October 2007 Ready to Respond MDH Preparedness Newsletter
On this page:
The 2007 flood in southeastern Minnesota
I-35W bridge collapse
Local Public Health Preparedness
Healthcare System Preparedness
Communications quick tips
What is HSEEP?
Create your personal “Go Pack”
Health Alert Network training available on Workspace
(Aggie Leitheiser, Director of Emergency Preparedness)
This issue of the Ready to Respond newsletter features several articles about the local and state response to recent emergency/disaster events. Each event leaves us with better skills, more experienced people, improved information about public health and healthcare needs and resources, additional partners, and exposure for new staff to our response plans. We also learn where we could have been more specific, or responded more quickly, or coordinated more closely with each other to reduce confusion.
While we all hope events are few and far between, we need to take time to review what we did, celebrate our accomplishments and analyze our limitations. The flooding in SE Minnesota involved many parts of MDH. We recently held three “hotwashes” to review our response. About 30 people attended each session to discuss incident management and communication, environmental health and laboratory services, and coordination with local health departments and local healthcare systems.
Results from those meetings are being compiled into an After Action Report that highlights the positive actions and response problems. A companion document, known as the Improvement Plan, will focus on a smaller number of response actions for improvement. These actions are included in a subsequent exercise to make sure the improvements actually work.
This logical progression of action steps fits with the Homeland Security Exercise Evaluation Program (HSEEP) that supports continued response improvement within a national framework. It also helps to make sure we don’t lose track of the many lessons we learned during our event response.
A quote that sums up this issue comes from that great philosopher Jennifer Aniston (yes, from the TV show Friends) who said: “There are no regrets in life, just lessons.” Our continuing application of lessons learned from exercises or events is a critical part of our preparedness and response mission.
Following are four articles that give different perspectives about the August flood and response activities.
Photo Source: Minneapolis Star-Tribune & Rochester Post Bulletin
Flood impact in southeastern Minnesota
Heavy rain fell across most of southern Minnesota on Saturday August 18 and Sunday August 19. The southeastern counties received the most rain.
- Hokah recorded 15 inches of rain in twenty-four hours, which easily broke the old state record of 10.84 inches for a twenty-four hour period.
- An unofficial twenty-four hour total of over 17 inches was recorded near Caledonia.
- The highest total for the entire event was 18 inches near La Crescent.
As the rains exceeded the absorption rate of 1.5 inches in six hours, flash floods rapidly overflowed the watercourses and spread across the valley floors.
Governor Tim Pawlenty declared a state of emergency in six counties: Dodge, Fillmore, Houston, Olmsted, Steele, Wabasha, and Winona, and ordered 240 Minnesota National Guard to assist these communities.
- The towns of Stockton, Houston, Elba, Minnesota City and portions of Winona (on the Mississippi River) were evacuated.
- Citizens were moved to St. Mary's College in Winona with a second shelter also set up in Winona.
- The City of Houston had a mandatory evacuation order to Caledonia High School because of concerns about water topping the levy.
- Twenty-two Valley View nursing home residents were evacuated to a nursing home in Caledonia.
- Thirty-three assisted living service residents were relocated to Spring Valley and Mable.
High floodwaters on the Middle Branch of the Whitewater River (which runs through Whitewater State Park) destroyed three bridges and damaged campgrounds, bathhouses, a group-dining hall, and water and sewer systems in the park. About 500 campers were staying in Whitewater State Park at the time. The park was closed to the public on August 20, 2007 for an indefinite period.
The city of Rushford was surrounded by water, had no gas, phones or power service, and the sewage plant was contaminated. Shelters were opened at TRW Factory and Rushford High School. Rushford Emergency Medical Services lost one ambulance and all their extra supplies. E. coli bacteria was found in the Rushford's water supply. Residents were urged not to use any water until the city's water system could be flushed. The primary care clinic in Rushford sustained heavy damage from floodwaters. To meet community needs, Winona expanded its Urgent Care Clinic to include a shuttle service between the two towns to transport individuals needing care.
