Disaster Strikes Environmental Health Responds: Stories from the Field

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Disaster Strikes-Environmental Health
RespondsStories from the Field

• Ready to Respond
• Spotlight on Minnesota Health Preparedness
• Brooklyn Park, MN
• May 1 2, 2007
• Twin Cities Metro
• Advanced Practice Center
• Minnesota
• Brian R. Golob, M.S.,CHMM, REHS
• brian.golob_at_co.hennepin.mn.us
• 612-543-5204

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Project Background8 Advanced Practice Centers
Nationally

• NACCHO in collaboration with CDC
• Create share models for strengthening local
  public health capacity for public health
  emergencies

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Disaster Denial Paradigm

• It isnt going to happen.
• If it happens, it will not be as they said it
  would be.
• If it happens, and it is as bad as they said, it
  will not happen to me.
• If it happens and it is as bad as they said, and
  it happens to me, then someone has planned for it
  and is coming to help.

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Emergency and Disaster Definitions

• Disaster overwhelms the affected community and
  requires outside assistance
• Emergency is not a disaster in itself, but an
  event requiring immediate response
• The role of an EHP in responding to a disaster or
  an emergency is essentially the same

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Storytelling
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Technical Topics in Module I

• Outbreak investigation
• Water safety
• Food safety
• Sanitation (sewage)
• Mass care
• Solid waste mgt
• Vector control

• 8. Hazardous Materials
• Household Hazardous Waste
• Hazardous Waste
• Medical/Infectious Waste
• Chemical Incidents
• Radiological Incidents

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• Story Based

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Welcome to a Different Kind of Training

• Interviewed EHP across the country
• Learned how they dealt with actual disasters and
  emergencies
• They shared valuable tips, techniques and lessons
  learned
• Experience is a powerful teacher

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Environmental Health Competencies

• Focused on 8 EH Core Competencies (defined by the
  American Public Health Association and the
  National Center for Environmental Health at CDC)
• There are a total of 14 EH Competencies
• Key to disaster emergency preparedness,
  response, recovery

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Environmental Health Competencies

• Organizational Knowledge Behavior
• Collaboration
• Information Gathering
• Data Analysis
• Problem Solving
• Reporting, Documentation, and Record Keeping
• Communication
• Education

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Competency Definition

• A cluster of related knowledge, skills, and
  attitudes that affect a major part of ones job,
  that correlates with performance on the job, that
  can be measured against some accepted standards,
  and that can be improved via training and
  development.
• Source Environmental Health Competency Project
  Recommendations for Core Competencies for Local
  Environmental Health Practitioners 2001

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How the Module Works

• Introduction followed by 8 lessons
• Each lesson focuses on one core competency
• Complete one or more lessons in a session
• No required specific order

• Lesson Format
• Competency Overview
• Field-based Stories
• Lessons Learned
• Resources
• Quiz Questions
• Print this Lesson

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Applying the Competencies

• Competencies brought to life
• Stories illustrate specific action steps
• Taken by EHP during actual events

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Event Descriptions

• Anhydrous Ammonia Spill
• Diazinon Spill
• Pesticide Warehouse Fire
• Hurricane Katrina
• Mercury Release

• Chlorine Leak
• Earthquakes
• Floods
• Landfill Odor
• TOPOFF Exercise
• Tornadoes

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Icon Graphics
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Training Module Perspective

• Be consistent with NIMS
• Provide guidance for Environmental Health
  Professionals
• Based on actual field experience
• Provide Useful Practical Information

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Organizational Knowledge BehaviorWhat does it
Mean?

• The capacity to function effectively within the
  culture of the organization and to be an
  effective team player.

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Organizational Knowledge BehaviorWhy is it
Important?

• To strengthen the EH teams performance during a
  disaster

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Organizational Knowledge BehaviorWhat is the
EHP Role?

• Understand ICS and how environmental health and
  your emergency response plan work within ICS
• Read/understand the procedures in your emergency
  response plan

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Organizational Knowledge BehaviorWhat is the
EHP Role? (Cont.)

• Help keep your team safe during a disaster
• Help ensure your team is always prepared to
  respond

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Organizational Knowledge BehaviorHow do you
build Organizational Knowledge?

• Ensure your staff is trained in ICS
• Meet with your jurisdictions Dir. Of Emergency
  Mgt. to discuss review roles for environmental
  health within ICS
• Know how your jurisdictions emergency plan
  works, your roles within it, and how it ties into
  ICS

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Organizational Knowledge BehaviorKeep Your
Team Safe!

