In this issue:
- New director in Office of Emergency Preparedness
- Minnesota’s health response to Hurricane Katrina
- National Incident Management System
- Emergency Management Assistance Compact (EMAC)
- MN Responds!
- MDH Office of Emergency Preparedness
- State Emergency Operations Center (SEOC)
- Minnesota Information Hotline
- Camp Ripley Health Mission
- Hospital response activities
- Emergency Coordination Center (ECC)
- State Assistance Center
- MDH Web site
- How local public health agencies participated
- Lessons learned: examples of critical areas for improvement
- Thank you!
- Other News
On September 29, 2005, Aggie Leitheiser became the new director of the MDH Office of Emergency Preparedness. Aggie has worked in many positions at the Minnesota Department of Health, including:
- Assistant Commissioner of the Health Protection Bureau
- Director and Assistant Director of the former Disease Prevention and Control division
- Section chief of the AIDS/STD Prevention Services section
- HIV services and planning coordinator
Prior to working at MDH, Aggie worked as Community Health Services supervisor at Wright County Human Services. She also worked as a public health nurse in Wausau, Wisconsin and as a staff nurse at United Hospital in St. Paul.
Some words from Aggie:
“Emergency preparedness issues have been a significant part of my work these past few years. I’m pleased and excited to have the opportunity to focus specifically on the issues of public health and health care preparedness and response, and to improve coordination with other emergency response partners during this coming year. The devastating impact of Hurricanes Katrina and Rita only serve to point out the importance of our role in preparing for or responding to significant emergencies. Avian and pandemic influenza media coverage have kept the importance of preparedness in the public’s mind.
“I look forward to working within MDH and with external partners to take advantage of this window of increased attention from policy makers, the media and the public to highlight our successes and improve where we need to make changes. In particular, I’m going to work on making sure the Department is ready to respond to a range of emergencies quickly and with many tools already in place.
“So many MDH staff participated in our hurricane response and many others were willing to volunteer their time and talents. It’s gratifying to work in an organization where we have waiting lists of staff wanting to help. I expect a busy but productive year and appreciate advice and suggestions readers may have to improve our ability to protect the health of all Minnesotans.”
“Hello. I write this note to you on my last day (September 28, 2005) at MDH as the Director of the Office of Emergency Preparedness (OEP). As you may know, I am taking a one-year leave of absence from this job, giving me the opportunity to coordinate Ramsey County’s health emergency preparedness activities. After leading health preparedness efforts at the State level since OEP’s inception 3 ½ years ago, the opportunity to gain the local perspective first hand is timely.
“I am truly amazed when I think back on where we were in early 2002, fleshing out the concept of health emergency preparedness. We were in the aftermath of September 11 and the anthrax attacks. The Office of Emergency Preparedness was a box on an organization chart. Now, emergency preparedness is a core activity of MDH, staffed with hard working, dedicated people who strive to make a difference. The preparedness work of the OEP came to fruition during the response to the aftermath of Hurricane Katrina. We were successful in our response, using systems and tools we created, benefiting from relationships we had developed, and implementing an incident management system we had learned.
“I have truly enjoyed our work together in this challenging field. I thank all of you for what I have learned from you, and look forward to continued work with you in my new capacity.” Robert Einweck
Editor’s Note: For the most part, this issue of the OEP newsletter is devoted to describing the many activities that occurred as public health and health care workers responded to the needs of hurricane survivors. Much of the information for this article was taken from Situation Reports, debriefing sessions and other documents. The sections appear in chronological order. Thank you to the many people who helped with Minnesota’s Hurricane response activities and to the people who helped write this newsletter.
While we are proud of our involvement with Hurricane Katrina, we learned we have significant work to do in order to be more effective when responding to future incidents and emergencies. The Hurricane Katrina activities showed we need to increase our proficiency when responding to a major incident or emergency.
“This was not an exercise. This was a real emergency where we worked in real time, to make real things happen for real people.” (A comment made during a Minnesota Department of Health’s debriefing session following Hurricane Katrina activities.)
