PUBLIC HEALTH EMERGENCY PREPAREDNESS

1. PUBLIC HEALTH EMERGENCY PREPAREDNESS Catherine Slemp, MD, MPH WV Bureau for Public Health When Disaster Strikes� Response and Recovery in WV, Summit II Charleston, WV April 23, 2007

2. Summary of Topics Key Principles PH System Structure Health and Medical Preparedness Planning Structure Coordination of Public Health and Emergency Management functions Key Accomplishments / Activities to Date Selected Areas for Further Work

3. Key Principles All hazard planning wherever feasible Must coordinate and align with broader Emergency Management (EM) and Emergency Operations Plans (EOPs) under NIMS By code and state EOP, response is local with state support / coordination. (Provision for state to step in if needed to protect health and safety) Public Health Agency Emergency Response Capacity is directly proportional to strength of everyday public health system

4. Key Principles Government can coordinate, can provide leadership, can provide many services. Government cannot and should not undertake preparedness or response alone. Private Sector, Organized Volunteer Community, Individuals, families, and communities

5. WV�s Public Health System Many community agencies: not formally part of governmental public health system, but integrally a player all the time. In any health disaster, even more the case. Governmental PHS: 49 LHDs. Not formally in any regional structure in WV. Autonomous agencies from BPH (work closely with, but autonomous from BPH). State: Bureau for Public Health Bureau for Public Health (BPH) within Dept of Health and Human Resources (DHHR); BPH includes Disease Surveillance and Control, Lab, Health Statistics, Health Promotion, Maternal Child and Family Health, Health Facility Licensure, Medical Examiner, Environmental Health, EMS, WIC, etc. DHHR includes Behavioral Health, Children and Families,.Medicaid, Child Support Enforcement. Local: Local Health Departments (LHDs) 49 Local Health Departments covering all 55 counties (47 county / city-county; two multi county agencies) LHDs are autonomous from state; report to a local Board of Health established by local gov�t. Work in close partnership with state Many community agencies: not formally part of governmental public health system, but integrally a player all the time. In any health disaster, even more the case. Governmental PHS: 49 LHDs. Not formally in any regional structure in WV. Autonomous agencies from BPH (work closely with, but autonomous from BPH). State: Bureau for Public Health Bureau for Public Health (BPH) within Dept of Health and Human Resources (DHHR); BPH includes Disease Surveillance and Control, Lab, Health Statistics, Health Promotion, Maternal Child and Family Health, Health Facility Licensure, Medical Examiner, Environmental Health, EMS, WIC, etc. DHHR includes Behavioral Health, Children and Families,.Medicaid, Child Support Enforcement. Local: Local Health Departments (LHDs) 49 Local Health Departments covering all 55 counties (47 county / city-county; two multi county agencies) LHDs are autonomous from state; report to a local Board of Health established by local gov�t. Work in close partnership with state

6. LHD PH Preparedness Organization Each LHD has a designated Threat Preparedness Coordinator and other defined roles (most not full time); Some regional leads. Each to have developed a local PH Threat Response Plan to address public health response functions All plans must align with local jurisdiction�s EOP Each is expected to participate in Regional Healthcare System Response Planning (Patient Surge Plans) Each participates in a defined Public Health Preparedness Planning region

7. --No defined regional authority by state code or practice. --Mutual benefit to LHDs and state to collaborate and coordinate within and across regions --Structures / working practices of how done are developed and defined by region --Examples of activities undertaken within regions: mutual aid agreements, common plan templates to enable sharing of staff, joint exercises and trainings, jointly determine use of preparedness funding, etc.--No defined regional authority by state code or practice. --Mutual benefit to LHDs and state to collaborate and coordinate within and across regions --Structures / working practices of how done are developed and defined by region --Examples of activities undertaken within regions: mutual aid agreements, common plan templates to enable sharing of staff, joint exercises and trainings, jointly determine use of preparedness funding, etc.

8. Health Care System Preparedness Organization Regional Health Care System Planning Groups�Hospitals, LHDs, EM, Primary Care, EMS, etc. WV Hospital Assoc partnership coordinating work with Hospitals�WV Hosp. Prep Task Force, facility response plans, regionally advancing surge capacity (plans, resources, sharing, etc.) Emphasis on linking with jurisdictional response Regions correspond to Medical Command Regions

9. Health care system preparedness planning regions correlate to state�s Medical Command System. Medical commands are not leads in this (organized by a regional planning committee), but are noted here.Health care system preparedness planning regions correlate to state�s Medical Command System. Medical commands are not leads in this (organized by a regional planning committee), but are noted here.