• Provide initial and annual training on the use of
  PPE
• Make sure your team members take mental-health
  breaks
• Use a buddy system

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Organizational Knowledge BehaviorKeep Your
Team Safe! (Continued)

• Wear easily identifiable uniforms
• Prepare field equipment kits for a quick response
• Ensure team members carry up to date info

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Organizational Knowledge BehaviorLessons
Learned

• Determine how your skills assets can aid the
  response
• Develop an EH emergency response plan
• Ensure staff are trained to carry it out

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Organizational Knowledge BehaviorLessons
Learned (Continued)

• Take action to minimize fatigue
• Enforce time limits for assistance
• Limit the number of response hours worked

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CollaborationWhat does it Mean?

• The capacity to form partnerships
• and alliances with other individuals
• and organizations in order to
• enhance performance on the job.

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CollaborationWhy is it Important?

• A multidisciplinary team of knowledgeable and
  experienced experts working together is essential
  for effective and timely response and recovery

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CollaborationWhat is the EHP Role?

• Planning Stage
• ID other disaster and emergency responders
• Build relationships with other responders work
  together on disaster/emergency planning
• Cross-train with other responders
• ID other resources that may help during a
  disaster/emergency

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CollaborationWhat is the EHP Role? (Continued)

• Response Recovery Stages
• Collaborate with all involved parties such as
  local, state, federal, businesses and remediation
  contractors

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CollaborationIdentify Partners

• Fire Police
• Public Utilities
• Medical Community
• Restaurant Assoc.
• Private Businesses
• Federal Agencies
• State Agencies
• Local Agencies
• Colleges

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CollaborationBuild Relationships

• Make appointments talk to partners now
• Make relationship-building part of your routine
• Join emergency management committees to work with
  other responders

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CollaborationBe Proactive in Your Community

• Make appointments to meet with medical hospital
  staff
• Make appointments to meet with local planning
  building officials
• Make appointments to meet with volunteer agencies

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CollaborationUnderstanding and Communicating
your Role

• Work with members of your own team as often as
  thoroughly as possible
• Work with private contractors when necessary
• Work with first responders to ID needs, assets
  opportunities

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CollaborationLessons Learned

• Make collaboration a high priority during
  planning, response recovery stages
• Always work within Incident Command System

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Information GatheringWhat does it Mean?

• The capacity to identify sources and compile
  relevant and appropriate information when needed,
  and the knowledge of where to go to obtain the
  information.

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Information GatheringWhy is it Important?

• Assessing risk and damage is critical to the
  health safety of victims and responders
• The assessment begins with information gathering

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Information GatheringWhat is the EHP Role?

• Continuous effort due to changing circumstances
• Think outside the box
• Be creative
• Work alone or with partners

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Information GatheringGetting Started

• What information do you need?
• Where will you find the information?
• How will you gather the information?
• What will you do with the information once you
  find it?

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Information GatheringTechniques

• Conduct initial overview inspections of affected
  area(s)
• Keep a running list of inspected area(s)
  collected information
• Develop a checklist to ensure consistent
  assessment

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Information GatheringTechniques (Cont.)

• Conduct individual interviews to assess impact on
  health
• Use technological tools to facilitate interviews
• Use telephone hotlines

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Information GatheringLessons Learned

• Remember to take notes
• Keep copies of records for future reference
• Watch for/adjust to unusual or unexpected hazards
  while collecting information

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Reporting, Documentation Record-KeepingWhat
does it mean?

• The capacity to produce reports to document
  actions, keep records, and inform appropriate
  parties.

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Reporting, Documentation Record-KeepingWhy is
it Important?

• Prevent duplication of effort
• Serve as communication tools
• Necessary for financial reimbursement
• Helpful for future preparedness activities

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Reporting, Documentation Record-KeepingWhat is
the EHP Role?

• Produce reports to document actions
• Document expenses for reimbursement
• Keep records for legal proceedings
• Keep and use records as learning tools

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Reporting, Documentation Record-KeepingDevelopi
ng a System

• Make sure your reports are accurate enough to
  prevent duplication of effort
• Become familiar with FEMA Applicant handbook

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Reporting, Documentation Record-KeepingDevelopi
ng a System (Cont.)

• Keep your reporting process simple and easy to
  use
• Use your normal, everyday recording methods
• Check with your legal advisor about
  record-keeping requirements prior to a disaster
• Review and critique your system

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Reporting, Documentation Record-KeepingLessons
Learned

• Consider developing a redundant record keeping
  system for your office
• Assign a person responsible for data entry
• Become familiar with FEMA record-keeping
  requirements

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Data AnalysisWhat does it Mean?

