In this issue:
- Proposed reductions in preparedness funds would leave nation vulnerable
- Multi-agency coordination needed during a major health incident
- MDH RN Barr Library has many emergency preparedness resources
- Upcoming Workshops
- Published Articles
- Web sites to check out
Proposed reductions in preparedness funds would leave Nation vulnerable to public health emergencies, public health officials warn
(Note from Robert Einweck, Director of MDH Office of Emergency Preparedness: Public health preparedness funds allotted to Minnesota for the upcoming 2005-2006 project period are close to the same level as last year. However, funds for future years are proposed to be cut.)
ASTHO press release
BOSTON, July 13, 2005. The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) today expressed serious concern about severe cuts proposed by both the House and Senate in state and local public health preparedness grants.
"While we have made great strides in preparedness, sustained support is critical. If the cuts to preparedness funding that Congress has proposed are accepted, state and local health departments will be forced to curtail crucial preparedness exercises and programs and layoff essential preparedness staff, including physicians, laboratorians, epidemiologists, and nurses," said Dr. Leah M. Devlin, ASTHO President-elect and State Health Director, North Carolina Division of Public Health.
"Critical funding is shrinking just as public health agencies are being required to expand their work in pandemic influenza preparation and response, disease monitoring, food safety and security, and distribution of lifesaving vaccines," said NACCHO President Dr. Rex Archer, Health Director of Kansas City, Missouri.
Mary C. Selecky, Secretary of the Washington State Department of Health said, "It is unrealistic to expect state and local public health agencies to continually do more with less."
"At the same time that the Administration is restating our nation's need to address the catastrophic effects of nuclear, chemical, and biological attacks, the system designed to protect us is being severely under funded," said NACCHO Immediate Past-president Michael C. Caldwell, Health Commissioner of Duchess County, New York.
ASTHO and NACCHO urge the full Senate Appropriations Committee to reject the Subcommittee's proposed cut in state and local public health preparedness and restore this important funding to the FY05 appropriated level. Cuts of this magnitude will adversely affect the ability to protect the public's health.
The Association of State and Territorial Health Officials (ASTHO) is the national nonprofit organization representing the state and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. ASTHO's members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in state-based public health practice.
What happens when several public and private entities among multiple jurisdictions respond to a major health incident when they…
- Have different policies and procedures?
- Use different terminology for personnel, assignments or resources?
- Have a lack of interagency communications, agreements or previous interaction with each other?
The MAC system is a component of the National Incident Management System (NIMS). It fully integrates use of the incident command system of the NIMS but it is different from command and control that occurs in an emergency operations center or at the site of an incident. The purpose of a regional MAC system is to provide a coordinating service to public and private entities that respond to a multi-jurisdictional incident. A MAC system would normally be activated when a regional emergency overwhelms public and private agencies and facilities within multiple jurisdictions. The MAC system becomes a coordinating hub that provides a manageable span of control for multiple jurisdictions’ emergency operations centers to communicate their need for support and resources to state agencies.
The Minnesota Department of Health’s Office of Emergency Preparedness (OEP) has assembled a committee of eleven people from several health-related fields and Homeland Security & Emergency Management (HSEM) to develop a framework for multiple health agencies and facilities to work together in a MAC system. The resulting MAC model template will allow emergency medical services, hospitals, clinics, public health and HSEM to coordinate response and support activities within a region (see figure below). When a region utilizes the MAC system, state agencies will receive information about the affected area via the MAC and respond to and support the needs of that region in a timely manner.
The MAC Committee will continue to develop a MAC model to be used statewide in health-related incidents. The MAC model will then be adapted and used by the Minnesota Department Health’s eight districts and incorporated into their regional preparedness plans.
To learn more about the multi-agency coordination system, check out NIMS Online.
The MDH RN Barr Library has many materials of interest to staff working on or interested in emergency preparedness, terrorism or disasters. These materials are available to MDH staff, local public health and school health staff. Others may view the materials in the library or borrow them through their public library.
Here are examples of emergency preparedness materials available.
Books on terrorism and disasters
Examples of books available:
- The anthrax letters: a medical detective story. Leonard A. Cole. 2003.
- Are you ready? a guide to citizen preparedness. 2002. Federal Emergency Management Agency.
- Disaster preparedness guidelines for school nurses. Janice Doyle and Thomas R. Loyacono. 2002. NASN.
Audiovisual programs on terrorism
Most of these programs are taped from the MDH Distance Communication and Learning Center and are available as videos or DVDs. The programs date from January 2004 to 2005. Videos are available to any MDH staff, local public health, school health and any organization in the state. Organizations from outside Minnesota are considered on a case-by-case basis.