On Monday August 29, 2005, Hurricane Katrina struck the Gulf of Mexico coastal areas of the United States. It severely damaged portions of Alabama, Mississippi and Louisiana. The Federal Emergency Management Agency (FEMA) requested the state of Minnesota to temporarily provide housing and services for up to 5,000 people from the affected areas. These individuals were expected to arrive in Minnesota around September 8.
The Minnesota National Guard named this response Operation Northern Comfort. In Minnesota, the agreed term was “hurricane survivors,” not refugees or victims. It was anticipated that Hurricane Katrina survivors would be offered services and temporary housing at Camp Ripley for four to six weeks until they would be relocated in communities throughout Minnesota or other states.
The primary role of the Minnesota Department of Health, local public health and health care providers was to provide services that would address the physical and mental health needs of the hurricane survivors when they arrived in Minnesota. Public health professionals from MDH and local public health agencies, hospital-based staff, trained mental health workers and public health sanitarians played an active role during this emergency.
Response activities were different in some ways from how public health normally operates. For the first time, public health staff worked at several emergency response centers, including the Emergency Management Assistance Compact Center, the State Emergency Operations Center, the Emergency Coordination Center, Camp Ripley and the State Assistance Center. The activities that occurred at those centers are described in this article.
The day and number of survivors to arrive in Minnesota kept changing. First, staff were told to prepare for 5,000 people; the number was lowered to 3,000; and then the number was reduced to 500 hundred survivors. Eventually, the news came that many people from the southern states wanted to remain in their region and did not want to come to Minnesota. On September 12, all flights carrying hurricane survivors out of the Gulf region were suspended. As a result, operations to house survivors at Camp Ripley came to a halt.
At the same time, hurricane survivors began to self evacuate to Minnesota. Local public health agencies received calls requesting many kinds of assistance. The nature of Minnesota’s response changed from responding to survivors arriving at Camp Ripley, to a statewide response that would meet the needs of survivors in many Minnesota communities.
Minnesota’s response activities that are described in this article occurred from August 31 through September 30, 2005. Even though weeks have past since Hurricane Katrina occurred, local agencies continue to help survivors settle into their new homes and adjust to life in Minnesota. Minnesota hospitals continue to recruit and deploy healthcare professionals to the Gulf. By October 10, 2005, over 4,500 hurricane survivors are now living in Minnesota.
Hurricane Katrina provided MDH, local public health and the state’s private health care sector with a valuable opportunity to implement emergency response plans that are based on the Incident Management System (IMS). This system is new to many public health and health care professionals. One of the important lessons learned from the Katrina experience is that there is a need for additional, intense IMS training for public health employees.
Homeland Security Presidential Directive (HSPD) 5 states “The National Incident Management System will provide a consistent nationwide approach for Federal, State and local governments to work effectively and efficiently together to prepare for, respond to and recover from domestic incidents, regardless of cause, size or complexity.”
During times of disasters or emergencies, how do states help each other? The Emergency Management Assistance Compact Center is a state-to-state mutual aid agreement that allows states to provide personnel and resources (such as equipment) to other states in times of disaster. The mission is to facilitate an efficient and effective sharing of resources between member states. EMAC is a congressionally ratified organization that provides structure in response to interstate assistance.
On Wednesday, August 31, 2005, the Minnesota Department of Homeland Security and Emergency Management (HSEM) activated the Emergency Management Assistance Coordination Center. The EMAC Center, located in New Brighton, assessed and coordinated requests for assistance to the affected states. Five MDH staff assisted with health-related EMAC requests.
Examples of EMAC activities during this emergency:
- Provided CDC immunization recommendations to responders being deployed to the gulf area.
- Identified and coordinated health assets (e.g., health personnel) to deploy to the gulf.
- Educated health personnel on the process of deployment and liability coverage.
- Communicated with the Louisiana State Emergency Operations Center regarding their requests for health and medical personnel.
- Took calls from health professionals who wanted to offer their services and referred them to the appropriate place to volunteer (MN Responds!)
- Enhanced partnerships with Homeland Security and Emergency Management (HSEM), Emergency Medical Services Regulatory Board, Minnesota National Guard and other city/county emergency managers.
For more information, see the National EMAC website.
As the events of Hurricane Katrina emerged, staff at the MDH Office of Emergency Preparedness addressed key issues.
Examples of OEP activities during this emergency:
- Developed incident objectives and action steps.
