July 2006 Ready to Respond MDH Preparedness Newsletter
Welcome to the first issue of Ready to Respond/MDH Preparedness Newsletter.
The MDH Office of Emergency Preparedness (OEP) has written and distributed an electronic newsletter (OEP Newsletter) since 2002. During those years, you read about many different topics pertaining to preparedness. All the OEP newsletters are available under "News Links" on the left of this screen. We appreciate the articles many of you contributed.
In 2006, OEP staff and the Health Emergency Preparedness Area Command Team (HEPACT) agreed the newsletter should have a broader focus and include articles that reflect emergency preparedness activities occurring at or impacting staff at the Minnesota Department of Health, local agencies and hospitals.
The purpose of this quarterly newsletter is to inform readers about Minnesota's health-related preparedness activities, successes, opportunities and pertinent news. Each issue we'll have standard columns: Director's Chair, a feature article, Division Highlights, Hospital Updates, District Office Preparedness Activities, Upcoming Events and Resources to investigate.
A new editorial board (see last page) will assist with story ideas and pertinent issues.
In order to give the newsletter a different look, first we needed a new name. The Editorial Board suggested names and voted on the name Ready to Respond/MDH Preparedness Newsletter. Then Micaela Vega, Web Designer from OEP, created a few logos and the Editorial Board voted again. Last, Micaela created a slightly different format. The newsletter will continue to be posted on the OEP Website. Many thanks to Micaela, the Editorial Board and MDH staff for your contributions.
We hope you will find this newsletter informative. Please contact the editor or Editorial Board members if you have story ideas or suggestions.
Ready to Respond
Did you have a skill you developed in your younger years? Do you remember the hours you practiced, the encouragement from your family, the recitals or tournaments to show off your new talent, the commitment and passion it took to make improvements? Well, dust off the memories of your ballet shoes or your football cleats or your debating note cards, because we're going to need that same level of effort from you over the next months.
We are embarking on an ambitious effort to expand our emergency response skills and practice our plans over the next year. We will likely discover that many things work well and just need a little practice to stay current. We will also discover areas that don't work so well and need more attention, training and exercising. As with all new skills, practice is something we need to make space for in our lives. We'll also need to remember that encouragement from those around us can make the effort more successful – and probably even more rewarding and fun.
Why are we increasing our attention to exercises? Our federal funding partners are asking us to measure our performance and outcomes; our state and local partners are asking for more specifics about who is doing what; and we need to be sure our capability to respond is consistent with the National Incident Management System (NIMS). The public is also asking "Are you ready?" and we can best answer that question by being able to point to events and exercises that demonstrate our skills and coordination.We will likely trip and stumble from time to time. Our mutual challenge is to increase our training, practice thoughtfully and work toward improvements. I'm excited about the work ahead and working with you to be "Ready to Respond" to all types of hazards and public health emergencies.
$5 Million for MN Pandemic Influenza Planning
In the final hours of the session, the Minnesota Legislature appropriated $5 million for pandemic flu preparations over the next year. This money will help the Minnesota Department of Health (MDH), local and state partners, such as Homeland Security Emergency Management (HSEM), to strengthen our ability to respond to a possible pandemic.
MDH Pandemic Influenza Plan Update
This Plan is posted on the Web on the MDH Influenza website. The Plan focuses on what MDH will do to prepare for and respond to a pandemic. It includes these topics:
- Epidemiology Surveillance
- Community Disease Containment
- Infection Control
- Clinical Issues
- Healthcare Planning
- Antivirals and Vaccines
- Poultry Worker Health
- Care of the Deceased
- Environmental Public Health
People from across the state attended two videoconferences in early May to share the plan with local public health, emergency managers, hospitals and clinics. The May 3, 2006 preview drew considerable attention from local media because the National Pandemic Influenza Implementation Plan (National Strategy from PandemicFlu.gov) was released that day.
You can find current information on the MDH Web site about three types of flu: Avian H5N1 influenza, pandemic planning and seasonal influenza. Special sections for health professionals are available under all three topics.
The Pandemic Influenza Planning Web site has information on pandemic basics, schools, local public health, what MDH is doing to plan for a Pandemic, and what other state agencies will do during a pandemic. Health professionals and local public health will find planning templates to use for their own plans, along with pandemic assumptions and materials to help when giving presentations on pandemic preparedness.
The Avian Influenza (Flu) Web site focuses on the Avian H5N1 virus, what we know now and the possibility that it could become the next pandemic. Look here for answers to common questions, links to maps and situation reports as we track the disease worldwide.