Examples of terrorism audiovisual programs available from the library:
- Chemical Terrorism for the Non-Chemist. 1/6/05
- Homeland Security for Buildings. 2004.
Available in the library
- Biosecurity and Bioterrorism
- Internet Journal of Rescue and Disaster Medicine
- Journal of Homeland Security and Emergency Management
- Journal of Exposure Analysis and Environmental Epidemiology
- Prehospital and Disaster Medicine
- Studies in Conflict and Terrorism
- Terrorism and Political Violence
Most electronic journals shown on the MDH Web site are available only for MDH staff. Recent issues may be embargoed because the journals require a subscription. A person could still view the table of contents and abstracts on line. Many of those articles could be available from other libraries via interlibrary loan.
Literature searches provide the most recent information on terrorism and can be done in several ways.
- You can do your own literature search through the National Library of Medicine's PubMed database. By using MyNCBI, you can save your searches. Then every time you revisit your search, the most recent articles will be added automatically.
- View the pre-packaged searches that are automatically updated at Hot Topics in Public Health
Biological and Chemical Warfare
Terrorism and Bioterrorism
Terrorism and Environmental Health
Weapons of Mass Destruction
- Contact the Library staff for a customized search. Just fill out the Library Literature Request Form.
- Additional journal databases are available on the Library's Web page. Some of them are only available to MDH staff. To view the Web page Databases: finding journal articles and books, go Search Tools: Finding Articles and Other Resources.
The R.N. Barr Library is moving to the new Orville L. Freeman Office Building in St. Paul this fall. The library will be located on the First Floor North. The new phone number will be 651-201-5090.
This training program is an adaptation of “Community-Based Psychological Support” developed by the International Red Cross. The training will focus on:
- Psychological support
- Stress and coping
- Supportive communication
- Promoting community self help
- Populations with special needs
- Helping the helper
Five workshops will be held throughout the state in August from 8:00 am to 5:00 pm:
Fairmont: Monday August 8, 2005
New Ulm: Tuesday August 9
Hutchinson: Wednesday August 10
Mankato: Thursday August 11
Mankato: Train-the-Trainer on Friday, August 12
Wednesday, August 17, 2005 from 8:30 am to 4:00 pm at McNamara Center, University of Minnesota, Minneapolis
It is increasingly important to be able to identify competencies embedded in training. Because of the rapid development of training in the area of Bioterrorism and Emergency Readiness (BT/ER) over the past several years, the need to identify the competencies addressed in training was often not given priority until recently.
This free, one-day conference will share a systematic method developed in Minnesota to identify the Core and BT/ER competencies embedded in existing training and education programming. Based on a strong understanding of instructional design, the system provides a theoretically sound yet practical method for identification of crosscutting competencies.
The speaker will be Mary Hoeppner, EdD, MS, RN, who has over twenty years experience in adult education. The target audience is state and local public health staff with responsibilities for developing and/or implementing training plans. This event is sponsored by the University of Minnesota, Center for Public Health Preparedness and the Midwest Center for Life-Long-Learning in Public Health.
Also, an article, Competency Mapping: A Tool for Identifying the Competencies in Existing Bioterrorism / Emergency Readiness Training Activities provides additional information on these topics:
- What are the University of Minnesota Center for Public Health Preparedness and the Midwest Center for Life-Long-Learning in Public Health?
- What is competency mapping, and why do it?
Friday, August 26, 2005
This free workshop will be held at the Mayo Clinic in Rochester, MN from 8:30 am to 3:30 pm. Bonnie Selzler, Ph.D., R.N. will focus on Community Response and Recovery from Disaster. Dr. Selzler currently provides on-site consultation for the States and private agencies regarding disaster issues. Registration deadline is August 12.
Testimony before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives, United States Government Accountability Office, May 26, 2005
Why GAO did this study. Vaccine shortages and distribution problems during the 2004-2005 influenza season raised concerns about the nation’s ability to respond to a worldwide influenza epidemic -– or influenza pandemic – which many experts believe to be inevitable. Some experts believe that the next pandemic could be spawned by the recurring avian influenza in Asia.
GAO was asked to discuss surveillance systems in place to identify and monitor an influenza pandemic and concerns about preparedness for and response to an influenza pandemic. This testimony is based on GAO’s 2004 report on disease surveillance; reports and testimony on influenza outbreaks; influenza vaccine supply; and pandemic planning that AGO has issued since October 2000; and work GAO has done in May 2005 to update key information.
What GAO found. Federal public health officials plan to rely on the nation’s existing influenza surveillance system and enhancements to identify an influenza pandemic. CDC currently collaborates with multiple public health partners, including the World Health Organization (WHO), to obtain data that provide national and international pictures of influenza activity. Federal public health officials and health care organizations have undertaken several initiatives that are intended to enhance influenza surveillance capabilities. While some of these initiatives are focused more generally on increasing preparedness for bioterrorism and other emerging infectious disease health threats, others have been undertaken in preparation for an influenza pandemic.
