In this issue:
- Legislature passes Isolation/Quarantine and All Hazards bills
- Red Lake Shooting: Planning pays off
- MDH public health preparedness grant update
- News from the NIMS Information Center
- Emergency and Community Health Outreach (ECHO) news
- ASTHO Public Health Preparedness Resources and Reports
- Connoisseur-Critic Scholarship available
- Upcoming Events
- Computer-based distance learning opportunities
- Articles of Interest
The Isolation and Quarantine and the All Hazards bills were finalized and passed by the Minnesota Legislature on the last day of the regular session. The bills went through many committee hearings before being passed.
HF1507 Isolation and Quarantine
Authors: Representatives Abeler, Huntley, Powell; Meslow; Tingelstad; Emmer; Cornish; Finstad Senators Lourey; Higgins; Kiscaden; McGinn
Final passage vote: House 115-18 Senate 63-2
The legislation continues the powers of the health commissioner to control dangerous communicable diseases through isolation of those already ill and quarantine of those exposed but still well. (“I/Q” is shorthand to cover both types of restrictions.) The bill improves I/Q powers that go back to territorial days by establishing rights of patients subject to such an order, assuring the least restriction necessary on their activities, and guaranteeing speedy judicial review of both need for and conditions of I/Q. Provisions added this year include right to appointed counsel, job protection while subject to I/Q, and clarification of peace officers’ roles. Unrelated to quarantine, but also important to protecting the public in an outbreak, is a new section on vaccination and drug dispensing in an emergency. Section 6 would facilitate mass clinics needed to get medicines quickly to large numbers of threatened persons by allowing the health commissioner to authorized additional persons, with training and supervision, to administer vaccinations and dispense drugs.
HF 1555 All Hazards Emergency Response
Authors: Representatives Powell; Tingelstad; Abeler; Huntley Senators Lourey; LeClair; Higgins; Kiscaden; McGinn
Final passage vote: House: 118-14 Senate: 61-0
The All Hazard Emergency Response bill strengthens the response to a variety of disasters. Minnesota Statutes Chapter 12 is the Emergency Management Act, state government’s basic framework for responding to an emergency event. It authorizes rapid action, requires coordination of effort, and includes checks and balances to assure that powers are used appropriately. Changes made by the 2002 legislature specifically addressed issues that might arise during an infectious disease outbreak, including the right to refuse examination and treatment, the sharing of medical supplies, safe management of the deceased, and restrictions on transportation or movement of people. These changes are important to many kinds of disasters and the bill continues and applies them to all types of hazards.
Link to the H.F. No. 1555, 5th Engrossment
(Ralph Morris, MD, MPH, public health preparedness consultant in the North West district wrote this article.)
On March 21, 2005 a student entered the Red Lake High School, Red Lake, Minnesota, shortly before 3:00 pm and started shooting. In less than ten minutes, fifteen people were shot, with eight deaths (including the shooter). There were two previous shooting fatalities just prior to the school incident.
No community expects that it will be involved in either a natural or manmade disaster until it happens. As the Red Lake school shootings show, no community is exempt from facing a disaster. Preparedness planning can and does help lessen the shock of a disaster and allows for responders to react more effectively and efficiently.
Fortunately for the Red Lake Nation, their hospital and tribal health agency have been actively involved in preparedness planning for the past 2 1/2 years through funding from the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC). By being involved in local and regional planning activities, Red Lake was able to benefit from the following regional activities:
- Developing a 15-hospital regional compact.
- Strengthening of existing Emergency Medical Services (EMS) mutual aid agreements.
- Developing a Strategic National Stockpile (SNS) regional plan.
- Upgrading and providing radio communication to healthcare organizations.
- Training in the Minnesota Incident Management System (MIMS) and the Hospital Emergency Incident Command System (HEICS).
- Conducting numerous drills and exercises in emergency health response at the county, tribal, and regional levels.
- Participating in regional emergency preparedness health conferences.
- Planning for a regional behavioral health disaster response plan.
- Developing a regional alert and notification system.
- Developing a regional health steering committee to plan and coordinate emergency preparedness and response activities.
Tribal EMS arrived on scene just as the shootings ended. EMS began to treat the victims of the shooting, establish patient triage, and transport patients to the Red Lake Hospital, which is part of the national Indian Health Service. The hospital immediately activated HEICS upon hearing the initial 911 call and went into lock-down. All of the victims were taken to the Red Lake Hospital for initial evaluation. Several victims, relatives, and others arrived at Red Lake Hospital in private cars. As word spread of the shootings, landline and cell phones became inoperable at the hospital.
