHEP exercisesRefine domains of PHEPTest reliability and validity of individual metrics of PHEPExpand training and number of exercise observers and evaluators

Improve inter-rater reliability

Further Opportunities for Academic-Local Partnerships

Give structured feedback about the realities of exercise conduct to state and federal exercise program officials and funders

Current Collaboration

MAVEN Functional ExerciseParticipants

Objectives

Logistics

Future Plans

Product Development

Discussion

Contact InformationDawn Carmen Sibor, M.EdBrookline (MA) Department of Public [email protected]

K C D ll MSWKerry C. Dunnell, MSWCambridge Advanced Practice [email protected]

Paul Biddinger, MD, FACEPHarvard School of Public Health Center for Public Health [email protected]

PHP Summit Conf 2009 Activities

Natural Disaster – Flood

Setting

Season: Summer - Mid August Issues: Major thunderstorm cell stalls out upstream of a city. Heavy rain and

localized street flooding was expected. However, about 8 to 10 inches of rain falls over a 24-hour window upstream of the city. Thunderstorm starts about 6:15 pm on a Tuesday. A river or creek runs through the city and the levees or dykes are damaged/breached and not high enough to control all of the rainfall. Flooding starts next day at 6:00am. People did not evacuate initially, because weather forecast did not reflect a stalled out thunderstorm and excessive rainfall. Many roads leading out of town closed due to high water. One major 4 lane highway and one two lane county road remained open for people to evacuate. People were ordered to evacuate their homes on day 2 at 8:15 a.m. Approximately 2-3% of city residents did not evacuate and remained in their homes. No electricity or telephone service for about one–third of the town. Outside of city limits there are farms with dairy cows; livestock is affected. Mayor contacted the governor who directed the National Guard to respond for security.

Size of city: 50,000 people Duration: Several days before water significantly recedes and residents/business

owners-operators are allowed back to inspect their properties. Receptors: The flooded area consists of hundreds of single family homes, a number of

large apartment buildings, one major grocery store, 2 to 3 day cares, 1-2 schools (an elementary and a middle school), 3-4 churches, 1 community center, 1 private full service athletic club, 1 strip style shopping mall with 12 retail tenants, 20 restaurants affected, 6 gas station/convenience stores, 1 nursing home, a large food processing plant, 2 hotels with swimming pools and restaurants and 1 hospital.


Activity No 1

EH and Disaster Related Impacts

Flooding is one of the most frequent and widespread of all weather-related hazards. Floods of various types and magnitudes occur in most regions of the country, causing huge annual losses in terms of damage and disruption to economic livelihoods, businesses, infrastructure, services and public health. Impacts associated with a flood can be significant and devastating to a community. Please discuss and list as many issues/problems as you can think of that would be associated with a flood.


List of Potential Issues/Problems Due to Flooding

• Evacuation of the population • Inoperable municipal water and wastewater systems • Significant soil erosion throughout the impacted area • Tremendous amount of solid waste/debris generated by a flood • Generation and management of household hazardous waste • Generation and management of white goods (e.g., appliances) • Medical waste management (e.g., storage and transportation) • Vulnerable populations • Water storage, disinfection and rationing • Power outages • Interrupted telephone service; limited or no service • Poor or non existent hand hygiene • Food safety and supply • Possible carbon monoxide poisoning • Assess on-site waste water systems • Testing private wells for possible contamination • Indoor air quality (e.g., mold and moisture levels) • Contaminated flood water • Sheltering affected population • Chemical releases and spills • Damaged licensed facilities (e.g., daycare, pools, retail food establishments)


Activity No.2

Potential Health Effects of Flooding

Floods have the potential to exact a major impact on the health of human populations, and for a given flood event the range of possible health outcomes is broad. These outcomes can result from health risks associated with the presence of floodwaters or indirectly via the impact of floods on shelters, livelihoods, infrastructure and health systems. Please discuss and write down as many direct and indirect health effects commonly associated with a flood.


Potential Health Effects of Flooding

Direct • Drowning • Injuries (e.g., cuts, sprains, fractures, punctures and electric shock) • Diarrheal disease • Vector and rodent-borne diseases (e.g., malaria, encephalitis, leptospirosis) • Chemical contamination (e.g. of food and water) • Respiratory infections • Skin/eye infections • Mental health Indirect • Damage to health care infrastructure • Loss of essential drugs/medicine • Damage to water and sanitation infrastructure • Damage to crops and/or disruption of food supplies • Damage/destruction to property • Disruption to livelihood and income • Population displacement


Activity No. 3

Immediate EH Issues for Response and Recovery

Go back to your notes that describe potential issues and problems associated with a flood. Take a moment and review your list. You may use any item on this list. Now, please discuss and compile a comprehensive list of issues that you think should be immediately addressed. In this case, immediate refers to within 24-hours of the flooding onset.


List of Potential Immediate Issues (Within 24-Hours)

• ICS • Communication • Shelter(s)/temporary housing • Medical/triage • Security • Life Safety • Food Safety • Wastewater • Personal hygiene • Potable water • Private wells • Clothing, blankets, bedding • Animal control & shelter • Staffing issues • PIO • Staff safety/tetanus/PPE • Donation management • Power outage consequences • Safe generator use • Pets • Special needs population


Activity No. 4

Short-Term EH Issues for Response and Recovery

Go back to your notes that describe potential issues and problems associated with a flood. Take a moment and review your list again. You may use any item on this list. Now, please discuss and compile a comprehensive list of short-term issues that you think need to be addressed. In this case, short-term refers to a time frame that begins after the immediate issues have been thought about and hopefully addressed.


Potential List of Short-Term Issues

• Damage assessment • Ongoing involvement with shelter(s) • Medical/triage • Discourage early returns • Personal hygiene • Communication • Roads and bridges • Transportation • Vector control • Mass casualty issues • Needed inspections for FBL • Identify debris removal sites • Disaster declaration • PIO • MOU/MOA/EMAC • Debris management • Food safety • Potable water • Pets • Air quality • Clearing roads (mud and debris) for emergency vehicles • Hazardous waste • Household hazardous waste


Activity No. 5

Long-Term EH Issues for Response and Recovery

Go back to your notes that describe potential issues and problems associated with a flood. Take a moment and review your list one final time. You may use any item on this list. Now, please discuss and compile a comprehensive list of long-term issues that you think need to be addressed. In this case, long-term refers to a time frame that begins after the short-term issues (which you listed) have been thought about and hopefully addressed.


Potential List of Long-Term Issues

• Vector control • Sampling (air, soil and water) • Medical/triage • Debris management • Restore potable water supply • Recovery of deceased people • Repair levees • Transition out of shelters • Evaluation and repair of infrastructure (roads, sewer and water) • Mitigate mold • Address fuel oil spills • Reopening inspections for: restaurants, grocery stores, convenience stores, delis,

hotels • Resume refuse collection • Restoration of all utilities • PIO • Environmental testing (% moisture in sheet rock and mold) • Food safety • Personal hygiene • Hazardous waste • Household hazardous waste • Housing needs


Activity No. 6 Potential Topics for Re-entry – Initial Visit Phase I

The water has begun to recede and the Mayor wants to allow community members to re-enter the impacted area during daylight hours to assess their property and recover personal items. Identify critical problems/issues/hazards that must be addressed to allow this re-entry/initial visit to occur safely. You can think broadly and not just focus on environmental health.


Potential Topics for Re-entry – Initial Visit Phase I

• No power • Roads cleared • Sewage mixed in standing and receding water • Security risks • Physical hazards (debris, heat, humidity, fire ants, mosquitoes, flies, gnats,snakes,

silt and mud • Need for positive ID/credentials • Collaborate with building officials (structural issues/mold) • Determine level of needed PPE • Time guidance recall mechanism (air horn) • Bring food, water, first aid kit, sunscreen, bug repellent, hat, sunglasses • Wildlife in homes (snakes, raccoons, squirrels, rodents) • Natural gas leaks • Up to date vaccinations for EH responders • Household chemicals • Hazardous waste • Awareness of structural issues/cracks • Clean-up procedures and required equipment • Overall damage assessment


Activity No. 7

Recovery and Re-occupancy Phase II

The flood waters in the city have receded and homeowners and business operators have pumped water out of flooded basements and lower levels. You are the Environmental Health Strike Team Leader. You and your team have been asked to determine the actions that should be taken to enable people to safely reenter their homes and businesses to reopen. What hazards should be removed? What systems should be operable before moving back permanently? What services should be in place before everyone returns? What tasks need to be accomplished for food establishments to reopen? What metrics will you use to measure progress in terms of a return to pre flood conditions?


Recovery and Re-occupancy Phase II

Hazards removed: perishable, spoiled foods

Damaged white goods (refrigerators, washers, dryers, dishwashers, microwave units Misc debris (contaminate soil, septic systems, dead animals, human bodies) Household hazardous waste Ruined automobiles Tree waste Destroyed personal possessions (furniture, draperies, carpet, ceiling tiles, wood paneling, pictures, books, toys, mattresses, box springs, clothing) Scared animals Propane tanks Home electronics (computers, game systems, televisions, music players, DVRs, VCRs, copiers and telephones)

Operable Systems Utilities Building/Inspections Dept. Security (police) Fire department Medical/hospital(s) Transportation Refuse collection In place Services Public affairs/PIO

Reopening inspections for FBL, grocery stores, pools, and septic systems

Tasks To Complete Public education/ distribute fact sheets on food and water

safety Post facility reopening form Distribute clean-up procedures Coordinate refuse collection Coordinate reopening inspections Indicators of Progress % FBL inspected % FBL reopened % of homes reoccupied % of homes with potable water and sewer service % of homes with electricity % of neighborhoods reoccupied




Event of National Significance

Imagine that your community will be the site for an event of national significance. By national significance, we mean a political party’s presidential nominating convention, a major sporting event like the Superbowl or World Series, an international economic or environmental conference and or Olympic Games. All of these events have many common issues such as: increased security, extensive media coverage, and an influx of people (participants, support personnel, reporters, technicians, family members, friends law enforcement, protestors and others). Different activities will be held simultaneously at multiple locations throughout your community and an adjoining one. For example, the event itself will take place in one building, but meetings and parties will occur over several days in a large geographic area encompassing a number of cities and possibly two counties. Environmental health professionals will be actively involved with pre-event planning and activities during the event itself. We all know environmental health is a broad based discipline ranging from air quality to vectors. In this situation, EH’s role will likely focus on food safety and defense. It could also include a foodborne outbreak investigation. You have six months to prepare for the event.


Event of National Significance Group Activity No. 1

How would you assure that public and environmental health issues and appropriate agencies are included in pre-event planning activities? Who (i.e., what agency) would take the lead in pre-event planning and why?


• Ensure that public health and environmental health are tied into emergency management planning

• Establish a working relationship with colleagues involved with planning and security for the event

• Ensure that your emergency plans include planned events in addition to disasters/emergencies

• Ensure that the agency which has the broadest responsibility for environmental and public health is actively involved in planning activities



What regional or multi-jurisdictional issues (include public health, environmental health and others too) do you think would arise, and what tools will you need to address those issues?


• Communication with hospitals/EMT • Liaison with police departments • Liaison with fire departments • Liaison with local, regional (if applicable) and state health depts. • Communicate with epidemiology staff • Communicate with environmental health staff • Communicate with appropriate laboratory • Communicate with PIOs • Liaison with environmental protection agency • Liaison with state dept of agriculture • Communicate with local water utilities • Liaison with emergency management personnel • Balancing direction from local IC with guidance/direction from others • Mutual aid • Common web site • 800 Megahertz radios • Common protocols for communication • Common protocols for foodborne outbreak investigations • Educational materials that licensed establishments can use to understand special

risks during the event



How will your agency efficiently communicate with multiple agencies on a daily basis during the event? What topics should be in your communication plan?


• Establish or use an existing web site (e.g. in MN, we used MNTrac) • Conduct twice a day conference calls with environmental health supervisors,

managers and directors • Plan for and have available equipment for a backup or contingency means to

communicate (e.g., 800 megahertz radios) • Assess possibility for a “blast” telephone message system • Conduct communication training prior to the event for EH professionals • Consistency in inspections • Consistency in educational materials • Mutual aid procedures • Proper and common identification for EH professionals • Coordination of messages to the media • Coordination of messages to elected officials • Resolution of “turf” issues



What training do you think you will need to prepare for the event? Where would you get the materials and who would actually lead the session(s)?


• Risk based inspections versus enforcement of food ordinance • Communication procedures • Regulated establishments • Accessing and using a common web site • Mutual aid • Using 800 megahertz radios • Common protocols for badges/identification • Common protocols for foodborne outbreak investigations • Documenting issues/actions using a common form • Work force assignment/scheduling tool • State agency • FDA • Twin Cities Metro APC

A Critical Preparedness Triad for the A Critical Preparedness Triad for the Local Health Department CommunityLocal Health Department Community

1

February 19, 2009February 19, 2009

Introductions 5 Tarrant County APC Program Overview 5 North Texas Preparedness Issues and Insights 15 Hypothetical Preparedness Scenario 5Mass Casualty Triage 25

AgendaAgenda

2

Mass Casualty Triage 25 Break 10 School Health Surveillance 25 Enabling a Viable Volunteer Workforce 25 Conclusion and Q/A 5

IntroductionsIntroductions

William F. Stephens– Manager

Dean Lampman– Regional Surveillance Coordinator

3

Regional Surveillance CoordinatorKay Sanyal-Mukherji– Workforce Training and Development Specialist

Session ObjectivesIdentify 4 critical components of Homeland Security Presidential Directive 21 (Pandemic All-Hazards Preparedness Act) – Relate these to capacity building for local health agencies in 3 key areas

Discuss key elements of mass casualty triage – Describe importance, types of mass casualty triage as a critical component

Explain key elements and functions of an effective school health

4

Explain key elements and functions of an effective school health surveillance program – Describe an open source Web portal that readily supports collaboration

Describe core competency matrix for knowledge, skills and capabilities of Medical Reserve Corps (MRC) volunteers– Discuss training requirements


AgendaAgenda

5


Tarrant County Public Health: Tarrant County Public Health: Serving a Large, Diverse RegionServing a Large, Diverse Region

County population: 1.7 million; Region: 6.2 million 60 million pass through DFW Airport daily22% speak a language other than English at homeTop 2 industries: Health and ManufacturingPublic venues: Texas Motor Speedway and recently

6

Public venues: Texas Motor Speedway and recently built Dallas Cowboys stadiumWeather : tornadoes, floods, wildfires

Tarrant County APC BackgroundTarrant County APC Background9-99: NACCHO and CDC funded 3 prototype local health departments to serve as APCs Work focused on:– Communications and information technology– Preparedness planning– Training and evaluation

7

Training and evaluation

12-03: Five new LHDs selected as APCs1-04: Tarrant County named APC

Tarrant County APC Focus AreasTarrant County APC Focus AreasDisease Detection and Investigation– Implementation and evaluation of syndromic surveillance – Build a public health community of practice (partners)– Facilitate health information exchange

Preparedness Planning and Readiness Assessment

8

– Provide emergency preparedness products and services– Conduct readiness assessments

Workforce Development– Assess competencies and evaluate results– Develop training tools, deliver training

Tarrant County APC: Some Key ProductsTarrant County APC: Some Key ProductsBiosurveillance Compendium

NDLS Decontamination Training

Mass Triage Training CD

Radiological Training Suite

9

g g

Preparing Your Business for Emergencies, Natural and Man-made Disasters

MRC Training


AgendaAgenda

10


Preparedness Issues in North TexasPreparedness Issues in North Texas

Among many public health threats:– Pandemic influenza– MRSA

R di l i l d i ( di b b)

11

– Radiological devices (e.g. dirty bomb)

Compliance with HSPD 21– Our focus: the critical preparedness triad

Pandemic InfluenzaPandemic InfluenzaPublic health officials consider H5N1 (“avian flu”) today’s greatest pandemic flu threat

New bacteria / virus

12

Can infect humans Nearly all have no immunity High mortality rate Easily spread person to person.

WHO Pandemic PhasesWHO Pandemic PhasesPhase 1. No new human flu virus subtypes

Animal flu viruses low risk to humans

Phase 2. No new human flu virus subtypesAnimal flu viruses high risk to humans

Phase 3. Human infections with a new subtypeHuman-to-human spread is difficult

13

Phase 4. Small clusters of human cases Limited human-to-human spread

Phase 5. Larger clusters of human casesImproving human-to-human spread

Phase 6. Pandemic phase: increased and sustained transmission in the general population

Texas in 1918 (Pop. 4.6 million)

70,000

107,000

40,000

60,000

80,000

100,000

120,000

Cas

e C

ount

s

14

500

20,000

9/23

9/30

10/7

10/14

10/21

10/28

Date

C

From zero to more than 2,100 deaths in 5 weeks!

Source:http://1918.pandemicflu.gov/your_state/texas.htm

Most likely to start in southeast Asia or Africa and escape local control measuresWill arrive in Tarrant County via exposed, infected international traveler

Pandemic Preparedness ScenarioPandemic Preparedness Scenario

15

Illness will spread within the business or school community and throughout the general public

If 1 person in 5 are infected (20% attack rate)– Then about 320,000 become ill– Nearly 32,000 will need to be hospitalized

A 2% death rate means 6 400 will die

Tarrant County ProjectionsTarrant County Projections

16

A 2% death rate means 6,400 will die– 800 deaths per week, for 8 weeks– Normal death rate is 183 per week

At least two waves are likely

Tarrant County Pan Flu Response PlanTarrant County Pan Flu Response PlanProvide ongoing surveillance for influenza-like-illnesses (ILI) that may signal pandemic

Timely, coordinated prevention measures

17

Educate public about individual and community preparedness processes

Rapid, frequent, accurate information shared with public, medical community and others

Timely communication

Training / Education Staffing

Biosurveillance Network

School Health

MRC Training

Medical community training (e.g. triage)

T i i f t

MRC Training

Medical community training (e.g. triage)

T i i f t

Tarrant County / APC EmphasisTarrant County / APC Emphasis

18

Surveillance System

Other systems (LE/FR, Health Alert Network)

Training for partners (schools, business)

Other public education

Training for partners (schools, business)

MRSA: Growing National ProblemMRSA: Growing National ProblemCA-MRSA: biggest cause of cultured skin infections among those seeking care for these infections at ERsCommon in athletes prisoners and soldiers

19

Common in athletes, prisoners and soldiers ’99 to ’05: Number treated in ERs doubled –127k to 278k; deaths up from 11k to 17k+Not easily treated, often see deep tissue infections from minor cuts and fatal pneumonia

MRSA: It’s Bigger in Texas MRSA: It’s Bigger in Texas

Texas DSHS studies: MRSA infection rate among football players: 16 times national avg.

