February 2007 Ready to Respond MDH Preparedness Newsletter
(Aggie Leitheiser, Director of Emergency Preparedness)
A new year offers a chance to review last year’s accomplishments and look forward to opportunities ahead. I’m going to highlight some of those events.
New electronic tools were either launched in 2006 or are almost ready –
- The Minnesota system for Tracking Resources, Alerts, and Communications (MNTrac) is a system that tracks available hospital bed capacity, pharmaceuticals, other resources, and hospitals that go on diversion status. It will soon provide a communication system during events, a resource library of relevant information and track healthcare resources. MNTRAC is a highly valued tool in the metro area and is rapidly being adopted throughout the state.
- The Minnesota system for Trainingfinder Real-time Affiliate Integrated Network (MN.TRAIN) is a recently acquired MDH learning management system. MN.TRAIN will provide information about required or recommended trainings, and keep track of trainings by individuals, organizations and type of profession.
- The Strategic National Stockpile (SNS) Asset Management System will meet federal requirements of tracking the federal resources when they come into Minnesota.
- A new quarterly MDH publication, Ready to Respond MDH Preparedness Newsletter, was launched in 2006.
- Plans are underway to enhance the Internet Workspace that provides a secure place to post documents, communicate with partners, and submit reports. The makeover will make the tool a more user-friendly and functional system.
- Minnesota Responds Medical Reserve Corps (formerly named Minnesota Responds) migrated to a new electronic platform and was able to show success in a recent federal exercise.
Other 2006 highlights
- Training and exercises for MDH’s response system accelerated, which helped staff who will assist in the Department Operations Center be better prepared for their roles.
- ChemPack and PharmCache materials are in place and ready for deployment if needed.
- Patient Care Coordination guidelines were finalized and plans are being developed in most parts of the state for alternate care sites.
- A unique partnership with the Minnesota Amateur Radio Advisory Group resulted in the first exercise using HAM radios – a requirement for a backup form of communication.
- Minnesota received the first state emergency preparedness funds in over 10 years to plan for pandemic influenza preparedness.
- Staffing changes included the re-location of the Public Health Preparedness Consultants and local grant management activities to the Office of Emergency Preparedness. This new organizational structure provides increased opportunities for coordination of activities and communication with our partners.
Looking forward to 2007
- Exercises of plans and response activities will include the Metro Operation Snowball III, cross-border exercises and discussions with our bordering Canadian provinces and neighboring states, MDH response actions, and coordination with regional and local partners.
- Expanded work on pandemic influenza preparedness, including comprehensive plans for the potential deployment of resources and staffing should this catastrophe occur.
- Coordinated planning and exercises will occur based on expected issues raised by the 2008 Republican National Convention.
- The MDH-LPH Strategic Planning Workgroup will implement their recommendations on issues, such as clarify roles/responsibilities, communication, planning, training and exercises, and public information.
- Continued and expanded use and evaluation of our response plans for public health events.
We have made measurable progress on the path of our vision of “Ready to Respond,” but still have much work to do. It’s gratifying to see the passion, commitment and enthusiasm of the staff and partners who are working collaboratively toward protecting all Minnesotans.
Mark your calendar!
The Minnesota Department of Health Office of Emergency Preparedness is hosting a
Ready To Respond Spotlight on MN Health Preparedness conference, to be held the first week of May, 2007.
Watch for more details.
Are you interested in getting access to an electronic-based system that will offer courses or conferences locally or across the nation? For free? How about a system that will be easy for you to learn about over 3000 training opportunities or to register online?
Professionals who work to protect the public’s health are busy people yet need to participate in continuing education. To provide courses to many audiences, the Minnesota Department of Health Office of Emergency Preparedness (OEP) has purchased a Learning Management System (LMS) called TRAIN (Trainingfinder Real-time Affiliate Integrated Network).
What is a Learning Management System?
The LMS facilitates training opportunities among multiple disciplines to improve knowledge and skills for health-related emergency preparedness. The LMS:
- Helps learners find and register for courses
- Manages registration processes from appropriate providers in multiple formats
- Manages course catalogs, rosters and certifications
- Maintains personal learning records for users
- Builds workers’ competencies
- Facilitates coordination between course providers, learners and managers
- Generates reports
What is MN.TRAIN?
The Minnesota system is called MN.TRAIN and is a password-protected, Web-based LMS software that features an amazing number of capabilities. The MDH is making this nationally-recognized system available at no cost to Minnesota professionals with roles in health-related emergency preparedness. Minnesota course providers, local public health, hospitals, emergency medical services staff and other users will be able to easily track their training activities. Over 3000 training opportunities from 800 course providers from 26 affiliates are listed through MN.TRAIN.