Looking for information about bird flu from other agencies? Now there is a one-stop Web site to Minnesota state agencies that have information on avian flu or pandemic planning. The State of Minnesota Bird Flu website has links to the Board of Animal Health; the Minnesota Departments of Agriculture, Health and Natural Resources; Homeland Security and Emergency Management; and the University of Minnesota's Extension Service and College of Veterinary Medicine.
MDH All-Hazards Response and Recovery Plan
Under development since 2002, the MDH All-Hazards Response and Recovery Plan reached a milestone in its evolution when the Base Plan draft version 2006.1 was recently posted on the MDH Office of Emergency Web site. When completed, this Plan will include the base plan, the MDH Multi-Agency Coordination (MAC) Plan, the MDH Pandemic Influenza Plan and many more components.
MDH All-Hazards Response and Recovery Base Plan
This latest version of the base Plan establishes the organizational framework to activate and manage the Minnesota Department of Health activities that will be implemented in response to incidents having public health and/or medical implications. The Plan also describes the capabilities and resources available to MDH to address various public health hazards that arise following emergency incidents and disasters.
The Plan describes:
- MDH roles and responsibilities in, and resulting from, an incident or disaster;
- The decision-making process to activate the Plan;
- The notification process to populate Plan functions and activities; and
- The incident management structure that will be used by MDH.
MDH Multi-Agency Coordination (MAC) Plan
The MDH Multi-Agency Coordination Plan is a supplement to the MDH All-Hazards Response and Recovery Plan. The MAC Plan was developed to facilitate health-related policy coordination and resource allocation decisions among multiple jurisdictions and multiple health-related entities to provide for the safe, rapid and coordinated response to health-related emergencies. The MDH MAC Plan establishes the generic framework for state support, coordination and communication with the eight MDH health regions.
MDH Pandemic Influenza Plan
The MDH Pandemic Influenza Plan is a supplement to the MDH All-Hazards Response and Recovery Base Plan.
Next steps and ongoing Plan development
Work continues on significant portions of the MDH All-Hazards Response & Recovery Plan, including procedures for the MDH Department Operations Center (DOC), functional annexes that broadly define departmental tasks and incident-specific annexes that provide hazard-specific response and recovery information and procedures. Additional portions of the Plan will be made available as appropriate.
The Choreography of Lab Relocation—The MDH-PHL Story
Moving into a new apartment or house can be a stressful, labor intensive and time consuming, life-changing event. For many of us, the longer we live in one location, the more possessions we accumulate, so when it is time to move, the task can be overwhelming.
This past November 2005, the Minnesota Department of Health Public Health Laboratory (MDH-PHL) embarked on such a journey when it moved from its residence of 37 years at 717 Delaware Street in Minneapolis into a new state-of-the-art facility located on the capitol complex near downtown St. Paul. Several months before the move, an enormous effort was taken to purge the lab of unwanted or unneeded items. Papers and old files that filled dozens of dumpsters were shredded and recycled. The University of Minnesota took old laboratory glassware and equipment to distribute to public schools for their science classrooms. Expired chemicals were also removed in several batches for proper disposal.
One of the main challenges with this move was to keep certain critical laboratory functions going. Many MDH-PHL programs are either mandated by state statute, plus this is the only lab in the state that can perform certain critical tests. Setting up redundancy for brief periods was the only way to keep core functions running. For example, the newborn screening program had enough equipment and staff to keep running samples at the old building while they moved into and set up the other half of their equipment in the new building.
Another major issue was how to package and transfer the contents of approximately 100 incubators, refrigerators, freezers and ultra-cold freezers. We contracted with a hazardous materials transfer company to properly package and label our chemicals and reagents for the move. Moving infectious agents was more challenging. After consulting with numerous laboratories and the Minnesota Department of Transportation, a plan was developed. Drivers trained in moving hazardous materials conducted the move during very low traffic times. A state highway patrol escort provided additional safety and security.
It took about two weeks to move an estimated 50 truckloads to the new facility. Moving several millions of dollars of laboratory equipment and having very little or no down time required an enormous amount of planning and cooperation of all laboratory staff. Many staff worked seven days a week, often from early morning to late into the evening. A few MDH-PHL staff remember the laboratory move from the old University of Minnesota building to 717 Delaware. Given the projected 50-year lifespan of the new building, this recent move will most likely be a once-in-a-career event.
Minnesota Departments of Health and Agriculture
in new building in St. Paul
The Laboratory Response Network
In the event of a covert biological or chemical attack, the first indication of that attack would be victims seeking treatment at nearby emergency rooms. Determining the agent used in the attack is essential for appropriate treatment and subsequent response. This agent identification begins in the local laboratory.