Three bridges either washed out or the approaches to bridges washed away. Many county roads were closed. Amtrak train service between Minneapolis and La Crosse, Wisconsin was shut down for a week because of damage to the tracks. Passengers were bussed between the two until repairs could be made.
Seven fatalities occurred [5 in Winona and 2 in Houston]. Close to 4,200 homes were damaged or destroyed. An estimated $67 million in damages occurred in the six declared federal disaster areas.
As of October 2007, flood recovery efforts continue in this region.
Communication issues during the southeastern flood
People forced from their homes, hungry for information about how to protect themselves and begin the long task of recovery.
Lack of access to conventional media channels.
Sporadic gaps in cell phone service.
An urgent need to communicate about safety concerns and availability of resources – and get the information to an elaborate and far-flung team of emergency responders.
Those are just a few of the communications issues that emerged during the recent flooding in southeast Minnesota. As part of the team that assembled in the Department Operations Center at the Minnesota Department of Health (MDH), the DOC Public Information Officer (PIO) worked with the MDH communications staff to help coordinate communications activities for the agency.
Although a major share of responsibility for media relations was handled at the local level – under very difficult circumstances – the PIO provided coordination and support for these efforts at the state level. Beginning on Aug. 21, the MDH Communications Office – working through the State Emergency Operations Center – began sending out a steady stream of news releases about flood-related issues. Often, the information in these releases was developed and disseminated in response to needs identified by local public health, or by MDH staff in the field.
- General information about protecting your health during a flood
- The status of local water supply systems in the flood area
- Activation of a public hotline at MDH
- How to use bleach safely and appropriately as a disinfectant
- Recommendations regarding vaccinations
- Recommendations for the use of N95 respirators (“masks”) to prevent exposure to mold
Messages provided to the public included an emergency news release sent out late in the day on Aug. 21, regarding the public water supply system in Rushford. The community water supply system in Rushford was being partially reactivated at that point for testing purposes, and concerns had been raised that people might be tempted to drink the water, which still wasn’t considered safe.
The flood response also included the first full-scale use of a new tool for communicating with MDH staff and external partners during an emergency event – the Event Summary.
The Event Summary concept was developed by MDH and local public health officials as part of a larger effort to define the roles and responsibilities of state and local public health during an emergency. Event Summaries are essentially “public” versions of the non-public Situation Reports that have always been part of the incident management model for emergency response.
Because they contain no non-public data, and the information is presented in a user-friendly format, Event Summaries are able to serve a dual function. In addition to keeping internal staff and external partners informed about an event, they also help address the need for “message coordination” function, providing a standardized summary of information that can be freely shared with media and the public.
Between activation of the MDH DOC on Aug. 20 and deactivation on Aug. 31, eight Event Summaries and two corrections/updates were developed by Communications Office staff working in the DOC PIO role. The Event Summaries were distributed internally at MDH by conventional e-mail, and to local public health and other external partners through the MDH WorkSpace messaging function. They were also posted on the public portion of the MDH website.
The MDH Communications staff are now participating in a series of “hot washes” designed to identify possible areas for improvement of the agency’s emergency response capabilities – including our capacity to communicate effectively in an emergency.
Are immunizations needed during a flood?
Even before the Minnesota Department of Health (MDH) set up the flood hotline on August 22nd, phone calls about tetanus shots were coming from southeastern Minnesota. Most callers wanted to know if MDH was recommending tetanus shots or other immunizations for people in the flood area, and if so, how they could get them.
Similar questions and concerns lingered as the hotline stayed open. About16 percent of hotline phone calls were about shots (primarily tetanus and hepatitis). People were confused about the recommendations and wanted assurance that it was okay to work in flooded areas even if it had been a while since they have had a tetanus shot. City officials were asking local health departments to provide tetanus shots to all community members and volunteers involved in the clean up. While MDH attempted to keep the message consistent, questions persisted.
Now that the flood efforts are in the recovery phase, it makes sense to repeat the message to communities that experienced flooding and to the rest of the state. As we know from studying risk communication, making information available is not the same as communicating. It is always easier to hear and digest information at times other than the height of an emergency.
