October 2006 Ready to Respond MDH Preparedness Newsletter
What a difference a year makes! Last year at this time we were still learning about and responding to the impact of a horrific hurricane season. So far, this is a much calmer year and we have had time to reflect on our preparedness for responding to events. Multiple projects have been launched to continually improve our work. Thank you for your participation in reviewing what we did and especially for your efforts to increase our capacity to assist the public.
Many of you have heard me describe this coming year as the "Year of Telling Our Story." I want to spend a little time talking about what that means to me. We all need to have some common way of describing what we are doing and what we have in place to be ready to respond. At this point, we don’t have a comprehensive or complete way to capture information about the work we are doing, the accomplishments we have made, and a system to analyze our level of preparedness. My goal for this coming year is that all of us can comfortably answer the question "Are we prepared?" with a consistent message that reflects reality.
MDH staff need to be able to describe what’s happening in the Department. In addition, we need to be ready to describe what’s happening at the local public health and healthcare system level because our response is a joint effort across the state. The federal government is also moving in this direction with increased attention to performance measures. Our approach needs to address the federal requirements but also include measures and information that is important to Minnesota.
I welcome your thoughts about your ideas and recommendations about "Telling Our Story." Send your suggestions to Aggie Leitheiser, Director of Emergency Preparedness at Aggie.Leitheiser@state.mn.us.
Governor Tim Pawlenty and Admiral John Agwunobi, Assistant U.S. Secretary of Health and Human Services, took part in an executive level pandemic influenza exercise on September 27, 2006 at the State Emergency Operations Center. Others involved in the exercise included Health Commissioner Dianne Mandernach, Public Safety Commissioner Michael Campion, and representatives of 11 other state agencies, including Agriculture, Natural Resources, and the Board of Animal Health.
Seventy-one agency officials took part in the tabletop exercise, which focused on two different scenarios. The first scenario involved the discovery of highly pathogenic avian flu in a group of wildfowl, and subsequent spread of the virus to domestic poultry flocks. The second scenario involved a child in West Central Minnesota who had become ill with the high-path avian flu virus, with subsequent spread of the illness, resulting in a regional outbreak in the human population.
Participants discussed a variety of issues as they worked through the two scenarios. Issues raised in connection with the human pandemic scenario included the need for – and advisability of – responding aggressively in a situation where there may still be a chance to contain the spread of the disease. The discussion included measures like school closings, aggressive tracking of flu cases, and administration of antivirals, which could be used to build a "fire break" around the cluster of illness.
Participants also discussed the implications of having the "first ever" human outbreak of avian influenza take place in Minnesota, including the likelihood of intensive involvement by federal agencies and the World Health Organization. Extensive discussion was devoted to describing the relationships and lines of authority that would come into play with the involvement of U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and the U.S. Department of Homeland Security. For more information, contact Buddy.Ferguson@state.mn.us or call 651-201-4997.
Are Minnesotans ready for an emergency?
Recent surveys indicate Americans are not prepared for an emergency. The Council for Excellence in Government and the American Red Cross surveyed more than 1,000 randomly selected adults across the U.S. to learn how prepared they were for a Hurricane Katrina scale disaster or 9/11 terrorist attack. The results were discouraging. More than half (54 percent) of those surveyed have not done more to prepare because "they do not think another disaster is likely to happen."
In Minnesota, we’re working to change this picture. Using funds appropriated by the Minnesota Legislature for pandemic influenza awareness, the Minnesota Department of Health (MDH) and the Minnesota Department of Public Safety Homeland Security and Emergency Management (HSEM) Division are planning a statewide all-hazards public information campaign to call citizens to action and encourage emergency planning.
Progress to date includes:
- Forming a joint MDH-HSEM steering team with representation from the Local Public Health Association of Minnesota (an affiliate organization of the Association of Minnesota Counties) and the Association of Minnesota Emergency Managers;
- Reviewing national and state efforts to improve emergency preparedness among the general public;
- Participation in the University of Minnesota Center for Survey Research statewide omnibus survey to find out what activities people do to prepare now. The results will provide a baseline from which to measure the campaign’s effectiveness;
- Publishing a Request for Proposals (RFP) for a marketing and public affairs contractor to develop a campaign that will help change Minnesotans’ attitudes and actions about individual and household emergency preparation;
- Conducting an informal survey of local public health and emergency management officials about what they need and want from a public information campaign; and
- Convening a statewide advisory group with stakeholders in public safety, business, local public health, health plans, community groups, voluntary organizations, faith-based communities and others. This group will ensure the campaign works in synch with successful strategies these partners have already implemented.
Lack of public preparedness is a growing concern, so the stakes are high and the campaign timeframe is tight. The campaign must be launched before June 30, 2007, the end of the state fiscal year. Stay tuned for new developments!