- Recruited volunteers from public health, hospital, emergency medical services, behavioral health and others for potential deployment to the Gulf region and to Camp Ripley.
- Coordinated Minnesota Responds! with other volunteer registration programs (e.g., Medical Reserve Corps). Increased registration of potential health professionals interested in volunteering during a public health emergency.
- Communicated information through Health Alerts, on the MDH Workspace (a password protected, web-based site), the MDH Web pages and e-mail messages to MDH staff and partners.
- Provided legal research concerning liability protections for volunteers.
- Provided staffing to the Minnesota Emergency Management Assistance Compact, State Emergency Operations Center, Information Hotline and the MDH Emergency Coordination Center.
The final step for OEP staff in this emergency is to write the After Action Report that describes what worked well, what did not, what changes need to be made and key lessons learned.
When a major incident occurs, public health and health care providers are often eager to help. But to whom can they inform of their willingness to volunteer?
The Minnesota Responds! is MDH’s registry for health care and public health personnel interested in volunteering their services during a public health emergency. People who are registered with Minnesota Responds! might work at a mass dispensing clinic, distribution sites for the Strategic National Stockpile or other facilities.
Examples of Minnesota Responds! activities during this emergency:
- Worked with the U.S. Department of Health and Human Services Secretary Leavitt, in collaboration with the American Hospital Association, to augment the hospital response.
- Planned for volunteers who initially would be deployed to the Gulf. Later, the database collected names of people who might provide services at Camp Ripley.
- Directed potential health volunteers to the Minnesota Responds website to register as a volunteer.
- Captured information from both hospital and non-hospital based volunteers.
- Worked closely with the Medical Reserve Corps and other partners on coordinating volunteer recruitment and deployment.
On August 20, 2005, only 200 people were registered with Minnesota Responds! to be a volunteer. In response to Hurricane Katrina, MDH received a high volume of inquiries about volunteer opportunities. As of October 3rd, 1,043 people were registered to serve as a volunteer through Minnesota Responds!
The State Emergency Operations Center is a physical location where the coordination of information and resources takes place to support domestic incident management activities. It is a place where key decision makers from multiple state agencies meet to coordinate and formulate a response to an incident.
In response to Hurricane Katrina, the SEOC opened on September 3, 2005 in St. Paul. Staff from 12 state agencies, a representative from the Federal Emergency Management Agency and staff from the American Red Cross and the Salvation Army worked at the SEOC. The Minnesota Department of Health was asked to address and coordinate the health needs of 3,000 to 5,000 survivors who might be coming to Minnesota.
The SEOC is a large room set up with tables, computers and telephones that were used by staff to accommodate the hurricane survivors based on the mission of their organization. This enhanced communication by having representatives from so many agencies located together. Each day, two debriefing sessions were held and representatives reported on their actions.
Examples of public health activities at the SEOC during this emergency:
- Supported the health responses at Camp Ripley.
- Registered and referred licensed medical practitioners who might be deployed to the gulf.
- Served in a liaison role with other agencies.
MDH staff worked at the SEOC for 14 days.
On Saturday, September 3, the State Emergency Operations Center opened its Information Hotline from 8:00 am to 8:00 pm. Initially, state employees from several agencies responded to phone calls on six telephone lines. People calling wanted to know where to make financial donations; where they could volunteer their time; offered housing options for Hurricane Survivors and other issues. Over time, the calls were regarding immunization questions.
MDH agreed to provide three staff for each shift. Initially, Office of Emergency Preparedness staff requested assistance from employees who are funded with emergency preparedness money, but they were committed to other duties. Then the SEOC requested staff for the following week, from Saturday September 10 through Friday September 16. MDH needed to schedule more staff, so on Friday (September 9) afternoon, an urgent email was sent to all MDH employees. Within two hours, over 40 MDH employees called and were assigned to one or more shifts. During the second week of operation, the number of phone calls at the Information Hotline dropped dramatically because the anticipated number of Hurricane Survivors had dropped to 300 people who would be coming to Minnesota. After 13 days, the Hotline closed on Thursday, August 15. A total of 46 MDH staff participated at the State Emergency Operations Center Information Hotline.