North Country Regional Hospital in Bemidji received notification of the shootings shortly after 3:00 pm and began to prepare to receive patients from the shootings. The hospital went into lockdown and instituted perimeter traffic control measures with the aid of Beltrami County Emergency Management. North Country received 6 victims, referring 2 patients to Fargo, ND, for trauma care. One victim was pronounced dead at North Country, and 3 victims were admitted to the hospital and treated.
EMS mutual aid agreements were activated from surrounding communities to assist in the transportation of patients from Red Lake to Bemidji, a distance of approximately 35 miles and to back fill ambulances dispatched to Red Lake from Bemidji. The hospital compact was also activated in surrounding hospitals for the purpose of diverting other emergency patients not associated with the shootings away from Bemidji and replenishing supplies and equipment to Red Lake. The MeritCare Urgent Care Clinic in Bemidji extended its hours to help with routine medical emergencies in Bemidji. Regional health notification was initiated with the aid of the “Red Book,” a listing of regional and local contact numbers for public health and healthcare organizations for northwestern Minnesota.
The following items were noted to have benefited from the planning efforts of the past two and a half years:
- The radio communication upgrades for EMS and hospitals worked effectively. This investment in these resources for the past two years was very worthwhile.
- The mutual aid agreements for EMS were beneficial for surrounding ambulances to respond to Red Lake and to provide backup services for the responding agencies.
- The existing working relationships between the tribe and the county proved to be extremely beneficial. Permission to respond to the reservation needed to be requested by all entities, and this was managed very well through the Beltrami County emergency manager.
- The Health Resources Service Administration (HRSA) grant requirement for key stakeholders in the planning process proved invaluable in this incident. There has been active participation from the Red Lake Reservation and the Red Lake Hospital from the beginning of the HRSA grant.
- When supplies were near exhaustion at Red Lake, surrounding hospitals agreed to resupply them so they were ready to respond, should another incident arise. The hospital compact that has been signed by all hospitals in the region was utilized.
- HEICS was used formally at Red Lake Hospital and informally at North Country Regional Hospital. This incident command system provides a good working structure for managing an incident. North Country utilized a unified command in managing perimeter control for the exterior perimeter and visitor management internal to the hospital.
- Fortunately, a committee had been formed about 6 months ago to develop a regional behavioral health response to disasters in the NW. This group was able to convene and help with the immediate response and longer recovery for mental health issues to the shootings.
While no community can adequately prepare for every disaster contingency, the Red Lake incident shows that having a plan in place, good communications, previous drills, mutual aid agreements, and good community relationships can and do make a difference in a disaster.
Minnesota Department of Health (MDH) staff are working with partners to prepare applications for the next round of bioterrorism preparedness grants. The current grants expire on August 31, 2005. These funds allow MDH to join forces with partners from the state’s public and private health care systems to improve Minnesota’s capacity to respond to and recover from a public health emergency, such as biological, chemical or radiological terrorism; natural disasters; pandemic influenza; and Severe Acute Respiratory Syndrome (SARS).CDC Public Health Emergency Preparedness Grant
Funding amount. The Centers for Disease Control and Prevention (CDC) is making available approximately $15 million in funds to MDH for the next CDC Public Health Emergency Preparedness Grant. MDH will sustain only a slight reduction in the base portion of the grant allocation to Minnesota. The Cities Readiness Initiative (CRI) portion of the grant will increase slightly over last year. However, the scope of CRI has been expanded to include the entire Metropolitan Statistical Area (includes 13 counties).
Grant Highlights. As anticipated, the guidance is significantly different from previous years' guidance. Notable is the elimination of focus areas. Instead, the grant is built around nine preparedness goals, critical tasks, and performance measures.
Timeline. MDH staff are working with local partners to prepare the grant application which is due to the CDC on July 13, 2005. Funds are anticipated to be available to MDH on September 1, 2005.HRSA Bioterrorism Hospital Preparedness Grant
Funding amount. The Health Resources and Services Administration (HRSA) has made available approximately $8.2 million in funds for Minnesota’s Bioterrorism Hospital Preparedness (BHPP) Grant. This represents a 4.2% reduction from the current year’s award.