20

December 2007: High school football player dies from MRSA-infected turf burns

Fall 2008: Tarrant County Public Health puts MRSA surveillance form on school portal

Radiological ThreatsRadiological Threats11-04: Led Texas Motor Speedway’s RDD (Cs-137) full-scale exercise Revealed serious gaps in radiation effects training, ER decontamination, and mass triage methodology differences between 1st responders and 1st receivers

21

p

Developed and implemented decon/PPE/triage 2-day training for healthcare disaster response teamsUltimately revealed weakness in mass triage capability and in mass casualty care capacity

HSPD 21 PreparednessHSPD 21 PreparednessFirst Homeland Security directive to assign direct responsibilities to public health

Four critical components:

22

Four critical components:– Biosurveillance – ER, schools, EMS– Counter Measure Stockpiling and Distribution– Mass Casualty Care – healthcare disaster training– Community Resilience – volunteer training

A Critical Preparedness TriadA Critical Preparedness Triad

Biosurveillance

School Health

SurveillanceHSPD 21 Critical

Components

TCPH APC Products

23

Mass Casualty Care Community ResilienceMRC TrainingMass Triage Training

Components

Building a public health community of practice

Hypothetical Disaster ScenarioHypothetical Disaster ScenarioMild weather, late-November afternoon; light winds in mid-size Washington, DC suburbA seasonal play is being held at a mid-size elementary school; neighborhood school students and families attend

24

students and families attend

…Suddenly a Disastrous Explosion!RDD or “dirty bomb” (undetected radiological agent) detonated outside the school as people leave

25

Initial assessment: – 50 victims (adults, children)

dead or severely hurt – 150+ affected by bomb blast

Some survivors, neighbors, first responders have non-specific GI, hemorrhagic symptoms

Local health department consults with state health officials and CDC

Over Next 5 Days, More Problems Emerge

26

with state health officials and CDC on symptoms

QUESTION: What preparedness tools from the “triad” might be used for this disaster?


AgendaAgenda

27



Biosurveillance

School Health


Components

TCPH APC Products

28


Components


Section Learning ObjectivesDiscuss key elements of mass casualty care

– Describe importance, types of mass casualty triage as a critical component

29

– Define linkage to HSPD 21

– Demonstrate overview of training CD tool

First Response on SceneFirst Response on SceneThis is a “mass casualty disaster”– Demand exceeds health resources– Need to transition to rapid, scalable, flexible victim triage to

meet needs of MCI in ethical mannerNeed integrated response of first responders receivers

30

– Need integrated response of first responders, receivers

Too many victims to fully treat all of themNeed method to classify victims by injury severity and likelihood of survival

In a Perfect ResponseFirst responders respond to disasterPatients are triaged in the fieldMost critical patients arrive with EMS

S t d d t i t d ti ll t t d

31

– Sorted, decontaminated, partially treatedHospital ER’s only need care for them

What Happens at Receiving ERs?“When hospitals can’t handle the influx, it results in patients being boarded in ED exam rooms or hallways.”

34%

Ambulance diversions i i

32

www.ashp.org/import/News/HealthSystemPharmacyNews/newsarticle.aspx?id=2322

“If our EDs are stretched thin now, how will they provide medical care in the event of a disaster?” - Sen. Richard Burr (R-NC)

No diversions reported

First Receivers at Hospital ERsToo many trauma victims arriving via EMS transport for immediate medical treatmentSome serious victims have had no treatment

Many victims self-

33

presenting with no medical assessment“Worried well” also presenting w/ delayed or minimal injuries

Making Matters Worse ...First responder training typically different than hospital ER staff– START– JUMP-START

SACCO

34

– SACCO– SIEVE/SORT

First receivers unsure of medical status of first victim arrivals; using different triage in the ER

The Solution: Unified Triage SystemNo single system is “best”“MASS Triage Interactive Training”– Based on elements from other methods– Didactic, interactive training/exercise, post-test

Additi l i l di t i th t i

35

– Additional resources including train the trainer– Taught to thousands of

both EMS and ER staff– Simple, rapid, easy to

learn or teach

Triage Origins and PurposeFrom the French word “trier” meaning to sort, select, or chooseSorting of victims based on seriousness of injury AND likelihood of survival

36

of injury AND likelihood of survival when medical needs exceed resourcesDeveloped on European battlefield end of 18th century and adapted for civilian use

Goal of TriageDo the greatest good for the greatest possible number of survivors– Relieve suffering– Allocate limited medical resources effectively

37

Allocate limited medical resources effectively

Basics of MASS TriageMOVE– Those who can walk or wave

ASSESS– Those who can’t walk or wave

38

SORT– Assign 4 color-coded tags – Based on priority for care

SEND– Living victims– Based on color codes

How Public Health SupportsDifficult logistically for work schedules to provide “leveling” training– Self-pacedComplete re-training for EMS and healthcare not necessary

39

healthcare not necessary– Uses elements from other triage methodsCan be distributed through local EMS and hospital disaster preparedness staff– But can also use non-medical staff

Demonstration

IntroductionRadiological sectionE l i ti

40

Explosives sectionInteractive exercise

Disaster Scenario Questions: What other individuals or groups could assist in the initial triage (assuming mass triage training was made available)?

Does mass triage subject responders to

41

Does mass triage subject responders to liability exposure?

What health precautions should mass triage responders observe?

Questions?

42

For more information, visit: http://www.texasapc.net


AgendaAgenda

43



AgendaAgenda

44



Biosurveillance

School Health


Components

TCPH APC Products

45


Components


Section Learning ObjectivesExplain key elements and functions of an effective school health surveillance program

Define linkage to HSPD 21

46

Describe an open source Web portal that readily supports collaboration

Demonstrate Tarrant County implementation of our open source Web portal

Schools: Common Soft Targets Abroad: – 2004 Beslan school siege: 333 people died, more than half

children, when pro-Chechen terrorists took more than 1,000 people hostage in a small school in southern Russia

In the U.S.:Th ll bli i d h l C l bi (4 99)

47

– Three well-publicized school massacres: Columbine (4-99), Amish schools (10-06), and Virginia Tech (4-07)

– Florida: Middle-Eastern men in trenchcoats get on school buses in mid-summer (5-06) unchecked for 30 minutes

– School bus drivers can be hired w/out background checkshttp://righttruth.typepad.com/right_truth/2007/02/next_attack_on_.html

Dirty Bomb: Next WMD We’ll See?No dirty bomb detonated, but devices have been found– First attempt using caesium-137 was in 11-95,

by Chechen separatists at a park in Moscow

– Similar attempt by Chechen terrorists in 12-98

Terrorists have sought to use them

48

Terrorists have sought to use them– Dhiren Barot arrested in 2004 for conspiring to murder innocent people

using dirty bombs at car parks in the UK and dozens of U.S. buildings

Called a Weapon of Mass Disruption (WMD) because they may result in more fear than deaths– Fear of radiation is not always logical

HSPD 21 and Biosurveillance Biosurveillance is a process of active data-gatheringwith appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health – whether infectious, toxic, metabolic, or otherwise, and regardless of intentional or natural origin – to achieve:

49

g g– Early detection of health events– Early warning of health threats– Overall situational awareness of disease activity

HSPD 21 and Biosurveillance A central element of biosurveillance must be an epidemiologic surveillance system to monitor human disease activity across populations.

State and local government health officials, public and private sector health care institutions, and practicing clinicians must be involved in system design.

50

clinicians must be involved in system design.

The overall system must be constructed with the principal objective of establishing or enhancing the capabilities of state and local government entities.

Syndromic Surveillance Defined“Surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response.”

51www.cdc.gov/ncphi/disss/nndss/syndromic.htm

Collecting Biosurveillance DataNorth Texas:

OTC, ED, EMS data

School health data added

W t d t

52

Water data forthcoming

Future plans for physician, lab, poison control data

Hospitals: A Foundational Component

53

Why School Surveillance MattersSchool-aged children often transmit flu, leading to lost days at work/school

54

Detecting outbreaks early and applying prevention measures can reduce the impact of disease in schools and in the community

Importance of ILI DataTotal absenteeism not a good early marker of flu outbreaks due to many reasons for absence

Provides data public

55

Provides data public health can use to better characterize flu and apply limited resources more appropriately

TCPH School Health Surveillance

District-level dataSubmitted weekly

Campus-level dataSubmitted daily

Prior method: Current (new) method:

56

Absenteeism onlyVia fax or e-mailOne-way dialogueNo school resources

Absenteeism & ILIVia Web-based portalTwo-way dialogueMany school resources

Must be a health information exchangeElectronic transfer of data (Web portal)Portal to allow easy construction of report formOpen source software* for content management

School Portal Key Features

57

Content free of jargon (interpretations, not raw data)Links should be well organized and useful to nursesContext-sensitive and general messaging support Scalable system to allow for future expansion

* TCPH chose DotNetNuke: www.dotnetnuke.com

FirstFirst--Year Results, Current WorkYear Results, Current WorkMore than 100 schools reported; most posted their data three days per week (on average)Most nurses said it took < than 5 minutes to collect data and < less than 2 to enter it

58

SHSS expanded to Dallas & Denton counties; TCPH to include school clinics, daycaresAlso being considered in Houston and El Paso, may become a state model

School Health Surveillance Next School Health Surveillance Next StepsStepsAssist others following TCPH’s lead

Pursuing automated feeds for routine data(Example: Skyward school administration software)

Work w/ partners on enhanced analytics

59

Develop a general guidance document Better understand value, uses of dataConduct national research on topic, issuesInvestigate idea of mandatory reporting

DemonstrationDemonstration

Flu report formOutbreak mapsSchool resources

60

School resourcesOnline databaseMRSA case form

61

The portal is a secure environment that requires a user log-in. No content is accessible without logging in. The registration link was removed to alleviate problems with duplicate accounts.

Users have said they can complete this form in five minutes or less. It helps that some fields are auto-filled based on user reg. data.

62

The report form is the primary feature of the “landing page” users see after they log in.

The CDC definition of ILI is given.

Other Features: News, Resources, Action Items and Overview:

From the home page, you can access:

• Action items

63

• News/analysis

• Resources

• Portal overview

This page

64

Users click on their choices among a series of images with large to small geographic coverage

p gserves up ESSENCE maps of flu and ILI patterns by region.

65

Users can click on the next or previous links to see other images in the series and click the close link to return the main maps page.

This page provides access to flu prevention resources

h l

66

school nurses can use.

More resources or topics could be added.

Downloading Data from the Portal for Analysis

67

1. Enter the Form Master module and select report from the options given.

2. Specify the date range you wish to view or download, then click your preferred format for data download (typically Excel 2002 +).

3. Select “save” when the dialogue box opens and save the file to your computer in the location of your preference.

MRSA Case Reporting

68Migration to e-form in March

09

Disaster Scenario Questions: How would public health and schools benefit from Web-based communications? How could school nurses or administrators help in response to the incident in the hypothetical scenario within the first few h ? Wh b h d k f i ?

69

hours? What about the days or weeks after it? What information would public health need to give school nurses and administrators? Would they be able to do so using a tool such as the School Health Surveillance System?

Questions?

70



AgendaAgenda

71



Biosurveillance

School Health


Components

TCPH APC Products

72


Components


Section Learning ObjectivesDescribe core competency matrix for knowledge, skills and capabilities of Medical Reserve Corps (MRC) volunteers

Discuss training requirements

73

Discuss training requirementsDefine linkage to HSPD 21Demonstrate overview of training CD tool

Defining Community ResilienceSurvey to define community resilienceSeveral themes emerged

74

– Agile and rugged– Prepared for risks– Invested in its institution– Inclusive and integrated

Community Resilience Defined

“Community resilience is the ability of a community to rebound from a disaster with a new focus on recovery

75

yand mitigation and a renewed sense of trust in government and other community leadership.”

Preparing for All-HazardsHSPD 21 calls for:

– Education on threats, mitigating personal risks

– Practice in responding

76

p gto a variety of threats

– Social networks – Familiarity with public

health, medical systems

Why We Need Community ResilienceGovernment cannot do all that’s needed alone Protect the vulnerable or at-risk population

77

Need critical partners in the community Reduce damage, death

Steps to Building a Resilient Community5 techniques for public involvement:– Mass marketing efforts– Education campaigns

78

Education campaigns– Organize opportunities– Relationship building– Organized forum

MRC Tool Supports Critical ComponentsLinks to HSPD 21– Educate, practice, familiarize

Demonstrating every day valueSurvey results rated organizing volunteer

79

opportunities on preparedness teams (MRC) as best way to build resilience Use APC training tool, MRC Self-Paced CD, to train volunteers, build resilient community

MRC Tool Product BenefitsAddresses common needs for:– More resources to fill void in disaster response– Necessary training of volunteers – Assigning volunteers to fill specific duties

80

– Avoiding impractical one-on-one training– Providing standardized training

Who are the Target Candidates?Support for multiple audiences:

Volunteers: medical and non-medicalMRC coordinatorsCommon man

81

MRC Training Tool OverviewOriginal MRC Self-Paced CD (2005)– Curriculum required for all volunteers

Updating MRC Self-Paced CD (2009)– New core competencies matrix

82

p– Training represents baseline

knowledge despite role– Eases interoperability

between units

Recent Product UpdatesDivided into 3 domains and specific competencies, knowledge, skills, and assessments

Updated courses: psychological first aid, PODs training, HIPAA and liability, universal

ti d P bli H lth 101

83

precautions, and Public Health 101

Exercises: building disaster kit, fit for duty checklist, and creating a disaster plan

Links to courses for additional training

Support for Critical ComponentsStrengthens community resilience– Need for training and education regarding

threats and mitigation of risks– Understanding public health, medical systems

84

Understanding public health, medical systems– Exercises to practice responding in events– Government cannot do this alone

Implementation StrategyUse for general training– Lets coordinators train volunteers in one setting– Lets volunteers work at their own pace and setting

Use for certification

85

– Required exercises and required tests

Use for accreditation– Persons interested in creating their own MRC unit – Used as guidance for developing curriculum

DemonstrationCD layout

Types of disasters

HIPAA compliance

86

Psychological first aid

PODs training

87

88

89

90

91

Types of Disasters

92

Types of Disasters

93

HIPAA Compliance

94

HIPAA Compliance

95

Psychological First Aid

96

Point of Dispensing (POD)

97

Disaster Scenario Questions What can volunteers do to help the various first responders after the dirty bomb?

Could volunteers be trained using this tool?

H ld h h b b if

98

How would the response have been better if they had used this tool?

Questions?

99



AgendaAgenda

100


ConclusionWhy a critical preparedness triad, not a square?– Communities focus on stockpiling (the 4th critical

component), but sometimes neglect other 3 areas– Success in other 3 areas is equally or more important

Some closing comments on our disaster scenario

101

Some closing comments on our disaster scenarioCaveat: tools presented are not a ‘baked cake’ – One size does NOT fit all– May require effort to customize– May not address all your needs

Useful Websites and pages:– APC main page: www.naccho.org/topics/emergency/APC/index.cfm– CDC syndromic surveillance: www.cdc.gov/epo/dphsi/syndromic.htm– Johns Hopkins APL (ESSENCE developer): www.jhuapl.edu/– HIPAA decision tool: www.hhs.gov/ocr/hipaa/decisiontool/– HSPD 21: www.fas.org/irp/offdocs/nspd/hspd-21.htm– MRC: www.medicalreservecorps.gov/HomePage– RODS Lab (Univ. of Pittsburgh): https://www.rods.pitt.edu/site/

Helpful Resources

102

RODS Lab (Univ. of Pittsburgh): https://www.rods.pitt.edu/site/– Tarrant County: www.tarrantcounty.com/eHealth/site/default.asp– Texas APC (NACCHO): www.naccho.org/topics/demonstration/APC/TX.cfm– Texas APC*: www.texasapc.net

* Use the NACCHO link to request copies of Texas APC products. Use the contact us page at www.texasapc.net to reach session presenters, who

can also provide more complete product demos upon request.

103

Questions?For more information, visit: http://www.texasapc.net


AgendaAgenda

104


Thanks for attending!Thanks for attending!

Preparing Our P.O.D. Volunteers:An Interactive Workshop for TrainersAn Interactive Workshop for Trainers

Cambridge Advanced Practice Center for Emergency Preparedness

Schedule

1. Background2 Demonstrations2. Demonstrations

a. Part 1b. Part 2

3. Customization

Background Demonstrations Customization


Goal & Objectives

Knowledge• Knowledge– Job Action Sheets– Incident Command/Management Principles– Fundamental Tasks

• Skills– Serving clients with varying language, physical, and

cognitive abilities• Teamwork


Part 1 – The MechanicsPart 2 – Facilitating Clients


Lesson Framework


Part 1: The Mechanics


Volunteers?




Part 1: The Mechanics

Team Tasks• Pick a recorder• Pick a reporter• Answer questions

– As a team– Reach consensus


Part 1 – The Mechanics


Part 1 - The Mechanics

Successful Activity• Stressful• Struggle

Li it d l t• Limited lecture• Peer-to-peer teaching• Simultaneous learning and application• Repetition


Part 2: Facilitating Clients


Part 2 – Facilitating Clients

• 5,000 people exposed to QRB (50%, 30%)• Prophylaxis is Med-X, IM-injection• Contraindicated: Med-X, Pill (2x/day x3)• All presenting clients are at risk




Part 2 – Facilitating ClientsPOD Service Policies• Keep families together• Children do not translate• Ask, never assume,• Aid and Support will provide medication• Clients are customers• Ask colleagues for ideas and input• Do not overwhelm clients• Be reassuring. Alleviate stress

Part 2 – Facilitating ClientsTeam Tasks• Pick a recorder• Pick a reporter• Review CaseReview Case• Answer

questions– As a team– Reach

consensus



[Insert Case Study] 1. What service?

2. Next station? Why?

3. Barrier to service?

4. Strategy to overcome?



[Insert Case Study] 1. What service?

2. Next station? Why?

3. Barrier to service?

4. Strategy to overcome?


Successful Activity• Repetition: Barrier?; Solution?• Reflect on experiences

Fi d l ti• Find solutions• Sensitivity• Open and accepting atmosphere• Develop awareness


Training Guide

• Training preparation

• Trainer’s guides • Training materials• Evaluation tools


Customizing Part 1

Y Pl


Flow Chart

J.A.S.

I.C.S. Chart

Questions

Your Plan

Customizing Part 2

Y Pl


Your Plan

Tips

• Facilitator is not the expert, rather work with what the participants discover

• Encourage team work (Copy Limits)• Timingg• Maintain an All-Hazards perspective• Have answers:

– Liability– Occupational health and family safety– Notification


Questions or Comments?


Charles Ishikawa, M.S.P.H.Kerry Dunnell, M.S.W.

Cambridge Advanced Practice Center for Emergency PreparednessCambridge Public Health Department

119 Windsor StreetCambridge, MA 02139

Phone: 617-665-3759Email: [email protected]

Grassroots Preparedness to Support Vulnerable Populations during

EmergenciesFebruary 20, 2009

Dawn Carmen SiborBrookline, MA Department of Public Health

Brookline, MA:

Population 57,000- very diverse suburban/urban community6 8 square miles6.8 square milesBrookline is part of MA Region 4b and UASIMA has 352 cities and towns and each has their own Health DepartmentBrookline Health Department has 15 employees

Where is Brookline, MA?

