Emergency Preparedness and Response: Public Health and Healthcare

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Emergency Preparedness and Response Public
Health and Healthcare

• Lisa G. Kaplowitz, M.D., M.S.H.A.
• Deputy Commissioner for Emergency
• Preparedness and Response
• Virginia Department of Health

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Emergency Preparedness and Response Program
(EPR) Virginia Department of Health (VDH)

• Preparedness and response to all emergencies,
  naturally occurring as well as terrorist related
  (all hazards approach)
• Response to outbreak situations
• Build public health infrastructure in VA
• Collaboration among all programs in VDH, and all
  emergency response programs in VA
• Availability to respond to emergencies 24/7

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Emergency Preparedness and Response Program
(EPR) Virginia Department of Health (VDH)

• Collaboration with healthcare community
• Hospitals
• Physicians
• Other healthcare providers
• Community Health Centers, outpatient clinics
• Mental Health provider community
• Chronic/long term care facilities, home care
  population, and populations with special needs

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Funding for Health Department Emergency
Preparedness

• CDC funding
• Public health preparedness
• Initial focus on bioterrorism
• Now an all-hazards approach
• Funding 20 million in 05-06 planned cut for
  06-07
• HRSA funding
• Emergency preparedness for healthcare delivery
  system
• Initially focused on hospital preparedness
• Now includes other health care providers

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EPR Program Progress

• Increase/Enhance Local Capacity Hired planner
  and epidemiologist for each of 35 District Health
  Departments
• Establish 5 Regional Response Teams physician,
  epidemiologist, planner, trainer, PIO
• Recruit key epidemiology, IT positions
• Upgrade information and communications
  technologies, and systems

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EPR Program Progress

• Enhance laboratory capacity and capability at
  state laboratory equipment, staff
• Develop Local, Regional, Statewide Plans
• Local, regional and statewide exercises
• Build working relationships with healthcare
  providers

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VDH Planning Initiatives Family of Plans
(including disease-specific plans)

• ESF 8 component Virginia Emergency Operations
  Plan (public health and healthcare)
• VHD Emergency Coordination Center (ECC)
• Strategic National Stockpile (SNS) Readiness
  Upgrade
• CHEMPACK
• Cities Readiness Initiative (CRI)
• District and Regional Plans
• Surge Planning

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VDH Planning Initiatives Family of Plans
(including disease-specific plans)

• Biowatch
• USPS Bio Hazard Detection System (BDS)
• 16 Medical Reserve Corps (MRCs)
• Pre-event Smallpox Vaccination Program
• Statewide BT Exercises
• Suspicious Substance Management
• State Agency Regional Interoperability Solution
• Disease specific plans smallpox, monkeypox,
  SARS, pandemic influenza

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Communications Internal and External to VDH

• HAN / SWAN Enhancement
• SNS management
• Volunteer Management
• Polycom / VTC
• Satellite Phones
• STARS
• Support LHD Wireless Linkages
• Cell, Pagers (Dig, msg and voice)
• 24/7 Hotline
• Priority to Landline and Wireless (GETS)
• Current Rosters
• Search for the Perfect Communications System
• (Reliable, Redundant, Reasonable, Scalable,
  Mobile)

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EPR Program Progress

• Collaboration with public health programs in
  adjacent states
• For Northern Virginia Maryland and Washington
  DC
• For South and SW Virginia Tennessee, North
  Carolina, Kentucky, West Virginia
• Participation in addressing issues of the
  National Capital Region (NCR)
• Develop linkages with other emergency response
  programs with joint planning and collaboration

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National Capital Region
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Planning for Use of Strategic National Stockpile
(SNS)

• Supply of prepackaged essential medical equipment
  and pharmaceuticals
• Collaboration with Virginia Department of
  Emergency Management (VDEM)
• State, regional, local plans, including
  distribution plans all tested by exercises at
  local, regional, state levels

