In this issue:
- 2005 Preparedness Legislative Issues
- 2006 Health Preparedness Funding Update
- Minnesota’s Compliance with National Incident Management System
- Cities Readiness Initiative in Metro Region
- MDH staff present at CDC Public Health Preparedness Conference
- After-Action Report of State Agency Exercise: Next Steps
- Recently published articles
- Upcoming Training Opportunities
- Coming Spring 2005: Preparedness training for MDH employees
- Distance Learning Opportunities
- FEMA courses IS139 Exercise Design and PDS139 Professional Development Series Capstone Seminar: Exercise Design
- Scholarships available for 2005 Public Health Institute!
Editor’s comment: We asked for your articles and you gave us plenty. Many thanks for your contributions.
Isolation and Quarantine (I/Q)
Minnesota has had quarantine provisions in the statutes since the nineteenth century. In response to the terrorist attacks in the U.S. in 2001, the Minnesota Legislature in 2002 reexamined Isolation and Quarantine issues. The Legislature approved modern protections for people infected with or exposed to a communicable disease who may require isolation or quarantine. It included provisions for expedited court hearings, and health and safety protection. These provisions are scheduled to expire in August 2005. MDH is seeking legislation to make these provisions permanent and to incorporate enhancements suggested by partners involved in preparedness plans.
Recent events at the global level demonstrate the need to continue these provisions. These events include the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, current reports of avian influenza (bird flu) in Asia, and the continuing risk of bioterrorism. Worldwide, SARS caused 8,098 cases of illness and 774 deaths in 2003. In Minnesota, 11 people were evaluated as potential SARS cases. The experience of Toronto – with hundreds of cases, 44 deaths, and 27,000 persons in quarantine – illustrates how quickly government must be ready to act to protect the public’s health. The 27 administrative orders for quarantine in Toronto show that health protection requires the use of limited, but significant legal powers.
Exercises conducted in Minnesota at the state and local levels that involved public health, emergency management, first responders, and the court system highlighted the need for an effective legal framework governing isolation and quarantine procedures. Appropriate statutory provisions will ensure the consistent application of authority, and establish the procedures to be followed in advance of an actual event.
The Isolation and Quarantine Procedures Fact Sheet includes information on proposed changes, the people affected by the changes, and the consequences if the legislation does not pass.
The full text of the legislation is available at:
Senate File 1482 (Lourey): S.F. No. 1482, as introduced - 84th Legislative Session (2005-2006)
House File 1507 (Abeler): H.F. No. 1507, as introduced - 84th Legislative Session (2005-2006)
The Minnesota Department of Health is sponsoring legislation to make limited changes to improve the quality and speed of emergency response. Better integration of available resources will allow for a faster and more coordinated response to an event. The proposed changes reflect an "all-hazard" approach to planning and response because many emergencies require public health involvement. These changes also address liability concerns that might deter volunteers and other responders, particularly in worst-case situations.
The Minnesota Emergency Management Act, Chapter 12, is state government’s framework for responding to an emergency. It authorizes rapid action, requires coordination of effort, and assures that powers are used appropriately.
Changes made in 2002 specifically addressed issues that might arise during an emergency, including the sharing of medical supplies, the right to refuse treatment, safe management of the deceased, and restrictions on the movement of people. The Minnesota Department of Health (MDH) supports these changes, which will expire in August 2005 unless the Legislature acts on them.
In recent years MDH staff, along with other local, state and federal officials, have taken part in hundreds of emergency exercises and training events. Numerous meetings have been held with nearby states and provinces. These activities highlighted the need to maximize participation by responders and to be prepared for any emergency.
The MDH is sponsoring legislation to make limited changes to improve the quality and speed of emergency response. Better integration of available resources will allow for a faster and more coordinated response to an event. The proposed changes reflect an "all-hazard" approach to planning and response because many emergencies require public health involvement. These changes also address liability concerns that might deter volunteers and other responders, particularly in worst-case situations.
The All Hazard Emergency Response Fact Sheet (PDF: 2 pages) provides information on proposed changes, the people affected by the changes, and the consequences if the legislation does not pass.