MNTrac delivers advance warning to hospitals during an emergency
On August 22, 2006, a chemical release was suspected at the Minneapolis/St. Paul International Airport. Patients exhibited eye, nose and throat problems. The chemical agent was unknown. Using MNTrac, a new web-based system, hospitals were able to receive advance notice of incoming patients, early symptoms, and details of the event.
The Minnesota system for Tracking Resources, Alerts and Communications (MNTrac) is a new resource tracking system maintained by the Minnesota Department of Health’s Office of Emergency Preparedness (OEP). MNTrac is a database-driven, password-protected web application that has been designed for all hospitals in the state to track bed capacity, pharmaceuticals and other resources (e.g., ventilators, personal protective and decontamination equipment) in real time.
MNTrac offers these benefits:
- Monitors hospital closures
- Tracks hospital bed capacity
- Tracks resources (e.g., ventilators, personal protective equipment)
- Tracks pharmaceuticals
- Sends alerts, advisories and notifications to hospitals and system users during an event
- Provides electronic reporting
- Matches patients to bed availability
- Contains a resource library
MNTrac will also soon offer real-time communication through emergency chat and on-line conferencing, improving collaboration and response times during an incident and bringing appropriate partners (e.g., hospitals, EMS, local public health and emergency management) together. The OEP expects this function to be completed by the end of 2006.
Early alerting and rapid sharing of information significantly increases the likelihood of positive outcomes for patients needing emergency care. MNTrac is an example of how technology and the dedication of first responders come together to make a difference in circumstances where minutes matter.
The OEP maintains MNTrac and provides training for users of the system. Training and implementation will continue until all hospitals in Minnesota are using the new system, which is anticipated in spring 2007.
Tracking resources, alerts and communications with MNTrac
Click image to enlarge
MDH Lab hosted fall meeting of CDC Level 1 Laboratories
In September, the Minnesota Department of Health’s Public Health Laboratory (PHL) hosted a meeting in St. Paul for the Laboratory Response Network for Chemical Emergency Response (LRN-C) surge capacity laboratories. The LRN-C activities include collaboration with hospital laboratories and emergency medical staff (Level 3), core analytical chemistry methods (Level 2), and advanced analytical techniques, method development and surge capacity activities (Level 1).
The MDH-PHL is one of ten Level 1 Laboratories in the country that incorporates all three levels of activities. Under the guidance of the Centers for Disease Control and Prevention (CDC), associates from these laboratories meet twice a year to exchange new information and ideas regarding emergency response and analytical chemistry issues. Meetings of this nature provide valuable opportunities to share ideas, network with counterparts in other state and federal laboratories, and learn best practices from experts in the field.
The first day, CDC program staff gave updates about current laboratory issues. The afternoon session focused on issues of toxicology and emergency medicine in a chemical emergency event. Kevin Sell from the Minnesota Poison Control System and John Hick, M.D. from Hennepin County Medical Center were featured speakers.
Updates from ten state Level 1 laboratories were delivered on the second day. Marty Bevan, Ph.D. discussed the analysis of nerve agent metabolites. Three academic talks were given, including a presentation by Dr. Peter Carr from the University of Minnesota. A poster session of research topics was presented by participants including Zheng Yang, Ph.D. and Julia Jiang, M.S. from the MDH-PHL. The day concluded with a guided tour of the Agriculture/Health Laboratory building.
The third day concerned the issues surrounding the evaluation and screening of potentially harmful, emergency, unknown environmental samples. The LRN-C laboratories are typically the primary laboratories within their respective states to accept, screen, evaluate, and provide confirmatory analyses for these potentially harmful samples. Presentations for making safety-based decisions on the handling of such samples included a talk by experts from the St. Paul Police Department Bomb Squad; radiological screening techniques presented by MDH-PHL’s John Lorenz; and a presentation on interpretation of field screening data by an FBI chemical weapons senior scientist from Quantico, Virginia.
In addition to the formal presentations, this meeting provided a chance for informal discussion and team building for this national emergency preparedness and response program. Hosting this event gave MDH the opportunity to showcase our new laboratory and meeting room facilities. MDH Lab staff received very positive comments on all aspects of the conference and extend their sincere appreciation to the MDH staff who helped make this effort a success.
For more information on the LRN-C, go to: CDC's Laboratory Network for Chemical Terrorism
West Central Region holds preparedness exercise
True to the purpose of exercises, many strengths and gaps were identified when the West Central Region recently held a preparedness exercise.
On September 11, 2006, public health agencies, hospitals, clinics, labs, behavioral health and community partners in the West Central Region were alerted that "XYZ" flu cases were being reported to the Minnesota Department of Health. Every few days thereafter, messages were sent to these partners asking pertinent questions about the increasing numbers of patients and how they would respond to the ever-changing status.
On September 20, the exercise became functional/full-scale and included:
- Activating the West Central Pharmaceutical cache plan
- Simulating hospital patient transfers
- Setting up and some run-through of mass dispensing sites
- Activating some county Emergency Operation Centers
- Prioritization of essential personnel for "XYZ" flu treatment
- Activation of the West Central Multi-Agency Coordination team.