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Planning for Use of Strategic National Stockpile
(SNS)

• Plan to receive and distribute SNS to all parts
  of the Commonwealth dispensing sites, healthcare
  facilities
• Identify dispensing sites in all health
  districts, exercise mass medication/vaccination
  clinics
• CHEMPACK forward placement of nerve agent
  antidotes (EMS, hospitals)

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Strategic National Stockpile

• 12 push packs, 50,000 lb each
• 130 pallets
• 8 tractor trailers (53 ft each)
• 1 wide body plane (DC 10, 747)
• Arrive in 4-12 hours by surface or plane
• Specific medications or supplies available
  through Vendor Managed Inventory (VMI)
  antibiotics, supplies, ventilators, other
  equipment

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CHEMPACK BACKGROUND

• SNS Program has a 12-hour response time, too long
  in the event of a nerve agent attack
• Some state and local governments dont have any
  nerve agent antidote stocks
• Hospitals carry limited supplies of treatments
  for nerve agent exposures
• Nerve agent antidotes have variable shelf lives
  (are not an easily sustainable resource)

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CHEMPACK Program

• Concept of forward placement of nerve agent
  antidotes
• Two types of containers hospital and field
• Hospital more multidose vials
• Field more autoinjectors
• Contain atropine, pralidoxime, valium

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CHEMPACK Program

• State decision where to place containers
• Require security
• Controlled substance requirements
• Locations most useful in emergency event with
  release of nerve agents
• Containers placed in sites throughout Virginia

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Exercises in 2003-2005

• Multiple local and regional exercises
• Mass dispensing/vaccination clinics
• Participate in military exercises
• Exercises in NCR
• Statewide bioterrorism exercise October, 03
• All health districts and over 80 hospitals
  participated communications, command/control
• SNS exercise successful
• Establishment of 6 dispensing sites

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Exercises in 2003-2005

• Determined Promise 04 August, 04
• Federal multi-site exercise with multiple
  chemical events in Virginia
• Test mass casualty, mass fatality and surge plans
• Multi-agency communications, command/control and
  incident command
• Multiple health districts and hospitals involved

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Exercises in 2003-2005

• Multistate exercise in late October, 2005 WV,
  KY, TN, NC, mainly SW and NW Virginia
• Zoonotic disease and foodborne disease
• 13 health districts, 33 hospitals
• Epidemiology, law enforcement, communications,
  command/control
• Multiple state agencies involved Emergency
  Management, Agriculture, Game and Inland
  Fisheries, State Police

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Real Events as Preparedness Exercises 2003-2005

• Hurricane Isabel September, 2003
• Massive loss of power and water supplies
  statewide, impacting largest population centers
• Injuries, deaths, flooding, mosquitoes
• Involvement of multiple programs within VDH
  drinking water, epidemiology, vector control,
  emergency medical services, environmental health,
  emergency preparedness and response, emergency
  medical services, medical examiner
• Multiple floods, severe weather 2004

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Real Events as Preparedness Exercises 2003-2005

• Anthrax episodes in NCR 2003, 2005
• Ricin episode in Congress 2004
• Thousands exposed to TB case in Chesapeake
• Management of other outbreak situations
• Influenza
• Annual mass vaccination clinics
• Vaccine shortage in 2004 distribution of
  vaccine to priority populations

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Real Events as Preparedness Exercises 2005

• Tularemia alert in Washington DC
• Hurricanes Katrina and Rita
• Coordinate sending assistance to Gulf states
• Establishment of medical screening facility at
  Ft. Pickett
• Severe water shortage in Wise County

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EPR Program Epidemiology

• Enhancement of capacity/capability
• Increased staff at all levels
• Availability 24/7
• Rapid assessment of outbreaks
• Norovirus
• Influenza
• Meningitis
• Hepatitis
• Group A streptococcus