Beginnings of Brookline, MA Vulnerable Populations and Emergencies Work:

Invited representatives from Brookline town departments and others who work with vulnerable populations to introductory meeting.Meeting held with representatives from Police Fire EMSMeeting held with representatives from Police, Fire, EMS, Council on Aging, Health, Housing Authority, Recreation, Human Relations, MA DPH and Cambridge Health Alliance to discuss vulnerable populations and emergency planning in Brookline (Fall 2005).Meeting attendees decided that next steps should be to develop forms that can be used for vulnerable populations (with social workers and others who work with special populations) to prepare for emergencies.

Plans for Vulnerable Populations

Form for Emergency Preparedness Supplies developed for vulnerable populations and information for caretakers social workersinformation for caretakers, social workers written.Information sent to meeting attendees to review and critique.Feedback mostly positive, but suggestion made that materials should be “tested” with vulnerable populations focus groups.

Focus Group Development

Groups contacted and Focus Groups identified: Seniors, Caretakers (Home Health Aides, etc..), Visually Impaired, Residential Facilities staff (mental health substance abuse homeless etc )(mental health, substance abuse, homeless,etc.), Seniors who are visually impaired and also many with hearing issues as well.Plans made with Cambridge Public Health Alliance and Institute for Community Health to work on project with Brookline.Attend Deaf and hard of hearing conference and gather information helpful for focus groups.

Focus groups comprised:

Focus Group #1: senior citizens active at the Brookline Senior Center Focus Group #2: home-care service workers employed through the Brookline Council on Aging Home and Escort g g gLinkage Program (H.E.L.P) Focus Group #3: administrators, program managers, and social workers employed at substance abuse and mental health group homes, homeless shelters or psychiatric hospitals in BrooklineFocus Group #4: visually impaired adultsFocus Group #5: visually impaired (hearing issues also) senior citizens participating in a support group through the Brookline Senior Center.

Focus Group Process

The Brookline Health Department worked with the Cambridge Public Health Alliance(CPHA) and the Institute for Community Health (ICH) to develop aInstitute for Community Health (ICH) to develop a guide for the focus groups. Focus Groups were held in spring and fall 2006.Focus Groups lasted for 1.5 to 2 hours with 8-12 participants.Focus Groups were facilitated and notes taken by CPHA and ICH.

Focus Group Outcomes/Lessons Learned

• Understanding government response.Citizens, to a certain degree, understand that they are responsible for being prepared in case y p g p pof an emergency. At the same time, citizens expect their local governments to provide a variety of services in the case of an emergency. It is important for local governments to understand their role in the event of an emergency and communicate this information to the public.


• Communication is essential. Citizens feel most at ease when they have all the necessary information that they need aboutnecessary information that they need about emergency planning and response. It is important to communicate to residents about on-going town emergency planning, the location of shelters, and which hospitals to go to (and not go to) in the event of an emergency.


Improve inter-agency coordination. There are several resources that are currently being used by different Brooklinebeing used by different Brookline governmental and non-governmental entities. Coordination of these resources needs to be improved upon in order to limit redundancies and increase reach and usage.


• Present information in multiple modalities. Individuals with special needs often times utilize different forms of media tooften times utilize different forms of media to get basic information and news. Information must be presented in multiple modalities in order to effectively communicate with these groups.


• Staff training is essential. For those individuals that require ongoing care and assistance from life service providers (e gassistance from life service providers (e.g., individuals living in group homes), it is important to train staff and volunteers about being prepared for an emergency. It is also important to train staff about the need for personal emergency preparedness in order to reduce staff loss at these facilities.

Next Steps

Meet with Brookline Emergency Management Team to review lessons learned and next steps (December 2006).Develop town wide committee of those who work with vulnerable

l ti t l f th f ll ipopulations to plan for the following.Re-format and re-design important emergency planning and communication resources.Coordinate development, outreach and usage of existing “vulnerable populations” resources.Develop emergency preparedness training for staff that serve vulnerable populations. Outreach from health department to local providers ( group homes, medical facilities, etc..) about the need for Continuity of Operations Plans (COOP).

Town-Wide Committee

Invitation sent to public and private human service/vulnerable populations providers to participate in committee to help design programs and materials.

M b f C itt i l d B kli H i A th itMembers of Committee include: Brookline Housing Authority, Brookline Police Department, Brookline Fire Department, Brookline Council on Aging, Brookline Commission for the Disabled, Brookline Veterans Services, Brookline Human Relations-Youth Resources Commission, Brookline Department of Public Health, Arbour HRI Hospital, Cambridge Public Health Alliance, Specialized Housing, Inc., Massachusetts Rehabilitation Commission, Brookline Community Mental Health Center, Brookline Public Schools

Committee begins monthly meetings (January 2007).

Workshop Planned– September 2007

Committee decides direction should be to plan an interactive emergency preparedness workshop for the staff/employees that serveworkshop for the staff/employees that serve vulnerable populations in Brookline. The focus of this workshop is to learn how to help clients (and staff) effectively prepare for emergencies using focus group outcomes as a guide. Developed an invitation list based upon contacts and information put together by Health Department.

Workshop Plans and Details

Introduction to Brookline Emergency Management Team and plans that have been put into place (Police, Fire and Health)Introduction to Brookline Volunteer Programs (MRC and CERT)Introduction to programs available to Vulnerable Populations, including Fil f Lif 9 1 1 Di bilit I di t F d P j t I d dFile of Life, 9-1-1 Disability Indicator Form and Project IndependenceEmergency Preparedness Begins at Home for attendees and clients/residents.Group activity to work on shelter in place and evacuation scenariosOutcomes of activity discussion, organizational needs and next steps80 people attended

Next Steps after 2007 Workshop

Evaluations and discussion outcomes used to inform next steps.Local Funding from Community Foundation sought and received to assist with programming.Committee continues to meet and work on plans for the next year.

Committee Plans for Continuing Work

Continue education of staff and develop Emergency Preparedness Program that can be used with staff and also given tobe used with staff and also given to residents/clients.Develop COOP program for organizations.Pilot programs for Committee and then contact Brookline organizations to present programs.

Results of Committee Work (2008)

Emergency Preparedness Program developed based upon Cambridge model.Pilot program approved by CommitteeP t d b H lth d P li D t th 25Programs presented by Health and Police Depts. more than 25 times April-September 2008 for service providers ( including nursing homes, assisted living facilities, elderly service provider, visually impaired, housing authority, visually and cognitively impaired educational facility and a developmental disabilities workshop and residences program) throughout Brookline.COOP integrated into program.Evaluations and follow-up evaluations completed and used to help plan for October 2008 workshop.

Workshop October 2008 Plans

Expand invitation list from 2007 to include daycare facilities, religious institutions, all private schools and colleges.Update attendees on emergency management activities and plans since 2007plans since 2007.Panel to present real life evacuation scenario of vulnerable populations building that occurred in Brookline in March 2008.Emergency Preparedness at Home presentation and COOP planning breakouts.100 people attended.Evaluations summarized and will use feedback for 2009 planning.

Where are we now?

More targeted programs need to be focused upon programs that serve children– day cares, pre-schools, etc.More outreach to those organizations who have not participated in any of the programs offeredin any of the programs offered.More work with organizations on development and practice of COOP.Continued follow-up with organizations regarding educating staff, clients, residents, families, etc.Do we have a third workshop in the fall of 2009?Long term plan for the committee needs to be developed, in conjunction with reviewing our goal and objectives.

Additional information that I can provide:

Copy of information folder given at staff/employee trainings.Copies of Moderator guide from focus groupsCopies of Moderator guide from focus groups.Copy of train the trainer information given to management staff at employee/staff trainings.COOP and other information given out at September 2007 and October 2008 agency workshops.Disk of resource materials.

For More Information, please contact:

Dawn Carmen SiborEmergency Preparedness CoordinatorBrookline Health DepartmentBrookline Health Department11 Pierce StreetBrookline, MA 02445617-730-2656 Telephone617-730-2296 [email protected]

Emergency Preparedness:

Targeting the Latino Community

By the end of the session the participant will be able to….

Discuss the collaboration between public health personnel and Latino health promoters in utilizing a culturally and linguistically appropriate emergencylinguistically appropriate emergency preparedness curriculum. Participate in a hands-on learning experience with activities of the curriculum. List how the curriculum can be utilized within their community.

This presentation will cover:

Overview of Latino Community in Montgomery County, MDFocus Groups ResultsD l t d T ti f C i lDevelopment and Testing of CurriculumEvaluation

What is the Advanced Practice Center?

An Advanced Practice Center is a local health department (LHD) that is developing cutting edgedeveloping cutting-edge tools and resources to help other LHD’s nationwide prepare for, respond to, and recover from major emergencies.

What is the mission and vision of the Advanced Practice Center?

To advance public health and improve local capacity to prepare and respond effectively to public health emergencies.Innovative Leaders for Public Health Preparedness

Montgomery County, MD APCThe Montgomery County Department of Health and Human Services serves a diverse semi-suburban population adjacent to the nation’s capital and is in close proximity to the NIH and other national health resources.Our focus includes public health emergency awareness and education, systems to dispense medicines and supplies, and vulnerable populations such as young children and senior residents.

Montgomery County, MD

Montgomery County Advanced Practice Center for Public Health Emergency Preparedness and Response

Overview of the Latino Community in MC

There are 316,257 Latinos living in Maryland (5.7% of total MD population)

About 40% (125,354) of the Latino population in ( , ) p pMD lives in Montgomery County.

Latinos constitute 13.7% of the county’s total population

Mostly from Central & South America (67%)

* 2005 American Community Survey Data

Overview of the Latino Community in MC

Fastest growing population in Montgomery County with a 5% annual growth rate between 2000 and 2005between 2000 and 2005

3.97.4

11.5

13.7

0

5

10

15

Perc

enta

ge

1980 1990 2000 2005

Percentage of Latinos in Montgomery County

Latino Population in 1980Latino Population in 1990Latino Population in 2000

Latino Population in 2005 (est.)

2005 American Community Survey Data

Characteristics of County Latinos

Young populationClose family/social networksLowest median incomeUnder educatedLimited English ProficiencyLack information about existing resources and services

Latino Health Initiative (LHI)

Established in 2000 under the Department of Health and Human Services by the County Executive and Council to developCounty Executive and Council to develop, implement, and evaluate a plan of action responsive to the health needs of Latinos in Montgomery County.

Background

Scarce information on emergency preparedness (EP) knowledge and attitudes in LatinosRacial/ethnic minorities more vulnerable to disastersNeed to develop culturally and linguistically competent (EP) interventions

Multi-Cultural Activity

Divide into groupsRead instructions givenFollow instructions and draw picture with

id dcrayons providedBe ready to share your artwork!

Emergency Preparedness Background

Collaborative Effort:Latino Health Initiative of Montgomery CountyCountyAdvance Practice Center of Montgomery CountyUniversity of Maryland

Objectives of the LHI Project

Compile information/assess Latino’s knowledge, perceptions of risk, and preferred and actual sources of information on EP.Develop and test an EP intervention among p glow-income LatinosDevelop culturally appropriate EP materials to be replicated and used in other jurisdictions

Focus Groups: Methods

Discussion guide developed in Spanish based on literature reviewParticipants included community members (5 groups) and health promoters (1 group) over

18age 18Participants recruited via LHI staff, entities serving Latinos, and health promotersSessions conducted by experienced bilingual Latino facilitators

Focus Groups: Results

51 individuals participated in 6 FGs: 30 women and 15 men (community FG) and 6 women (health promoter FG)67% of participants were from Central67% of participants were from Central and South America65% had been in the US less than 6 years and 27% had been in the US more than 6 years


Participants had difficulty defining “emergency”Wide range of perceived personal emergency risksFew participants reported receiving information on EPConcern with government’s readinessMost participants did not have an EP planImmigration identified as a current emergency


Reported most trusted sources of information:– Fire fighters and police – Red CrossRed Cross– Someone who is well trained with charisma– Doctors– Community leaders– TV & Radio– Spanish language newspapers


Reported preferences for receiving information:

– Courses or seminars– TV or radio programs– Pamphlets, flyers, or manuals– Participating in simulations or practice


Reported messages to communicate to the Latinocommunity:

Be calm (calma)Be alert (esten atentos)Be alert (esten atentos)Be united (esten unidos)Act (actuar)Keep important telephone numbers handy and preparePrepare for an emergency

Implications

Latinos are a key population to target regarding EPThe matter of relative risk in comparison with other priority issues faced by the community should be taken into considerationConsistent and unified messages should be delivered through credible sourcesCurrent immigration climate needs to be acknowledge when reaching the Latino community

EP Efforts in the Latino Community EP Efforts in the Latino Community of MCof MC

Developed an implementation plan using Developed an implementation plan using health promoters (HP)health promoters (HP)Developed a (HP) SpanishDeveloped a (HP) Spanish-- language training language training curriculumcurriculumcu cu ucu cu uPilot Tested an intervention in two Latino Pilot Tested an intervention in two Latino communities communities

Health Promoter Curriculum

Basic information on public health emergencies and actions to take to prepare for an emergencyOutreach, community engagement , y g gtechniques, and use of educational materials Outlines specific knowledge and skills learning objectives, training content and methodsIncludes simple record keeping tool

Emergency Preparedness Education for the Latino Community Conducted by Health

Promoters:

Pilot Project

Vias de la Salud: The Promotoras

Volunteer lay health educators

Grassroots community members

Trained

The Pilot Intervention

October 2007 – January 2008October: Six Vias promoters trainedDraft Spanish-language curriculum

The Intervention: Community Educational Sessions

Two sites: school & community centerThree educational sessions each siteAbout 20 participants each siteCulturally competent practices to reduceCulturally competent practices to reduce barriers

The Intervention: Content

What is an emergency: public vs personal/family

Th t tThree steps to emergency preparedness– Initiate a conversation– Make a plan– Prepare emergency

supply kit: 9 items

Step One: Have a Conversation

Why prepareContactsWhere to meetWhere to meetWhere to shelterWhat to do

Step Two: Make a Plan

Personal informationLocal contactOut-of-state contactNearest relativeNearest relativePetsMeeting places

Step Three: Prepare a Kit

9 essential items– Water– Food– Clothing– Medications– Flashlight & batteries– Manual can opener– Radio– Personal hygiene– First aid

Have a Conversation

Make a Plan

Prepare a Kit

9 Essential Items

Evaluation

Effects on Participant Attitudes & Practices: Pre-post Design– 7 questions: attitudes & practices– Pre-test: 1st session– Post-test: after 2nd session– Post-test 2: after 3rd session

Effects on Promoters’ Knowledge, Attitudes & Practices: Pre-postQualitative Data

Results: Participant Feelings about Family Preparedness

49

3843 46

69

4050607080

cent Pre n = 39

Post n = 37

8 11

24

30

10203040

FeelPrepared

More or LessPrepared

Do Not FeelPrepared

Perc

Post 2 n = 29

Results: Participant Preparedness Practices

81

65 6270 70

100 100 97 93 90

60

80

100

120

ent Y

es

3323

1021

28

0

20

40

60

HaveTalked

Have Plan Have Water Have Food Have Other

Practice

Perc

e

Pre n = 39

Post n =37Post 2 n =29

Results: Other Reported Items in Supply Kit

Item Pre Post Post 2Clothing 0 7 12Medications 0 7 17Medications 0 7 17Flashlight 1 6 10Can opener 1 4 4Radio 0 5 6Hygiene items 0 4 4First aid 0 1 5Other 4 8 15

Results: Participant Knowledge of School Emergency Plans

Participants' Knowledge of Children's School Emergency Plans

798090

41

2838

51

10714

31

010203040506070

Yes No NA/NoChildren

Perc

ent Pre n = 39

Post n = 37Post 2 n = 29

Results: Participant Opinions of Sessions

“Excellent.” “Perfect.” “Very good.” “Very interesting. Very important.” “Very well explained and very easy to understand.” “They motivate us to prepare for an emergency.”g y“Everything was very clear. Moreover, we put it into practice.” “Thank you for the information in Spanish.”“Continue with these sessions because I think there are a lot of people like us who didn’t know how to react in the event of an emergency.”

Factors Contributing to Success

Carefully designed culturally & linguistically competent interventionLimited number of key messagesCollaboration with trusted agenciesCollaboration with trusted agenciesIncentives?Skills, talents, enthusiasm, experience of promotersCommunity trust in promoters

Conclusion

Training curriculum & accompanying materials facilitate replication in other sites.

Careful attention to building relationships with community & nurturing promoters

Purpose and Objectives of the Curriculum

Pre-Test

Educational Methodologies

IcebreakersRole play/practiceBrainstormingGamesSmall Group ActivitiesDiscussionPreparation for the Training

Complementary Materials

Plan to Be Safe MaterialsSimple Answers to Basic Questions

Activity 9: Preparing for Emergencies

RULES:RULES:Form two teamsForm two teams30 seconds to state how the object is related to 30 seconds to state how the object is related to emergency preparednessemergency preparednessemergency preparednessemergency preparednessMust state if this an essential item or notMust state if this an essential item or notIncorrect answers allow the other team to Incorrect answers allow the other team to answeranswerPoints are awarded to the team that can Points are awarded to the team that can correctly answer the two questionscorrectly answer the two questions

Montgomery County Public

Schools

EmergencyEmergency Preparedness

Plans

Group DiscussionGroup Discussion

Please discuss with others on how you can Please discuss with others on how you can use the use the Emergency Preparedness in the Emergency Preparedness in the Latino Community: Training Manual for Latino Community: Training Manual for PromotersPromoters in your communityin your communityPromotersPromoters in your community.in your community.

Contact Information

Kay [email protected] BurroughsBetsy BurroughsBetsy.Burroughs@montgomerycountymd.gov240-777-3033Advanced Practice Centerwww.montgomerycountymd.gov/apc

Talk to Me! Communicating with Community Partners during a Public Health Emergency

December 3, 2008

Welcome

Dr. Marty Fenstersheib, Health Officer Santa Clara County Public Health Department

Joy Alexiou, Public Information Officer Santa Clara Valley Health & Hospital System

2© 2008 Santa Clara Valley Health & Hospital System

y p y

Marta Lugo, Public Communications Specialist Santa Clara County Public Health Department

Sponsored by: Santa Clara County Public Health Department, Social Services Agency, Office of Human Relations and CADRE

Objectives

Increase Understanding1. Public Health’s role as an emergency responder during a

medical/health event.

2. What’s different about communicating during a medical/health emergency.


g y

3. Introduction to Incident Command, it’s relationships, operations and functions.

4. How a Joint Information Center functions and it’s key roles.

5. How governmental and community organizations can work together to reach and serve special and vulnerable populations.

Agenda

Part I Public Health’s role in emergency preparedness

Part II What’s different about communicating in an emergency?