To read the full text of the bill, go to:
Senate File 1483 (Lourey) S.F. No. 1483, as introduced - 84th Legislative Session (2005-2006)
House File 1555 (Powell) H.F. No. 1555, as introduced - 84th Legislative Session (2005-2006)
The Governor recommends a General Fund appropriation of $382,000 in FY 2006 and $352,000 in FY 2007 to establish a statewide trauma system. The Minnesota trauma system will save lives and reduce disability by ensuring seriously injured people are promptly transported and treated at facilities appropriate to the severity of their injuries."
"Congratulations to everyone, past and present, who dedicated immeasurable time, passion, and expertise toward the development and implementation of a statewide trauma system in Minnesota," said Tim Held, Trauma Systems Coordinator at the Minnesota Department of Health. The first step to making the system a reality occurred on March 10, 2005, when Governor Pawlenty proposed in his supplemental budget that the Minnesota Department of Health should assume the new and ongoing activity for implementation and oversight of a statewide trauma system. The system will be funded through the state general fund, with allocations of $382,000 in FY 2006 and $352,000 each year thereafter.
The legislative language that will outline the details of the trauma system will be introduced as part of a comprehensive amendment to the Health and Human Services budget bill (HF 1422/SF 1313). Representative Fran Bradley, author of HF 1442, will introduce the amendment at the March 17, 2005, meeting of the House Health Policy and Finance Committee. Check out these websites:
Department of Finance’s change item reflecting the Governor’s Supplemental Budget recommendation for trauma
MDH site with the Governor’s recommendations
Governor Pawlenty’s 2006-07 Budget Recommendations for MDH
The federal budget picture is beginning to take shape, although the ramifications for the Minnesota Department of Health’s (MDH) health preparedness programs are unclear.
President Bush has proposed a budget of $797 million ($130 million less than FY05) for the CDC state and local preparedness grant funding and $483 million ($8 million less than the previous year) for the HRSA Hospital Preparedness Program. The budget proposal also includes a new $70 million Federal Mass Casualty Initiative to assist local medical systems in the event of an attack involving the use of weapons of mass destruction.
It is unclear how these budget cuts will affect the bioterrorism preparedness grants that MDH receives from the CDC and HRSA. Those federal agencies expect to release their 2005 – 06 grant guidance documents, including the amount of funding that MDH is eligible to receive for the continuation of its health preparedness planning efforts, in May 2005. Watch future OEP Newsletters for details.
In February 2005, Governor Pawlenty signed the Governor’s Executive Order #5-02, which established the National Incident Management System (NIMS) as the state standard for incident management.
As a condition for receiving preparedness funds, state and local jurisdictions will be asked to adopt principles and policies of NIMS. State and local compliance of agencies with NIMS will be done primarily by self-report in 2005 and 2006, with more objective measurement likely to occur in 2007.
The Minnesota Department of Public Safety, Division of Homeland Security and Emergency Management recently conducted an assessment of the consistency between the Minnesota Incident Management System (MIMS) and NIMS. The agency concluded that the state system is 97% compliant with NIMS.
To read Minnesota Department of Public Safety Information Sheet, Minnesota’s Compliance with National Initiatives.
The Minnesota Department of Public Safety, Division of Homeland Security and Emergency Management (HSEM) is moving towards a tiered approach to Minnesota Incident Management System (MIMS) training this year, with different levels of training required for individuals with different roles in a response. HSEM recommends that agencies continue to receive training on Incident Management System. All individuals involved in a response will likely be required to receive some level of training. The IS 700 - National Incident Management System (NIMS), An Introduction is a good three-hour introduction for individuals who are new to IMS.
Later in the OEP Newsletter is the article Coming Spring 2005, Preparedness training for MDH employees
The Twin Cities metropolitan area is one of twenty regions in the nation that is part of the Centers for Disease Control and Prevention's Strategic National Stockpile's pilot project, Cities Readiness Initiative (CRI). CRI Sites were chose based on population and geographic location. The program is intended to improve capacity to respond to a large-scale bioterrorism event or natural disease outbreak.
The SNS CRI emphasizes mass prophylaxis to the public with a focus on distribution of oral antibiotics within 48-hours of a known event or exposure. This would require using non-medical models, called "push" methods, to distribute the inial prophylaxis quickly. Mass dispensing sites would still be open to give antibiotics to the public.
In order to meet these challenges while working to improve all prophylaxis operations, local public health is using CRI funds, available through August 2005, to hire or contract with individuals to serve the region and assist with regional SNS planning priorities.