The goal at Camp Ripley was to provide integrated medical, mental and public health triage, treatment and follow-up services for a potential 3,000 Hurricane Katrina survivors. Services would include health screenings, emergency medical services, urgent and primary care, mental health screening, and public health nursing services for children and adults. Additional public health measures included controlling infectious diseases, addressing sanitation issues, and monitoring food safety. A reception center consolidated health screenings, identification, housing assignments and security screenings. A full service clinic was set up at Camp Ripley that included pediatric and adult examination rooms, laboratory, x-ray, pharmacy and emergency medical services. Follow along mental health services were provided in the Camp Ripley Assistance Center. Many agencies provided staffing and resources at the Camp.
Examples of health-related activities at Camp Ripley during this emergency:
- The first priority was to form a core team to set up a health triage site and medical clinic that would provide an integrated approach to medical, mental and public health services.
- A Hospital Emergency Incident Command System (HEICS) was implemented to manage the entire health response. The HEICS Incident Commander worked closely with the military incident command team and other coordinating agencies.
- A daylong orientation and training was provided to health volunteers, which included a half-day of exercising.
- A volunteer staffing plan was developed in collaboration with the Regional Hospital Resource Center Coordinators, Minnesota Hospital Association, emergency medical service providers, local public health agencies, regional behavioral health coordinators, the Department of Human Services, and the MDH.
- Public health nurses, mental health providers, clinic providers and emergency medical services providers worked collaboratively to develop a range of integrated services and sites.
- The MDH Central District office and Morrison County public health sanitarians did a walk-through inspection of the kitchens.
One of the major difficulties at Camp Ripley had to do with equipment needs. The entire Health Mission was expected to be self-sufficient. All health equipment and supplies used in the Reception Center and Medical Clinic were donated by various hospitals throughout the state. Hospitals sent five truckloads of medical equipment and supplies that had to be sorted and shelved. Another challenge included the lack of telephone and Internet connectivity for four days. This was very difficult for staff and volunteers at Camp Ripley because cell phones and satellite phones didn’t work indoors. Satellite phones worked outside, as did some (but not all) cell phone companies. Thus, communication between Camp Ripley, MDH and our partners was a major challenge.
People worked very hard to have a smooth operation at Camp Ripley. Then when the news came that no hurricane survivors would arrive at the Camp, many people felt let down.
When the initial events of Hurricane Katrina unfolded, teams of 100 medical professionals were requested to go to the Gulf region to provide medical care. In response, the Minnesota Hospital Association (MHA), Regional Hospital Resource Center Coordinators (RHRCs), the hospital community and the MDH worked collaboratively to recruit five teams of 100 hospital-based healthcare professionals who were willing to volunteer to go to the Gulf. The MHA took the lead to communicate to hospitals regarding recruitment and deployment of hospital volunteers.
Before these teams were activated, the State received word that we would be accepting 3,000 to 5,000 hurricane survivors. To meet this request, these teams were deployed to Camp Ripley. The primary focus of the Regional Hospital Resource Center Coordinators shifted to support the Camp Ripley mission. As the number of anticipated hurricane survivors decreased from 3,000 to 300-500, the RHRCs expanded their focus to recruit and deploy healthcare professionals to the Gulf, and still support the Camp Ripley mission.
To facilitate hospital communication within and across regions, the Metro Region extended the use of MissionMode, a web-based emergency communication system, to all Regional Hospital Resource Center Coordinators in the State. This provided immediate and up-to-date information that was shared with all hospitals in the State, facilitating recruitment and deployment functions. In addition, the RHRCs participated in conference calls several times daily with the Incident Command at Camp Ripley and in conference calls with National groups to coordinate their Gulf response.
Hospitals spent a huge amount of time and effort to facilitate the Minnesota response to both Camp Ripley and the Gulf. Most regions and some individual hospitals activated their Emergency Operations Centers (EOC) and used their Hospital Emergency Incident Command System (HEICS) to manage the planning, operations, logistics, and administrative/financial components of this major medical emergency response effort. Some regions also activated their Multi-Agency Coordination Center to facilitate response planning and operations.