Grant Highlights. MDH staff are working closely with hospitals and other partners from Minnesota’s health care system to continue to address many of the same areas of planning that were included in the current grant.
Timeline. The grant application is due the HRSA on July 1, 2005, with the expectation that funds will be available on September 1, 2005.
National Incident Management System
In February 2005, Governor Pawlenty signed Executive Order 05-02 which establishes the National Incident Management System (NIMS) as Minnesota’s standard for incident management.
Developed by the Secretary of Homeland Security at the request of the President, the NIMS integrates effective practices in emergency preparedness and response into a comprehensive national framework for incident management. The NIMS will enable responders at all levels to work together more effectively to manage domestic incidents no matter what the cause, size or complexity.
The benefits of the NIMS system will be significant:
- Standardized organizational structures, processes and procedures;
- Standards for planning, training and exercising, and personnel qualification standards;
- Equipment acquisition and certification standards;
- Interoperable communications processes, procedures and systems;
- Information management systems; and
- Supporting technologies – voice and data communications systems, information systems, data display systems and specialized technologies.
Here is additional link about NIMS.
- National Incident Management System National Standard Curriculum Training Development Guidance (PDF: 23 pages)
These are guidelines for ICS training providers that will help them ensure that the training they offer meets the requirements of the National Incident Management System (NIMS). The Guidance provides an evaluation checklist for content that may be used to make sure that ICS training meets the “as taught by DHS” standard. It also outlines NIMS ICS concepts and principles, management characteristics, organizations and operations, organizational element titles and recommendations for a model curriculum.
- IS-700 NIMS, An Introduction - Who Needs to Take It? (PDF: 1 page)
- When the Secretary of Homeland Security outlined for the nation’s governors the steps that states and territories and tribal and local entities should take during FY 2005 to implement the concepts and principles of NIMS, he specifically said that “jurisdictions…should [complete] the NIMS awareness course, IS-700. This statement further clarifies who should take IS-700.
- This paper is intended to provide an historical perspective on the development of ICS, explain how NIMS ICS works, describe how it is different from previous systems, and discuss the future of NIMS ICS training.
ECHO is now an award-winning program. At the 2005 recognition ceremony, the ECHO Health, Safety and Ethnic Regional Collaborative won two awards at the Minnesota Association of Government Communicators’ Northern Lights Award Ceremony. The project received an Award of Excellence for Public Information Campaigns and an Award of Merit in the Video-Local Programming categories.
Over the last several decades, Minnesota has experienced a large influx of immigrants and refuges, representing a variety of cultures and languages. Providing these special populations with time-critical emergency health information is a significant challenge.
ECHO provides public information through television programs in six languages: Lao, Somali, Khmer, Hmong, Spanish, and Vietnamese.
ECHO also has a Web site and a phone line. The staff also maintains partnerships with ethnic organizations to reach these populations. ECHO is truly a collaborative effort. The important work of providing critical health and safety information to limited English speaking populations in Minnesota could not be accomplished without the help of many organizations, including the Minnesota Department of Health, St. Paul/Ramsey County Health Department, Hennepin County and over 31 local public health agencies and community organizations.
The Minnesota Association of Government Communicators’ annual competition, called Northern Lights, seeks to find the best in government communications, from brochures and Web sites to periodicals and annual reports. The 2005 competition had hundreds of entries in 13 categories for work produced in 2004.
Two types of awards are given: Award of Excellence and Award of Merit. Excellence is for entries of high quality that met or exceeded their intended results, taking into account constraints on time and money. These entries demonstrate creativity and wise use of resources. Merit is for entries that are a credit to the organization for which they were created and exhibit creativity and wise use of resources.
The judges commented “The ECHO Emergency Communications for Special Populations boldly goes where few government agencies have dared to enter: the world of foreign language and the world of broadcast television. The medium chosen, TV, is free and accessible to the intended audience and available at an affordable cost to the agency. The messages are important, even lifesaving in nature.”
For more information about ECHO, a list of all ECHO partners, a series of links to important health and safety information in the six languages, and streaming video of the ECHO TV series, visit the ECHO website.Announcing new ECHO position
ECHO (Emergency Community and Health Outreach) provides health and safety information to limited English speaking persons in Minnesota. The project is seeking a part time Project Director.
The person in this new position will provide administrative management and coordination to the project. This position will manage a collaborative network developed to communicate public health educational and/or emergency information. The ECHO network uses several mass-messaging vehicles such as television programming, broadcast fax, email distribution lists, phone lines, web site and more to reach non-English speaking people. The Project Director will work with local, state and private agencies and partners to insure ECHO activities are carried out.