What does MN.TRAIN do in an incident?
- Allows for development and tracking of a prepared workforce, and supports credentialing during an incident
- Makes available on-line, just-in-time training
- Backs up and makes available learner records and credentials if the facility is struck by disaster.
What is the role of MDH and MN.TRAIN?
The MDH Office of Emergency Preparedness will administer and maintain MN.TRAIN, offer support to course providers, organizational MN.TRAIN administrators, and users in both urban areas and Greater Minnesota. Initially, the OEP and our partners will establish, pilot test and market this customized site called MN.TRAIN.
Watch for more news about MN.TRAIN. For more information, email email@example.com or call Deb Grundmanis at 651-201-5702.
Minnesota survey on personal and family emergency preparedness
In 2006, the Minnesota Department of Health (MDH) contracted with the Minnesota Center for Survey Research to add five questions about personal and family emergency preparedness to its annual statewide omnibus survey. The intent of this public opinion research was to assess basic emergency preparedness among Minnesota citizens and factors that might hinder preparedness or be important to the state regarding pandemic flu planning. Results will be used as a baseline to evaluate the impacts of the statewide, joint MDH and MN Department of Public Safety Homeland Security & Emergency Management (HSEM) Emergency Preparedness Public Information Campaign. Follow-up participation in the 2007 statewide survey with identical questions should provide data showing any change that has taken place post campaign introduction.
The survey sample consisted of households selected randomly from all Minnesota telephone exchanges. A total of 803 telephone interviews were completed. No more than one time in 20 should chance variations in the sample cause the results to vary by more than 3.5 percentage points from the answers that would be obtained if all Minnesota residents were interviewed. In each household, the person interviewed was the adult with the most recent birthday. The project used trained interviewers and the WinCati System for Computer Interviewing, software allowing data to be available shortly after collection with minimal editing. Overall response rate was 34 percent and cooperation rate was 43 percent, based on formulas specified by the American Association for Public Opinion Research. Numbers of completed surveys by region correlated closely to census figures for overall population in those regions.
Question #1: Have you heard, seen or read any information about how to prepare your household for a serious emergency such as a flood, widespread disease outbreak, or terrorist incident?
- Yes – 362 (45%)
- No – 435 (55%)
- Don’t Know – 7 (less than 1%)
Question #2: There are many things that people might do to prepare for a serious emergency. Have you or anyone else in your household:
Made a phone list for contacting your family members?
- Yes – 402 (50%)
- Partially – 13 (2%)
- No – 388 (48%)
Stored enough food, water, and supplies to meet your household needs for at least three days?
- Yes – 445 (56%)
- Partially – 33 (4%)
- No – 323 (40%)
- Don’t Know – 2 (less than 1%)
Obtained a working battery-operated or hand-cranked radio?
- Yes – 422 (52%)
- Partially – 7 (1%)
- No – 374 (47%)
Assembled an emergency kit with basic medical supplies?
- Yes – 356 (44%)
- Partially – 33 (4%)
- No – 414 (52%)
Question #3: How often do you stay home from work, school, or other activities when you have a respiratory illness, such as a cold or the flu?
- Almost Always – 138 (18%)
- Sometimes – 196 (25%)
- Rarely – 289 (37%)
- Never – 162 (21%)
- Don’t Know – 11 (Less than 1%)
- Refused – 6 (Less than 1%)
Question #4: How often do you care for someone in your home who has a medical or mental health condition, such as an elderly parent, a disabled spouse, or an injured child?
- Almost Always – 140 (18%)
- Sometimes – 111 (14%)
- Rarely – 159 (20%)
- Never – 385 (48%)
- Don’t Know – 7 (Less than 1%)
- Refused – 1 (Less than 1%)
Question #5: Of the past five years, in how many years have you gotten a flu shot?
- Zero – 328 (41%)
- One Year – 89 (11%)
- Two Years – 60 (8%)
- Three Years – 47 (6%)
- Four Years – 43 (5%)
- Five Years – 229 (29%)
- Don’t Know – 8 (Less than 1%)
Polio exposure provides exercise potential
In October, 2006, the Minnesota Department of Health (MDH) and local public health (LPH) mobilized a timely and comprehensive response to the possibility that new Somali and Ethiopian refugees arriving in Minnesota had been exposed to wild poliovirus while in Kenya. Because Minnesota has the largest Somali population in the U.S., any transmission or circulation of polio virus in the community could be devastating.