In order to have an effective response to a covert attack, it is imperative to have:
- Trained laboratory staff able to recognize all the agents of biological and chemical terrorism;
- A reference laboratory that can provide information and training as well as receive referred samples for confirmation, and
- A network connecting all of the labs in order to standardize testing protocols and share information.
The Laboratory Response Network (LRN) and the Minnesota Laboratory System (MLS) meet all of those needs.
In 1999, the Centers for Disease Prevention and Control (CDC) established the LRN, which is an integrated national and international network of laboratories fully trained and equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases and other public health threats. The LRN is separated into two structures: bioterrorism and chemical terrorism. The Minnesota Department of Health Public Health Laboratory (MN-PHL) is designated as a Reference laboratory for bioterrorism and a Level 1 laboratory for chemical terrorism.
The LRN for bioterrorism consists of three levels of laboratories:
- National level laboratories provide definitive agent characterization, bioforensics and select agent program management.
- Reference level laboratories perform tests to detect and confirm the presence of potential threat agents and include more than 100 state and local public health, military, international, veterinary, agriculture and food testing laboratories.
- Sentinel level laboratories represent thousands of hospital and clinic-based labs, as well as veterinary, agriculture, and food testing laboratories. (See diagram)
LRN Sentinel laboratories have direct contact with patients and may be the first to recognize a covert terrorist attack and other public health threats. In Minnesota, 125 LRN Sentinel laboratories make up the clinical- and hospital-based laboratories. These labs perform "high complexity" testing in microbiology, and are responsible for clinical diagnostics of infectious agents and ruling-out and/or referring potential agents of bioterrorism to the MN-PHL LRN Reference laboratory.
The MN-PHL is the LRN Reference laboratory for the State of Minnesota and performs tests to detect and confirm the presence of biological threat agents. MN-PHL ensures a timely local response in the event of a terrorist incident. Rather than relying on confirmation from labs at CDC, our reference lab is capable of producing conclusive results. This allows local authorities and epidemiologists to respond more rapidly to emergencies and also ensures local control of information.
The LRN provides validated test methods to rule out and confirm the presence of all category A and some B pathogenic agents in both clinical and environmental sample. It also provides exclusive use of validated test methods and standardized reagents for the confirmation of the bioterrorism agents and other agents of public health importance, such as SARS and avian influenza.
The analytical capability and capacity to perform these LRN assays have been utilized by MN-PHL routinely for clinical diagnostic samples referred by our Sentinel laboratories. During the anthrax attacks of 2001, MN-PHL played a key role in responding to potential threats in Minnesota in both clinical and environmental samples. We continue to test unknown samples for local law enforcement, the State Chemical Assessment Teams and the FBI.
The LRN is just one example of the infrastructures and networks utilized by the MN-PHL to protect, maintain and improve the health of all Minnesotans.
For more information visit the CDC's Laboratory Response Network.
* Watch for future articles from MN-PHL on the laboratories' roles and responsibilities in emergency preparedness, the Minnesota Laboratory System, our Regional Emergency Preparedness Conferences, our LRN level 1 chemistry laboratory and more.
Environmental Health professionals reduce potential harm to human health
Tornados are a common emergency event in Minnesota. In 1998, tornados caused extensive destruction to the southwestern part of the state. Close to 1,200 housing units were destroyed and 4,000 were severely damaged. Mass care was essential during the days that followed the tornado. Many restaurants, commercial buildings, schools and churches were also badly hit. During this event, local EH professionals helped staff a local Emergency Operations Center (EOC), assisted community members and businesses, and established a new EH office in a county garage because their offices were severely damaged.
For the complete story of the roles environmental health professionals played during this event, go to the CD Emergency Preparedness and Response Fundamentals Training for Environmental Health Professionals. Then go to "Course Menu," Module II and play Scenario 3: Tornado. The Twin Cities Metro Advanced Practice Center developed this CD.
Lessons learned that apply to all emergencies
(Note: the staff mentioned here work at the MDH Environmental Health Division.)
1. Participate early. Speak up if you see a need.
Tom Steffl is an active member of the volunteer fire department. Tom was one of the first responders during the 1998 Comfrey and St. Peter tornados. His actions played a key role in preventing future ground water contamination. Because unsealed wells can provide an opening for toxins to enter groundwater, he notified emergency managers of the need to identify and mark unsealed wells before those areas were bulldozed. Mitigation plans then included well sealing, and costs shifted from the local communities to become potentially FEMA-reimbursable expenses.