MDH Commissioner Diane Mandernach, plus several other MDH staff, gave presentations at the conference Building State and Local Preparedness, A Strong foundation for National Response was the theme of a public health preparedness conference held at the Centers for Disease Control and Prevention on February 22-25, 2005.
Commissioner Dianne Mandernach presented Food Safety and Food Security: State Perspectives at the plenary session on Food Safety and Security. During her presentation, she explained how food safety and food security are interrelated; she defined food security-- activities to prevent and prepare for an attack on the food supply--as an increasingly important component of food safety efforts. Her presentation highlighted federal food security initiatives, including the Department of Homeland Security’s Government Coordinating Council. She also provided an overview of ASTHO’s Food Safety and Food Security Task Force. In addition, Commissioner Mandernach discussed food security activities being conducted by state health agencies and state departments of agriculture. She explained that the Minnesota Department of Health’s food safety and security efforts include working with multiple partners within the state including the Minnesota Department of Agriculture, the Board of Animal Health, the University of Minnesota, and Homeland Security and Emergency Management. The Department of Health is also raising awareness among the public and private sector, developing response and recovery plans, holding workshops and conferences, and building connections between different parts of the food system. Commissioner Mandernach emphasizes that communication is key to addressing threats to the food supply.
Also presenting at this conference:
Norman Crouch, PhD, was the moderator for the Food Safety and Security session. Dr. Crouch also presented State Public Health Laboratory Bioterrorism Capacity at a session on The Public Health and Environmental Laboratory: A Strong Foundation for Public Health Readiness. He was also on the conference planning committee.
Paul Moyer, MS, presented A Tiered Approach to All Hazards Laboratory Testing of Unknown Environmental Samples.
Richard Danila, PhD, MPH, presented An Electronic System for Monitoring Persons in Isolation or Quarantine.
Two staff gave their presentations at two sessions. Ralph D. Morris, MD, MPH, presented Improving Communications Infrastructure in Rural Minnesota. LuAnne McNichols, MN, presented Improving Efficiency in Mass Dispensing: How Exercising can Strengthen Mass Dispensing Strategies.
Staff from the Minnesota Department of Health took part in two State Agency Exercises in 2004. These exercises, one a "tabletop" and the other a "functional exercise," were designed to test the ability of state agencies to respond to a large-scale emergency. After-Action Reports highlighted the agencies’ strengths, successes and opportunities for improvement.
Measuring Exposure to an Elemental Mercury Spill --- Dakota County, Minnesota, 2004 MMWR February 18, 2005 / 54(06):146-149
Reported by: BA Baker, MD, Regions Hospital Occupational Medicine Clinic, St. Paul; C Herbrandson, PhD, T Eshenaur, MPH, RB Messing, PhD, Minnesota Dept of Health, Environmental Health.
Elemental mercury spills can cause contamination of neighborhoods and homes and result in neurologic and kidney disorders in exposed persons who inhale mercury vapors. Often, however, difficulties exist in determining the magnitude of exposure and effectiveness of decontamination or in recognizing that reexposure has occurred. This report summarizes the response to an elemental mercury exposure that resulted in the decontamination of 48 persons and the subsequent analysis of blood and urine samples from 14 exposed youths aged 6--16 years. Data from these analyses suggest that 1) blood samples are more sufficiently acquired and can be used to evaluate recent acute exposure and 2) use of a real-time mercury vapor analyzer can help public health officials determine the magnitude of exposures and help prevent reexposures. In addition, demolition and waste-disposal firms and government agencies must take actions to ensure that elemental mercury is adequately secured before disposal.
In preparation for demolition of a factory in Dakota County, Minnesota, hazardous waste from the factory was temporarily stored in a shed, which was not effectively secured. During a late afternoon in September 2004, two teenagers entered the shed and found two canning jars containing approximately 21 pounds of elemental mercury. The teenagers brought the mercury back to their neighborhood, where they and approximately 12 other youths played with it, throwing handfuls of mercury at each other and splashing in a large puddle of mercury on an outdoor basketball court. This initial exposure was limited to < 2 hours because of rapid response by a parent who saw what the youths were doing, told them to go home and shower, and contacted the police. Subsequently, 48 persons, including 18 youths, were decontaminated with water and detergent by the Dakota County Special Operations Team between 10 p.m. and 2 a.m. Beginning at 9 p.m., homes were scanned for contamination by using a real-time mercury vapor analyzer (RA-915+; Ohio Lumex Company; Twinsburg, Ohio). On the recommendation of Minnesota Department of Health (MDH) staff, residents of 12 contaminated homes* were sheltered in a motel by the American Red Cross.