Group Activity and Lunch


Part III Introduction to Incident Command relationships and the Joint Information Center

Quiz Activity

Part IV Working together during a medical/health emergency

Group Discussion and Wrap Up

PART I


Public Health’s Role

Dr. Marty Fenstersheib MD, MPH - Health Officer, SCCPHD• Mission of Public Health

• Background Public Health Emergency Preparedness


• Background Public Health Emergency Preparedness

• Public Health as a First Responder

• Why communications is key?

Mission of Public Health

Goals of the Public Health Department

• Protect the health of the community• Authority in Health & Safety Code

• Prevent spread of disease


Prevent spread of disease

• Promote health• Provide health status; trend data

Background

Public Health & Emergency PreparednessFrom 911 and anthrax attacks, PH recognized as a first responders by Presidential Directive

Began with Biological Terrorism


Need for all-hazard emergency plans for different scenarios that are medical/health emergencies either natural or man-made

May require mass prophylaxis, mass vaccination, isolation and quarantine, mass fatality management, etc.

As a First Responder

Public Health’s Role• Lead agency for medical/ health response

Current SituationWh t t di l/ h lth th t ?


• What are current medical/ health threats?

• Pandemic Flu Status - why the concern?

Communications is Key

Why it’s so Important?Provide health information so that people will make an informed choice and take actions needed to protect their own health.

C 't d it l d it t i hi ll


Can't do it alone - need community partners in reaching all parts of our community to help save lives.

Especially reaching special & vulnerable populations:Young Women & Children, Elderly, Homeless, Mentally & Physically Disabled, Blind and Hard of Hearing, Immigrant Populations, etc.

Public Health at Work

Mass Vaccination DrillVideo Clip


PART IIWh t’ diff t b t i ti i


What’s different about communicating in an emergency event?

Role of Public Information in Medical/ Health Emergency

To provide sound and thoughtful information to preserve and protect the public’s health in a crisis or emergency risk situation

To provide necessary information to limit ineffective, fear-driven and


limit ineffective, fear driven and potentially damaging response to a serious event.

To establish and maintain confidence in the response by providing timely, accurate and consistent information.

Public Information Operations

No one is above a human reaction

No longer business as usual

Working in a Joint Information Center

Centralized Satellite Virtual


Centralized, Satellite, Virtual

Postponement of normal reporting/job responsibilities

May never be quick enough

At first, the information is often inaccurate

Never have enough, whether it be resources, information

News Media

No one is above a human reaction

Journalists are part of the community

Their perspective: what does the public need to know?

Some will be the first to arrive at the scene


Some will be the first to arrive at the scene

Most want to treat victims with dignity and respect

Accuracy does matter, they’ll need details

To do their job they need access - to officials, people in the field, victims and their families

Public Perception of Risks

Risk Communication – Our Role in Response

Communicate Risks and Benefits


Experts Perception versus Public Perception

Risk = Hazard + Outrage


Outrage FactorsKey Factors

• Voluntary

Control


Control

Fairness

Trust

Responsiveness


Outrage FactorsKey Factors

Mortality

Familiarity


Familiarity

Memorable

Dread

Diffusion in Time and Space

Risk Communication

During an Emergency Event…

Start where your audience starts


Start where your audience starts

Don’t be afraid to frighten people

Risk Communication

and…

Acknowledge uncertainty


Acknowledge uncertainty

Share dilemmas

Risk Communication

and…Give people things to do

Be willing to speculate - responsibly


g p p y

Don’t get caught in the numbers game

Stress magnitude more than probability

Guide the adjustment reaction

Risk Communication

and finally…

Inform the public early and aim for total


Inform the public early and aim for total candor and transparency

Other Risk Communication Basics

People process information differently, need a variety of ways of presenting the information

Empathy first – a person is more likely to hear what you have to say after a statement of


y yempathy

Different or contradictory information causes confusion and distrust – this can slow or stop a person from taking action

Our mission – protect the health of this community

GROUP EXERCISE


GROUP EXERCISE

PART III


Understanding Incident Command Relationships

Incident Command

Miguel Grey, SCC Office of Emergency Services (OES)

• Santa Clara County Emergency Operations Services (OES)

• Incident Command Systems Overview


• Local Operations and Relationships with other EOCs

• Importance of working with community partners

Incident Command Structure


Incident Command

All Command Staff report to the Incident Commander:

Public Information Officer (PIO).Responsible for distribution of information to the public, government officials and collaborating agencies. Safety Officer Responsible for scene


Safety Officer. Responsible for scene safety, availability and appropriate use of personal protective equipment, basic human needs.Liaison Officer. Responsible for coordinating activities with other agencies and groups involved in the response

Incident Command

General Staff has responsibility for primary segments of incident management.

Operations Section Chief is responsible for managing all tactical operations at an incident.

Planning Section Chief is responsible for providing planning


services for the incident.

Logistics Section Chief provides all incident support needs with the exception of support to air operations. The Logistics Section is responsible for providing: facilities, transportation, communications, supplies, equipment maintenance and fueling, food services etc.

Finance/Administration Section Chief is responsible for managing all financial aspects of an incident.

Local Operations and Relationships with other EOCs

The Santa Clara County EOC must be activated when:

A local EOC is activated and requests County activation

There is more than one (1) local emergency proclamation


Importance of working with community partners

Consistency of information

Distribution of information to key audiences & partners

Best use of available/limited resources

Public Health Emergency Operations

In the Case of a Pan Flu Emergency

Activate Medical Health Operations Center

Responsible for Medical/Health Operations


Risk Communications for Pandemic flu Accomplished through the use of a Joint Information Center- established by County EOC

Medical/ Health Functions in ICS

Comparisons of structure, functions, and relationships of jurisdictions and


jurisdictions and health-related EOCs, that may be involved in the response to a medical/health emergency event.

Joint Information Center (JIC)

A JIC gathers, coordinates, and disseminates information across jurisdictions and agencies effectively and efficiently.

The JIC serves as a “central hub” for information to be coordinated and


shared across jurisdictions and agencies and among all government partners, the private sector, and nongovernmental agencies.

A well-organized Joint Information Center increases our capacity to direct the public’s response & protect their health.

Joint Information Center (JIC)

A Joint Information Center (JIC) can be activated by Incident Command or the EOC.

County of Santa Clara PIOs have agreed:


If the event involves more than one agency, activation of the JIC should be requested

PIO of the lead agency responding to the event can also request the JIC be activated (if its going to be BIG!)


JIC Sections

JIC Command has overall oversight of JIC operations and is responsible for activating under direction of Incident Command/ EOC. Key positions include: Lead PIO, JIC Manager and Admin/Support. The Lead PIO activates functions as needed to manage and conduct risk commutations activities.

Media Relations is responsible for getting information from and to the


Media Relations is responsible for getting information from and to the news media. Key positions include: Media Relations Lead, News Desk, Media Logistics, Media Monitoring and Deputy/ Field PIO.

Research and Writing is responsible for overseeing the gathering of information, verifying and updating of information, and for the final content development of materials. Key positions include: Research & Writing Lead, Content Development, Rapid Response, and Translations.

Special Projects Section

Role & ResponsibilitiesResponsible for handling and distributing information to all non-media partners.

Key positions include: Special


Projects Lead, Key Partners, Employee Communications, Web Page, and Call Center.

Special Projects Section

Key Partners RoleWorks with other JIC units such as

Research and Writing to develop content and get translations. Provides this information to Key Partner groups and organizations.

Key Partner groups include community


ey a e g oups c ude co u yand faith-based, education, government, non-profits, and business organizations.

Key Partners staff will use various communications tools, including E-mail list and servers, phones and faxes, websites and any other communication vehicles.

Jeopardy

Jeopardy Quiz


PART IV


Working Together During an Emergency Event

Community Partners

Barbara Larson, CEO American Red Cross Santa Clara Valley Chapter

Role and priorities for the Red CrossDisaster Preparedness (Disaster Training, CPR/ First Aid)

Disaster Response (primary provider of mass care/ shelter)

Volunteer Led


Volunteer Led Emergency preparedness efforts and activities

Community Disaster Education (businesses, employees, ngos)

Partnerships (faith based, government agencies, nonprofits, corporations

Participation in local trainings, drills and exercisesLocal, regional, state-wide – ARC and non-ARC

Community Partners

Red Cross Activities During a Local Emergency

Teams of volunteers on call 24 hours/7 days a week

Approximately 100 local disasters per year (increasing)

Local Red Cross volunteers sent to National Disasters


Shelter/Mass Care (primary), client services, and mental health counseling

Coordinate Red Cross communications with governmental agencies regarding where shelters are open

Community Partners

Importance of Working Together in an Emergency

Community preparedness is critical

Partnerships are key - we can’t do it alone

Neighbors helping neighbors


Faith Based/Business/Non-profit continuity of operations planning is essential

Red Cross is here for the community

The JIC, Public Health & Community Partners

JIC

Provides and distributes overall event information, including information supplied by Public Health

Communicates with news media, elected officials and Key Partners

Public Health


Public Health

Works in the JIC to produce medical/health information, including instructions for medically vulnerable populations

Communicates with the medical/ health community

Community Partners

Gets information from the JIC, shares what they know, learn, hear

Distributes information to your audiences

TALK to ME!

Day-to-Day Communications

Who do you serve?

Who are your primary external audiences?


Who are your primary external audiences?

How do you communicate with them now?

TALK to ME!

Emergency Communications

What might be different in communicating during an emergency?

Does your organization have an emergency


communication plan? Where will you be working? Will you have additional resources?

How will you reach your key audiences during an event?

What will you need for communications during an event?

TALK to ME!

Communications Resources

How can we reach you?

How can you reach us?

Would other trainings or workshops help? What kind?


Would other trainings or workshops help? What kind?

What else?

Contacts

Dr. Marty Fenstersheib, Santa Clara County Public Health Department

408.792.3798 [email protected]

J Al i S t Cl V ll H lth &

Miguel Grey, Santa Clara County OES


B b L A i R d C


Joy Alexiou, Santa Clara Valley Health & Hospital System


Marta Lugo, Santa Clara County Public Health Department


Barbara Larson, American Red Cross Santa Clara Valley Chapter



Dedicated to the Health of the Whole Community

Communications Basics

1

Crisis and Emergency Risk Communications Crisis Communications This term is used most often to describe an organization that is facing a crisis and needs to communicate information about that crisis, as well as respond to the crisis.

The crisis is typically unexpected, may not be in the organization’s control, and may cause harm to the organization’s good reputation or viability, employees or patients, or significantly disrupt the organization’s ability to provide healthcare services. Also, the organization is likely to face some legal or moral responsibility for the crisis (or at least it’s response to the crisis), i.e., the organization will be judged on its response to the crisis. Examples of the types of crisis a Public Health Department must be ready to handle include:

• Workplace incidents: employee/ personnel issues; workplace violence, etc. • Issue regarding senior management/staff: arrests; sexual harassment, etc. • Political and/or legal actions: lawsuits, public protests, negative news story.

Emergency Risk Communications Different from crisis communication in that organization is not perceived as a participant in the disaster, except as having a role to resolve the situation. This type of communications provides the risks and benefits (provides information) to allow the audience to make the best possible decisions about their well-being. The emergency happens with nearly impossible time constraints and people will have to decide within the parameters of imperfect choices during the event. Decisions are typically made with narrow time constraints, decisions may need to be made with imperfect or incomplete information and decisions may be irreversible. Emergency risk communication provides expert opinions in the hope that it benefits the audience and advances a behavior or action that allows for rapid and efficient recovery from the event. Examples of the types of emergencies that Public Health would have to respond to:

• Natural or man-made disasters: disease outbreaks, floods, fires, earthquakes bomb or terrorist attacks.

• Environmental/Safety related incidents: chemical spills, mass casualties & fatalities incidents, fires, explosions, and other accidents


2

Communicating during an emergency is different. There are a number of communication failures that can dampen success. Things to avoid include mixed messages from multiple experts, information being released late, paternalistic attitude, not countering rumors and myths in real time, and displays of public power struggles that can cause confusion. The key to successful communications is to be first, be right, and be credible. In a serious crisis, all affected people

• Take in information differently • Process Information Differently • Act on Information Differently

Decision making in a crisis is different

• People Simplify • Cling to current beliefs • Remember what we see or previously experience • People limit intake of new information (3-7 bits)

Four basic elements to establishing trust and credibility:

• Expressing empathy and caring • Showing competence and expertise • Remaining honest and open • Being committed

What do people feel when disaster looms?

• Denial • Fear, anxiety, confusion, dread • Hopelessness or helplessness • Seldom panic • Vicarious rehearsal

What does the public need?

• To feel empowered- Reduce fear and victimization • Mental preparation reduces anxiety • Taking action reduces anxiety • Uncertainty must be addressed


3

Communicating with the Media The media’s role is a crucial in helping get your message out quickly during a serious crisis. By being responsive to the media, you can provide timely and accurate information to help guide the public’s response and potentially minimize further injury or save lives. Timeliness is of the Essence. In emergency, crisis or risk situations, gather accurate information (What happened? When? Where? Who is involved/affected?), and get that information out to the media as quickly as possible. However, do not feel so pressured to get the information out so fast that you jeopardize accuracy. It is always best to update the media – rather than correct or retract statements -- as information becomes available. Know Your Message. Determine what you can and cannot say and obtain appropriate approvals. All public statements should contain a message in emergency, crisis and risk situations, and clearly communicate that message. Additionally, when addressing media questions, it is always advisable to come back to your message. When answering reporter’s questions, “A.T.M.”: Answer the question directly – It is OK to even repeat the question as part of your answer.

Transition – Use some “bridge” or transitional language to get back to your message. Phrases such as “Let me go back to what a said a few moments ago,” “What I want to say is,” or “It is important for you to know that” are good transitions to your message. Message – Repeat your message. It’s OK to repeat it up to three times in your communication with the media. Return to your message before you’ve fully answered the question – no matter what question you’re asked. Keep it Short & Simple or “K.I.S.S.” Be brief, specific and credible. For on camera and radio interviews, think ahead of “soundbites” that communicate accurate information, as well as your message – such “soundbites” should be no more than 30 seconds. Avoid Using Acronyms, Jargon and/or Overly Technical Language. In dealing with emergency, crisis or risk situations, it is often easy to slip into “technical speak,” and use terms, word or acronyms that the media, and more importantly, the public do not know or understand. If it is necessary to use such terms (it’s often simpler), always define the term when first used in any communication. Everything is “On the Record.” Especially in a crisis. “On the record” is media relations jargon – it means that what you say can be quoted in print, aired on TV or broadcast on the radio. Be extremely thoughtful about what you say and when you say it. Do not assume that anything is off the record, even if you say so.


4

Tell the Truth. Do Not Guess or Speculate. Never Lie. If you do not know the answer to a question, it is OK to tell reporters that you don’t know. You can let them know that you’ll back to them with information. The Media Has A Job to Do. While the media sometimes perceived as being too inquisitive, aggressive or even sensational, it is important to remember they, just like you, have a job to do. Their job is to provide information to the public in a timely and accurate manner. Providing reporters with accurate and timely information helps them do their job, and it also helps you meet your goal too. Ultimately, as communicators and public information officers, we have the same interest as the media. However, do not assume reporters are your friends. And, do not get angry or argumentative with them if they are misinformed or rude. Keep your cool. If you do not understand a reporter’s question, ask him or her to repeat it or ask it another way. Anticipate Questions, Think About Your Answers. Remember to “A.T.M.” Never Say “No Comment.” If you are not able to answer a question, say, “I am not going to answer that question,” “I am not authorized to answer the question,” or better yet, “Let me get back to you on that question.”


5

Delivering Your Message How You Look and Sound is Often As Important as What You Say. As public information officers in an emergency, crisis or risk situation, it is very important to be calm, credible and assertive. Most often in these situations, the media is looking to you as an authority or expert. Remember to check your appearance, maintain steady eye contact and use an even tone of voice. Communicating empathy and compassion in both words and body language is critical in emergencies and crises. Location During an emergency, interviews may take place outside an emergency site/scene or in a conference/briefing room, or maybe even in a television studio.

• Inside venues: Set up the environment with things like identifying or “official” signs, banners and flags. Remove any inappropriate or distracting background items

• Outside venues: Be aware of back drops, wind and reflections from windows or other distractions.

Physical Appearance Think about what’s appropriate for the setting when selecting your clothing – professional, perhaps conservative is best, but not always -- make it simple and understated.

• For men, suits and ties may look inappropriate or even “out of touch” at the scene/site of an emergency

• Ditto for women -- business suits, fancy dresses and high heels may be out of place. • Wear any identifying or “official” clothing/badges relevant/appropriate to your job.

• Look professional unless it’s an interview related to a site or program outcome • Gaudy sport coats/ trendy dresses will probably distract from the content of your answers • Shiny and/or complex clothing patterns will show badly and detract from your message

• For television, avoid shiny jewelry and bold, dangling earrings. Avoid white shirts/blouses- light blue is best. This is still true even with recent refinements in camera technology.

Body Language When standing:

• Stand straight and steady – Be comfortable and “natural,” but avoid slouching, shrugging and shifting

• Look at the reporter. With TV crews, avoid looking into the camera and/or monitor. • Avoid tilting your head away from the reporter - it suggests discomfort, uncertainty or deception • Let your arms hang comfortably at your side, or fold them in front of or behind you. Gesturing

mildly with your hands is appropriate, but keep your gestures “tight” to your body. Think of your body as a “box” – gestures should stay “inside the box” of your upper torso… below your head/chest and above your waist, no wider or broader than your torso itself.


6

When sitting: • Sit with your back straight • Lean slightly forward - it presents a positive, comfortable look; leaning back in your chair can

make you appear cocky or too carefree • Keep knees close together or crossed neatly • Keep hands in on the table/desk or in your lap, except when you gesture, then put them back • For men in suits/sports coats, tuck and sit the bottom of your jacket – this will keep the coat from

bunching or creeping up around your neck.

Additional Training Resources

1

The following list provides additional resources on crisis and risk communications, incident command management, and joint information centers. ICS Courses FEMA Online Trainings • ICS for Single Resources and Initial Action Incidents (ICS-200) http://training.fema.gov/EMIWeb/IS/is200.asp • Intermediate Incident Command System (ICS-300) http://www.fema.gov/about/contact/statedr.shtm • Advanced Incident Command System (ICS-400) http://www.fema.gov/about/contact/statedr.shtm • National Incident Management System (NIMS), An Introduction (IS-700) http://training.fema.gov/EMIWeb/IS/is700.asp • National Incident Management Systems (NIMS), Public Information Systems (IS- 702) http://training.fema.gov/EMIWeb/IS/is702.asp • National Response Plan (NRP), An Introduction (IS-800) http://training.fema.gov/EMIWeb/IS/is800a.asp PIO Courses • Basic Public Information Officers Course (G-290) http://training.fema.gov/EMIWeb/EMICourses/E388.asp and http://www.fema.gov/about/contact/statedr.shtm • Advanced Public Information Officer (E-388) http://training.fema.gov/EMIWeb/EMICourses/E388.asp Crisis and Emergency Risk Communications ASTHO: Risk Communication http://www.astho.org/?template=risk_communication.html The Association of State and Territorial Health Officials offers free risk and crisis communication tools online, including a workbook, risk communication assessment tool, and an event assessment checklist.