Although most hospitals have deactivated their EOCs, they continue to be involved in the ongoing recruitment and deployment of healthcare professionals to the Gulf region. As part of the broader National response to Hurricanes Katrina and Rita, this response will need to continue until the Gulf States have rebuilt their health care capacity.
The Minnesota hospital response was outstanding. Clearly, the health care system was well prepared to respond. The volunteer response was excellent, well coordinated and efficient. The interagency collaboration between the health care system and other agencies involved in public health and hospital preparedness planning provided a coordinated and effective response.
The ECC was opened to coordinate response activities with local public health, the Regional Public Health Preparedness Coordinators (PHPCs), the health team at Camp Ripley, the Emergency Assistance Compact Center, the State Emergency Operations Center, and the Minnesota Information Hotline. The ECC had staff who worked with each of the Incident Management functions, including incident command, operations, planning, logistics and finance administration.
Examples of activities at the ECC during this emergency:
- Identified issues that would be managed by the ECC, local public health or hospitals.
- Coordinated the health-related actions to support Operation Northern Comfort and the community based hurricane survivors arriving in Minnesota.
- Coordinated requests for staffing positions at the various sites.
- Fulfilled health requests received by key agencies, or from the SEOC, EMAC and Camp Ripley.
- Developed and coordinated public and media responses.
- Assured communication among response partners
- Posted materials on the Website and the password-protected Workspace.
- Helped set up and coordinate the State Assistance Center (SAC).
- Provided public health staff for the State Emergency Operations Center and the SAC.
We had good representation at the ECC from various MDH programs and divisions. Staff had a good understanding of roles of MDH, local public health and hospitals. Appropriate staff working together allowed for good, timely solutions as situations developed.
By September 12, 2005, approximately 350 hurricane survivor families had arrived in Minnesota. The State Assistance Center, located in St. Paul, was a one-stop center where hurricane survivors received assistance regarding a variety of issues.
The SAC was a multi-agency collaboration of providers who worked to address potential survivor needs. Participating agencies included key departments of the State of Minnesota, federal agencies such as the Social Security Administration and the Internal Revenue Service, plus other organizations. The SAC was located at 1410 Energy Park Drive in St. Paul and operated seven days a week.
Examples of how hurricane survivors were helped:
- FEMA helped people register for the Individual Assistance Program.
- Red Cross offered food, shelter and housing vouchers.
- Salvation Army offered food and gasoline vouchers, plus had a “free store” in the SAC where people could get clothing and personal items.
- Minnesota Department of Health staff pulled immunization records from the Gulf states; gave information on the location of immunization clinics; made referrals for free or low cost health services; assisted with licensure issues for relocated health professionals; and made referrals to local public health agencies.
- Individuals received employment and unemployment assistance.
- Social Services including health care benefits, mental heath services (short-, long-term and specialized), food support, welfare assistance and other services specific to individual circumstances.
- Behavioral health counselors were available; over 750 people met with a counselor.
- Minnesota Department of Education helped survivors enroll their children in schools and gave backpacks and school supplies.
- Minnesota Department of Driver & Vehicle Services either located a copy of a person’s driver’s license from the Gulf region, or helped them apply for a Minnesota drivers’ license.
According to the Minnesota Homeland Security and Emergency Management, over 1,800 hurricane survivors received assistance at the State Assistance Center.
An Information Sheet, Hurricane Disaster Assistance available through federal and state sources, is posted on the Department of Public Safety’s web site.
Communication during any major incident can be a huge challenge. Below are examples of materials that were posted on the MDH web page:
- Hurricane Katrina Survivors: How to Get Health Help Important information and sources of help for people who have come to Minnesota as hurricane survivors.
- Health Resources for Healthcare Professionals Working with Hurricane Survivors Information for professionals and volunteers who are working with hurricane survivors, individually or as part of an organized response.
- Responding to Katrina - How Health Personnel Can Help Information about how and where professionals can volunteer to help, as part of the health response to Katrina.
- Katrina Volunteers Getting Ready to Go: Health Concerns Health resources were available for people getting ready to go to the Gulf.
In response to the expectation that hurricane survivors would be coming to Minnesota, on Saturday, September 3, (Labor Day weekend) pagers, cell phones and home phones began ringing all across the Central Region. A health alert was sent to the 24/7 contacts, requesting they call the Central Region Public Health Preparedness Consultant (PHPC) at home. Within two hours, all 14 agencies had responded and in most cases, at least 2 people from each agency had called.