The response involved monitoring for polio-like symptoms, providing vaccine and obtaining specimens for laboratory testing. Although all CDC (Centers for Disease Control and Prevention) goals were not met, no other state accomplished what Minnesota did—and with far greater numbers of Somali arrivals than other areas. Virtually all 688 arriving Somali and Ethiopian refugees who had passed through the Nairobi Transit Center between September 1 and mid-October 2006 were contacted in little more than a week. No further cases of polio were found.
Several LPH agencies approached this event as an incident management exercise. Participating counties included Anoka, Benton, Dakota, Hennepin, Mower, Olmsted, Otter Tail, Ramsey, Rice, Scott, Stearns and Steele. The MDH refugee and immunization programs were activated, as was the virology lab.
An after-action evaluation identified gaps and weaknesses that will need to be addressed for future events. Many of the identified gaps were related to data sharing, transportation services, initial event notification and situation briefings. For more information, contact Kristen.Ehresmann@state.mn.us
Minnesota Laboratory System connects more than 175 labs throughout the state
The Minnesota Laboratory System (MLS) is a statewide, voluntary network of laboratories, established by the Minnesota Department of Health Public Health Laboratory (MN PHL) to facilitate inter-laboratory communication, collaboration and cooperation. Over 175 member labs (public health, private clinical, veterinary and agricultural laboratories) serve Minnesota residents. A vital component of this system is electronic connectivity (fax and email) among members.
- Provides a laboratory network essential for statewide emergency preparedness and response
- Plays a key role in detecting and investigating common and emerging infectious disease outbreaks
- Monitors trends in antibiotic resistance
- Provides continuing education and training
- Establishes safe transport of specimens
- Assures quality laboratory practices.
The MLS was developed just before the attacks of 9/11 and the subsequent anthrax events. It focused on the collaboration of clinical laboratories (mainly hospital-based and reference labs) whose personnel were considered “first responders” in a bioterrorism event. Since that time, a shift has occurred from a laboratory “bioterrorism” or “chemical terrorism” preparedness focus, to a concentration on “all-hazards” laboratory emergency preparedness (e.g., pandemic flu, natural disasters). Members of our staff are currently working to expand the MLS to include Physician Office-based Laboratories (POLs) and other clinic-based labs, all of which are extremely important parts of the MLS emergency response system.
One key feature of the MLS program is education and training offerings. The yearly MLS Challenge Set is an example of an educational program which offers Laboratory Response Network (LRN) Sentinel Laboratories the opportunity to test their laboratory’s ability to identify and work through an unknown challenge set of organisms. These organisms, prepared by MDH PHL staff, are chosen for their implication in diseases of public health importance or as surrogates for bioterrorism agents. The MN PHL also offers bioterrorism workshops to the MLS LRN Sentinel Laboratories. The yearly workshops consist of an 8 hour day of intense, hands-on training on the primary agents of bioterrorism. All LRN Sentinel Laboratories (approximately 125 serving Minnesota) must be able to rule out and potentially refer these organisms to the MN-PHL (an LRN Reference Laboratory).
For more information to to MLS. Useful information for laboratory personnel includes “hot topics,” “education and training,” “disease specific information” and more.
MDH employees stock up for emergencies
More Minnesota Department of Health (MDH) employees are ready to survive for an extended period at home in the event of a natural or intentional disaster as a result of a recent campaign.
A survey conducted just prior to the MDH Employee Emergency Preparedness Campaign found that employees who filled out a campaign questionnaire had some kind of emergency kit at home. After the campaign, the number of employees who reported having kits increased.
Whether disaster strikes as an influenza pandemic, a tornado, a terrorist attack or some other emergency, people may need to rely on available resources at home. This means having — and maintaining — a home emergency kit stocked with nonperishable food, water and other essential supplies.
The amount of supplies needed varies with the number of family members and the type of disaster. While winter storms might strand people for a few days, a pandemic could keep them homebound for several weeks or longer.
The MDH campaign guided employees to create a home emergency kit, via weekly e-mails for eight weeks. Several essential emergency kit items were added each week to a display case located in the Orville L. Freeman Building at 625 N. Robert St. in St. Paul. Photographs of the items were placed on the MDH intranet, where employees could watch the kit being built, virtually. Participating employees who added the featured items to their home emergency kits each week had a complete kit by the end of the campaign.