10. Public Health and Medical System (Everyday Activities)

11. Emergency Response Plans Plans Nest: Not all is held in any single plan Plan Holder WV Emergency Operations Plan DHSEM Annex G: Health and Medical DHSEM WVDHHR Threat Response Plan WVDHHR Agency / Office Response Office /Bureau Plans, protocols, policies, tools Family / Individual Plan You & Me

12. WVDHHR Incident Command Structure

13. WV Health and Medical System Emergency Response

14. Health and Medical Response Functions (sample) Disease Detection, Investigation, and Control Laboratory Diagnostics�Bio, Chem, Envir Environmental Health (drinking water, food safety, health effects of environmental exposure, infectious medical waste, etc.) Mass Immunization and Prophylaxis Communicating Health Risk and What to do Coordinating Selected Medical Resource Distribution Support / Coordinate Health Care System in Providing Medical Response Behavioral Health

15. Selected Key Activities / Accomplishments

16. WVDHHR Activities Distributing Funds and Supporting System Development 2006-07: CDC- $ 8.5 million (incl. 1 time Pan Flu $); HRSA $3 million Local Health Departments Hospitals Community Mental Health Centers EMS WV Poison Center WV Council of Churches WV Department of Agriculture WV Department of Education American Red Cross

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18. Biosafety Level 3 Lab

19. Mass Vaccination / Strategic National Stockpile Planning Caches of medical equipment & medications stored in US Delivery to state within 12 hrs Accessed by State Health Department who oversees management and distribution Local Health Departments responsible for dispensing to public; hospitals to own staff / patients Two systems: Push Pack Vendor managed inventory

20. WV REDI WV Responder Emergency Deployment Information System Registers and Credentials Health Professional and Other Health Volunteers in advance Web based Links Vol to local H & M Volunteer Group for training, support, etc. Now training system administrators & preparing for launch

21. Pandemic Flu Planning State and Regional Summits State and Agency Plan Development State and Regional Tabletop Exercises Caches of basic supplies and equipment (alternate care facilities x 7; antivirals; N-95 masks for HCWs; etc.) Developing plans for allocating scarce resources: antivirals, vaccine, etc. Planning for Non Pharmaceutical Interventions COOP

22. Communications Health Alert Network Wide Area Network with LHDs & DHHR Offices Collecting and maintaining partner contact info (providers, law enforcement, etc.) Rapidly disseminates info to partners when necessary, via multiple possible modalities Linking in groups that reach Special Needs Pops Tactical Communications Radios (EMS, Hospitals, Med Comm) Rapid Notification System Satellite Phones, Cell Phones, etc.

23. Training People Awareness � Emergency Preparedness, Pandemic Influenza, etc. Incident Command / NIMS Outbreak investigation Mass Dispensing / Vaccination Identifying and treating casualties of an event Psychological Impacts of Disaster / Critical Incident Stress Management Techniques Risk Communications Other trainings done locally. Also work to link community providers and others with CDC and other applicable trainings.Other trainings done locally. Also work to link community providers and others with CDC and other applicable trainings.

24. Areas Needing Attention Enhancing Individual / Family Preparedness Enhancing Private Sector Preparedness COOP�all sectors; in manageable chunks Health and Medical Resource Tracking Coordinating with Volunteers Coordinating with Special Needs Populations

25. Additional Resources http://training.fema.gov/EMIWeb/IS/crslist.asp : Incident command and other training on line http://www.pandemicflu.gov: Federal Gov�t Pandemic Flu information and resources http://www.wvdhhr.org/healthprep : WVBPH Public Health Preparedness webpage. http://www.wvflu.org: WV flu planning resources and information (site now being revised) WVBPH Division of Surveillance and Disease Control http://www.wvdhhr.org/idep/ : protocols, disease fact sheets, WV outbreak & disease reporting info, etc. (1-800-423-1271) http://www.ready.gov : Individual and Family Readiness materials from the US Department of Homeland Security http://www.bt.cdc.gov : disease info, fact sheets, etc.

26. Preparedness Lessons From Noah Don�t miss the boat Remember that we are all in the same boat For safety�s sake, travel in pairs Plan ahead, it wasn�t raining when Noah built the ark Build your future on high ground Don�t listen to critics; just get on with the job that needs to be done.

27. Remember, the ark was built by amateurs; the Titanic by professionals

28. Thank You!