August 21, 2002
PURPOSE OF THE OEP NEWSLETTER
The Office of Emergency Preparedness is distributing an online newsletter to local public health departments. The newsletter is intended to provide timely communication about program development within the various focus areas of the CDC Public Health Preparedness Grant. Contributors to this issue of the newsletter are individuals throughout the MDH, who are responsible for particular focus areas of the CDC grant. Topics discussed in future newsletters will vary according to the information we need to share.
A MESSAGE FROM THE DIRECTOR
Welcome to the first issue of the OEP Newsletter. The Office of Emergency Preparedness is a newlycreated office within the MDH to assist in the coordination of activities in both the CDC Public Health Preparedness grant and the HRSA Hospital Bioterrorism Preparedness Program. The OEP will lead assessment, planning, Health Alert Network, and education grant activities.
We have established an email address for the OEP at firstname.lastname@example.org. You will occasionally receive information from the OEP. Its our way of assuring that your questions and suggestions are forwarded to the most appropriate person. You can email us at that address or feel free to email any of the staff in the OEP directly.
The staff currently in the OEP include:
Robert is the Director of the OEP and will be responsible for the overall management and direction of OEP activities.
Dee is responsible for coordination and supervision of planning, education, and training activities in the OEP.
Myrlah is responsible for coordination and supervision of assessment, web development, and Health Alert Network activities. Myrlah can be reached at email@example.com.
Brent is responsible for the development of the smallpox and National Pharmaceutical Stockpile plan.
Jim is responsible for assisting local public health in development of their grant activities and local plans.
Micaela is responsible for the development of the OEP website.
The mailing address for all staff will be Minnesota Department of Health, Office of Emergency Preparedness, Golden Rule Building, 85 East 7th Place, P.O. Box 64882, Saint Paul, MN 551640882.
Hopefully you will find the information presented in the newsletters helpful. Let us know.
A MESSAGE FROM ASSISTANT COMMISSIONER, AGGIE LEITHEISER
A reminder from Assistant Commissioner Aggie Leitheiser. The next meeting of the Commissioners Task Force on Terrorism and Health is scheduled for August 27, from 1:00 to 4:30 p.m. at the MDH Snelling Office Park. The Task Force will hear updates on federal activities, smallpox vaccination issues, establishment of the Office of Emergency Preparedness and information on the Homeland Security Advisory Council, a joint committee of the MDH and the Department of Public Safety established by the 2002 legislature. The primary focus of the Task Force meeting will be a discussion of the Emergency Health Powers Act study and other related issues. The meeting is open to all interested parties.
FOCUS AREA A: PREPAREDNES PLANNING AND READINESS ASSESSMENT
Brent Mather, Principal Planner in the OEP is continuing to work on the State Distribution Plan for the CDC National Pharmaceutical Stockpile (NPS) of pharmaceuticals and medical supplies. Often referred to as the "12hour push package," the NPS is a federal program used to rapidly deliver supplies to respond to terrorism events involving biological and chemical agents. The planning group for the push package includes participation from Ramsey and Hennepin counties, the Minnesota Division of Emergency Management, and the National Guard. The CDC is conducting a site visit on August 20, to offer guidance, and review the status of the state plan.
In addition, Brent is leading the development of the Minnesota Smallpox Plan. A Smallpox Steering Team has been organized to assist in the writing the plan. The steering team held its fourth meeting on August 15. In order to ensure the smallpox plan meets local needs the MDH has added four local public health representatives from a broad geographic area. The following individuals expressed interest in working on the smallpox plan and were selected to join the group: Mary Jo Fritz, Hennepin County Community Health Department, Margene Gunderson, Mower County Community Health Services, Susan Carolan, Anoka County Health Department, and Franchetta Haupert, Stevens County Health Department. Steering team members are responsible for assisting in the development of content on procedures for surveillance, contact tracing and identification, quarantine and isolation, communications, specimen collection, and infection control.
Supporting the Smallpox Steering Team is Jim Losinski, Principal Planner for local public health in the OEP. Jim will coordinate a Smallpox Review Committee made up of local public health representatives. This group is responsible for reviewing drafts of the smallpox plan, and then making recommendations to the steering team. The first meeting of the committee will take place in the middle of October. The review committee includes: Jane Norbin, St. PaulRamsey County Public Health, Mary Jo Chippendale, Chisago County Public Health, Denice Tracy, Wright County Public Health, Amy Springer, Morrison County Public Health, Larry Edmonson, Olmsted County Public Health, Becky Felling, McLeod County Public Health, Mary L. Vos, Clay County Public Health.
Jim has also been working closely with staff in the Community Health Division to assess the needs of the MDH District offices. The Community Health Division will be hiring bioterrorism/emergency preparedness staff in each of the district offices to assist local public health agencies plan for, and respond to, bioterrorism, and other public health emergencies. To date, staff have been interviewed and hired in the Marshall, Mankato, and Bemidji District offices.