Incident Command procedures were used in all areas of the exercise.
October 4, 2006 was the last day of the regional exercise. Canadian Pacific Railroad partnered with our region to have a full scale train derailment/bus accident to further test our systems. At the time of the derailment, all of the West Central hospitals were full with "XYZ" flu patients.
Grant County Emergency Management led the full scale exercise with assistance from their county and area counties’ fire departments, law enforcement, EMS, Life Link, West Central Environmental Consultants, Fargo/Moorhead HAZMAT, Salvation Army, Red Cross, social services and the health partners listed previously.
As a result of this exercise, identified gaps are being strategically addressed and the West Central Region response systems will be further strengthened for future events.
State officials promote family preparedness at state fair
Although government has a vital role in responding to emergencies, individual citizens must be actively involved as well, Health Commissioner Dianne Mandernach told Minnesotans in August during a special appearance at the Minnesota State Fair.
Public Safety Commissioner Michael Campion joined Commissioner Mandernach to urge the public to start building an emergency kit to mark the September observance of National Preparedness Month. This year, the Minnesota Department of Health’s booth at the state fair stressed family preparedness.
"The first thing you need to do is have a family emergency plan," Commissioner Campion said. "You need to know how to get in touch with each family member — and how to find each other — in an emergency. Creating an emergency kit with food, water and other supplies will help you get through an emergency."
Since last fall, concerns about bird flu have prompted health and emergency preparedness officials to step up their planning for a possible influenza pandemic. "Although the current bird flu strain remains primarily a disease of birds, that could change," Commissioner Mandernach said. "In a worst case, a pandemic could spread rapidly around the globe, resulting in millions of deaths worldwide. If that happens, people might need to stay home for an extended period to help stop the spread of the virus. A well-stocked emergency kit will be helpful to people."
It is believed that if bird flu never becomes a major human disease threat, history suggests that some other strain of the flu virus will eventually cause a pandemic. The world has experienced three pandemics over the last century.
"The lack of certainty — not knowing when or how something bad might happen — is the hard part," she said. "It’s one of the big reasons people have trouble planning for an emergency. But we want you to start thinking about it, and today is as good a day as any."
Recommended emergency kit items include food, water, personal care items, medicines, important documents and extra clothing.
This is the MDH preparedness exhibit that appeared
at the 2006 Minnesota State Fair
Seven staff (a public health representative and six fire fighters) from the Twin Cities Metropolitan Area went to the Boundary Waters Canoe Area on July 26 to shadow a Pacific Northwest Type 2 Incident Management Team that was fighting a wildfire. Shadowing is part of the process to become an All-Hazards Incident Management Team.
The metro team shadowed the Pacific Northwest team in Incident Command, Operations, Logistics, Planning, Public Information, Safety and Liaison areas for one week. Erin Schroeder, emergency preparedness responder at the Minneapolis Department of Health and Family Support, shadowed the public information officers who updated the community daily on the progress to contain the fire.
Schroeder said "Even though it was a wildland fire and a new type of disaster for the Twin Cities responders, the incident management principles observed and learned can be transferred to any incident. It was an amazing sight to see the organization, professionalism and concern for safety on an incident as large as the Cavity Lake Fire that had over 500 staff working on the fire at its peak."
National Incident Management Teams manage the response efforts of large scale natural disasters. These teams are made up of members from many local, state and federal organizations and respond to emergency needs throughout the United States. The Cavity Lake Fire was started by a lightning strike on July 14 and was one of the largest fires in the BWCA.
Pandemic flu CD compiles public information and planning resources for partners
Minnesota Department of Health resources for communicating with citizens about seasonal, avian and pandemic flu were packaged in a CD that was mailed in September to local public health, emergency managers and local healthcare entities. Partners trying to prepare their communities for a possible pandemic are looking for appropriate materials, especially to communicate with the general public.
The CD is a compilation of brochures, fact sheets, checklists and templates. The CD will not be reproduced, but updated versions and new information will be available on the MDH’s Influenza Web site.
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, contact any of these people.Aggie Leitheiser, Director of Emergency Preparedness
Marcia Robért, Editor, Office of Emergency Preparedness
Cathy Hockert, Community and Family Health
Jo-Ann Champagne, Office of Emergency Preparedness Healthcare System Preparedness
Lynne Marcus, Environmental Health
Nancy Torner, Communications Office
Randy Graham, Public Health Laboratory
Susan Erstad, Infectious Disease, Epidemiology and Prevention
Contributors to this issueAggie Leitheiser, Office of Emergency Preparedness
Buddy Ferguson, Communications Office
Erin Schroeder, Minneapolis Department of Health and Family Support
Karen Moser, West Central District Office
Marcia Robért, Office of Emergency Preparedness
Kathy Carlson, Infectious Disease, Epidemiology and Prevention
Megan Thompson, Office of Emergency Preparedness
Nancy Torner, Communications Office
Paul Moyer, Public Health Laboratory