The State Emergency Operations Center (SEOC) asked the Central region to determine the number of public health nurses that could be assembled on short notice to receive Hurricane Katrina survivors. By Saturday evening, several agencies had implemented their agency call down lists and were reporting numbers. By Sunday noon, the Central Region had 30 nurses on standby. By Monday, close to 100 nurses and a significant number of health educators, case aids, support staff and others were available, ready and willing to assist. At the same time, the PHPCs in other regions in the state were contacting their agencies to put them on alert to be ready to respond, too. We didn’t know how many or when the nurses would be needed.
As the local public health agencies in the state waited to be called, a small planning team went to Camp Ripley on Tuesday, September 6. The planning team was a combination of six MDH staff and three local public health staff from Morrison and Crow Wing counties. We quickly determined what services public health could provide and how many staff would be needed. The team developed Job Action Sheets, Standard Operating Guidelines, an Immunization Clinic Plan, Protocols, Resource Manuals and Supply “kits”. We met with the Medical Director, conferred with the medical clinic staff, behavioral health staff, triage center staff and American Red Cross nurses. We routinely met and problem-solved, shared information, added staff, and participated in briefings and exercises. We were ready to receive survivors at Camp Ripley by Wednesday, September 7 at 8:00 a.m.
While the team of local public health (LPH) and MDH professionals worked at Camp Ripley, local public health agencies also worked to be ready to respond. The LPH directors went to their county board meetings and presented the limited information they had. They received permission to send public health staff to Camp Ripley. Staff examined their schedules and determined the number of staff they could send and still maintain their agency operations. Knowing how many staff would be needed was difficult because the information kept changing about the number of Hurricane Survivors arriving at Camp Ripley and the arrival dates.
Then we learned the hurricane survivors were not going to go to Camp Ripley. Survivors who had arrived in Minnesota began to call local public health agencies, and suddenly we became the frontline response team. This required a shift in planning, resource development and other response efforts. Within a day, information for survivors in communities was available to local public health.
Even though Hurricanes Katrina and Rita have ended, Minnesota’s local public health agencies continue to do what local public health has always done: signing up individual survivors for the Woman Infant and Children program (WIC), public health nursing visits, family visiting, and referring them to community services and resources.
During the hurricane emergencies, local public health agencies showed they could respond quickly when needed, and could adapt to changing situations and information. The staff who were members of the Camp Ripley planning team illustrated how important the state and local partnership is to be able to respond, the importance of developing relationships prior to an incident, and how all the planning we have been doing for the past 3-4 years is easily applied, adapted and used.
After holding the debriefing sessions and writing the After Action Report on Hurricane Katrina activities, significantly more work is needed in order to be more effective when responding to future incidents and emergencies. Here are examples of critical areas that need to be addressed:
- Employees need to become more knowledgeable and proficient regarding the National Incident Management System and the Incident Command System. Staff should be pre-identified and trained for key roles in the Incident Management System.
- Employees need to understand how the “centers” function during an emergency: the Emergency Management Assistance Compact Center, the State Emergency Operations Center, the Emergency Coordination Center and the State Assistance Center.
- During an emergency, it is essential that the workforce know what the MDH relationships are with other state agencies, and how other state agencies function.
- Human resource issues should be clarified before an emergency occurs. All staff need to know what is expected and required of them.
- All MDH employees, not just those actively involved in a response, will recognize that during an emergency, many or all staff will be contacted. Requests for assistance will take priority over the individual’s job. Staff need to set aside their less essential tasks and become more engaged in the emergency activities.
- In order to sustain a long-term response, more employees need to be given assignments. A long-term emergency response requires many more staff be involved than what occurred with Hurricane Katrina.
- Strong, reliable communication tools that serve as a central source of information need to be improved and used all of the time by multiple agencies.
Public health emergency preparedness and response activities will continue to evolve as lessons are learned and more staff are trained and understand that all employees have a role during an emergency. Sometimes that role will be to continue doing their regular job.
We extend a hearty thank you to each of you who offered your time, energy and expertise as we prepared for hurricane Katrina survivors.