Additional Training Resources

2

Center for Risk Communication http://www.centerforriskcommunication.com/home.htm The Center for Risk Communication offers services in risk communication research, strategy development, and training. Their web site also houses readings by members of their staff, including Vincent Covello, a leading risk communication expert. Emergency Risk Communication CDCynergy http://www.orau.gov/cdcynergy/erc/CERC%20Course%20Materials/CERC_Book.pdf The Centers for Disease Control and Prevention (CDC) developed this comprehensive ERC planning tool on CD-ROM that includes specific planning guides and a wealth of reference resources. Contact the CDC’s Office of Communication to obtain a copy of the CD-ROM. Peter Sandman Crisis Communication Web Site http://www.psandman.com/terror.htm A leading expert in crisis communication offers many useful articles, handouts, and a Q&A board. National Cancer Institute’s Risk Communication Bibliography http://dccps.nci.nih.gov/DECC/riskcommbib/ The Risk Communication Bibliography contains over 650 references to published documents that address the communication of public health hazards. Included documents address the risks, prevention, and treatments of health hazards. Many documents contain information about illnesses, environmental conditions, and accidents National Incident Management System (NIMS). Basic Guidance for Public Information Officers (PIOs) http://www.fema.gov/library/viewRecord.do?id=3095 FEMA offers basic guidance for Public Information Officers in a guidebook that includes an overview of basic Crisis and Risk Emergency principals, including how to work within the incident management and command structure frameworks. It also includes information on how to integrate Joint Information Systems (JIS) and organize Joint Information Centers (JICs). World Health Organization Field Guide. Effective Media Communication during a Public Heath Emergency http://www.who.int/csr/resources/publications/WHO%20MEDIA%20FIELD%20GUIDE.pdf The World Health Organization (WHO) offers a comprehensive guide that covers principals of how to respond and communicate with the media during a public health emergency. Yale Center of Public Health Preparedness: Fundamentals of Crisis and Emergency Risk Communication Web Site. http://publichealth.yale.edu/ycphp/cerc.html

Talk to Me! Emergency Contact Form

Name Job Title Organization Address Work/Direct Phone Line ( ) Cell ( ) __ Work/Office Main Phone Line ( ) Pager ( ) Fax ( ) Home Phone ( ) Email Website Would you like to receive electronic updates from the Public Health Department about emergency preparedness efforts and issues? Yes □ No□ Would you like to receive electronic newsletters from the Public Health Department? Yes □ No□

Martin Fenstersheib, MD, MPH Health Officer 976 Lenzen Avenue, Second Floor | San Jose, CA 95126 408.792.3798 | 408.792.3799 fax

September 5, 2008 Mr. Tim Quigley, Director CADRE-Volunteer Center of Silicon Valley 1933 The Alameda, Suite 100 San Jose, CA 95126 Dear Mr. Quigley, For the past several years, the Santa Clara County Public Health Department has undertaken a comprehensive effort to prepare and train medical/health professionals and staff to effectively respond to emergencies. As you know, a key component in preparing for any large-scale medical/health emergency includes working with our community partners to prepare, respond and recover from an emergency event.

The Santa Clara County Public Health Department is conducting a series of local community partner trainings focusing on risk communications activities during medical/health emergencies. We would like to formally invite CADRE to be one of our key partners in helping us reach out to other community organizations to invite to these trainings. We have also invited the Human Relations Commission and the Social Services Agency to help in this outreach effort as well.

The Santa Clara County Public Health Department is able to conduct these trainings because of a CDC grant. This grant is one part of our Advanced Practice Center (APC) work in emergency preparedness. By conducting these trainings for local community organizations, our goal is to increase understanding of the importance of emergency and risk communication activities and the role of communications during an event.

We plan to hold a fall and spring training for managers and other staff in community-based organizations. The community partner trainings will cover key principals and components of risk communications during a public health emergency event:

• How communication is different during an emergency event; • How communications fits into the overall emergency response efforts (Incident Command System

(ICS)/Joint Information Center (JIC) structures), including how community organizations can work with the JIC in communicating important information, and;

• What community partners can expect from lead agencies responding to the event and what may be asked of community organizations during a medical/health emergency.

We are excited at the possibility of having CADRE as one of our partners in this effort. The tentative dates that we have in mind are either Wednesday, December 3rd or Thursday, December 4th between 10 am and 3:30 pm. Please let us know if your agency will be able to participate by assisting us in the promotion of this event. Our public communications staff will follow up with your staff to work on details such as confirming a final date and venue. If you have any questions in the meantime, please feel free to contact us at 408-885-7515.

Sincerely,

Marty Fenstersheib, MD, MPH Health Officer

Public Health Department 976 Lenzen Avenue, Second Floor | San Jose, CA 95126 408.792.3798 | 408.792.3799 fax

October 14, 2008 Dear Community Partner: Recent disasters such as the California Wildfires and Hurricane Katrina have demonstrated the importance and value of pre-event emergency planning and preparedness for both government agencies and community organizations alike. While Santa Clara County has not experienced a significant natural disaster in many years, it is critically important to plan and prepare for when a disaster strikes. While Federal, State and local government agencies continue to work together to plan and prepare for emergencies, an important aspect in preparing for any large-scale emergency also includes working with our local community partners to prepare, respond and recover from an emergency event. The Santa Clara County Public Health Department has been awarded grant money to begin a series of local community partner trainings to increase understanding of how emergency risk communication works and fits into overall emergency response efforts. The trainings are aimed at managers within community organizations that would be responsible for public communications during an emergency. The Santa Clara County Public Health Department has partnered with the Office of Human Relations, CADRE, and the Santa Clara County Social Services Agency to host fall and spring trainings around risk communications during a medical/health emergency: Talk to Me, Please! Communicating with Community Partners during a Public Health Emergency Event. The community partner trainings will cover key principals and components of risk communications during a public health emergency event:

• How communication differs during an emergency event; • How communications fits into the overall emergency response efforts (Incident Command System (ICS)/Joint

Information Center (JIC) structures), including how community organizations can work with the JIC for communication purposes; and

• What community partners can expect from Public Health (PH role in communications) and what may be asked of community organizations (the role we'd like them to play) during a medical/health emergency event.

We will have special guest speakers Marty Fenstersheib, MD, MPH, Santa Clara County Health Officer, Miguel Grey, Sr. Emergency Planning Coordinator, Office of Emergency Services, and Mrs. Barbara Larson, Chief Executive Officer of the Santa Clara Valley Chapter of the American Red Cross join us to give insights around key emergency planning efforts going on in Santa Clara County. The date for the fall training is Wednesday, December 3, 2008 from 10 am to 3:30 pm at the Santa Clara County Medical Association at 700 Empey Way in San Jose. Space is limited to the first 45 participants. Please RSVP to Marta Lugo at [email protected] or 408-885-7515 by COB November 14, 2008. We hope that you will be able to join us for this exciting training opportunity. Thank You on behalf of:

mailto:[email protected]

Talk to Me, Please!Communicating with Community Partners During a Public Health Emergency Event

Dedicated to the Health of the Whole Community

Save the Date!

Wednesday, December 3, 2008

Time: 10 a.m. – 3:30 p.m. Lunch and refreshments provided

Location: Santa Clara County Medical Association 700 Empey Way San Jose, CA 95128

Space is limited to the first 45 participants. RSVP by Nov. 14: [email protected] or 408.885.7515. For more information, please call 408.885.7515.

The Santa Clara County Public Health Department has partnered with the Santa Clara County Office of Human Relations, Social Services Agency, and CADRE to present this training program on risk communications during a medical/health emergency.

Disasters such as wildfires, hurricanes and earthquakes have demonstrated the importance of pre-event emergency planning and preparedness for both government agencies and community organizations alike.

This training will cover key principles and components of risk communications during a public health emergency event:

• How communication differs during an emergency event

• How communications fit into the overall emergency response efforts—Incident Command System (ICS) and Joint Information Center (JIC) structures

• How community organizations can work with the JIC for communication purposes—particularly to provide information to vulnerable populations

This training is aimed at managers in community organizations who are responsible for public communications during an emergency.

Incident Command SystemIncident Command System

Incident Management & Command Systems

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The National Incident Management System The federal government – in order to achieve unified, single- and interagency management in emergency response - adopted the National Incident Management System (NIMS). The central purpose is to ensure a comprehensive national framework designed to efficiently support incident management, regardless of the size, nature, or complexity of the event. Under NIMS, the framework of operations is the Incident Command System (ICS). NIMS requires the use of the Incident Command System by all levels of government and by healthcare organizations. The Incident Command System The purpose of the Incident Command System (ICS) is to provide an interdisciplinary and flexible management system that is adaptable to an incident of any kind or size. ICS defines a clear chain-of-command and provides logistical and administrative support to operational staff responding to the incident. The Incident Command System is a proven system based on organizational “best practices” and the successful use in military and business practices. ICS has been built on lessons learned in response to incidents. ICS is a framework (not a plan) that defines the actions to be carried out by whom, what, when, where, and how (the Incident Action Plan). The ICS puts into place common terminology, standards and procedures. The activation of ICS is scalable, and its standardized structure allows for the integrations of other agencies and organizations. ICS can be used in planned events (NASCAR), exercises and for actual incidents. The main components of the ICS are the Command Staff, and the General Staff or functional sections. The ICS may exist in its full form or in a truncated form in more minor events in which certain pieces are not necessary. In the full form, the ICS Command Staff is lead by the Incident Commander. The Incident Commander (IC) or the Agency Incident Commander, if the disaster involves several agencies working together, is in charge of the incident. The Incident Commander is responsible for the development of an Incident Action Plan, allocation of resources and assuring that the necessary sections are activated (and subsequently de-activated at the end of the crisis). This person has the authority to make decisions and ultimately execute the Incident Action Plan. The Chain of Command refers to the orderly line of authority within the ranks of the incident management organization. Unity of Command means that every individual has a designated supervisor to whom he or she reports at the scene of the incident. These principles clarify reporting relationships and eliminate the confusion caused by multiple, conflicting directives. Incident managers at all levels must be able to control the actions of all personnel under their supervision. A Unified Command takes place when multiple jurisdictions, a single jurisdiction with multi-agency involvement, or multiple jurisdictions with multi-agency involvement respond to an incident. Unified Command allows agencies with different legal, geographic, and functional authorities and responsibilities to work together effectively without affecting individual agency authority, responsibility, or accountability. A Unified Command analyzes information, establishes common objectives and strategies, and develops a common Incident Action Plan.


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An Emergency Operations Center (EOC) is established for incidents involving multiple organizations or governmental agencies. Multiple agencies and/or disciplines are represented in the EOC. The purpose of the EOC is to provide support and coordination for on-scene responders, and to coordinate and allocate resources. The Span of Control refers to the number of individuals or resources one supervisor can manage effectively. The Span of Control is accomplished by organizing resources in Sections, Branches, Groups, Divisions and Teams. The recommended span of control for is one to five reports per supervisor. Ratios may vary from three to seven reports per supervisor. Command Staff The Command Staff consists of the Public Information Officer, Safety Officer, and Liaison Officer. They report directly to the Incident Commander, and are made up of the following positions:

• Public Information Officer (PIO) - responsible for assuring that appropriate information is provided to the public, as well as to government officials and collaborating agencies.

• Safety Officer - responsible for scene safety, availability and appropriate use of personal protective equipment, and basic human needs (rest, nutrition, and hydration).

• Liaison Officer - responsible for coordinating all activities with other agencies and groups involved in the response.

Note: The Documentation Officer is responsible for recording all activity, particularly meetings, phone calls, and other logistic matters. General Staff This organization level has functional responsibility for primary segments of incident management (Operations, Planning, Logistics, Finance/Administration). The General Staff (or functional section leads) also report directly to the Incident Commander. These are the General Staff positions:

• Operations Section Chief is responsible for managing all tactical operations at an incident. The Incident Action Plan provides the necessary guidance. The need to expand the Operations Section is generally dictated by the number of tactical resources involved and is influenced by span of control considerations.

• Planning Section Chief is responsible for providing planning services for the incident. Under the direction of the Planning Section Chief, this section collects situation and resources status information, evaluates it, and processes the information for use in developing action plans. Dissemination of information can be in the form of the Incident Action Plan, formal briefings, or through map and status board displays

• Logistics Section Chief provides all incident support needs with the exception of support to air operations. The Logistics Section is responsible for providing: facilities, transportation, communications, supplies, equipment maintenance and fueling, food services (for responders), medical services (for responders), and all off-incident resources.

• Finance/Administration Section Chief is responsible for managing all financial aspects of an incident. Not all incidents will require a Finance/Administration Section. This section is activated only when the involved agencies have a specific need for finance services.

Joint Information Systems The purpose of a Joint Information Systems (JIS) is to communicate timely and accurate information to the public. Local, regional and state governments set up the Joint Information System. Public Information Officers operate in a Joint Information System to:

• Establish plans, procedures and structures for gathering and disseminating information • Develop coordinated messages • Ensure that the public and decision-makers are informed throughout a response


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The Lead Public Information Officer (PIO) ensures that all messages are approved by the Incident Commander before release. Joint Information Center The Joint Information Center (JIC) is a temporary organization or entity where information management activities are performed. A Joint Information Center will:

• Gather information and intelligence • Develop consistent and coordinated messages • Disseminate messages and information

JIC activities enhance the likelihood that information released to the public will be accurate and coordinated across agencies. One or more JICs may be operating under the JIS, and may be large or small and may not house all communications staff. The base of operations for a JIC may be federal, state, or local, and its resources may flow from any of these sources. As with the ICS, the JIC may be scaled to fit the situation by enlarging or contracting its services and resources. A large JIC may activate all components: media relations, research and writing, and all special project functions. In a full health and medical activation, the JIC could include a spokesperson, hospital liaisons, media monitoring, State PIO, and State Medical Advisor, all working together under the ICS-PIO. A large JIC may include audiovisual and production support, web management, briefing room staff, and more. Organizing a Joint Information Center (JIC) A JIC enhances the likelihood that information released to the public will be accurate and coordinated across agencies. A well-organized JIC can increase the ability to do so quickly and effectively. The Lead Public Information Officer (PIO) in a JIC is responsible for overall JIC operations and providing prompt and organized responses to the news media. The lead PIO coordinates all public information efforts out of the JIC, ensures protocols are follows, attends Command briefings and coordinates these efforts with local and state partners. Research and Writing is responsible for researching, verifying information and writing media advisories, releases and other materials. They generate reports and obtain approvals from the PIO. Media Relations is responsible for dealing with all media requests and logistics. They distribute news releases, brief and support spokespersons, determine and set up media-briefing area, generate reports and obtain approvals from the PIO. Special Projects is responsible for working with key partners and posting accurate information to Web sites and making sure information is distributed to non-media partners, organizations, agencies and audiences. They monitor Web sites generate reports and obtain approvals from the PIO. As with all disaster planning, communications services personnel should practice protocols, roles and responsibilities. This can be done through formal NIMS and ICS trainings, as well as by conducting tabletop exercises and drills specific to public communications.

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Lessons LearnedLessons Learned from a from a Public Health Emergency Public Health Emergency

and a Followand a Follow--Up POD Up POD ExerciseExercise

The Erie County The Erie County Hepatitis A ExperienceHepatitis A Experience

OverviewOverview

Hepatitis A InvestigationHepatitis A InvestigationPost Exposure ProphylaxisPost Exposure ProphylaxisPOD ExperiencePOD ExperienceLessons LearnedLessons LearnedPlan of Correction Plan of Correction FollowFollow--up PODup POD

Hepatitis A Hepatitis A

Disease caused by the hepatitis A virus (HAV)Disease caused by the hepatitis A virus (HAV)Viral illness that affects the liverViral illness that affects the liverSpread through fecalSpread through fecal--oral routeoral routeIncubation period 15Incubation period 15--50 days50 daysSigns/symptomsSigns/symptoms

Nausea, vomiting, diarrhea, feverNausea, vomiting, diarrhea, feverDark urine, jaundice, light stoolDark urine, jaundice, light stool

Hepatitis A Hepatitis A Case Investigation (1)Case Investigation (1)

Erie County notified on Friday, Erie County notified on Friday, 2/8/08:2/8/08:

51 year51 year--old femaleold femaleAntiAnti--HAV IgM positive HAV IgM positive (HBV(HBV--, HCV, HCV--))SymptomaticSymptomaticElevated liver function testsElevated liver function testsProduce worker at WegmansProduce worker at WegmansNotified NYSDOHNotified NYSDOH


Identify work dutiesIdentify work dutiesStocked raw produceStocked raw produce

Fruits Fruits Vegetables Vegetables

Assess hand hygieneAssess hand hygieneSelfSelf--reported glove use was not 100%reported glove use was not 100%Reported good handReported good hand--washingwashing

Worked through 2/8/08Worked through 2/8/08


Determine infectious periodDetermine infectious period

Symptom OnsetSymptom Onset

2 Weeks2 Weeks 1 Week1 Week

2


January 21January 21st st -- malaise, general malaise, general ““sicksick”” feelingfeelingJanuary 28January 28th th -- jaundice, fever, dark urinejaundice, fever, dark urine

Jan. 7th

Jan. 7th Feb. 8th

Worked

Infectious Period

Jan. 21st Jan. 28th

Feb. 4th

PostPost--Exposure Prophylaxis Exposure Prophylaxis Recommendations (1)Recommendations (1)

ACIP recommendations updated June 27, 2007ACIP recommendations updated June 27, 2007Hepatitis A Vaccine (HAV)Hepatitis A Vaccine (HAV)

Healthy persons 1Healthy persons 1--40 years40 yearsNot previously vaccinatedNot previously vaccinatedNot previously infected Not previously infected

Immunoglobulin (IG)Immunoglobulin (IG)Children <1 year and adults >40 yearsChildren <1 year and adults >40 yearsImmune compromisedImmune compromisedChronic liver diseaseChronic liver diseaseContraindications to vaccineContraindications to vaccine

Post Exposure ProphylaxisPost Exposure Prophylaxis--Recommendations (2)Recommendations (2)

Household contactsHousehold contactsSexual contactsSexual contactsPlaymatesPlaymatesDaycare contactsDaycare contactsPersons sharing illegal drugsPersons sharing illegal drugsPersons sharing food or beverages Persons sharing food or beverages Persons in commonPersons in common--source exposures (i.e. source exposures (i.e. restaurant patrons, corestaurant patrons, co--workers)workers)

Making The DecisionMaking The Decision

Multiple conference calls held Friday afternoon Multiple conference calls held Friday afternoon and eveningand evening

Erie County DOHErie County DOHNYSDOH Regional and Central OfficesNYSDOH Regional and Central OfficesCDC ImmunizationCDC ImmunizationCDC DSNSCDC DSNSWegmansWegmans

Open a POD in less than 24 Open a POD in less than 24 hours?hours?