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.
ASTHO has a variety of documents, online reports and other good resources. ASTHO published the following two articles.
Use of Incident Command During Influenza Vaccine Shortage
ASTHO recently completed a survey on the use of the Incident Command System (ICS) to respond to the vaccine shortage during the 2004-05 influenza season. Of the 45 respondents from state and territorial health agencies, nearly two-thirds used ICS at some point to manage the flu vaccine shortage. In the states that did not use ICS, the shortage was generally not considered a situation that required the activation of an emergency response. However, slightly more than half of states that did not use ICS reported that some of their local jurisdictions had. Regardless of whether a state used ICS in 2004-2005, more than 58 percent plan to use it in 2005-06 to manage flu vaccine distribution in the event of another vaccine shortage.
Master Exercise Practitioner Program
The Master Exercise Practitioner Program (MEPP) is a course series offered by the Emergency Management Institute on the design, implementation, and evaluation of preparedness exercises. The course is open to local, state, and federal officials in emergency response organizations. Two state public health participants in this winter’s MEPP have given ASTHO very positive evaluations of the course, and have said that it will help them with public health preparedness exercises in their own states.
A new MEPP course designed specifically for health professionals will be held twice in Fiscal Year 2006. The first series will encompass three week-long sessions in November, January, and April. A second series will take place in February, June, and September.
As we face the possibility of intentional or unintentional biological, chemical, and radiological emergencies, the need for collaboration between public health and emergency response personnel has expanded. The University of Minnesota Center for Public Health Practice (UMNCPHP) is sponsoring the “Connoisseur-Critic Project” which is intended to foster this collaboration.
The University of Minnesota Centers for Public Health Education and Outreach (CPHEO) currently offers courses for individuals working with hazardous materials through its participation in the Midwest Consortium for Hazardous Waste Worker Training and as a partner in the Great Lakes Regional OTI (OSHA Training Institute) Education Center. Public health professionals who are interested in this content because of its applicability to their work are invited to apply for full scholarships to attend selected courses. Awardees will be required to provide evaluative feedback related to the course content using a ‘connoisseur critic’ process. The intent of this process is to identify those course content areas helpful to public health professionals in their role and those areas where public health information and perspective could reasonably be integrated, while maintaining the original intended purpose and time frame of the course.
Individuals wishing to participate in the UMNCPHP Connoisseur-Critic Evaluation Program must meet all the following criteria:
- Currently employed in state or local public health
- Has worked in public health for at least one year
- Has responsibilities related to hazardous materials or emergency planning
- Agrees to full attendance
- Agrees to submit completed connoisseur-critic feedback immediately following this course
- Has not provided connoisseur-critic feedback before for this particular course
- Has not provided connoisseur-critic feedback to UMNCPHP for more than one course prior to this one
- IMS Awareness
- Evacuation Coordination
- 40 hr Industrial Emergency Response
- 24 hr Industrial Emergency Response
- 16 hr Incident Management System (MIMS)
- Homeland Security
- OSHA 2225 Respiratory Protection
- OSHA 5600 Disaster Site Worker Program Train-the-Trainer (Note: this course has prerequisites.)
By accepting this scholarship through the Connoisseur-Critic Evaluation program, individuals must agree to attend the entire course or courses as a Connoisseur-Critic and provide Connoisseur-Critic feedback as requested.
The Minnesota State Council on Disability (MSCOD), in collaboration with other state agencies, is sponsoring a one-day conference on emergency planning that addresses the needs of individuals living with a disability. The conference will be held at RiverCentre in St. Paul MN from 8:00 am to 4:00 pm.
The event is targeted toward:
- Professionals who work with a disability organization
- Municipal, county and state planners responsible for all hazard emergency response planning
- Community leaders
- First responder trainers
The speakers will address:
- Disability issues as they pertain to emergency planning
- The resources available to address those needs
- The responsibility of government and the public to coordinate a response
Participants will be able to:
- Identify disability issues in emergency situations
- Develop an emergency plan to meet all needs
- Ask questions
- Network with state disability professionals and emergency response planners
Registration is required for the conference. To obtain a registration form or for further information, please contact the Minnesota State Council on Disability, (651) 296-6785 or 1-800-945-8913 V/TTY.