To read the entire article, go to Measuring Exposure to an Elemental Mercury Spill --- Dakota County, Minnesota, 2004
This article was written by Judy Farlow, Mass Dispensing Coordinator, from MDH Infectious Disease and Epidemiology, Prevention and Control.
Scenario: On a Friday evening, a high school student with neurological symptoms indicative of a potentially lethal infection is admitted to a community hospital. Two hours later, a second teen is admitted with similar symptoms. The following morning the bacteria is identified and the Minnesota Department of Health (MDH) is notified by 10 a.m. of the worrisome diagnosis. A third teen is admitted to the same hospital with a comparable clinical picture.
In the subsequent weeks, as community spread of the disease becomes evident, 30,000 residents in a city of 55,000 are vaccinated and thousands of people are given an antibiotic prophylaxis. Rifampin syrup is prepared by the gallon, with thousands of bottles of capsules prepared in room 250 at the MDH 717 Delaware building. A hotline is activated, over 600 people are enlisted in the response, and the Red Cross and National Guard help provide food, shelter, and traffic management for the massive effort. Local companies donate food and cell phones. Thousands of throat cultures are obtained and analyzed. Media briefings, crisis action teams and stakeholder meetings become regular components of the response.
While this may sound like a hypothetical situation for current emergency preparedness planners, these true events unfolded ten years ago, beginning January 27, 1995 and culminating on March 6. This was the Mankato meningococcal outbreak. Disease from the identified Neisseria meningitis ultimately resulted in 10 cases and one death in two clusters over the six-week span. The majority of the cases were students, ranging from elementary through high school and college. The fatality was a high school junior.
The MDH Infectious Disease and Epidemiology, Prevention and Control staff coordinated a vigorous response with local public health agencies and the Mankato community. That effort halted the outbreak. Even so, the stress on human and other resources, the public panic and stigma on the community, plus the complex logistics of mass vaccination and antibiotic dispensing highlighted the need for additional preparedness.
Today, ten years later, MDH continues its drive toward readiness. The Health Alert Network (HAN) was launched. Internal organization has incorporated the Incident Command System into emergency planning. Syndromic surveillance has emerged as a tool for early detection of outbreaks. Specific, detailed plans for mass dispensing of antibiotics and immunizations are in process throughout the state. Public information strategies are continually honed and polished.
While recent CDC funding has provided the impetus and support for these efforts, a Mankato outbreak laid the groundwork for the MDH’s response planning.
By Kevin A. Sell, RPh, Certified Specialist, Hennepin County Poison Control and Strategic National Stockpile (SNS,) Consultant Pharmacist/Health Resources & Services Administration (HRSA), Minnesota Department of Health
Editor’s Note: On October 19, 2004, Pharmacist Kevin Sell presented to the MPhA Board of Directors. All pharmacists, Sell urged, must have a level of awareness of the emergency preparedness plans in the region where he/she practices. In the event of a natural disaster or bioterrorism, pharmacists will be an integral part of caring for the needs of citizens in their communities. Because awareness is the first step toward preparedness, this article provides an overview of state and federal initiative.
Minnesotans expect to have floods in our vast system of river valleys, tornados across our plains, and utility interruptions that will test our resolve year after year. Minnesota’s pharmacists need to be prepared for the expected, high probability events while thinking about the potential for less likely events such as civil unrest, technological mishaps, and terrorism. Pharmacists need to be willing to lead their businesses, organizations, associations, institutions and communities towards disaster preparedness including mitigation, planning, response and recovery.
The Association of State and Territorial Health Office (ASTHO) has published Interstate Planning for the Strategic National Stockpile: Experiences in Five Regions to provide a current assessment of accomplishments and challenges in interstate planning. Based on telephone interviews with selected public health agency representatives, the report demonstrates that interstate planning is being used to overcome state-specific challenges. The report also describes additional challenges created by limited resources, legal liability, political issues, and lack of coordination of federal programs.