““We asked ourselves what We asked ourselves what was the right thing to was the right thing to

do. We asked the State do. We asked the State and the CDC. All and the CDC. All

three levels decided to three levels decided to do what science says do what science says we should do,we should do,”” said said

Billittier. Billittier. (Buffalo News)(Buffalo News)

The Decision: Provide HAV PostThe Decision: Provide HAV Post--Exposure Exposure Prophylaxis (PEP)Prophylaxis (PEP)

PEP to be offered to persons who PEP to be offered to persons who met all criteria:met all criteria:

Purchased raw, unwrapped produce Purchased raw, unwrapped produce 1/7/081/7/08--2/8/08 2/8/08 Consumed same produce in last 2 Consumed same produce in last 2 weeksweeksNever received HAV vaccine or had Never received HAV vaccine or had hepatitis A disease in the pasthepatitis A disease in the past

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Friday, February 8thFriday, February 8th

Last day produce expected to be on shelvesLast day produce expected to be on shelvesCritical staff gathered to begin planningCritical staff gathered to begin planningSupplies identified/requestedSupplies identified/requestedInitial press releaseInitial press releaseECDOH staff contactedECDOH staff contactedInitial contact of SMART volunteers and Initial contact of SMART volunteers and WNYPHA Preparedness CoordinatorsWNYPHA Preparedness CoordinatorsAccidental Accidental ““notificationnotification”” of other EC of other EC departmentsdepartments

Identification of Exposed PopulationIdentification of Exposed Population

Wegmans identified 84,000 produce Wegmans identified 84,000 produce transactions during the potential transactions during the potential exposure periodexposure period

CouldnCouldn’’t identify whether they t identify whether they washed/cooked producewashed/cooked produceCouldnCouldn’’t identify multiple transactions t identify multiple transactions by same familyby same familyCould have shared food with othersCould have shared food with others

Notifying Wegmans PatronsNotifying Wegmans Patrons

Wegmans notified ShopperWegmans notified Shopper’’s Club memberss Club membersCalled 13,000 people with recorded messageCalled 13,000 people with recorded messageWebsite informationWebsite information

Press conference on 2/8/08Press conference on 2/8/08Press ReleasePress Release

Buffalo NewsBuffalo NewsLocal TV networksLocal TV networks

HAV POD: When?HAV POD: When?

Saturday, February 9Saturday, February 9thth

4:00 PM 4:00 PM –– 12:00 Midnight12:00 Midnight

Sunday, February 10Sunday, February 10thth

12:00 Noon 12:00 Noon –– 8:00 PM8:00 PM

HAV POD: Where?HAV POD: Where?

Erie Community College Erie Community College -- North CampusNorth CampusClose proximity to Wegmans store Close proximity to Wegmans store PrePre--determined POD site determined POD site

Existing MOU for use as POD siteExisting MOU for use as POD siteCounty facilityCounty facilityWeekend availabilityWeekend availabilitySite previously reviewed and found to meet Site previously reviewed and found to meet basic requirements basic requirements Parking availableParking availableStudent Center, Dental Clinic, Cafeteria and Student Center, Dental Clinic, Cafeteria and Culinary/Hospitality WingCulinary/Hospitality Wing

Initial Supplies, Equipment, Initial Supplies, Equipment, Resources NeededResources Needed

Vaccine, Immune GlobulinVaccine, Immune GlobulinNeedles, syringes, medical suppliesNeedles, syringes, medical suppliesDraping for privacyDraping for privacyOffice suppliesOffice suppliesVests to identify rolesVests to identify rolesSigns to identify stations, etc.Signs to identify stations, etc.Communication equipment/connectionsCommunication equipment/connectionsPaper forms and education materialsPaper forms and education materialsStaff and VolunteersStaff and VolunteersFood and beverages for staffFood and beverages for staff

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IG and Vaccine SupplyIG and Vaccine Supply

IG was ordered from Cardinal HealthIG was ordered from Cardinal HealthVaccine Vaccine

NYSDOH Immunization ProgramNYSDOH Immunization ProgramCDC StockpileCDC StockpileNYSDOH SNS Coordinator onNYSDOH SNS Coordinator on--sitesiteSurrounding LHDsSurrounding LHDs

Monroe Co. ~100 doses of vaccineMonroe Co. ~100 doses of vaccine

NN1

Saturday, February 9thSaturday, February 9th

Vaccine and IG receivedVaccine and IG receivedNYSDOH resources arrivedNYSDOH resources arrivedCritical staff met to continue planning and preparationsCritical staff met to continue planning and preparationsECDOH staff notified and scheduledECDOH staff notified and scheduledConference call held with regional partners to determine Conference call held with regional partners to determine staff availabilitystaff availabilityECDOH and NYSDOH Health Alerts disseminatedECDOH and NYSDOH Health Alerts disseminatedCall centers activatedCall centers activated

Initial IssuesInitial Issues

Technical issues with CDMS formTechnical issues with CDMS formAvailability of ECDOH staffAvailability of ECDOH staffLack of mutual aid agreementLack of mutual aid agreementWrong size needles sent from DOHWrong size needles sent from DOHPrivacy requirements for IGPrivacy requirements for IGEarly BirdsEarly BirdsDifficult to plan for unknownDifficult to plan for unknown


Command and General Staff Command and General Staff positions filledpositions filledUnified Command utilizedUnified Command utilizedCommand expanded as Command expanded as incident expandedincident expandedEOC located onEOC located on--sitesiteBriefings and planning Briefings and planning meetings heldmeetings heldIAPIAP’’s utilizeds utilized

Initial ECDOH ICS StructureInitial ECDOH ICS Structure

Unified Command(Health/ES)

Operations(Clinical Ops)

Logistics(Clinical Logistics) Planning

Liaison Officer Safety Officer

Public InformationOfficer

NYSDOH ICS ActivatedNYSDOH ICS Activated

NYSDOH initiates Incident Management System (IMS)NYSDOH initiates Incident Management System (IMS)NYSDOH Health Emergency Preparedness Team led the NYSDOH Health Emergency Preparedness Team led the callscalls

Participants included NYSDOH Central Office, CDC SMO, SNS, Participants included NYSDOH Central Office, CDC SMO, SNS, Logistics, Epidemiology, Environmental Health, Office of Health Logistics, Epidemiology, Environmental Health, Office of Health Systems Management, Legal Affairs, Public Information, ExecutiveSystems Management, Legal Affairs, Public Information, Executives, s, and Regional Office, Erie County DOH and Regional Office, Erie County DOH

Briefings daily or more often as neededBriefings daily or more often as neededIMS Situation Report issued after each callIMS Situation Report issued after each call

Western Region Emergency Operations Center is Western Region Emergency Operations Center is activated in the Rochester Officeactivated in the Rochester Office

Slide 19

NN1 Removed the word Stockpile after SNSNikhil Natarajan, 1/23/2009

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NYSDOH Incident Management System :

Essential Programs for Readiness

Health Emergency Preparedness Program - OPHDivision of Epidemiology- CCHBureau of Communicable Disease Control – CCHImmunization Program – CCHBureau of Environmental Radiation Protection – CEHBureau of Toxic Substance Assessment – CEHBureau of Public Water Supply – CEHBureau of Hospital Services – OHSMBureau of Emergency Medical Services – OHSMBureau of Long Term Care- OHSMPublic Affairs –AdministrationInformation Systems and Health Statistics Group- AdministrationRisk Communication - OSPHStatewide Laboratory Network (Chemical and Biological) – Wadsworth Center for Laboratories and Research

Current NYSDOH IMS StructureCurrent NYSDOH IMS Structure

What does IMS look like ?

Command:

What does IMS look like ?What does IMS look like ?

Section Chiefs - Ops, Logistics, Planning

What does IMS look like ?What does IMS look like ?

Groups - Leaders/Alts/Assistants� Branches (managers)� HOC Groups, Technical Expertise � DOH Staff

Typical IMS Activities:Typical IMS Activities:

IMS Daily/Weekly Conference CallsIMS Daily/Weekly Conference Calls

As the event requiresAs the event requires

Situation Reporting (Daily)Situation Reporting (Daily)

CDC Conference Calls (if necessary)CDC Conference Calls (if necessary)

Monitor the Executive DashboardMonitor the Executive Dashboard

Coordination with other State partnersCoordination with other State partners

MultiMulti--agency Coordination Groups (MAC)agency Coordination Groups (MAC)

Conducted inConducted in--person (HOC) or virtuallyperson (HOC) or virtually

6

Alerts and NotificationAlerts and Notification

February 9th February 9th NYSDOH Problem Alert postedNYSDOH Problem Alert postedCDC EpiCDC Epi--X Alert postedX Alert postedErie County DOH Health AlertErie County DOH Health Alert

Emailed to local healthcare providersEmailed to local healthcare providersFaxed to local hospitalsFaxed to local hospitalsPosted on Erie County websitePosted on Erie County website

Risk CommunicationRisk Communication

Close coordination between ECDOH, NYSDOH Close coordination between ECDOH, NYSDOH Public Affairs Group, and WegmansPublic Affairs Group, and WegmansCall CentersCall Centers

NYSDOHNYSDOHCoordinated setup of call center with international Coordinated setup of call center with international capabilitycapabilityCoordinated change of callCoordinated change of call--center on Day 2 after initial center on Day 2 after initial call center failed to meet demands (~200 calls per hour at call center failed to meet demands (~200 calls per hour at peak)peak)

ECDOH ECDOH ––utilized 211utilized 211WegmansWegmans

Need to Expand OperationsNeed to Expand Operations

Decision made to extend POD operationsDecision made to extend POD operationsUtilized media to communicate with publicUtilized media to communicate with publicIdentified exposed persons who were unable to Identified exposed persons who were unable to come to PODcome to PODIdentified affected food pantriesIdentified affected food pantriesAdditional resource requirementsAdditional resource requirements

StaffStaffMedical suppliesMedical supplies

Expanded OperationsExpanded Operations

OperationsSection Chief

Clinical Operations(Clinic Manager)

On-SiteEpidemiology

Off-Site Home Visits

Hep A Clinic Manager

Hep A / IG Clinic Manager

Medical Evaluation

Medical ScreeningClinic Manager

Task Force

Clinic Flow

Front End / Primary Back End / Secondary

Basic Clinic LayoutBasic Clinic Layout

Adjusted based on:Adjusted based on:VolumeVolumeWeather conditionsWeather conditionsStaffing resourcesStaffing resourcesAvailability of IGAvailability of IGAccommodation of familiesAccommodation of families

Typical stationsTypical stations

POD StationsPOD Stations

EntranceEntranceForms DistributionForms DistributionEducationEducationForms ScreeningForms ScreeningMedical Evaluation Medical Evaluation Epidemiological Interview (If needed)Epidemiological Interview (If needed)Vaccination/IG AdministrationVaccination/IG AdministrationPostPost--Vaccination/IG MonitoringVaccination/IG MonitoringExitExit

FLO

W

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Primary POD FlowPrimary POD Flow Interim POD FlowInterim POD Flow

Buses used for Buses used for interim staginginterim stagingProvided by Provided by Williamsville school Williamsville school district and NFTAdistrict and NFTAKept people warmKept people warmEducation sessions Education sessions conductedconducted

POD Flow InsidePOD Flow Inside

Halls used as waiting Halls used as waiting areas to keep people areas to keep people insideinsideFlow modified as needed Flow modified as needed to accommodate volumeto accommodate volumeSeparated entrance and Separated entrance and exitexit

Patient EducationPatient Education

Educators Educators answered answered questions and questions and prepared prepared vaccineesvaccineesPatients educated Patients educated in groups of 30in groups of 30--50+50+

• Forms Screeners reviewed screening questions on paper form

• At least one nurse available at each table

• Questions referred to Medical Evaluator

Form Review/ScreeningForm Review/Screening Forms ScreeningForms Screening

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Medical EvaluationMedical Evaluation IG Administration StationIG Administration Station

Privacy Screen NeededPrivacy Screen NeededVaccinator and assistantVaccinator and assistantNumber of stations Number of stations depended on volume and depended on volume and staff availablestaff available

Hep A Vaccine StationHep A Vaccine Station

Families moved as Families moved as unitunitSupplemental lighting Supplemental lighting neededneededTreats provided for Treats provided for kidskidsPrivacy not neededPrivacy not needed

Post Vaccination Waiting AreaPost Vaccination Waiting Area

Medical First AidMedical First Aid

Staffed by EMTsStaffed by EMTsVasovagal/syncopal Vasovagal/syncopal episodesepisodesOne transport (unrelated One transport (unrelated to HAV)to HAV)

Expanded LogisticsExpanded Logistics

Logistics

Facilities / Security

Ground Support/Transportation Food Unit Communications

Unit

Medical Supplies

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Medical SuppliesMedical Supplies Medical Logistics Medical Logistics -- NYSDOHNYSDOH

OnOn--site logistics supportsite logistics supportCoordination between ECDOH and NYSDOHCoordination between ECDOH and NYSDOHCoordinated acquisition and purchase of Immune Globulin with Coordinated acquisition and purchase of Immune Globulin with distributordistributorDeployed POD GoDeployed POD Go--kits to eventkits to eventCoordinated shipment of additional vaccine and return of Coordinated shipment of additional vaccine and return of suppliessuppliesCoordinated with CDC and DEOC regarding available federal Coordinated with CDC and DEOC regarding available federal assetsassetsCoordinated with pharmaceutical distributors regarding availableCoordinated with pharmaceutical distributors regarding availablelocal assetslocal assetsCoordinated purchase of remaining Immune Globulin from Erie Coordinated purchase of remaining Immune Globulin from Erie County for redeployment to NYC Hepatitis A incidentCounty for redeployment to NYC Hepatitis A incident

POD GoPOD Go--Kits (3 complete sets)Kits (3 complete sets)1. Administrative

2. Anthrax

3. Clinician

4. Safety Equipment

5. Vaccine

6. Smallpox (not shown)

LogisticsLogistics

CommunicationsCommunicationsMobile Operations Mobile Operations Command vehicleCommand vehiclePortable radioPortable radioCell phonesCell phones

FoodFoodMeals provided by Meals provided by WegmansWegmans

Expanded Planning SectionExpanded Planning Section

Planning

Resource Unit Situation Unit DemobilizationUnit

DocumentationUnit

How do you plan for the unknown?How do you plan for the unknown?

How many will come?How many will come?How many days will we need to do this?How many days will we need to do this?How much IG to order?How much IG to order?How many supplies to order?How many supplies to order?What will the weather be like?What will the weather be like?Have we worn out our welcome?Have we worn out our welcome?How many days will people continue to come? How many days will people continue to come? How many staff to assign each day?How many staff to assign each day?Did we order enough lunch?Did we order enough lunch?Who will pay for this?Who will pay for this?

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Planning SectionPlanning Section

Resource Unit Resource Unit –– staff and volunteers from multiple staff and volunteers from multiple agencies with multiple points of contact, lack of info agencies with multiple points of contact, lack of info from other sectionsfrom other sectionsSituation Unit Situation Unit –– gathered weather info, patient counts, gathered weather info, patient counts, assessed volume of call from hotlines, postassessed volume of call from hotlines, post--event data event data entryentryDemobilization Unit Demobilization Unit –– staff selected for release based on staff selected for release based on weather and distanceweather and distanceDocumentation Unit Documentation Unit –– IAPs, sitrepsIAPs, sitrepsStaff Staff –– Section Chief, Deputy (Liaison), clericalSection Chief, Deputy (Liaison), clerical

Finance AdministrationFinance Administration

Purchasing Purchasing –– accomplished through existing accomplished through existing budget lines and Health Accounting staffbudget lines and Health Accounting staffTime/AttendanceTime/Attendance

OnOn--site attendancesite attendanceManaged by regular payroll clerkManaged by regular payroll clerkOvertime and compOvertime and comp--time coststime costs

Expenditure CategoriesExpenditure Categories

Staff Salary and Overtime Staff Salary and Overtime ImmunoglobulinImmunoglobulinVarious medical supplies Various medical supplies Buses used as shelterBuses used as shelterFood for workers Food for workers Printing and copying Printing and copying Office supplies Office supplies Medical waste pickMedical waste pick--up up IGM Testing IGM Testing Erie Community College Facility Charge Erie Community College Facility Charge

Overall NYSDOH ResponseOverall NYSDOH Response

Human Resource totals Human Resource totals 168 staff168 staff5553 hours worked5553 hours worked$154,839.20 Total cost (without salary or Article 6 $154,839.20 Total cost (without salary or Article 6 funds)funds)

Materials Materials 3120 Adult Hep A VAX3120 Adult Hep A VAX1832 Ped Hep A VAC1832 Ped Hep A VAC5400 syringes5400 syringes2 sets POD go kits2 sets POD go kitsPurchased Ig postPurchased Ig post--eventevent

NYS Public Health Law Article 6NYS Public Health Law Article 6

State reimbursement for local public health emergencyState reimbursement for local public health emergencyIf the state commissioner or a county health department or partIf the state commissioner or a county health department or part--county county department of health or municipality, with the approval of the sdepartment of health or municipality, with the approval of the state commissioner, tate commissioner, determines that there is an imminent threat to public health, determines that there is an imminent threat to public health, the department the department shall reimburse counties or municipalities atshall reimburse counties or municipalities at fifty per centum for the cost of fifty per centum for the cost of emergency measures as approved by the department and subject to emergency measures as approved by the department and subject to the the approval of the director of the budget.approval of the director of the budget. Such funds shall be made available from Such funds shall be made available from funds appropriated for public health emergencies, funds appropriated for public health emergencies, only to those counties or only to those counties or municipalities, which have expended all other state aid which mamunicipalities, which have expended all other state aid which may be y be available for related activities and have developed measures to available for related activities and have developed measures to adequately adequately address the emergency. Reimbursement is conditioned upon availabaddress the emergency. Reimbursement is conditioned upon availability of ility of appropriated funds.appropriated funds. For purposes of this section, "municipality" means a health For purposes of this section, "municipality" means a health department of a city that is not located in a county or partdepartment of a city that is not located in a county or part--county health district or county health district or a county in which the legislature has the powers and duties of aa county in which the legislature has the powers and duties of a board of health of board of health of a county or parta county or part--county health district and cities with a population of over one county health district and cities with a population of over one million persons. (Article 6, Title 3, million persons. (Article 6, Title 3, §§621 NYS Public Health Law)621 NYS Public Health Law)

Lessons LearnedLessons Learned

What Went Well?What Went Well?