We learned a lot from this experience and will use the lessons learned to be better prepared to respond to and support future incidents of all types.
The Centers for Disease Control and Prevention (CDC) announced that the MDH Public Health Laboratory has been selected to serve as a Level-1 laboratory for the nation’s Laboratory Response Network (LRN), effective September 1, 2005. This selection was based on an objective review by the CDC of each applicant laboratory’s technical capability. Minnesota’s new laboratory facility, its excellent laboratory staff and the state’s overall preparedness for emergency response were rated very highly.
The MDH laboratory had been functioning at LRN Level-2. At Level 2, public health laboratories must have the equipment, analytical expertise, and training to analyze patient specimens for the presence of a subset of common chemicals that could be used for terrorism. In addition, the Level-2 laboratories are responsible for educating the technical staff of clinical chemistry laboratories statewide in collection, chain-of-custody, documentation, packaging, and shipping of human specimens for testing.
At LRN Level-1, the MDH laboratory will now also have the equipment, analytical staff, CDC training, and close CDC collaboration required to analyze specimens for extreme agents of chemical terrorism, as well as exposure to other chemicals. This additional capability is important for Minnesota at both the state and local levels, not only for responding to possible acts of mass chemical terrorism, but also for emergency responses to more localized exposures caused accidentally or by criminal intent. Also, this new Level-1 analytical capability, and its intrinsic close working partnership with CDC scientists, places the MDH laboratory in a strong position for future efforts to develop technology and work with Minnesota’s environmental health and medical communities to investigate possible chronic health effects, or fetal development impacts, resulting from exposure to potentially hazardous chemicals.
Before this new CDC selection, the nation’s LRN Level-1 laboratories were located in five states: California, Michigan, New Mexico, New York, and Virginia. Of the 11 states that recently applied to become additional Level-1 sites, Minnesota and Florida were the two states that became LRN Level-1 labs. Next year, Massachusetts, South Carolina and Wisconsin will be added bringing the total number of LRN Level 1 laboratories for the nation up to the CDC projected goal of 10.
The Central Region public health departments of Stearns, Wright, Benton, and Sherburne counties, along with the Minnesota Department of Health (MDH), conducted a functional exercise of mass dispensing on August 16, 2005. The Mass Dispensing Site (MDS) exercise tested various plan components to determine how quickly local public health (LPH) agencies could dispense medications to the community in the event of an emergency. Over 300,000 people live in this four-county area.
- Introduce Mass Dispensing Site designs, forms, and staff roles in a clinical setting
- Test accuracy, reliability and efficiency of MDS designs, forms, and staff roles
- Test Just-In-Time training.
Over 100 staff members from LPH, MDH and 130 community volunteers participated. Public Health staff reported to the Monticello Middle School and received Just-In-Time training on the emergency scenario, Incident Command, job action sheets, and clinic guidelines on proper dispensing of medication. Staff participated in setting up the clinic operations.
Volunteers received an orientation to the anthrax exposure scenario and how they would be routed through the clinic to receive preventative medication. Staff received training on risk communication and communicating with the public. Community partners also involved in the exercise included the Monticello Middle School staff, the Salvation Army, and the Wright County Sheriff’s Department.
Many valuable lessons were learned from the drill which was held under less than ideal conditions--the day was humid with temperatures in the mid-80s; the gym did not have air conditioning so staff and volunteers were quite warm; and the gym floor had recently been waxed, leaving a strong odor in the air.
Key lessons learned included:
- The Incident Command structure provided a way to bring multiple public health agencies together to work cooperatively.
- Cross training within major roles is needed to allow more flexibility in staffing.
- The basic design worked well although redesign of the flow plan (queuing & signage) could increase throughput.
- Job Action Sheets should only have information that pertains to the specific job assigned.
- Planning team members would better fill roles of observer, evaluator, documentation, or media contact, rather than being part of the Incident Command structure.
An additional benefit of the exercise was measuring the number of people going through the clinic as both individuals and then head of household. Evaluation comments reflect the success of the exercise. “Good learning experience – increased my self-confidence.” “Everyone seemed to do what they were suppose to be doing. Good job.” “I thought there was great cooperation among agencies.”