According to the Centers for Disease Control and Prevention (CDC), outbreaks of infectious diseases after a flood are unusual. Generally, an increased risk of getting vaccine-preventable diseases (such as tetanus, hepatitis A or hepatitis B) does not occur. Also, mass immunization programs are normally not needed during a flood and are not a standard recommendation. The same recommendations that apply at any other time also apply to a flood. Any need for vaccination during flood recovery depends on individual circumstances.
During a flood emergency, getting people up to date on their immunizations does not need to be a high priority activity. For people involved in flood response and recovery, the risk of getting these diseases is generally no greater than that faced by the general population. There is concern that emphasis on immunizations may divert time and resources from more pressing flood clean-up and recovery activities. Making immunizations a priority could send a misleading message to the public about the risks they face during a flood. People should always be encouraged to keep current with their shots—whether during a time of emergency or not.
Let’s educate ourselves, our partners and our communities about the importance of keeping up to date on all immunizations.
For more information (including a fact sheet for the public), go to MDH webpage Immunizations and Floods.
Know and plan for your level of flood risk
"Everyone lives in a flood zone - it's just a question of whether you live in a low, moderate or high risk area" according to the Federal Emergency Management Agency (FEMA). The National Flood Insurance Program in FEMA, which produces the maps used for flood plain management and insurance, states "the maps are constantly being updated due to changes in geography, construction and mitigation activities, and meteorological events."
To determine your relative level of flood risk, view an interactive video on flood damage, learn about community participation in flood insurance and find other flood information, visit floodsmart.gov.
Communities that participate in the National Flood Program are listed on the Federal Emergency Management Agency Communication Status Book Report - Minnesota (PDF: 15 pages). If data is not available for your community on these Websites, contact FEMA or your local government.
Staying current with flood risk classifications can help you avoid or lesson the impact of a flood on the health of your family and your community.
MNTrac worked well during I-35W Bridge Collapse
Important decisions that could potentially affect the lives and safety of individuals are made based on information received (or not received) during an event. Thanks to MNTrac, the Minnesota System for Tracking Resources, Alerts and Communication, Minnesota has a tool that rapidly sends critical information to hospitals and first responders during a disaster.
During the bridge collapse on August 1, 2007, the initial alert read, “I-35W Bridge over river has collapsed, unknown patient count at this time, EMS command structure at scene, more to follow as information comes in.” Twenty-one alert updates with additional information were sent over the next five hours.
MNTrac alerts are sent via multiple methods, such as text messages to cell phones, blackberries and pagers. Updates with new information are sent as often as needed.
In this incident, the information sent through MNTrac greatly assisted hospitals and Emergency Medical Services. Hospitals were able to get an idea of the scope of the incident, the types of injuries that patients had sustained, and the ability to determine their proximity to the event. This important information helped hospitals determine whether to increase staffing or to shift emergency department patients to other areas of the hospital in anticipation of a patient flux.
The Minnesota Department of Health Office of Emergency Preparedness implemented MNTrac in the Twin Cities Metropolitan Area in May 2006. During the bridge collapse, cell phones were jammed and failed as a means of communication, but other methods of communication prevailed. Using MNTrac gave Minnesota greater interoperable and redundant communication capabilities. MNTrac was one of the systems that worked very well.
Quiz yourself about environmental health, our partners and the I-35W Bridge Collapse
After the I-35W bridge collapse, it was critical to find out if potentially harmful substances were released into the environment. Local, regional, state and federal agencies collaborated and initiated public health protection measures. They applied their expertise in a variety of scientific disciplines.
“The good news is that no public health hazards were detected,” noted David Wulff, environmental health program manager, Minnesota Department of Health. “If any hazards had been detected, MDH was prepared to assist the City of Minneapolis with assessing the risk and providing the public with information.”
Listed below are state partners and some of the actions they performed due to the I-35W bridge collapse. Can you match them up?