The new district office staff will play a crucial role in developing training exercises for local public health agencies. Currently, Mary Rippke, bioterrorism staff, and Public Health Nurse Consultant for the Mankato District Office, and Jan Forfang, District Epidemiologist for the Mankato District office have initiated the development of a pandemic flu scenario that can be used for statewide training. Assisting Jan and Mary are Kris Ehresman, and Shelly Feaver of the Acute Disease Prevention Services Section of MDH. They are writing templates for the flu training scenario. The templates will cover topics such as: whos in charge, invitees, county plans, the Minnesota Incident Management System (MIMS), risk communications and details of the flu scenario.
FOCUS AREA B: SURVEILLANCE AND EPIDEMIOLGY CAPACITY
John Clare, Epidemiology Field Services Supervisor will be recruiting candidates for the new District Epidemiologist positions in Northeast (Duluth) and Southwest (Marshall) districts. These positions are designed to improve surveillance, outbreak reporting and response capabilities in greater Minnesota and to better assist local public health agencies in support of surveillance activities with local providers. Although, not funded with bioterrorism grant funds, the District Epidemiologist position in St. Cloud will also be filled.
Additionally, Dr. Heidi Kassenborg is coordinating multiple projects within Focus Area B. The following is an up to date summary of Dr. Kassenborgs activities.
BIOTERRORISM AND RESPIRATORY DISEASE SYNDROME SURVEILLANCE
Initial symptoms of many diseases that could be due to bioterrorism can be similar to symptoms associated with influenzalike illness (ILI). A clinicalbased surveillance system involving expeditious reporting of ILI patient symptoms greatly enhances the ability to detect a possible bioterrorismrelated illness. Selected data from patient encounter data forms, stripped of identifying information, are transmitted electronically each day to MDH from Health Partners Medical Group (HPMG), a provider of medical care to approximately 220,000 in the Minneapolis/St. Paul metropolitan area. Changes in patterns of ILI symptoms are analyzed to determine if there may be an unexpected increase in the number of patients with these symptoms, which may signal a bioterrorism event.
ELECTRONIC LABORATORY REPORTING PROJECT
MDH receives electronic laboratory reports of infectious disease diagnoses from five clinical laboratories. Rapid infectious disease reporting may help to quickly identify infectious disease outbreaks.
MINNESOTA POISON CONTROL CENTER (MPCC)
MDH is in the process of setting up a system to be able to receive and analyze data on the types of poisonrelated inquiries made to the MPCC. In addition to household exposures, MPCC data contain information on exposure to known or unknown substances in the environment. Analysis of changes in these data could assist in the detection of a possible bioterrorism incident.
EMERGENCY MEDICAL SERVICES SURVEILLANCE
Initial symptoms of many diseases that could be due to bioterrorism can be similar to symptoms associated with influenzalike illness (ILI). We are in the process of developing a system to receive and analyze data from the Minnesota Emergency Medical Services Research Board, which includes illness, and demographic data for a patient requiring an ambulance or emergency response. Changes in pattern of illness will be analyzed to determine if there may be an unexpected increase in the number of patients with these symptoms, which may signal a bioterrorism event.
UNEXPLAINED DEATHS AND CRITICAL ILLNESSES PROJECT
All unexplained deaths and critical illnesses likely due to an infectious disease are requested to be reported to MDH along with the submission of certain laboratory samples. During a bioterrorism event an email is sent daily to an infection control practitioner at every hospital in Minnesota asking if the healthcare facility has had any seriously ill or fatal cases of a possibly infectious disease for which there is no diagnosis.
SENTINEL ANIMAL SURVEILLANCE
A system will be developed to receive and review data from the Minnesota Veterinary Diagnostic Laboratory to detect unusual or reportable disease events. Three quarters of all emerging infectious diseases are diseases that can be transmitted from animals to humans. Disease in animals can be an early warning sign of disease occurrence in human populations.
FOCUS AREA C: PUBLIC HEALTH LABORATORY FOR BIOTERRORISM PREPAREDNESS AN RESPONSE
The MDH Public Health Laboratory continues to focus on the Minnesota Laboratory System (MLS), a system of communication, collaboration, and cooperation with clinical laboratories serving Minnesota residents. Building a solid relationship with these laboratories is one of the main goals of the grant.
Another goal is to increase MDH capacity for laboratory testing. MDH has focused on hiring staff to improve laboratory capacity. Currently, three positions have been filled, a Molecular Biologist, a Bacteriologist to assist with the MLS, and a support position. In addition, interviews are being conducted to hire a Safety Coordinator, a Laboratory Planner, and a person responsible for developing a system for the safe and rapid transport of clinical specimens from all areas of our state and bordering states.
