January 22, 2003
In this issue:
- Smallpox Vaccination Implementation
- Minnesota Infrastructure Preparedness
- Hospital Emergency Preparedness Planning
- Second Quarter Report: Public Health Preparedness Grant
- Mental Health Information
Local public health departments throughout Minnesota are doing a phenomenal
job planning for the implementation of phase 1 of the smallpox vaccination
program. The work is challenging and at times frustrating. We know you are
all working very hard to ensure that the smallpox vaccination program will
not jeopardize the health of any vaccinated individual.
Due to a number of contributing factors, the MDH decided to delay the initiation of smallpox vaccination clinics to mid February. The MDH has rescheduled its clinic for MDH staff to February 12. On February 13 and 14, these MDH staff will head out and vaccinate regional clinic vaccinators. Once vaccinated, these staff can begin vaccinating at regional clinics.
This revised schedule for clinics depends on resolution of some key issues:
1) Approval by CDC of Minnesota’s Phase 1 Vaccination Plan. Full approval was received, January 17, 2003.
2) A declaration by the Secretary of Department of Health and Human Services,
(DHHS) that an actual or potential bioterrorist incident warrants the administration
of a covered countermeasure i.e., the smallpox vaccine, according to the Federal
Homeland Security Act. A declaration is still anticipated to be January 24,
2003, according to a DHHS memo we received on January 14, 2003.
3) CDC issuance of protocols for dealing with adverse events of the smallpox vaccine. These protocols are crucial to ensure the ability to appropriately respond to any situation where a vaccinated individual experiences any adverse consequences to the vaccine. The protocols have not yet been issued, but are anticipated shortly.
4) Identification of physicians who will respond to individuals with adverse events, and provision of training to these physicians. The MDH is in the process of identifying these physicians. Anticipating the protocols, CDC’s training of physicians is scheduled for February 4, 2003.
5) Other training of key participants in the vaccination program. Over 700
public health staff filling clinical roles at regional clinics participated
in a training event on January 17. Repeat training sessions for those unable
to attend the training will be scheduled shortly. Video of the training will
be available as well.
We hope you understand our decision is based on doing our best to implement a vaccination program that will not begin until we have a system in place that can respond swiftly and adequately to any health issues caused by vaccine administration. We are hopeful that resolution of these key issues will occur over the next couple weeks to allow implementation of our revised schedule.
If you have concerns, please continue to work with your MDH public health preparedness consultants. We are hopeful that we can collectively implement this program together. Thanks for your continued support and hard work.
The Minnesota Department of Health is working with critical infrastructure sectors in Minnesota to understand the impact of terrorist attacks on water utilities, and will assist these utilities to protect their facilities and distribution systems.
During the summer of 2002, the U.S. Environmental Protection Agency (EPA) sent letters to all community water systems that serve more than 3300 people to officially notify these systems of the requirement to perform vulnerability assessments and update their emergency plans. The EPA is handling this requirement directly with the systems rather than delegating it to the states. At issue is the variety of state data privacy laws that the EPA fears may require some states to give out vulnerability information about water systems.
On June 11, 2002, the cities of Minneapolis and St. Paul were each awarded Environmental Protection Agency, (EPA) security grants of $115,000 each to be used for vulnerability assessments of their drinking water facilities. Cities serving more than 100,000 people are required to submit vulnerability assessments to EPA by March 31, 2003. On September 23, 2002 MDH sent in a modification to the grant to receive an additional $362,200. Using these funds, MDH will work with water utilities, professional associations, EPA and other partners to provide tools, training, and technical support to assist water utilities to conduct vulnerability assessments, implement security improvements, and effectively respond to terrorist events.
The MDH and Minnesota Rural Water Association staff has also attended a train the trainer workshop presented by a Sandia National Laboratories contractor on water system vulnerability assessments. Since the course, those trained have met to develop a vulnerability assessment course for small Minnesota drinking water systems. The course will target those systems that provide services to less than 3300 people. The course will be given throughout the state, with the first session debuting at the Rural Water Conference in St. Cloud scheduled on March 4, 2003. In the interim, a Security Vulnerability Assessment Guide is available on the MDH Drinking Water Website.
The MDH has assembled emergency incident response kits for use by MDH staff or first responders when there is a security breach or other emergency at a water system. Two kits will be located in each MDH district office.