The Public’s Health and the Law in the 21st Century: 4th Annual Partnership Conference, June 13-15, 2005, Atlanta, GA
The CDC Public Health Law Program and the American Society for Law, Medicine and Ethics present their 4th Annual Partnership Conference. This annual conference is directed to elected officials who make public health laws; public health practitioners and legal counsel; physicians and nurses in public health and clinical practice; emergency management and law enforcement officials; judges and attorneys active in public health and health care; educators and researchers in public health law, and all who are active in, and interested in, law as a tool for improved public health. The conference will be held at The Sheraton Midtown Atlanta Hotel at Colony Square in Atlanta, GA.
Homeland Security Medical Executive Course
June 13-17 2005, Austin, TX
This course is designed to train senior medical officers for command and senior staff positions in support of the National Response Plan. It is also designed to address the challenges and complexities of a chemical, biological, radiological, nuclear, or high-explosive event or natural disaster in the United States and its territories.
Hospital Emergency Response Training for Mass Casualty Incidents
June 26-29, 2005, Providence, RI
This course is sponsored by the Federal Emergency Management Agency (FEMA) and will be held during the National, Environmental, Safety and Health Training Association’s (NESHTA) 27th Annual Conference. The FEMA L461 Hospital Emergency Response Training (HERT) for Mass Casualty Incidents Train-the-Trainer Course focuses on the hospital’s role outside of the emergency department. Trainers, doctors, nurses, physicians, security personnel, and other hospital staff who would make up their Hospital’s Emergency Response Team (HERT) should attend this four day course.Free public health courses online
Johns Hopkins Bloomberg School of Public Health has launched a project known as OpenCourseWare, which provides free online access to some of the school's most popular courses. Courses are not offered for credit and do not count toward a degree or certificate. Five courses are currently available, including "Problem Solving for Immunization Programs," and "History of Public Health.""SARS: When a Global Outbreak Hits Home"
This program is part of the series Public Health Grand Rounds and is available on-line and on demand for Continuing Education credit.
The program provides an analysis of the steps taken by Toronto public health professionals with their community partners during the Severe Acute Respiratory Syndrome (SARS) outbreak of 2003. The program is aimed at public health leaders and professionals from local and state government agencies, hospitals, clinics, boards of health, community-based health organizations, academic institutions, federal agencies, and others who seek to learn lessons from the 2003 SARS outbreak response and prepare for future disease outbreaks.
Panelists include William L. Roper, MD, MPH, Dean, School of Medicine, The University of North Carolina at Chapel Hill; Julie L. Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention; M. Anita Barry, MD, MPH, Director, Communicable Disease Control, Boston Public Health Commission; Hugh H. Tilson, MD, DrPH, Clinical Professor, Epidemiology and Health Policy, School of Public Health, The University of North Carolina at Chapel Hill.
This Internet program runs for 64 minutes, is free. The program is a collaboration of the Centers for Disease Control and Prevention and the University of North Carolina School of Public Health.
- Positive Test Results for Acute Hepatitis A Virus Infection Among Persons
With No Recent History of Acute Hepatitis — United States, 2002–2004 (PDF: 24 pages)
- Brief Report: Terrorism and Emergency Preparedness in State and Territorial Public Health Departments --- United States, 2004
This report describes the results of assessments that indicated increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level.
- Improvement in Local Public Health Preparedness and Response Capacity --- Kansas, 2002--2003
This article describes Local Health Departments (LHD) preparedness capacity using a CDC assessment tool. Repeated assessments of preparedness using standardized tools can provide useful information to help guide federal, state, and local public health policies and investments.
According to the Florida Department of Health, last year during the 2004 hurricane season in Florida, at least 7 deaths and 166 injuries or illnesses were attributed to carbon monoxide poisoning caused by people who incorrectly used a portable generator. Each of these deaths or illnesses was preventable.
In Minnesota, as we enter the tornado and possible severe weather that may cause power outages, some people will use portable generators. Portable generators are useful when temporary or remote electric power is needed, but they can also be hazardous. The primary hazards to avoid when using a generator are carbon monoxide (CO) poisoning from the toxic engine exhaust, electric shock or electrocution, and fire.For more information:
- Portable generator hazards (PDF: 1 page)
U.S. Consumer Product Safety Commission.
- Carbon monoxide poisoning in the home, Minnesota Department of Health
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 to protect you and your loved ones. This site provides guidance on what kinds of emergency supplies to put aside and advice on how.