Coming Spring 2005
Preparedness training for MDH employees
The Commissioner of Health and the Health Steering Team have endorsed the need for all MDH employees to understand the fundamentals of Emergency Preparedness, including the MDH All Hazards Response and Recovery Plan and the roles that they may or may not be asked to fill during a public health emergency. The Office of Emergency Preparedness in partnership with other preparedness programs and divisions will provide training to all MDH employees beginning spring 2005.
The two-hour training sessions will highlight the role of Public Health in an emergency, the MDH All Hazards Response and Recovery Plan, the Incident Management System, and Personal and Family Preparedness.
Learning objectives include:
- Be able to describe the role of the Minnesota Department of Health during a public health emergency.
- Have an understanding of the roles you may or may not have during an emergency.
- Be aware of the MDH All Hazards Response and Recovery Plan.
- Be able to describe the Incident Management System.
- Explain activities that will assure personal and family preparedness during an emergency.
Scheduling Sessions will be announced in the Employee training Bulletin. All MDH employees will receive an e-mail directing you to that site when registrations are open.
You are invited to participate in the Public Health Institute, offered through the University of Minnesota School of Public Health from May 23-June 10, 2005. Choose a course of study and spend one day or three weeks.
Courses are offered for continuing education or academic credit in the following concentration areas:
- Occupational Health and Safety
- Public Health Preparedness, Response and Recovery
- Food Safety and Biosecurity
- Public Health Leadership
- Culturally Responsive Public Health Leadership
- Infectious Disease Epidemiology
- Maternal Child Health and Nutrition
- Evaluation Methods
- Applied Biostatistics
Scholarships are available for individuals to attend Public Health Institute courses and complete the following Public Health Certificate programs:
- Occupational Health and Safety
- Preparedness Response and Recovery
Scholarships are also available for individuals to attend selected courses in the following concentration areas:
- Food Safety and Biosecurity
- Cultural Responsiveness in Public Health
FEMA courses IS139 Exercise Design and PDS139 Professional Development Series Capstone Seminar: Exercise Design
The Minnesota Department of Public Safety, Division of Homeland Security and Emergency Management is sponsoring the Federal Emergency Management Agency (FEMA) independent study course, IS139 Exercise Design and the corresponding 8-hour class, PDS 139 Professional Development Series Capstone Seminar: Exercise Design.
Space is limited; emergency managers have first priority for this training. To register, please email Suzanne Donnell, the HSEM training officer, at firstname.lastname@example.org You must complete IS 139 before taking PDS 139.
The IS 139 Exercise Design course can be downloaded from FEMA's Independent Study Program (ISP) site.
HSEM is also offering two 16-hour classes on Homeland Security Exercise and Evaluation Program (HSEEP). This training will instruct participants in the HSEEP process and Office of Domestic Preparedness (ODP) reporting requirements.
HSEEP Scheduled trainings April 12-14, 2005 Nicollet County EOC, St. Peter
April 25-27, 2005 MN Interagency Fire Center, Grand Rapids
Schedule for each day: Day 1: 1:00 - 4:30 p.m. Day 2: 8:00 a.m. - 4:30 p.m. Day 3: 8:00 a.m. - noon
The HSEM classroom offerings are listed on the HSEM web site.
The following learning opportunities are available from the MDH Distance Communication and Learning Center (DLC). All are free of charge. Space is limited. Advance registration is requested.
To inquire about the capability of viewing any of these programs at other MDH locations (such as district offices), contact the DLC at (651) 282-6301. Non-MDH employees who would like to downlink the program at distant sites should contact your Extension Office, education facilities, or other organization that has a steerable satellite dish. Please note that some of these programs require online registration as well as registration with the MDH Distance Communication and Learning Center.
"The National Incident Management System "
The National Terrorism Preparedness Institute (NTPI) at St. Petersburg College presents Live Response, a 60-minute live discussion in which a panel of experts explores topics related to Weapons of Mass Destruction (WMD) consequence management. The National Incident Management System (NIMS) integrates effective practices in emergency response into a comprehensive national framework for incident management. Live Response explains the importance of understanding the key features and advantages of NIMS, and the role of the NIMS Integration Center. For more information go to A WMD Interactive Discussion Program.
Part of the series Public Health Grand Rounds, is now available on-line, on demand for Continuing Education credit. This presentation shows the steps taken by Toronto public health professionals with their community partners during the 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.
- 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, and can be accessed at Public Health Grand Rounds.
The program is a collaboration of the Centers for Disease Control and Prevention and the University of North Carolina School of Public Health.