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Effectiveness of Preventive Public Effectiveness of Preventive Public HealthHealth

ECC POD PEP Final Numbers:ECC POD PEP Final Numbers:IGIG 4,716 4,716 Hep A Hep A 5,4375,437Hep A AdultHep A Adult 3,496 3,496

Hep A PedsHep A Peds 1,941 1,941

TotalTotal 10,15310,153Secondary Cases: Secondary Cases: 00

Post POD PEPPost POD PEP

ECDOH Primary Care ClinicECDOH Primary Care ClinicHandled through routine hours and staffingHandled through routine hours and staffingOperated Thursday, February 14Operated Thursday, February 14thth and Friday, February and Friday, February 1515thth

IGIG 1919Hep AHep A 77

-- Hep A PedsHep A Peds 11-- Hep A AdultsHep A Adults 66

TotalTotal 2626

POD FlowPOD Flow-- Time StudiesTime Studies

Wait time at POD decreasedWait time at POD decreased>2 hours to ~37 minutes>2 hours to ~37 minutes

Flow was reFlow was re--arranged as neededarranged as neededMade more IG stations availableMade more IG stations availableIncreased # persons through education sessionsIncreased # persons through education sessions

Domino effectDomino effect-- helped to helped to reduce bottlenecksreduce bottlenecks

Time Study DataTime Study Data

DATE Number DATE Number Wait Wait Time atTime at TOTAL TIME AT PODTOTAL TIME AT PODFollowedFollowed Time ClinicTime Clinic

2/92/9 99 147 min147 min 44 min44 min 192 min192 min2/102/10 2525 63 min63 min 32 min32 min 94 min94 min2/122/12 7575 12 min12 min 31 min31 min 44 min44 min2/132/13 3939 9 min9 min 28 min28 min 37 min37 min

Note: time study data collected and reported by NYSDOH

Practice learned skills Practice learned skills Test feasibility of plansTest feasibility of plansIdentify gaps in trainingIdentify gaps in trainingDemonstrate capacity Demonstrate capacity and role to new and role to new administrationadministrationUtilize mental health Utilize mental health resourcesresources

POD Provided Opportunity to:POD Provided Opportunity to: Built and Expanded PartnershipsBuilt and Expanded Partnerships

NYSDOHNYSDOHOther Erie County Other Erie County departmentsdepartmentsWNYPHA CountiesWNYPHA CountiesTown of AmherstTown of AmherstWegmansWegmans

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NYSDOH ResponseNYSDOH Response

Central Office StaffCentral Office StaffHealth Emergency Preparedness ProgramHealth Emergency Preparedness ProgramPublic Health Emergency Epidemiology ProgramPublic Health Emergency Epidemiology ProgramPublic Affairs Group / Risk CommunicationPublic Affairs Group / Risk CommunicationCoordination with New York State Office of General Coordination with New York State Office of General ServicesServicesCoordination with New York State Coordination with New York State Department of Agriculture and MarketsDepartment of Agriculture and Markets

Regional Office StaffRegional Office StaffHealth Operations CenterHealth Operations CenterDirect support to Erie CountyDirect support to Erie County

NYSDOH Incident Management SystemNYSDOH Incident Management System

Wegmans Was An Active PartnerWegmans Was An Active Partner

Participated in conference calls and decisionParticipated in conference calls and decision--makingmakingWegmans had their own Wegmans had their own ““command centercommand center””Identified and notified targeted produce shoppers Identified and notified targeted produce shoppers through recorded phone messagethrough recorded phone messageDeveloped system to accept returned produce and Developed system to accept returned produce and refund money to shoppersrefund money to shoppersProvided food and resources for staff at POD siteProvided food and resources for staff at POD siteProvided clinic for their own exposed staffProvided clinic for their own exposed staff

Collaborative Epidemiologic Collaborative Epidemiologic InvestigationsInvestigations

Interview of potentially symptomatic personsInterview of potentially symptomatic personsLaboratory testing of suspect personLaboratory testing of suspect personIdentification of secondary distribution of produce Identification of secondary distribution of produce to food pantries and sheltersto food pantries and sheltersIdentification of potential exposure of sports teamsIdentification of potential exposure of sports teams

NYSOH conducted StateNYSOH conducted State--wide epi conference call wide epi conference call EIS Officer deployedEIS Officer deployed

NYS Lessons LearnedNYS Lessons Learned

Risk communication messages were clear and consistentRisk communication messages were clear and consistentA POD was established quickly and efficientlyA POD was established quickly and efficientlyRegional Office HOC worked well in coordination with Central Regional Office HOC worked well in coordination with Central OfficeOfficeContact with staff during offContact with staff during off--hours was quick and efficienthours was quick and efficientMany NYSDOH staff were previously trained due to prior Many NYSDOH staff were previously trained due to prior NYSDOH POD exercisesNYSDOH POD exercisesFinance aspect was captured well postFinance aspect was captured well post--eventeventIMS calls were efficient and wellIMS calls were efficient and well--coordinatedcoordinatedVaccine was delivered in a timely manner when requested (with Vaccine was delivered in a timely manner when requested (with one shipment occurring overnight on Saturday)one shipment occurring overnight on Saturday)Identification of one NYSDOH POC at POD site was effectiveIdentification of one NYSDOH POC at POD site was effectiveCall centers messages were coordinated with Erie County 211 Call centers messages were coordinated with Erie County 211 systemsystem

Lessons LearnedLessons Learned

What DidnWhat Didn’’t Go Well?t Go Well?

What Areas Need Work?What Areas Need Work?

Personnel Related NeedsPersonnel Related Needs

Better onBetter on--site personnel / resource tracking, site personnel / resource tracking, credentialing, and accountabilitycredentialing, and accountabilityDesignated staff area (checkDesignated staff area (check--in, break area, restrooms, in, break area, restrooms, etc.)etc.)Appropriate role assignment and JITTAppropriate role assignment and JITTFrequent briefings (Safety, Operational)Frequent briefings (Safety, Operational)Designation and communication of chain of command Designation and communication of chain of command and command structureand command structure

13

Integrating Staff/Volunteers Integrating Staff/Volunteers

May have to merge staff or volunteers from May have to merge staff or volunteers from various agencies various agencies

Liaison needed if large numbersLiaison needed if large numbersInclude agency reps in planning meetingsInclude agency reps in planning meetingsInclude staff in trainings/briefingsInclude staff in trainings/briefingsPrePre--identification of credentialsidentification of credentialsSensitivity of staff to volunteersSensitivity of staff to volunteers

CommunicationCommunication

InternallyInternallyNeed a reliable and efficient means of contacting and Need a reliable and efficient means of contacting and informing staffinforming staff

ExternallyExternallyBetter coordination with partner agencies for common Better coordination with partner agencies for common source of consistent message for publicsource of consistent message for publicHCS Alerting Tool was not utilizedHCS Alerting Tool was not utilized

OnOn--sitesiteBetter communication within chain of commandBetter communication within chain of commandDisaster LAN was underDisaster LAN was under--utilizedutilized


Earlier expansion of structureEarlier expansion of structureBetter utilization of persons with experience in Better utilization of persons with experience in ICS (i.e. IMAT)ICS (i.e. IMAT)Identification / designation of EOC managerIdentification / designation of EOC managerBetter communication of organizational chart, Better communication of organizational chart, IAP, safety messages, etc. down through chain IAP, safety messages, etc. down through chain of commandof command

Training Needs IdentifiedTraining Needs Identified

Review of PH Core CompetenciesReview of PH Core CompetenciesICS / NIMSICS / NIMS

Annual review / refresher for all employeesAnnual review / refresher for all employeesPosition specific training for Command and General Position specific training for Command and General StaffStaff

Working in a POD Working in a POD –– for all employees and for all employees and volunteers that could be utilized in a PODvolunteers that could be utilized in a POD

Did we wear out our welcome?Did we wear out our welcome?

Disruption to staff, Disruption to staff, students, and clientsstudents, and clientsCosts to siteCosts to siteSpace restrictionsSpace restrictionsPolitical issuesPolitical issues

NYS Lessons LearnedNYS Lessons Learned

Areas for ImprovementAreas for ImprovementPolicy decision makingPolicy decision makingClearly identify which parties need to be on which callsClearly identify which parties need to be on which callsCommunicationCommunicationProcurement of Immune GlobulinProcurement of Immune GlobulinStaff underStaff under--utilizationutilizationPOD site inventory managementPOD site inventory managementTechnical issues with Clinic Data Management System Technical issues with Clinic Data Management System (CDMS)(CDMS)Additional alternate communication channels for those who Additional alternate communication channels for those who can not access mass mediacan not access mass media

14

Media and VIPsMedia and VIPs

Plan for mediaPlan for mediaProvide regular briefingsProvide regular briefingsDesignate a media staging areaDesignate a media staging areaBe sensitive to deadlinesBe sensitive to deadlines

Elected officials may visitElected officials may visitDesignate staff to provide Designate staff to provide walkwalk--thruthruWork with their staffWork with their staff

Elected officials may stayElected officials may stay

Other Issues IdentifiedOther Issues Identified

Flexibility and creative thinking Flexibility and creative thinking are importantare importantMental Health resources should Mental Health resources should be better identified and more be better identified and more accessible to staffaccessible to staffAddition of 24/7 response Addition of 24/7 response ––would help to add to job would help to add to job descriptions descriptions

Next StepsNext Steps

Completion of After Action ReportCompletion of After Action ReportCompilation and analysis of POD Staff survey Compilation and analysis of POD Staff survey results (Albany)results (Albany)Plan of correction and revised training planPlan of correction and revised training planRevisions to Mass Vaccination and Prophylaxis Revisions to Mass Vaccination and Prophylaxis plan annexesplan annexesFollowFollow--up PODup POD

FollowFollow--Up PODUp POD

ObjectivesObjectivesDetermine effectiveness of alternate POD methods Determine effectiveness of alternate POD methods (i.e. Drive(i.e. Drive--Thru, Push POD)Thru, Push POD)Test revisions to operational plans as indicated in Test revisions to operational plans as indicated in AARAARProvide training opportunity for staff to implement Provide training opportunity for staff to implement recommendations from AARrecommendations from AARConvenience for recipients of first Hep A vaccineConvenience for recipients of first Hep A vaccine

FollowFollow--Up POD PlanningUp POD Planning

MultiMulti--disciplinary planning teamdisciplinary planning teamOngoing meetings since late AprilOngoing meetings since late AprilTentative POD detailsTentative POD details

September 12September 12thth –– 1414thth

DriveDrive--Thru in Highway GarageThru in Highway GarageApproximately 5,500 HAV recipients contacted to Approximately 5,500 HAV recipients contacted to assess interestassess interestEvaluation component builtEvaluation component built--in in

PrePre--Event TrainingEvent Training

Intended audienceIntended audienceErie County staff (required)Erie County staff (required)SMART membersSMART membersCERT membersCERT members

Offered on multiple days/timesOffered on multiple days/timesApproximately 2 hours in lengthApproximately 2 hours in lengthPower Point presentationPower Point presentationThree presentersThree presenters

15

PrePre--Event Training TopicsEvent Training Topics

Review of Working in a PODReview of Working in a PODOverview of event/exercise ICS structureOverview of event/exercise ICS structureDriveDrive--through Concept of Operationsthrough Concept of OperationsStaff / Volunteer instructionsStaff / Volunteer instructions

CheckCheck--ininCredentialsCredentialsAppropriate supplies and clothingAppropriate supplies and clothing

Overview of POD layout with maps and flow Overview of POD layout with maps and flow diagramsdiagrams

Implementation of Corrective Implementation of Corrective Measures Measures -- CommunicationCommunication

Notification of staff / volunteers not testedNotification of staff / volunteers not testedUtilization of Communication UnitUtilization of Communication Unit

Development and implementation of Development and implementation of communications plancommunications planPrePre--determined radio frequenciesdetermined radio frequenciesCentralized monitoring of all communicationsCentralized monitoring of all communications

Operational and safety briefing for all staffOperational and safety briefing for all staffICS forms and IAP posted in common areaICS forms and IAP posted in common area

Corrective Measures Corrective Measures ––PersonnelPersonnel--Related NeedsRelated Needs

Staff / volunteer checkStaff / volunteer check--ininDesignated staff Designated staff Separate signSeparate sign--in for groupsin for groupsID checkID checkDot systemDot system

Staff briefingsStaff briefingsOperational and SafetyOperational and SafetyIntroduction to Command StaffIntroduction to Command Staff

Designated area for lunch/breaksDesignated area for lunch/breaks

Corrective Measures Corrective Measures ––PersonnelPersonnel--Related NeedsRelated Needs

Role assignmentRole assignmentJob action sheet and role briefingJob action sheet and role briefingWork locationWork locationSingle supervisorSingle supervisorIssued vest or other suppliesIssued vest or other supplies

Resource UnitResource UnitMaintained staff availability Maintained staff availability Provided staff from resource pool as requestedProvided staff from resource pool as requested

Corrective Measures Corrective Measures ––Incident Command SystemIncident Command System

Early expansion of structure through planning Early expansion of structure through planning processprocessRegular, preRegular, pre--scheduled planning meetings and scheduled planning meetings and Command meetingsCommand meetingsUtilization of appropriate ICS forms for IAPUtilization of appropriate ICS forms for IAPForms and Org charts posted in lunchroomForms and Org charts posted in lunchroomNYSEMO reps onNYSEMO reps on--site for mentoring and site for mentoring and position trainingposition training

Corrective Measures Corrective Measures ––Integrating Staff and VolunteersIntegrating Staff and Volunteers

Unified Command Unified Command Volunteers treated as equalsVolunteers treated as equalsVolunteers assigned to supervisory positions Volunteers assigned to supervisory positions when appropriatewhen appropriateEncouraged participation of multiple volunteer Encouraged participation of multiple volunteer groupsgroupsS.M.A.R.T. / MRC Coordinator participated as S.M.A.R.T. / MRC Coordinator participated as an observeran observer

16

NYSDOH IssuesNYSDOH Issues

StaffingStaffingScheduled Scheduled ““exerciseexercise”” vs. real eventvs. real eventExtent of need was unclearExtent of need was unclearProvided approximately 10 staffProvided approximately 10 staff

CostsCostsA bad time with ongoing State budget issues and ongoing A bad time with ongoing State budget issues and ongoing surveys (most nurses conducting mandated surveys and on a surveys (most nurses conducting mandated surveys and on a strict schedule)strict schedule)

Planning supportPlanning supportFacilitated acquisition of Hep A Vaccine from Facilitated acquisition of Hep A Vaccine from NYSDOH Vaccine DepotNYSDOH Vaccine Depot

S.M.A.R.T. VolunteersS.M.A.R.T. Volunteers

Increased number of participants from February Increased number of participants from February POD (24) to September (56)POD (24) to September (56)Members had advanced noticeMembers had advanced notice

Weekend eventWeekend eventNonNon--emergencyemergency

PrePre--trainedtrainedNational Guard Logistics Sector National Guard Logistics Sector –– POD POD counted as a counted as a ““MissionMission””

Hepatitis A FollowHepatitis A Follow--Up ICSUp ICS

CommandNeaverthZymanekCooley

OperationsSchmittendorf

Whittington

LogisticsBalesterCreamer

PlanningChalmers

Glass

Finance/AdminSimonetta

Muck

SafetyAdolf

LiaisonHarvey

PIOMontgomery

Policy GroupBillittier

Skibitsky

Operations SectionOperations SectionOperations Section

ChiefDeputy Chief

POD Group Supervisor

Amherst HighwayGroup Supervisor

UB StagingGroup Supervisor

POD Sector 1 AH Sector 1Main Entrance

AH Sector 5Exit Drive

AH Sector 4Post VX Holding

AH Sector 3Garage Exit

AH Sector2Rear of Garage

UB Staging Sector 1

UB Staging Sector 2POD Sector 2

POD Sector 3

POD Sector 4

POD ComponentsPOD Components

Primary Staging (OffPrimary Staging (Off--site at Center For Tomorrow)site at Center For Tomorrow)Initial screening to determine if basic qualifications met Initial screening to determine if basic qualifications met PaperPaper--work filled out work filled out Triaged for FAST or SLOWTriaged for FAST or SLOW

Forms reviewed for completionForms reviewed for completionDirected to vaccination destinationDirected to vaccination destination

F S

Vaccination SiteVaccination Site

Driveway: final medical screeningDriveway: final medical screeningDirected toward vaccination areaDirected toward vaccination area

Vehicles may be reVehicles may be re--triaged for fast/slowtriaged for fast/slowVehicles evaluated caseVehicles evaluated case--byby--case to determine if patients case to determine if patients (especially children) will have to exit (especially children) will have to exit

Directed to postDirected to post--vaccination waiting areavaccination waiting area10 minute wait time10 minute wait timeEvaluation completedEvaluation completedGoody bag issuedGoody bag issued

ExitExit

17

Logistics SectionLogistics Section

LogisticsSection ChiefDeputy Chief

CommunicationsUnit Leader

Medical Unit Leader

Supply Unit Leader

Food Unit Leader

POD Supply Supply

Facility UnitLeader

Planning SectionPlanning Section

Planning SectionChief

Deputy Chief

Resource UnitLeader

Situation Unit Leader

DemobilizationUnit

Leader

DocumentationUnit

Leader

EC Staff Check-in / Status Recorder

Non-EC Staff Check-in /

Status Recorder

TechnicalSpecialist

CDMS

DataCollection

Coordinator

Data Analysis

Coordinator

Finance / AdministrationFinance / Administration

Finance/AdminSection ChiefDeputy Chief

Time Unit Leader

(Personnel Time Recorder)

Cost UnitLeader

CDC Modeling SupportCDC Modeling Support

Support provided by CDC to conduct patient Support provided by CDC to conduct patient throughput modelingthroughput modeling

Report received and helped validate existing dataReport received and helped validate existing data

Staff/Volunteer SurveyStaff/Volunteer Survey

Surveys returned by 184 individualsSurveys returned by 184 individuals32% volunteers32% volunteers

17% S.M.A.R.T.17% S.M.A.R.T.15% Others (CERT)15% Others (CERT)

69% Government employees69% Government employeesPrevious POD experiencePrevious POD experience

50% worked in previous POD50% worked in previous POD39% had no POD experience39% had no POD experience1% had drive1% had drive--through experiencethrough experience

Reporting to the PODReporting to the POD

SeptemberSeptember FebruaryFebruary

Directed to registration table: Directed to registration table: ImprovedImprovedAlways Always 83% 83% 56% 56% Sometimes Sometimes 9% 9% 25%25%Never Never 9% 9% 16%16%

Asked to sign in: Asked to sign in: ImprovedImprovedAlways Always 94%94% 65%65%Sometimes Sometimes 4%4% 23%23%Never Never 2%2% 9%9%

18

Reporting to the POD ContinuedReporting to the POD Continued

SeptemberSeptember FebruaryFebruary

Asked to show photo ID: Asked to show photo ID: ImprovedImproved

Always Always 64%64% 26%26%Sometimes 10%Sometimes 10% 12%12%Never Never 26%26% 58%58%

Provided with necessary supplies: Provided with necessary supplies: ImprovedImproved

Always Always 91%91% 65% 65% Sometimes 9%Sometimes 9% 25% 25% Never Never 1%1% 4%4%

Role in the PODRole in the POD

Most respondents served as:Most respondents served as:Other: 31%Other: 31%Clinic flow/greeters: 21%Clinic flow/greeters: 21%Vaccinators: 19%Vaccinators: 19%

Felt POD role was wellFelt POD role was well--defined: 94% defined: 94% Felt wellFelt well--trained (intrained (in--person) for role: 92% person) for role: 92% Received adequate written information to be Received adequate written information to be prepared for role: 74%prepared for role: 74%

JustJust--inin--Time TrainingTime Training

Majority of staff received multiple trainingMajority of staff received multiple trainingType of training varied and included:Type of training varied and included:

Role/position training (86%)Role/position training (86%)Overview of clinic process (83%)Overview of clinic process (83%)General staff briefing (96%)General staff briefing (96%)Paperwork review (55%)Paperwork review (55%)Job Action Sheet (63%)Job Action Sheet (63%)

All types of training received were increasedAll types of training received were increasedTraining modes were found helpful by almost all Training modes were found helpful by almost all respondents (90 respondents (90 –– 98%) (JAS 98%) (JAS –– overview of clinic overview of clinic process)process)

Previous POD TrainingPrevious POD Training

Respondents had completed a higher % of training:Respondents had completed a higher % of training:IS 100 (88%)IS 100 (88%)BloodborneBloodborne Pathogen ( 82%)Pathogen ( 82%)ICS 200 (69%)ICS 200 (69%)Infection Control (66%)Infection Control (66%)CPR (63%)CPR (63%)IS 700 (62%)IS 700 (62%)Working in a POD (33%)Working in a POD (33%)

Most respondents found trainings very or somewhat Most respondents found trainings very or somewhat helpfulhelpful

CommunicationCommunication

Overall, all measures of communication were Overall, all measures of communication were significantly significantly improvedimproved: :

Between staff from your POD section and other Between staff from your POD section and other sections of the PODsections of the PODWith the public: very (73%) or somewhat (25%) With the public: very (73%) or somewhat (25%) effective effective Between staff from your POD section going up the Between staff from your POD section going up the chain of command to other sections of the incident chain of command to other sections of the incident command. (very 55%, somewhat 37%)command. (very 55%, somewhat 37%)

Individual Skill in POD TasksIndividual Skill in POD Tasks

Describe the importance of using easy to understand Describe the importance of using easy to understand language while working at the PODlanguage while working at the PODUndertake effective strategies for coping with stress Undertake effective strategies for coping with stress and get help if necessaryand get help if necessaryRespond to conflict between myself and an attendee in Respond to conflict between myself and an attendee in a manner appropriate to my joba manner appropriate to my jobUnderstand the rules concerning communicating with Understand the rules concerning communicating with the media, the public, friends and familythe media, the public, friends and familyRespondents improved from 46% to 79% (Strongly Respondents improved from 46% to 79% (Strongly Agree)Agree)

19

Best Meets Specific POD Tasks?Best Meets Specific POD Tasks?