Northeast Region receives award
On July 18, 2007 the Wolters Kluwer Health Award was presented to the Northeast Minnesota Emergency Preparedness Coalition for their work in planning for pandemic flu. The award was presented at the American Medical Association/Centers for Disease Control (AMA/CDC) Second National Congress on Health System Readiness in Washington D.C.
With over 200 proposals submitted, representatives of the Northeast Minnesota Emergency Preparedness Coalition were among four groups selected by the AMA/CDC for this award.
Proposal writers were:
- Jim Gangl, public health emergency preparedness coordinator, St. Louis County Public Health and Human Services
- Bonnie Holz, public health preparedness consultant, Minnesota Department of Health
- John Jordan, St. Mary’s life flight manager and emergency preparedness coordinator, SMDC Health Systems
- Cheryl Stephens, regional hospital resource center coordinator and executive director, Community Health Information Collaborative
Jim Gangl and Bonnie Holz hold the Wolters Kluwer Health Award
Jim and Cheryl attended the conference, made the presentation, and received the award. The presentation focused on the integration of public health, tribal, health care leadership, emergency medical services and emergency management at the community and regional levels. An integrated response is necessary for a community-wide response to pandemic influenza and is a prototype for an all-hazards approach to community readiness.
Minnesota uses a tiered emergency response system which begins at the local/community level. It transitions to a regional level only when the community is overwhelmed, and finally, to a state- level response as dictated by the size, scope and nature of the incident. Each region documents their response as part of a Regional All-Hazards Health and Medical Response and Recovery Plan, which is an integrated public health and healthcare system plan.
The NE Minnesota Emergency Preparedness Coalition includes:
- Governments (7 counties, 3 tribes and 8 cities)
- 10 public health agencies
- 16 hospitals
- 65 clinics
- Emergency Medical Services (35 ambulance services and 115 First Responder Units)
Membership includes public safety units (police, sheriff, fire, emergency management, Coast Guard, Border Patrol, and Immigration and Naturalization Service), 17 colleges and universities, and many volunteer organizations including a strong Red Cross Chapter.
MDH collaborates with partners on patient tracking pilot
Disasters such as the I-35W Bridge collapse have shown the need for tracking patients during a mass casualty incident. After the bridge collapsed, hospitals were deluged with phone calls from victims’ families, the National Transportation Safety Board (NTSB), the Hennepin County Sheriff’s department and many others looking for patient lists and patient information. This put an enormous strain on hospitals and other health care entities to respond during an already chaotic and overwhelming time. Significant time was lost and resources drained before a comprehensive list of patients, their locations, and general impressions was developed.
The Minnesota Department of Health Office of Emergency Preparedness is currently developing a web-based patient tracking application to lessen the difficulties surrounding the tracking of patients during a mass casualty incident. This new application will be incorporated into MNTrac, Minnesota’s resource and hospital bed tracking system that was implemented to all hospitals statewide over the last year.
During this year’s Minnesota State Fair, the MDH collaborated with the American Red Cross and ImageTrend, Inc. to pilot its newly developed patient tracking application. The First Aid Station West at the Minnesota State Fair was a perfect venue to conduct a test of the new software application. Visitors to the first aid station were given a bar-coded wrist band to wear. A wireless, hand-held scanner was used to open new patient records, scan bar-code numbers into the system, and house patient data. A good number and sampling of patients was received during the pilot; therefore, a great amount of the system’s functionality was fully tested.
The pilot was a tremendous success. Information and feedback gathered from the pilot will lead to a better, honed and more efficient patient tracking application. New ways of streamlining the data collection process were identified, as well as ideas for greater ease of use. The end product will be a powerful tool assisting healthcare and the greater community in the tracking of patients during a disaster.
The patient tracking application was tested on a larger scale at the National Disaster Medical System’s full scale exercise on October 12, 2007. Several hospitals in the Metropolitan area, the Medical Resource Control Centers and the Regional Hospital Resource Center for the Metropolitan area assisted in testing the application. Roll-out and implementation for the patient tracking application will begin later this fall.
Whether you contact media or media contact you for comments, the person in charge of any interview should be you. This means understanding as much as possible about your topic, having a concrete message or messages to deliver about that topic and exercising tact and skill in refocusing interviews that wander off target.