Examples of kit items:
- a change of clothing
- a first–aid kit
- a flashlight
- blankets or sleeping bags
- bottled water
- extra medications
- medical information and other important records
- nonperishable food
- pet supplies
- plastic sheeting
- radio and batteries
A broader list of emergency kit items is available on the MDH Family and Personal Emergency Preparedness Web page.
Respiratory Protection: Increasing Fit Testing Capacity in Minnesota
Since 2003, regions throughout Minnesota have expanded their respiratory protection capacity by providing train-the-trainer sessions and fit testing to local public health agencies. However, additional capacity is needed – particularly in clinics, smaller hospitals and among emergency medical services. During an influenza pandemic, a robust respiratory protection program assures that all employees who care for patients with a potential airborne infectious disease are protected from respiratory hazards through the proper use of respirators.
The Minnesota Department of Health has the following recommendations to assure sustainable fit testing capacity and staff protection.
- Hospitals and clinics should identify all healthcare workers (HCWs) that have direct face-to-face patient care responsibilities. Hospitals and clinics should also develop a plan to limit the number of HCWs who have direct patient contact for use in the setting of a patient with a known or suspect airborne infectious disease.
- All current HCWs with direct face-to-face patient care responsibilities should undergo fit-testing through a “phasing in” approach. Those individuals working in critical care (intensive care specialists, respiratory therapists and Intensive Care Unit (ICU) nurses) should be prioritized with other HCWs to follow. Employers should be aware that current OSHA regulations require that those employees who have not been fit-tested must complete a medical evaluation form prior to being fit-tested. A possible approach would be to have employees complete the medical evaluation form at their annual review (or other “landmark” date). Also per OSHA, fit testing must be done prior to using a respirator, whenever a different type of respirator is worn, and at least annually thereafter.
- All new employees who will have direct face-to-face patient care responsibilities should complete a medical evaluation form and be fit-tested as part of the new employee orientation.
- Hospitals and clinics should have staff trained to provide respiratory protection education and fit testing. In large facilities several staff members should be trained to provide fit testing. Facility/organizations should have fit testing equipment and N95 masks in case a “just in time” response to an airborne infectious event becomes necessary.
The intention is to incorporate respiratory protection training throughout the state by regional and local education and training programs.
Respiratory protection training toolkit available
This kit has information on training options, tools and resources designed to assist the user to develop a long-term plan for building fit testing capacity. The toolkit was designed to assist hospitals and clinics in training personnel on respiratory protection.
(Kit no longer available - May, 2010)
Plans Do Work!
On October 12, 2006, Wright County Public Health (WCPH) tested its Special Populations Plan in a real event. WCPH was notified by both the Minnesota Department of Health (who was notified by the state duty officer) and the Wright County emergency manager regarding an emergency in the City of Buffalo. Natural gas was shut down to the entire city when a digging crew hit a major pressure line.
Initially, it was anticipated the entire city would be without natural gas for days, affecting approximately 5,500 facilities and households. CenterPoint Energy needed to visit all buildings and homes to shut down each meter. Once the lines were fixed, the Company returned to each place to turn meters on and ignite pilot lights. Fortunately, no danger was eminent in this emergency situation.
Wright County Public Health participated in many ways at the City of Buffalo Emergency Operations Center. WCPH had current lists of 24/7contacts for hospitals, nursing homes, assisted living facilities, medical clinics, group homes, foster homes, day cares, schools and other groups that cared for potential vulnerable populations. WCPH staff made telephone calls to those agencies to determine their needs regarding heating, cooking and caring for patients/residents. It was discovered many facilities relied on natural gas for their cooking supply. Others had backup heating systems but relied on a natural gas pilot light to use for their reserve heating source.
WCPH contacted the American Red Cross, who agreed to provide meals to facilities, if needed, and set up a shelter at a school. Transportation to the shelter was arranged through a local provider. (Ultimately the shelter and meals were not used.) A hotline was set up and staffed 24/7 by city workers who relayed needs of individuals.
As time progressed, it was determined the shutdown would not last as long as first anticipated. CenterPoint Energy technicians worked through the night. Using WCPH’s Special Populations Plan, a priority list of facilities was established to determine who would be first in line to have the gas turned back on. Priority went to facilities and individuals most vulnerable to the 25ºF night temperatures. This 24/7 contact list helped CenterPoint Energy work around the clock to reconnect the gas supply to the hospital, nursing homes, assisted living facilities, clinics, schools, day cares and vulnerable at-home people.
In addition to assisting with special populations, WCPH communicated to the public. Using the Wright County CityWatch system, a telephone message was sent to Buffalo homes which informed people about the school shelter, how to get up-to-date information, and to expect a technician to arrive to reconnect the gas supply.