After a tornado occurred in Burnsville, Sue Hibberd was called to the EOC. Emergency managers wanted to clear debris quickly from neighborhoods. Her advice to them:
- Do not put out one large dumpster;
- Ask residents to sort debris at the curb; and
- Separate organic yard waste from recyclable white goods (such as refrigerators) from toxic chemicals to reduce landfill costs.
These actions kept chemical hazards separated from people. They also made good use of the residents' and volunteers' clean up efforts and time.
2. For safety's sake, listen to weather reports and road conditions when in the field.
Staff do not take personal safety lightly. Weather radios have been placed in metro and district offices. To ensure personal safety and be able to assess and respond to community needs, Glenn Donnay keeps tabs on potential hazards by listening to the local radio and shares field information with local emergency management staff.
3. To address the public's fears and concerns, use commonly used terms, not acronyms or technical language.
To describe a vehicle that brings drinking water to a site, the public may not comprehend the terms "tanker" (NIMS-compliant term) or "water buffalo" (military term). Brian Noma, an engineer, suggests using descriptive words: "a clean, sanitized, bacteriologically tested container especially meant to carry potable water."
Using volunteers during a pandemic flu outbreak
Minnesota Responds Medical Reserve Corps (formerly named Minnesota Responds) is a partnership that coordinates volunteers on a local, regional and statewide basis to assist our public health and healthcare systems. It is part of a national initiative to pre-register and pre-credential health personnel who are willing to volunteer during an emergency. Many health professionals and other health workers will volunteer during a disaster, but it is difficult to use them if they are not pre-registered and pre-credentialed.
Every state is in some phase of implementing a system for advanced registration of health personnel. The Minnesota Responds Medical Reserve Corps has been in place for almost two years and MDH staff are available to support local and regional program coordinators.
An important question: How can Minnesota Responds be used during a pandemic influenza or other large-scale event when health personnel surge capacity needs are increased and available resources are decreased? It is possible that all areas of the state and surrounding states would be affected by such an event, and shortages of regular health workers and volunteers would occur.
During this type of emergency, non-traditional and allied health personnel might become available to support local and regional public health and healthcare needs. Examples of these volunteers include:
- Retired physicians, nurses, behavioral health professionals and other retired healthcare providers
- Dentists, physical therapists and other providers
- National Guard medical unit
- College students, in addition to those already registered in the University of Minnesota's Medical Reserve Corps unit
- Other people willing and able to provide support to a health response during a disaster.
Regardless of what type of incident might occur in Minnesota, public health and healthcare agencies will be better prepared to respond to needs for volunteer staffing by pre-identifying and training volunteers before a disaster strikes. For more information about the Minnesota Responds Medical Reserve Corps program, send an email to firstname.lastname@example.org or call 651-201-5723. Go to Minnesota Responds to register in the database.
Northeast preparedness event for deaf and hard-of-hearing
On Saturday May 6, 2006, over 50 deaf or hard-of-hearing individuals and families, staff from public health, the Red Cross, Health and Human Services, and interpreters met for a four-hour preparedness event in Duluth. The program included a closed-captioning set-up and three American Sign Language (ALS) interpreters to assist with communications.
The Red Cross described how they could help the community during a disaster. Jim Skoog, health educator from St Louis County Public Health and Human Services, created the character "Ready Man," who showed what items should be included in an emergency preparedness kit.
The group participated in a Mass Dispensing Exercise, which included a PowerPoint presentation, diagrams and a skit. Five clients walked through the dispensing stations:
- Getting off the bus
- Triage (sorting)
- Level 1 screening
- Level 2 screening
- Getting on the bus
The event ended with a brief presentation on Pandemic Influenza and the awarding of door prizes. Displays, refreshments and bags with hand sanitizer, whistles and preparedness information were given to attendees. Staff who assisted with this event were from Fond du Lac (tribe), St. Louis County, Minnesota Department of Health and the Regional Hospital Resource Center.
Designing, Conducting and Evaluating Functional Exercises
August 7-9, 2006 Holiday Inn Select, Bloomington MN
The goal of this workshop is to provide emergency public health planners with the concepts and tools needed to develop, conduct and evaluate an exercise that will challenge specific performance objectives of a health department. The $125 registration fee includes extensive course materials, CEU credit, lunches and refreshments.
The event is sponsored by UCLS Center for Public Health and Disasters and the University of Minnesota, School of Public Health, Centers for Public Health Education and Outreach.