FOCUS AREA E: HEALTH ALERT NETWORK/COMMUNICATION AND INFORMATION TECHNOLOGY
Because of our concerns about our ability to respond to an event that might happen tomorrow, the first priority for the Health Alert Network (HAN) is to develop and test a 24/7 alert system for local public health agencies, hospitals, and Tribal Governments. As we talked with LPH staff about this project, it became clear that work needed to be done before a wireless email alert system could be implemented statewide. We are in negotiations now with a vendor of an autotelephone call system that will allow us to reach designated managers at home or by cellular phone. We will be working with the HAN Advisory Group to develop procedures that work for everyone. Stay tuned for more information. There are LPH agencies now using wireless email, and for those of you who are interested in moving forward with this, we will have information available within the next month or so.
We are happy to announce that Peter Edstrom will be joining the HAN staff this week. Peter has an impressive background in dynamic Web page development. Peter will be designing online data gathering tools that will help us all do the work of this grant.
Micaela Vega, our HAN Web Specialist, is designing a new OEP Web site that we hope will be ready to show you by the Community Health Conference.
FOCUS AREA F: RISK COMMUNICATION AND HEALTH INFORMATION DISSEMINATION (PUBLIC INFORMATION AND COMMUNICATION)
Within Focus Area F, Buddy Ferguson, the Risk Communications Director, will be asking local public health agencies for the people who will speak for the local health departments during a public health emergency. Each local health agency in Minnesota is being asked to designate an emergency spokesperson, and ideally, one or more backup spokespersons, so local health departments are able to respond to emergencies on a 24/7 basis.
Realistically, many local public health agencies may want to partner with other agencies to provide this function. Smaller communities may also have to answer questions about events occurring elsewhere, and other kinds of emergencies pandemic flu, for example, that may potentially affect all of us.
Once a local public health agency has appointed the spokesperson(s), the next step is to ensure that they are trained in the principles of risk communication, this is the scientificallybased discipline that provides essential tools for communicating with the public in a crisis situation. Peter Sandman, who is one of the leading national authorities, will be making a major presentation at this years Community Health Conference, Sept. 1113. Many of the local public health agencies have already identified "risk communicators," and they need to be at the conference if at all possible.
Other important issues that await local public health agencies in the future include the development of an emergency communications plan for each local agency, and the crafting of consistent and effective emergency messages. Further discussion about these tasks, and assistance in getting them done, will be forthcoming.
FOCUS AREA G: EDUCATION AND TRAINING
The MDH has entered into a contract with the University of Minnesota Center for Public Health Preparedness to conduct a workforce assessment. This project will identify the core competencies in bioterrorism, and emergency preparedness for a number of disciplines including public health, emergency department staff, EMS and other fields related to emergency response. The outcome of the assessment will be to develop training plans that address the competencies.
In addition, the OEP will be hiring health education staff to develop training materials, and provide training coordination on bioterrorism and other public health emergencies.
UPDATE ON HRSA HOSPITAL BIOTERRORISM PREPAREDNESS PROGRAM
The implementation of the HRSA Hospital Bioterrorism Preparedness Program (HBPP) is underway. Guidelines for Phase I of the HBPP have been developed and distributed to hospitals. Hospitals have begun to meet regionally to develop their Phase I applications. The Phase II guidelines will be distributed by September. For the Phase II application, each region must develop a plan to handle a sudden surge of 500 acutely ill patients, and be able to handle a progression of more patients than the initial 500 for the weeks following a bioterroist attack. The regions will decide on a permanent Regional Hospital Resource Center (RHRC) to provide organizational and planning leadership. Information on where you can view the Phase II guidance to hospitals will be included in a future newsletter.
Local public health representatives have been identified for each of the regions. These staff will attend regional hospital meetings, and share information with other local public health agencies in the region. Below is a listing of the RHRC for Phase I of the HRSA grant and the identified local public health representatives for the regions:
RHRC: St. Marys and St. Lukes, Duluth
LPH Reps: Julie Burns, St. Louis County
Sue Erzar, Itasca County
RHRC: Weiner Memorial Medical Center, Marshall
LPH Rep: Liz Auch, Countryside
RHRC: Douglas County Hospital, Alexandria
LPH Rep: Diane Thorson, Otter Tail
Sandy Tubbs, Douglas (backup but will participate)
RHRC: St. Cloud Hospital, St. Cloud
LPH Rep: Karen Nelson, Wadena
Renee Frauendienst, Stearns
Amy Springer, Morrison (backup to Karen)
Mary Jo Chippendale, Chisago (backup to Renee)
RHRC: Immanuel St. Josephs, Mankato
LPH Rep: Local representative being identified. Contact Ann Bajari, MeekerMcLeodSibley for now.
RHRC: Mayo Medical Center, Rochester
LPH Rep: Mary Wellik, Olmsted
Mary Ho, Rice
Margene Gunderson, Mower (backup to Mary Ho)
RHRC: Hennepin County Medical Center, Minneapolis
LPH Rep: Jane Norbin, St. PaulRamsey
Susan Paulchick, Hennepin
Lowell Johnson, Washington
Jennifer Deschaine, Scott
Pat Adams, Dakota (backup)