Lessons Learned: The Wright County Public Health Special Populations Plan was invaluable in reaching agencies that serve vulnerable populations. At the time of the incident, all agencies appeared on a county-wide listing. After observing city staff re-type lists that included only facilities located in Buffalo, WCPH now uses an Excel spreadsheet for contact lists. This allows sorting by city, type of facility or used as a comprehensive county-wide listing. Another important lesson: It is really worth the time and effort to keep contact lists current.
Workspace trainings available
The Minnesota Department of Health (MDH) Workspace is:
- a password-protected Website
- a library that houses documents and applications used by MDH, local public health (LPH) and other partners in emergency preparedness and response
- a directory of MDH, LPH, tribal government and hospital emergency responders
- a communication tool used by the Health Alert Network to send out health alerts to state wide health responders.
Several recorded training opportunities are now available through the Workspace.
1. Introduction to MDH Workspace
This training explains how to use the Workspace. Look for the recorded session on the Workspace login page.
The following two training sessions are available only to individuals who are designated DOC staff or HAN Coordinators.
2. Department Operation Center (DOC) Staff Orientation to Communication Tools
Log on to Workspace, click on “Training,” click on “Workspace Trainings,” and click on “DOC training.”
3. Workspace Training for Health Alert Network (HAN) Coordinators
Amateurs? Not at all!
The Minnesota Department of Health (MDH) Office of Emergency Preparedness Partner Alerting and Communications team developed a questionnaire for health organizations that use amateur radio. In November 2006, the questionnaire was sent to MDH Regional Offices, local public health agencies, Tribal Health and hospitals. Out of 248 organizations, 120 responded.
Results gave useful information
- The two most common radio brands used are Kenwood and Yaesu
- Agencies are working with local clubs/operators
- Agencies are including amateur radio in their regular exercises
- Of the 120 responses, 19% of agencies have three or more licensed staff
- 83% of agencies have an antenna installed at the radio location
- 66% individuals are interested in receiving additional training on amateur radio
- 52% of hospitals have radio equipment
- 44% local Emergency Operations Centers are equipped with amateur radio
Having a backup communication system for emergencies is essential for responding to public health emergencies. Developing connections, planning and exercising with local amateur radio operators can be part of that system.
Helpful link for amateur radios
For more information about the amateur radio survey, contact firstname.lastname@example.org
Skip Jackson (left) and Erik Westgard set up and tested amateur radio equipment for an exercise.
Check out these preparedness Web sites
MDH Pandemic Influenza Newsletter is a monthly publication for Minnesota organizations preparing for a possible influenza pandemic.
The San Francisco Office of Emergency Services has developed an emergency preparedness Web site that covers a variety of disasters. www.72hours.org Are You Prepared.
Joining Forces: Responding to the health care needs of our returning military April 20, 2007 conference
In 2007, Minnesota anticipates 3,000+ veterans will return from Iraq and Afghanistan to their homes throughout the state. (To date, 1,200 Minnesota veterans have returned from these countries.)
According to U.S. Department of Veteran Affairs, of the 4,200 veterans, approximately:
- 3150 (75%) had direct combat experience
- 1400 (33%) will have related injury or illness
- Of the 1400, 350 (25%) will have mental illness/acute stress.
The most frequently encountered conditions the veterans experience are:
- infectious disease
- orthopedic injuries
- sexual trauma (13% of returning veterans are women)
- traumatic brain injury (with symptoms often emerging after discharge)
The Veterans Administration system will provide services for 28% of this population, leaving approximately 3,000 to be cared for by the non-military health care providers in Minnesota. The return of these veterans is an important issue for the civilian health care community.
In response, HealthPartners’ Institute for Medical Education is sponsoring a conference Joining Forces: Responding to the Healthcare Needs of Our Returning Military. This highly interactive conference will be held at Metropolitan State University on April 20, 2007.
Conference topics include:
- Action plans
- Behavioral health
- Family dynamics
- Infectious disease
- Musculoskeletal conditions
- Neurological Injuries (including Traumatic Brain Injury)
- OB Gyn (Sexual Trauma)
- Tri-Care insurance
- VA & National Guard Resources
Target audience for this conference includes primary care physicians, nurse practitioners, nurse specialists, physician assistants, registered nurses, chaplains and behavioral health professionals who work in outpatient settings and emergency rooms across the state and in the border regions of our four adjacent states.
Ready to Respond/MDH Preparedness Newsletter
Editorial Board members include 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