Having a key message is vital. If you do not have a message, you have no reason to do an interview. And sticking to the message, or messages, helps keep you and the interview focused and guards against speculation and other media pitfalls.
In an ideal situation, you know about an interview in advance and can refine your messages. Taking time to anticipate a reporter’s questions and plan your responses also helps you to keep control of an interview.
When an interview happens on the spot, you still can drive the content. Take a moment to collect your thoughts and identify the key messages. Never talk before you know what you want to say. And if you do not have the answer to a question, say so, adding that you will gather that information and get back to the reporter.
If someone else in your organization is better qualified to discuss the subject, tell the reporter you will contact this person about giving an interview. It is unwise to talk on matters outside the scope of your responsibilities.
Whatever the circumstances of an interview, it helps to have some stock responses for bringing a discussion that has digressed back to the point that you wish to make. The following phrases might help you to control the content of an interview:
What I am really here to discuss is …
What your readers/viewers/listeners need to know is …
I think that what you really are asking is …
The overall issue is …
What is important to remember is …
It is our policy not to discuss this issue. However, what I can tell you is …
The Homeland Security Exercise and Evaluation Program (HSEEP) is a program of the Federal Emergency Management Agency (FEMA). HSEEP provides a standardized policy, methodology and language for individuals who design, develop, conduct and evaluate exercises. This standard format is strongly recommended for any exercise that receives funding from federal sources.
The HSEEP website https://hseep.dhs.gov/ includes exercise resources, upcoming events and exercises, HSEEP policy and guidance, trainings, and a link to the HSEEP Toolkit.
Users are required to register for an account and create a Username and Password.
Examples of what this website includes:
- Volume I, Overview and Exercise Program Management
- Volume II, Exercise Planning and Conduct
- Volume III, Exercise Evaluation and Improvement Planning
- Volume IV, Resource Library
The HSEEP Toolkit has three components:
- The National Exercise Schedule System (NEXS) is a nationwide calendar where you can view exercises in your state.
- The Design and Development System (DDS) provides:
- A process to describe and enter your exercise into NEXS.
- A step-by-step process to develop an exercise with templates for exercise documents. You can work on documents over months, saving your work as you go. The DDS provides support with meetings and shares tasks with other members of your exercise planning team.
- The Corrective Action Program (CAP) tracks the recommendations and improvement actions submitted with the After Action Report and Improvement Plan (AAR/IP) from an exercise.
If you are responsible for creating an exercise, visit the HSEEP website.
“Where did I put that number?” “What was that login and password again?”
If a public health emergency happens and you are at a meeting away from your office or at home, will you have the information you need? By creating your personal “Go-Pack” in advance of an event, you will be in a better position to focus your attention on response activities.
Here are examples of what information to include in your Go-Pack:
- Important contact information (including after hours information)
- The MDH Emergency Operations after hours phone number is 651-201-5735.
- Don’t forget to include phone numbers that are on your speed dial. Will you remember those numbers if you are using a different phone?
- Logins, passwords and URLs to access information/response tools
- If you need to login to the Workspace from a computer that does not have it bookmarked, could you remember the URL?
- Instructions and information for phone and radio communications
- If you need to set up a conference call from home, do you have the phone numbers and moderator PIN?
- Location or codes for certain equipment
- If your response supplies are locked up, do you know where the key is kept?
To share your great Go-Pack ideas and response stories, send an email to firstname.lastname@example.org . Be Ready to Respond!
Understanding and being familiar with communication systems, such as the MDH Workspace, can be essential to a swift response. New or current Health Alert Network (HAN) Coordinators can access the HAN Coordinator Training on the Workspace.
Login to the Workspace
> Training (left hand menu)
> Workspace Trainings
> HAN Coordinator Training
The training will take you through:
* Definition of the HAN Coordinator role
* How to add and deactivate users on the Workspace
* Maintain your Organization Role Matrix
* Background and information on the Health Alert Network
Questions about the Workspace or the HAN Coordinator role can be sent to email@example.com .
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