• The capacity to analyze data, recognize
  meaningful test results, interpret results, and
  present the results in an appropriate way to
  different types of audiences.

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Data AnalysisWhy is it Important?

• To determine priorities next steps
• To evaluate effectiveness of your response
• To accurately assess the impact on environmental
  health
• To eliminate guesswork and validate the necessity
  of your actions

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Data AnalysisWhat is the EHP Role?

• Perform a variety of analyses
• Use a variety of resources to analyze data
• Use results from your analyses to develop
  accurate reports

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Data AnalysisGetting the most from your Data

• You are accountable for the health and safety of
  the public
• If you need help analyzing data, request the
  resources you need
• Make your data requirements known early
• If a sampling protocol is being developed, get
  involved
• Remember analyzing poor quality data may be
  worse than not having any data

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Data AnalysisLesson Learned

• Be open to exploring other factors (such as
  weather patterns, cultural practices and
  vulnerable populations) that may affect your
  response

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Problem SolvingWhat does it Mean?

• The capacity to develop insight into and
  appropriate solutions to environmental health
  problems.

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Problem SolvingWhy is it Important?

• Your expertise experience make you uniquely
  qualified to ID and solve problems
• Your proactive involvement is critical to keeping
  the public safe and healthy

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Problem SolvingWhat is the EHP Role?

• ID current potential problems
• Propose solutions and actions
• Prioritize actions
• Prevent future problems

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Problem SolvingDecision Making with Incomplete
Information

• In a chaotic situation, you can receive limited
  or inaccurate information
• Understand your threshold for making decisions
  with minimal or no data
• When you lack sufficient data, use common sense

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Problem SolvingStrategies

• Learn understand brainstorming techniques
• Use existing emergency response plans with
  predetermined priorities
• Set realistic priorities according to your needs

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CommunicationWhat does it Mean?

• The capacity to effectively communicate risk and
  exchange information with colleagues, other
  practitioners, clients, policy-makers, interest
  groups, media, and the public through public
  speaking, print and electronic media, and
  interpersonal relations.

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CommunicationWhy is it important?

• Frequent communication is essential to successful
  disaster/emergency response and recovery
• Responders must share assessments, discoveries,
  challenges and actions
• Public must be regularly informed

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CommunicationWhat is the EHP Role?

• Routinely communicate with team members
• Communicate regularly with responders
• Communicate with public in a variety of ways
• Acquire reliable communication equipment

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Communication Tips Techniques

• Ensure the accuracy of your messages
• Use simple tools for immediate messaging
• Develop good listening skills

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Communication Tips Techniques (Cont.)

• Be prepared to provide emotional support
• Be cognizant of cultural, educational and
  regional differences
• Develop skills for dealing with mental-health
  issues

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EducationWhat does it Mean?

• The capacity to use the environmental health
  practitioners front-line role to effectively
  educate the public on environmental health issues
  and the public health rationale for
  recommendations.

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EducationWhy is it Important?

• Disasters/emergencies cause a wide range of
  hazards
• EHPs must educate people about these hazards to
  ensure their health safety

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EducationWhat is the EHP Role?

• Prepare generic educational materials
• Deliver educational messages effectively
• Use a variety of methods materials to educate
  the public

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Education Present Effective Messages

• Use clear, understandable language
• Be optimistic factual
• Talk slowly and calmly
• Avoid using acronyms
• Share essential information

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EducationDelivering the Message-Incorporate
Education

• Incorporate education during interviews

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EducationDelivering the Message-Print Materials

• Identify potential distribution locations for
  educational materials
• Compile examples of existing fact sheets

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In Every Lesson There Are

• Think about it exercises
• Quiz questions

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Resources

• Links to Specific Documents
• Sample Field Equipment Kit Lists
• Sample Field Assessment Form
• Sample Facility Survey Checklist
• Fact Sheets

• Links to Specific Websites
• Sample Mutual-aid Agreements
• Sample Disaster Survey Form
• Sample Door Hangers

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Summary

• Interviewed 22 EHP
• Ten Incidents
• Highlight their collective disaster experience
• Relate their experiences to the EH Core
  Competencies
• There is no linear, step by step formula for
  success
• Creativity, flexibility teamwork are essential

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Remember

• Experience is a powerful teacher, especially
  in the realm of disasters and emergencies

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Finally

• One small step for Twin Cities Metro APC/NACCHO
  and one giant leap for environmental health and
  emergency preparedness