88%88%12%12%results in the greatest levels of results in the greatest levels of vaccineevaccineesatisfaction.satisfaction.

34%34%66%66%is safest for staff and volunteers. is safest for staff and volunteers.

80%80%20%20%is easiest for staff and volunteers to is easiest for staff and volunteers to participate in (i.e. has roles which are easily participate in (i.e. has roles which are easily and successfully fulfilled by staff and and successfully fulfilled by staff and volunteers). volunteers).

86%86%14%14%has the fewest number of interruptions in has the fewest number of interruptions in flow of vaccinees through the POD. flow of vaccinees through the POD.

91%91%9%9%is the quickest for vaccinees (i.e. which is the quickest for vaccinees (i.e. which method allows vaccinees to complete the method allows vaccinees to complete the POD in the shortest time).POD in the shortest time).

DriveDrive--Thru Thru ModelModel

WalkWalk--Thru Thru ModelModel

POD Model whichPOD Model which……

Ongoing IssuesOngoing Issues

Integration of volunteersIntegration of volunteersAttitude of paid staff versus volunteersAttitude of paid staff versus volunteersNeed for single volunteer point of contactNeed for single volunteer point of contact

EmployeesEmployeesRequirement to hold trainings during working hoursRequirement to hold trainings during working hours““ItIt’’s not my jobs not my job”” mentalitymentalityJob title versus functional roleJob title versus functional role

Training needsTraining needs

Contact InformationContact Information

Tracy Fricano ChalmersTracy Fricano ChalmersDirector, Erie CountyDirector, Erie County

Office of Public Health Office of Public Health Emergency PreparednessEmergency [email protected]@erie.gov

(716) 961(716) 961--68656865

Nikhil NatarajanNikhil NatarajanAssociate Director, Associate Director,

NYSDOH Public Health NYSDOH Public Health PreparednessPreparedness

[email protected]@health.state.ny.us(518) 402(518) 402--77137713

1

Urban to Rural Evacuation: Urban to Rural Evacuation: Planning for Population SurgePlanning for Population Surge

Tracy Fricano Chalmers, M.S.Program Manager, WNYPHA Advanced

Practice Center

Michael Meit, M.A., M.P.HDeputy Director, NORC Walsh Center

for Rural Health Analysis

WNY Public Health Alliance• The Western New Public Health Alliance APC is the only APC to focus on rural preparedness.

• Working with the eight counties of western New York and contiguous Pennsylvania and Canadian provincial agencies, the WNYPHA APC develops tools and resources to assist emergency planners with urban to rural evacuation and cross-jurisdictional planning.

WNYPHA: APC focus • Evacuation/migration of populations from urban torural areas and prediction of post-event population surge

• Cross border issues including legal, jurisdictional, mutual aid, constraints to collaboration, and ongoing activities

• Training needs of public health/emergency planners relevant to evacuation, rural issues

• Partnering and collaboration with new and diverse partners– Regional Mass Fatality Planning– Alternate Care Site Planning

Evacuation Tools and Products

Spontaneous Evacuation• Evacuation should not

be conceptualized as the government bringing in buses and taking people to shelters

• Rather, the vast majority of people evacuate on their own, in their own vehicles

• Where do they go?• What are the

implications for reception communities?

What would you do?

• Imagine yourself transported nearly 30 years back in time, living in Harrisburg, PA.

Three Mile Island - March 28, 1979

• Only 3,500 should have left…144,000 people within a 15 mile radius of the plant evacuated (evacuation shadow)

• Median evacuation response: 85mi (137km), 100 mi (161km), 111 mi (180km) (depending on study cited)

• Virtually none went to Hershey shelter

• What might happen today?– Post 9/11 & Katrina– 24 hour news cycle

NORC Policy Briefs

Key Informant Interviews:Methods

• 30-45 minutes by phone

3 Key Informant Groups:

• National Experts (6)– Academics– Government Experts– Private-Sector

Researchers

• semi-structured interviews

• Urban/Rural Pairs– Local Rural Preparedness

Experts (6)– Local Urban Preparedness

Experts (5)• Emergency preparedness

coordinators• Public health department

directors

Key Informant Interview Findings -National Experts

• Evacuation “to” and “through”• Risk communications is key• Traffic control a major issue• Mandatory evacuations generally less

successful• Perceptions of rural regions:

– Rural regions unprepared– May not be receptive to evacuees– Need for development of regional coordinating

bodies and response plans

Key Informant Interview Findings -Urban Experts

• Few have considered urban evacuation to rural communities

• Destinations:– Most feel citizens will go to other urban areas, where they will

“feel comfortable”– Family/friends, hotels & away from the threat/danger

• Shelter-in-place– Believe citizens will cooperate if message delivered

appropriately– Consistent with national and rural experts, urban planners

mixed in opinion of whether or not citizens will isolate/quarantine or evacuate if faced with pandemic flu

Rural Experts’ Bottom Line

While a larger overall number of evacuees may go to other urban areas in many scenarios, it will take fewer evacuees to overwhelm smaller, rural community systems. In addition to considering raw numbers of evacuees, an analysis of the ratio of evacuees to existing population is an important planning consideration.

NORC Walsh Center Survey

Fig. 1: Expected Reactions to Explosion of a Dirty Bomb

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Governmentadvises not to

evacuate

No governmentrecommendation

Trusted friend orfamily urgesevacuation

Governmentsuggests

evacuation

Governmentorders evacuation

External Influence

Perc

enta

ge o

f res

pond

ents

Likely to evacuateNot likely to evacuateDon't know


Fig 2: Expected Reactions to a Flu Pandemic

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Governmentadvises not to

evacuate

No governmentrecommendation

Trusted friend orfamily urgesevacuation

Governmentsuggests

evacuation

Government ordersevacuation

External Influence

Perc

enta

ge o

f res

pond

ents

Likely to evacuateNot likely to evacuateDon't know


Fig 3: Likelihood of Following Instructions to Shelter-in-Place and Advice Not to Evacuate

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dirty Bomb -Instructed to SIP

Pandemic Flu -Instructed to SIP

Dirty Bomb -Advised NOT To

Evacuate

Pandemic Flu -Advised NOT To

Evacuate

Condition

Perc

enta

ge o

f res

pond

ents

Likely to followinstruction/advice

Likely not to followinstruction/advice


Fig 4: Expected Destinations of Survey Respondents in Evacuation Scenarios

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban Rural Don't Know

Destination

Perc

enta

ge o

f Sur

vey

Res

pond

ents

Dirty Bomb

Pandemic Flu


Fig. 5: Expected Travel Distances of Survey Respondents in Evacuation Scenarios

0%

10%

20%

30%

40%

50%

Less than 50 MilesAw ay

Betw een 50 and 150Miles Aw ay

Betw een 150 and 250Miles Aw ay

More than 250 MilesAw ay

I don't know

Distance

Perc

ent o

f Sur

vey

Res

pond

ents

Dirty Bomb

Pandemic Flu

Likelihood of Evacuation by Race/Ethnicity, Odds Ratios*

Black p Hispani

c p

Dirty Bomb 1.84 0.01 1.96 < 0.01

Pandemic Influenza

3.18 < 0.01 2.49 < 0.01


* Note that white survey respondents (equivalent to 1) served as the reference group for this odds ratio analysis.

WNYPHA Evacuation Planning Tool: Purpose

The objective of this project is to develop a mapThe objective of this project is to develop a map--based based tool to predict community population surge following tool to predict community population surge following potential urban disasters. We envision the final product potential urban disasters. We envision the final product being used as a planning tool for preparedness planners, being used as a planning tool for preparedness planners, and as an educational tool to inform policy makers about and as an educational tool to inform policy makers about the issue of population surge resulting from urban the issue of population surge resulting from urban evacuation.evacuation.

The tool includes information on the number of likely The tool includes information on the number of likely evacuees, evacuee demographic information (such as evacuees, evacuee demographic information (such as presence of children, disability status, etc.), and local presence of children, disability status, etc.), and local planning information.planning information.

WNYPHA Evacuation Planning Tool: An Environmental Scan

•• To date, community risk assessments have tended to To date, community risk assessments have tended to focus on issues within the specific community and have focus on issues within the specific community and have not examined the implications of population surge not examined the implications of population surge resulting from evacuating residents from neighboring resulting from evacuating residents from neighboring urban areas.urban areas. In many areas, public health infrastructure In many areas, public health infrastructure is likely to be stretched thin or possibly overwhelmed in is likely to be stretched thin or possibly overwhelmed in such a scenario.such a scenario.

•• At the same time, evacuation planning research has At the same time, evacuation planning research has focused primarily on the successful exodus of urban focused primarily on the successful exodus of urban citizens following a disaster situation, with little focus on citizens following a disaster situation, with little focus on likely destinations or secondary impacts.likely destinations or secondary impacts.

"In preparing for battle, I have always found that plans are useless, but planning is indispensable." –General Dwight D. Eisenhower

WNYPHA APC Project: A Modeling Tool

“All models are wrong, some are useful”- George Box, Industrial Statistician

"Prediction is very difficult, especially if it's about the future."

- Nils Bohr, Nobel Laureate in Physics

WNYPHA Evacuation Planning Tool: Methods

–– Identified variables predictive of urban evacuation Identified variables predictive of urban evacuation patterns based upon historical evidence and key patterns based upon historical evidence and key informant interviews with preparedness experts in informant interviews with preparedness experts in metropolitan and nonmetropolitan and non--metropolitan communities and metropolitan communities and national authoritiesnational authorities

–– Developed modeling algorithms using identified Developed modeling algorithms using identified variables based upon availability of nationwide data variables based upon availability of nationwide data sets containing countysets containing county--level informationlevel information

–– Set variables based on NORC survey findings and Set variables based on NORC survey findings and historical evidencehistorical evidence

–– Worked with Penn State UniversityWorked with Penn State University’’s Center for s Center for Environmental Informatics to develop a webEnvironmental Informatics to develop a web--based based interface that provides access to evacuation interface that provides access to evacuation information in a userinformation in a user--friendly manner.friendly manner.

How the tool works – 3 types of variables

Scenario Specific Variables: Scenario Specific Variables: Based on the nature of the precipitating event Based on the nature of the precipitating event –– how much how much ““pushpush””does it have, and how many urban citizens are likely to evacuatedoes it have, and how many urban citizens are likely to evacuateas a result?as a result?Current scenarios: dirty bomb, pandemic flu, industrial/chemicaCurrent scenarios: dirty bomb, pandemic flu, industrial/chemicall

Demographics Variables:Demographics Variables:Based on the demographics of the urban area, who is more or Based on the demographics of the urban area, who is more or less likely to evacuate? For example, people with children are less likely to evacuate? For example, people with children are more likely to evacuate; people with disabilities are less likelmore likely to evacuate; people with disabilities are less likely to y to evacuate, etc.evacuate, etc.

Pull Variables:Pull Variables:Based on known information about counties surrounding the Based on known information about counties surrounding the urban area, which will be more or less attractive to evacuees? urban area, which will be more or less attractive to evacuees? Features that make a county more attractive include things such Features that make a county more attractive include things such as road networks into the county, number of hotel rooms and as road networks into the county, number of hotel rooms and second homes, family networks, etc.second homes, family networks, etc.

Setting Variables

Setting variables:Setting variables:•• Historical studies (e.g., TMI, hurricanes)Historical studies (e.g., TMI, hurricanes)•• Survey researchSurvey research•• Expert opinionExpert opinion

Data sources:Data sources:•• U.S. Census BureauU.S. Census Bureau•• U.S. Bureau of Labor StatisticsU.S. Bureau of Labor Statistics•• Smith Travel ResearchSmith Travel Research

Urban to Rural Evacuation: 2008 –2009 Objectives• Enhancement of Evacuation Modeling Tool

Features– Custom analysis (selection of radius, block areas)– Ability to save/print reports

• Usability Testing and User Feedback• Refinement of Evacuee Demographic Predictions

of Evacuation Modeling Tool and Data Updates– (age, household composition, special medical needs,

language, disability, etc.)• Production of User Guides and Promotional

Materials; Stakeholder Outreach

Expert Panel

•• Convened expert panel of rural/ suburban Convened expert panel of rural/ suburban first responders and emergency planners on first responders and emergency planners on February 4February 4thth to identify key planning to identify key planning considerations for rural communities.considerations for rural communities.

•• Developing planning guidelines and Developing planning guidelines and recommendations to disseminate to rural/ recommendations to disseminate to rural/ suburban responders and planners.suburban responders and planners.

Planning Guide Outline

• Pre-Event– Partners and volunteers– Regional coordination– Vulnerability assessment and training/exercising

• Event– Incident command structure– Facilitated movement and reception sites– Addressing evacuee and resident needs– Communications– Time length and legal considerations– State/federal assistance

• Post-Event– Going home, assessment, monitoring, and

evaluation

Expert Panel Findings: Pre-Event

• Imperative to establish relationships with partners and volunteers pre-event.

• Be inclusive when recruiting partners and make they are active, invested participants in the planning process.

• An offer of training/education can be incentive to recruit volunteers and partners and can be an effective mechanism for raising awareness.

Discussion: Pre-Event

• Who should be included in a community response planning team? Roles?

• What sort of training/exercises should the community response planning team undergo?

• Discuss regional planning considerations. Share personal experiences with spontaneous evacuation if possible.

• How do you ensure local systems are ready to serve incoming evacuees?

Expert Panel Findings: Event

• Establish an alternate care facility to conserve hospital resources.

• Identify those resources that could be used to facilitate movement (i.e. buses from business partner to move people to destination better equipped to handle population influx).

• Know pharmacies’ capacities.• Be suspicious of claimed eligibilities among

evacuees and credentials among volunteers

Discussion: Event

• Discuss methods to facilitate population movement and disperse evacuees.

• Discuss strategies for establishing and maintaining reception points.

• What can a community do to prepare for evacuees from a disaster with direct health implications?

• What can a community do to prepare for special needs populations?

• How can a community maintain supplies and staff and allocate these resources so that both evacuee and resident needs are met?

• Discuss impacts of lengths of time in evacuations.

Expert Panel Findings: Post-Event

• Often, post-event, people must get back to their day-to-day jobs and have little time for evaluation; consider asking universities or local academic institutions to help with assessments.

• Do not count on state/federal aid, but know processes for obtaining aid.

• Seek aid or borrow from partners.

Discussion: Post-Event

• How would you facilitate the return of evacuees to their respective homes?

• Would you conduct a post-evacuation assessment of community response?

• Discuss processes for evaluating community recovery needs.

• Discuss process for identifying gaps in preparedness efforts and conducting a post-disaster vulnerability assessment.

• Rural Preparedness Planning Guide

• Panel findings synthesized into set of guidelines

• Intended audience: rural preparedness planners (local health depts., emergency managers, etc.)

Implications for Rural Preparedness Planning

Volunteers

RegionalCoordination

VulnerabilityAssessment

Training/Exercising

Needs

Communications

ResponsePartners

Pre-Event

FacilitatedMovement

ReceptionSites

Evacueeswith and without

ImmediateHealthNeeds

EvacueesWith

ChronicConditions

AddressingResidentConcerns

Communications

State/FedAssistance

Length ofStay &LegalIssues

IncidentCommand

System(ICS)

Event

Post-eventvulnerabilityassessment

Recouplosses

Assist thosewho suffered

hardship

Post-Event

Appendices

• Documents/templates the panelists felt rural planners would find helpful

• Appendices include:– Sample mutual aid agreements– Sample portable trailer supply list– Sample emergency supply check-list to

distribute to residents– Sample triage plan

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General recommendations

• General issues planners must keep in mind when formulating response plans

For More Information:

Michael Michael MeitMeit, MA, MPH, MA, MPHDeputy DirectorDeputy DirectorNORC Walsh Center for NORC Walsh Center for Rural Health AnalysisRural Health Analysis4350 East West Highway, 4350 East West Highway, Suite 800Suite 800Bethesda, MD 20814Bethesda, MD 20814Phone: 301Phone: 301--634634--93249324Email: Email: [email protected]@norc.org

Tracy Fricano Chalmers, M.S.Project ManagerWestern New York Public Health

Alliance Rural APC462 Grider StreetBB Building, Room 172Buffalo, NY 14215Phone: 716-961-6865Email: [email protected]