Environmental health staff will also build security concerns into on going review systems (e.g., sanitary survey, capacity development, operator certification, and treatment optimization program for drinking water systems and pretreatment program, and operator certification programs). The MDH is also partnering with other federal and state government agencies, utility organizations, and water utilities to establish formal communication mechanisms that will facilitate the timely and effective exchange of information on water utility security threats and incidents.
The eight hospital regions in Minnesota’s Hospital Bioterrorism Preparedness Program, (HBPP) recently submitted their Health Resources and Services Administration, (HRSA) second-phase grant proposals. A review team consisting of members of the HBPP advisory committee will review the grants over the next few weeks. Partnerships between hospitals and public health continue to be a focus, especially in the areas of incident command and control and communications.
Planning activities for smallpox vaccination of public health and hospital employees has greatly strengthened the relationships between local and regional public health and hospitals. This has been of great value and has added tremendously to our understanding of each other’s resources and needs.
Liability issues and personal risk from smallpox vaccination seem to be weighing heavily on the minds of hospital staff in the early stages of hospital personnel recruitment for vaccination, with many facilities reporting much a much lower level of interest than anticipated. However, Department of Health and Human Services, (DHHS) Secretary Tommy Thompson recently issued a statement that addresses the liability concerns of the Phase 1 vaccination implementation. Also, our hope is that through comprehensive screening, vaccinees will experience low rates of complications.
Though you may feel that you are driving 90 mph in a fog right now, hold on, soon we’ll be actually implementing the plan, which is always better than waiting and worrying. As we move through this vaccination planning process, please keep your eyes open for areas of partnership and gaps in health/hospital/EMS planning so that we can truly apply some ‘all-hazards’ solutions, and not just those that work for this particular smallpox vaccination problem. Good luck with your planning, thanks for your patience, and bring on the bifurcated needles!
The form local public health departments will use to complete their second quarter report for the Centers for Disease Control and Prevention, (CDC) public health preparedness grant is now available. It has been sent to Bioterrorism Coordinators, CHS Administrators and Public Health Nursing Directors.
The State Community Health Services Advisory Committee, (SCHSAC) Local Public Health Preparedness Review Group indicated that a three-week time frame to complete the report was sufficient. However, due to current demands on public health departments and as a result of feedback from district staff, we will are allowing four weeks to complete the report. The report is due on Friday, February 14, 2003.
Please note that the SCHSAC Local Public Health Preparedness Review Group identified a separate need to collect detailed expenditure data for Phase I implementation of the smallpox pre-event vaccination plan. This detailed information will be requested soon, in a separate format. This should not change the expenditure data you are submitting in your second quarter report. Include any appropriate costs related to smallpox vaccination preparation.
If you have any questions regarding preparation of your report, please call the Public Health Preparedness Grant Manager assigned to your region.
The following information about mental health may assist you in your daily work activities.
“PERSPECTIVE: Use it or lose it”: by Drevis Hager, EdD, LP, Behavioral Services Inc. 651-681-1600
When it comes to problem solving, including emotional problems, perspective is everything. Your personalized and unique understanding of any situation will profoundly influence your emotional reactions, the solutions that you develop, and how you outwardly respond. Keep this axiom in mind:
Narrowed perspective makes problems seem bigger.
Broadened perspective makes problems seem smaller.
Perspective shifting is an effective way of reducing your distress about a situation, and the necessary first step of creative problem solving. By shifting to a broader perspective, we are getting out of “the box” of our habitual and rigid ways of viewing a problem. Here are four ways that we can shift perspective:
1. Shifting time perspective.
* Remind yourself that, “This too shall pass”
* Will this matter in a year? In five?
* When you are very old, will this be remembered as important?
2. Shifting space perspective.
* Ask yourself “Am I too close to the trees to see the forest?
* See yourself and your problems as merely a small dot on a map of the world. Imagine that you are in outer space looking back at the earth. If we adopt this type of “big scheme of things” perspective, then many of our problems seem trivial.
3. Interpersonal Shifts.
* How does the other person experience this? (situation)
* Does the other person actually have a point worth considering?
* Remember that there is always somebody else who has it worse.
* Is this event actually helpful to somebody else?
4. Shifting priorities and meanings.
* Ask yourself “What really matters? Is this important?” Give the issue an importance rating, e.g. on a 1-100 scale.
* Ask yourself “Is this a moral/ethical issue for me, or am I upset merely because I want my way?”
* How might this actually be for the better?
* Can you imagine that this could lead to something valuable later?
* Look for something to be grateful for. Try to find the big picture. For example, a person who has suffered a terrible injury might be grateful that she/he is still alive.