Beyond the Yellow Ribbon: Governor's Military & Veterans Support Cabinet Summit
September 21, 2006 from 7:00am to 4:30 pm
Minneapolis Convention Center
A new program called Beyond the Yellow Ribbon is trying to prepare
returning troops for the transition from a war zone to home and family life. Approximately
3,000 to 5,000 National Guard and Reserve Troops will be coming home to Minnesota
within the next nine months. According to Minnesota Veterans Affairs
Deputy Commissioner Mike Pugliese, "There's never been this large a group
returning home in so short a time. It's unprecedented in our state's history.
These veterans live in over 500 communities in Minnesota. There needs to be
a collaborative effort between the private, public and non-profit sectors,
and we have to let people in the communities know what resources are out there."
Beyond the Yellow Ribbon Summit will hold 18 workshops on topics such as:
- Homelessness and Housing
- Post Traumatic Stress Disorder
- Traumatic Brain Injury
- Faith-Based Recovery Support Services
- Marriage and Family Therapy Services
- Additive Behaviors
- County VA Benefits
- Military One Source
Calendar of exercises now on OEP Website
(updated 10/26/2006--calendar no longer available)
What exercises are being held in the metro region? Northeast region? Minnesota Department of Health? Now you have a way to learn what exercises are being planned, and you can have your exercises posted on the calendar.
The newly created Exercise Calendar includes these categories:
- State agencies
- West Central
- South Central
Right now, the calendars are empty. When you create your exercise, please submit the following information about your exercises to Elizabeth.Tangwall@state.mn.us.
- Name of exercise
- Type of exercise (tabletop, functional exercise, full-scale exercise)
- Date of exercise
- Sponsoring agency
- Person to contact (name, phone number or email)
MDH Worksheet for creating a tabletop exercise
If your agency plans to create a tabletop exercise, here is a document that may be helpful. Created by the Minnesota Department of Health Office of Emergency Preparedness staff, this worksheet includes two handbooks: Creating the Player Handbook and Creating the Facilitator's Book. Here is a quick overview of the information in this 10-page resource.
Creating the Player Handbook
This handbook provides information for the players and provides a structure for the exercise.
- Exercise overview (name, goal, objectives)
- List of references
- Participants [players, facilitator, evaluator(s), controller(s), scribe(s)]
- Concept of play
- Roles and responsibilities of participants
- Exercise assumptions
- Exercise artificialities
- Data injects
Creating the Facilitator's Book
This handbook provides information for the facilitator.
- Basic guidelines for any facilitator
- Debriefing (hotwash)
- Hotwash facilitator guidelines
- Evaluating the tabletop exercise
To access this worksheet, contact Elizabeth.Tangwall@state.mn.us\
The United States Department of Health and Human Services (DHHS) has prepared pandemic planning checklists appropriate for specific audiences. The following English language checklists are currently available online:
A new publication, Pandemic Influenza Planning: A Guide for Individuals and
Families, is designed to help you understand the threat of a pandemic flu
outbreak in our country and your community. It describes common sense actions
that you can take in preparing for a pandemic. The Spanish language version of
the Planning Guide is being developed and should become available soon.
Check out Indiana State Health Department Website
On this Website, you'll find information on the Windows Media Player on various topics such as
- Emergency preparedness in child care setting
- Vincent Covello explains how to apply crisis + emergency risk communication to a possible flu outbreak
- Preparing for disasters in nursing homes
Workspace Communication Exercise Request and Report forms
If Workspace communication tools such as Health Alerts, general messages, auto-call/auto-fax systems, satellite telephones and amateur radio are a part of your plans, now there’s an easier way to include the use of these tools in your exercises.
Staff at the Minnesota Department of Health, local public health agencies and other partner organizations who use MDH Workspace communication tools may request the Workspace Team conduct an exercise. After completion of the exercise, a report will be developed to include in your After Action Report and improvement planning.
1. To request a communication exercise, log on to the Workspace and click on 'Exercise' then 'Communication Tools.’ This section includes policies and procedures, plus the two forms.
2. Complete the Workspace Communication Exercise Request form and submit to email@example.com. A Workspace staff person will get back to you to clarify any questions.
3. After the exercise is completed, Workspace staff and the Division/organization that requested the exercise will complete the Workspace Communication Exercise Report. That report, which includes improvement actions, will be posted on the Workspace.
Questions? Contact firstname.lastname@example.org
Ready to Respond/MDH Preparedness Newsletter
Editorial Board members includes representatives from MDH divisions that receive preparedness funds. If you have an idea for an article, please contact any of these people.
Aggie Leitheiser, Director of Emergency Preparedness
Contributors to this issue
Aggie Leitheiser, Office of Emergency Preparedness