March 1, 2004
In this issue:
- CDC Public Health Law Newsletter
- ASTHO: Public Health Preparedness Newsletter
- Mass Vaccination Clinics - A Reality Check
- Mental Health Regional Planning
- Public Perspectives on the Mental Health Effects of Terrorism
- Risk Communication Training Sessions Offered For Local Public Health
- Hospital Preparedness Planning
- Update On Preparedness Tools For Drinking Water Systems
- Tri-State SARS Tabletop Held In Worthington Terrorism and Health Task Force
- Terrorism and Health Task Force
- Emergency Health Powers Legislation Proposed
CDC's Public Health Law News is a free electronic newsletter published every weekday except holidays by CDC's Public Health Law Program. The newsletter contains summaries of news reports on public health law and related subjects; announcements of public health law related publications, conferences, congressional hearings, and other events; a news quotation of the day; and other timely material. Subscribe to a CDC Mailing List, including this one.
Association of State and Territorial Health Officials (ASTHO) - Public Health Preparedness Newsletter
ASTHO's Public Health Preparedness Newsletter is distributed to key state health agency staff and to ASTHO partners and affiliates. ASTHO has also archived previous issues.
Learn how your community can prepare for a local mass vaccination campaign. On Thursday March 18, 2004 a satellite broadcast will be offered by the California Distance Learning Health Network to help public health professionals to improve their competency and capacity to provide mass vaccination services during a public health emergency. The broadcast is targeted for local public health department staff, and anyone involved in public health and safety.
Minnesota is divided into 8 public health emergency preparedness regions. Every region has a public health preparedness consultant, public health nurse consultant, epidemiology consultant, environmental health consultant, hospital consultant, and hospital resource center working on a variety of preparedness issues related to public health.
Each of the regions will also be adding a mental health coordinator to facilitate mental health planning efforts.
On January 15, 2004 the National Association of State Mental Health Program Directors (NASMHPD) and the National Mental Health Association (NMHA) released findings from a nationally representative survey that shows that more needs to be done to increase support for the mental heath impact of terrorism and prepare for the trauma and distress that would follow another terrorist attack. In fact, only a quarter of Americans feel the nation's public health system is currently meeting terrorism-related mental health needs. Listed below are some of the highlights from the survey
Americans Understand the Psychological Nature of Terrorism
- Nearly all Americans (93%) agree that the primary goal of a terrorist attack is to generate fear and distress. Three in four Americans (75%) say creating fear and distress among the public is the most important objective of terrorists.
- Half of Americans (50%) and two in three parents (65%) are concerned that members of their family will experience fear and distress about the threat of terrorism.
- Young children, people with prior mental health problems and senior citizens top the list of special populations that Americans believe are especially at risk of experiencing fear and distress about terrorism.
- Although attitudes about terrorism differ somewhat by gender, age, income and education, survey results clearly indicate that Americans of all demographics are highly concerned about the threat of terrorism and its mental health consequences.
- More than four in five Americans expect another terrorist attack in the near future – and that belief is consistent across the country, not just in the northeast.
Americans Want Reassurance, Programs to Cope with Fear and Distress
- Only a quarter of Americans (25%) think the nation's public health system is currently meeting terrorism-related mental health needs.
- Three in four Americans (75%) say that public officials could do a better job of communicating with the public about the threat of terrorism and its impact on our national psyche and mental health.
- Half of all Americans (50%) say public officials are not effective at encouraging people to seek help about fear and distress due to the threat of terrorism.
- Seven in ten Americans (70%) agree with the statement: it is just as important for the government to develop programs that deal with the fear and distress people experience as a result of terrorism as it is to take security precautions at physical installations and airports to prevent terrorism.
- Message matters, particularly by gender: 44% of men, but only 35% of women, prefer to hear that the country should stay resolute in the face of terrorism. But 61% of women, and 47% of men, think that public officials should: a) stress that it is natural to feel anxious and fearful about terrorism; and b) offer advice on dealing with it.
- To provide basic knowledge and practical skills in risk communication and media relations for key local public health staff.
- To introduce the crisis and emergency risk training curricula and tools developed by the CDC.
- To role-play media interviews and interactions.
Local public health agency staff who will be expected to communicate public health messages to the media and the public during a crisis or emergency, including designated emergency spokespersons, administrators, directors, policy planners, clinic coordinators, epidemiologists and public information staff.
This training will meet the risk communication training duties requirement for the CDC Bioterrorism grant.
Recurring Pitfalls in Hospital Preparedness and Response written by Jeffrey Rubin, a seasoned Oregon emergency manager, EMS/rescue responder, WMD planner, and HEICS trainer. The article discusses the results of numerous exercises and actual emergency responses across the United States. The author assembles a predictable list of pitfalls that continue to hinder effective disaster operations in hospitals: Mr. Rubin's analysis covers the following areas:
- Hospital security
- Decontamination procedures, equipment, and training
- Hospital staff management
- Exercise realism, content, follow-up
The Minnesota Department of Health Environmental Health Division (EHD) staff participated in a conference call for the American Society of Drinking Water Administrators' (ASDWA) Security Committee. During this call, U.S. Environmental Protection Agency (EPA) staff announced that they have released several modules of their Emergency Response Toolbox. The ASDWA committee reminded EPA that the modules are too lengthy and complex for a majority of water systems. At another conference call with the Interstate Chemical Terrorism group in January, it was stated that four of the six EPA modules are done and two are in draft. Only the very largest water systems will find these modules of practical value.To address smaller water system issues, MDH Environmental Health staff negotiated with the Minnesota Rural Water Association to purchase 50 copies of their Security and Emergency Management System (SEMS) software. This software will be distributed to small water systems in Minnesota. The software is relatively user-friendly and prepares an emergency response plan in addition to a vulnerability assessment.
