PART I: RISKS AND THREATS

1. PART I: RISKS AND THREATS Presented to: California Indian Health Centers Presented by: Brian Tisdale April 2007

2. GOALS • Recognize the risk of a natural disaster, local terrorist event, or public health emergency. • Understand why Indian Health Centers need to be prepared. • Understand the clinics role in a disaster.

3. RISKS • Agricultural • Earthquakes • Epidemics • Fires • Floods • Hurricanes • Hazardous Materials • Infrastructure Failure • Mudslides • Nuclear • Pestilence • Riots • Terrorism • Transportation • Tsunamis • Volcanoes

4. 1984 DALLES, OREGON Bhagwan Shree Rajneesh 751 cases of Salmonella

5. 1995 Oklahoma City Alfred E. Murrah building 161 DEAD

6. 1995 TOKYO SUBWAY Shoko Asahara 12 Killed 5,500 Affected

7. 2001 NEW YORK & WASHINGTON DC 3000Dead

8. 2001 ANTHRAX FLORIDA WASHINGTON NEW JERSEY 5 DEAD 22 INFECTED 30,000 placed on prophylaxis

9. 2003 SOUTHERN CALIFORNIA FIRES

10. 2003 San Simeon Earthquake

11. 2004 Levee Near Stockton

12. Tsunamis2004

13. 2005 LACONCHITA, CALIFORNIA

14. 2005 GLENDALE, CALIFORNIA 11 DEAD 180 INJURED

15. 2005 Red Lake High School Red Lake Indian Reservation in Minnesota 10 Dead 7 Wounded

16. Hurricane Katrina New Orleans August 2005

17. So what else can happen? H5N1

18. Pandemic Influenza

19. WHY DO CLINICS AND MEDICAL GROUPS NEED TO BE PREPARED? • Disasters are unpredictable and can happen at anytime. • First victims could present in a clinic, private practice, or other outpatient setting. • In a bioterrorism emergency, physicians and nurses are “first responders.” • Rural clinics are the sole provider in their area. • Small accident near a rural clinic with a relatively small number of patients could overwhelm that system.

20. WHY DO CLINICS AND MEDICAL GROUPS NEED TO BE PREPARED? • Small number of patients could overwhelm a smaller facility. • The disaster could occur near you and may involve your clinic and staff. • Due to the potential numbers affected, clinics and private practices may be needed to augment the county-wide response.

21. “If you thought you had smallpox, where would you go for diagnosis or treatment?” • 83 percent said they would go to their own doctor or medical clinic. • 27 percent said they would go to a public health department clinic. Source: Harvard School of Public Health/Robert Wood Johnson Foundation Survey; 2,009 surveyed on May 10-21, 2002

22. How does emergency response fit into health center priorities? • All clinics have a basic level of preparedness as required by licensing and accreditation. • Advanced preparedness is usually the result of a preparedness champion – physician or staff at clinic or consortia who is passionate about its importance. • It would be a bigger priority if benefits in other areas can be seen – e.g., Avian Flu, SARS, natural disasters, disease surveillance, data warehousing. • Fits in better if handled centrally with a coordinator and adequate resources that the clinics also benefit from.

23. WHAT IS A REASONABLE LEVEL OF PREPAREDNESS? • Develop an “All Hazards” Emergency Preparedness Plan. • Provide appropriate patient care. • Protect self, staff and other patients. • Communicate with local government officials. • Prepare for an influx of patients and “worried well.”

24. LOCATION OF INDIAN HEALTH CENTERS

25. RURAL vs. URBAN

26. FIRESTORM 2003

27. INDIAN HEALTH CENTERS RESPONSE • 3 of 4 San Diego Indian clinics are rural areas. • Some clinics were closed for the first week or had limited operations. • All rural clinics and their communities were in the path of the fire. • Community members evacuated and homes destroyed • Staff evacuated and homes destroyed. • Limited generator capabilities. • Limited or no communications. • ***No one reported using their Emergency Plans

28. Lessons Learned from the Fires • Clinic patients WILL go to their clinic in an emergency. Be ready for them! Some will show up having lost their homes and possessions. What will you do for them? • Pharmaceutical supplies, prescription and over-the-counter, are quickly depleted in an emergency. “I’m out of blood pressure medicine and my pharmacy is closed.” • Rural clinics need to be more self-reliant. Basic emergency supplies are of the utmost importance. • Many phone calls and visits are related to stress and anxiety. Be ready to meet mental health needs. • Refugees and immigrants experience flashbacks to war in their home countries. They will call clinics for information and will not want to leave their homes.

29. More lessons learned… • Leadership may be impacted by the emergency. Some will not be able to drive to their clinics. Have a backup plan! • Power loss will bring clinics to a standstill. Basic generators are needed by all. • Keep your cell phone charged (if you have power!) You will need it when the phones go down. • When phone lines go down, Internet connections are lost. Only computers with satellite connections will remain in service. • A natural relationship occurred between Red Cross and Clinics, in some cases coordinating care and services. • Cross-border resources WILL BE used in border region – e.g., firefighters.

30. Family Disaster Plan

31. Plan Ahead • Preparation for a disaster is essential to maintaining the health and safety of yourself and those around you • Develop an emergency preparedness plan with your family • Learn what to prepare for

32. How to Start • Develop a family communication and emergency preparedness plan • Practice evacuation plans • Make a 1-week kit

33. Family Emergency Communication Plan • Create a support network • At least three contacts in an emergency • Give contacts all pertinent information (where important documents are, special needs of family members, etc.) • Make sure contact information is easily accessible to children

34. Communicate Disaster Plan • In the event of an emergency be sure: • All family members know the best route to evacuate • Have a designated meeting places • Outside the home • Outside the neighborhood or city • Be sure all family members know the addresses and phone numbers of all meeting places

35. Phone Numbers to Keep Close • Home • Work • School • Two additional phone numbers out of state (phone lines may be jammed)

36. 72 Hour Disaster Kit*Following Hurricane Katrina a 7 day Kit is Recommended • Enough basic supplies to last three days • Water • Food • First aid • Clothing and bedding • Tools and emergency supplies • Special needs items

37. Additional Supply Considerations • Have extra prescription medications in stock- minimum 2 week supply of all essential medications • Extra supplies for assistance devices (hearing aids, wheel chairs, oxygen) • First aid supplies

38. Water • Three to seven days supply • One gallon of water per person per day • Store in plastic containers • Hot regions may need more • Replace water every 6 months

39. Three to seven days supply of nonperishable food items Sealed food products Canned ready to eat: No refrigeration No cooking Little or no water Examples: Canned tuna, pork and beans, dried fruit, canned juice, peanut butter Rotate food out every 6 months Food

40. First Aid Kit (Home and Car)

41. Additional needs Cash $$$ Prescription medication Entertainment items: books, games Special foods/drinks/snacks DVD players Etc…………… Children’s Needs

42. Pets • Extra food and water • Pet carriers ready • Vaccinations up to date • Veterinary contact info • medications

43. Preparing Before an Event Occurs The Key to Success is-

45. CONTACT INFORMATION… Brian Tisdale, MS 951-440-7495 btisdale@co.riverside.ca.us