- Influenza Pandemic: Challenges Remain in Preparedness (PDF: 1 page)
- Influenza Pandemic: Challenges Remain in Preparedness (PDF: 24 pages)
(This article was published in July-August 2005 Minnesota Fire Chief magazine.)
The Minnesota Department of Public Safety, Division of Homeland security and Emergency Management (HSEM) was required to develop a state strategy to identify gaps in the state’s emergency operations plan when responding to an act of terrorism. Through this process, it identified that Minnesota has been challenged for many years on how best to respond to a major building collapse within our state.
The initial response to a collapse structure is the primary responsibility of local government with assistance from state and federal government. In Minnesota, the ability of local and state government to respond to and manage a major multi–level structural collapse is limited. Assistance from the federal government Urban Search and Rescue (USAR) Team is at least 24 hours away.
After identifying that local and state government had limited capabilities to respond to a building collapse, the Division of Homeland Security and Emergency Management started to implement a plan in 1999 to fill this gap. Through roundtable discussions with interested local responders, Federal Emergency Management Agency (FEMA) and USAR Team representatives, a work group was established to develop a program that would be compatible with the response of a USAR Team prior to their arrival.
As a result of those meetings, the Minneapolis Fire Department was identified as a Heavy Team. The Edina Fire Department, Dakota County Special Operations Team, St. Paul Fire Department and the Rochester Fire Department were identified as Medium Teams.
Emergency preparedness and bioterrorism response: development of an educational program for public health personnel
Karen Baldwin, Joanne LaMantia, Linda Proziack
Public health departments are under increasing pressure to provide emergency preparedness and bioterrorism response education to public health personnel. The challenge that health departments face is to provide cost-efficient, timely education to a large number of multidisciplinary personnel. This article describes an innovative strategy for providing this education to public health personnel using the health department's intranet system. The intranet system provided confidential information specific to the staff role and allowed for concurrent access to the program by multiple individuals at different service sites. Knowledge acquisition was tested through short multiple-choice questions that followed the specific information modules. The intranet system faced a number of challenges during the pilot-testing phase, primarily related to changes in the role of the public health nurse and limitations in funding and public health staff to maintain and monitor the bioterrorism response program and the intranet system. The design of the program may prove useful for other public health organizations when a need exists for quick delivery of information to a large number of personnel. It may especially be useful in providing basic emergency preparedness and bioterrorism education to new personnel in health departments.
In November 2004, the Centers for Disease Control and Prevention (CDC) released the Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors. This guide is an all-hazards reference tool for health professionals who are responsible for initiating the public health response during the first 24 hours (i.e., the acute phase) of an emergency or disaster. It provides useful information on the activation and integration of a jurisdiction’s public health system into the existing overall emergency response structure during the acute phase of an incident. It also contains guidance that may be unique to specific types of incidents, such as floods, earthquakes, and acts of terrorism.
Although terrorists use a variety of methods to inflict harm and create fear, bombs are used most frequently. According to the U. S. Federal Bureau of Investigation, bombings accounted for nearly 70 percent of all terrorist attacks in the U.S. and its territories between 1980 and 2001. This 65 page document focuses on common sense principles that will be useful in a bombing event. Topics covered are:
- What can I do now?
- What should I do during a terrorist bombing?
- What should I do after the bombing?
- What if rescue workers are not available to transport me or other injured persons?
- When should I go to the hospital or clinic?
- Where should I go for care?
- What can I expect at the hospital?
The document begins: “State, local, and tribal public health departments play an extremely important role in all-hazards emergency preparedness and response. Public health professionals within these departments should have immediate access to guidance and information that will assist them in rapidly establishing priorities and undertaking necessary actions during the response to an emergency or disaster. The National Center for Environmental Health (NCEH), Division of Emergency and Environmental Health Services (EEHS), Environmental Public Health Readiness Branch (EPHRB) have developed an all-hazards public health emergency response guide to address this need.
The possibility of terrorist incidents in the United States concerns many people. To help, the American Red Cross and the Centers for Disease Control and Prevention (CDC) have teamed up to answer common questions and provide guidance on steps you can take now to protect you and your loved ones.
On this site, you will find:
- Guidance on what kinds of emergency supplies to put aside.
- Advice on food and water to disaster supplies kits.
- What sheltering-in-place means, how it would work and what it would involve.
- When quarantine and isolation may be called for, what they are and how it would work.
- Tools for coping with terrorism for adults, parents, children, students and seniors.