The Nobles-Rock Public Health Service in conjunction with community partners, MDH, Department of Homeland Security and Emergency Management (HSEM), and County Emergency Management held a SARS Tabletop Exercise on January 28, 2004.
Exercise objectives included :
- Border issues in responding to an infectious disease
- Identify roles and responsibilities of community partners in detecting and responding to public health emergencies
- Increase understanding of infectious disease agents such as SARS
- Identify resources at the federal, state and local level to help plan and respond to public health emergencies
- Increase understanding in the Incident Command System that is used in all emergencies
Approximately 65 people attended the event, which included a broad array of community partners, regional partners, border agencies, employers, & elected officials. Two local radio stations conducted interviews at the exercise and broadcast them to regional and statewide audiences.
MDH staff provided information on SARS, risk communication and legal issues. Representatives from HSEM, local Emergency Management and Public Health presented an overview of their roles and responsibilities during an emergency. Attendees were assigned tables, with group leaders in charge of group discussions. The scenario was broken into three parts, with questions following each segment. Questions were open ended to allow for discussion from all table participants who represented various disciplines and agencies.
Participant evaluations indicated the table discussions about the scenario were the most beneficial. Other comments include; a need for teamwork, knowing community resources, understanding incident command and the roles of all partners, and the importance of doing drills like this to brainstorm. Issues such as how our community communicates and plans with the minority population were addressed as well as the importance of mental health issues.
A debriefing meeting was held on February 9, 2004 to help Nobles-Rock Public Health Service identify the priorities to further the agency's capacity to respond to a public health emergency. The priorities include:
- Risk communication training for local partners
- Training and local discussion on isolation and quarantine
- Development of regional project(s) with bordering counties (i.e. surveillance, response activities, roles & responsibilities relating to an infectious disease outbreak)
Additional areas that need to be addressed include:
- Multicultural issues
- Mental health
- Incident Command training
- Community-wide planning, incorporating HRSA, Public Health and Emergency Management (continued engagement of partners and community).
The Commissioner's Terrorism and Health Task Force met on January 22, 2004 in St. Paul. Dianne Mandernach, Commissioner of Health and Aggie Leitheiser, Assistant Commissioner of Health briefed the Task Force on the upcoming legislative session, including proposed changes to the Minnesota Emergency Health Powers Act. In addition, attendees discussed the impact of the terrorism threat levels on local public health. Hospitals and other organizations; heard lessons learned from the recent influenza vaccine distribution; and received an update on SARS.
The 2002 Minnesota Emergency Health Powers Act (MEHPA) clarified and strengthened the ability of the state and local public health system to develop a coordinated plan with other emergency partners. The Act increased the capacity to effectively respond to public health emergencies, including those caused by acts of terrorism. These powers are scheduled to expire in August 2004.
A February 2003 Minnesota Emergency Health Powers Act Report, (MEHPA) provided to the legislature includes information and comments from health care providers, emergency responders, local government, and citizens. These groups recommended practicing the use of the MEHPA powers through local, regional and state exercises. They also raised some concerns about legal immunity and liability.
Based on input from partners and public health experts, the Minnesota Department of Health recommends reauthorization of current powers and a few additional provisions:
- Public health emergency declaration and legislative oversight
- Declares a public health emergency Identification and safe disposition of the deceased
- Right to refuse testing and treatment
- Due process and fair treatment protections in isolation or quarantine orders
2. Include Additional Provisions;
- Provide workers compensation and liability protection for volunteers to state or local government
- Give Good Samaritan liability protection to responders when hospitals are overwhelmed and care is given in temporary settings
- Allow the commissioner of health to authorize additional persons to assist in providing vaccinations or medications
- Authorize sharing of security information, such as volunteer home phone numbers, with emergency response partners
- Clarify peace officer authority for enforcing isolation or quarantine
- Allow court hearings for isolation or quarantine through electronic means
- Prohibit employers from discharging an employee who is in isolation or quarantine
Who Will Be Affected:
- Hospitals, physicians and other health care and emergency providers will have Good Samaritan liability when acting in good faith and according to emergency plans when hospital capacity is exceeded.
- Volunteers acting under state or local government during a public health emergency will have workers compensation and liability protection of a government employee.
- Sick or exposed individuals will have right to expedited court hearings, assurances for safe and least restrictive isolation or quarantine, and job protection.
- Local and state government personnel will have clarity about roles and responsibilities for public health emergency response.
The Minnesota Department of Health Legislative Information has a fact sheet about the Minnesota Emergency Health Powers Act Reauthorization and Amendments.