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EPR Program Epidemiology

• Planning for pandemic flu, SARS
• Use of incident command for recent large TB
  exposure in Virginia Beach
• Rapid determination of lack of outbreak
• Syndromic surveillance (NCR, Eastern Region)
• Electronic reporting (NEDSS)

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EPR Program Epidemiology

• Planning for BioWatch
• System of air sensors
• Testing once a day for biologic agents
• Plan to dispense antibiotics rapidly to entire
  population if necessary (Cities Readiness
  Initiative (CRI) administer antibiotics within
  48 hours)
• Biohazard Detection System (BDS)
• Anthrax detection in postal distribution centers
• Dispense antibiotics if confirmed positive

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EPR Program Laboratory

• Enhanced, rapid testing for biologic and chemical
  agents (one of top 5 labs in country)
• Improved equipment
• Increased staff
• Linkages to laboratories throughout Virginia
• Rapid transport
• Suspicious substance reporting

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EPR Program Communications

• Creation of Emergency Coordination Center within
  VDH, reach back from state EOC
• Handle ESF 8 (Health and Medical)
• Link to coordinating hospitals in 6 regions
• Develop appropriate health messages for public
• Focus on being proactive with public and media
• Prevention messages

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EPR Program Command and Control

• Incident Command system Incident
  Commander/Unified Command
• Operations, Logistics, Planning, Administration
• Requirement to use NIMS National Incident
  Management System
• Train public health staff on incident command and
  NIMS

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EPR Program Training and Education

• Ensure the development and delivery of
  appropriate education and training to
• Public Health Professionals
• Physicians
• Emergency Response Personnel
• Other Healthcare Providers
• VDH web site www.vdh.virginia.gov
• Information on biologic and chemical agents,
  infections
• Links to other resources, including CDC
• Recent VDH news and information

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HRSA - Hospital Preparedness Cooperative Agreement

• Initial focus on hospital preparedness
• Partnership with Virginia Hospital and Healthcare
  Association (VHHA)
• Regional planning 6 planning regions
• Funds distributed to regions based on population,
  hospital beds and vulnerability
• Regional planning groups decide on use of funds
  within region, within HRSA and VDH guidelines

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Hospital Planning Regions
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HRSA - Hospital Preparedness Cooperative Agreement

• Increased HRSA funding, with increased grant
  requirements in past 2 years
• Focus on special needs populations (children,
  elderly, disabled, non-English speaking)
• Mental/behavioral health response to emergencies
• EMS, other providers
• Healthcare volunteer registry/network

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Present Focus Surge PlanningRegional and State
levels

• Hospital beds and other facilities bedtracking
  capability, overflow sites
• Communications systems
• Isolation capabilities
• Health care personnel
• Equipment and supplies
• Pharmaceutical caches

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Present Focus Surge PlanningRegional and State
Levels

• Pre-hospital services (EMS)
• Triage/outpatient sites
• Mental/behavioral health services
• Public health surge
• Disease investigation and prevention
• Public information
• Medication/vaccine dispensing

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Partnerships Healthcare Community and Public
Health

• Surveillance, including disease reporting,
  suspicion of disease
• Screening for disease and disease prevention
• Diagnosis and treatment appropriate
  antibiotics, resistant organisms
• Prophylaxis vaccination, antibiotic prophylaxis

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Public Health in Emergencies

• Rapid notification
• Public through media
• Healthcare providers through Health Alert
  Network, which is being upgraded to allow phone,
  FAX, pager, e-mail notification of public health
  partners
• Disease surveillance, tracking and prevention

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Public Health in Emergencies

• Dispensing clinics
• Vaccination influenza, anthrax, smallpox
• Antibiotic prophylaxis anthrax, plague,
  tularemia
• Other issues being addressed
• Special needs populations
• Shelters
• Volunteer coordination

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Public Health in Emergencies Isolation and
Quarantine

• New legislation diseases of public health threat
• Easily transmissible SARS, influenza
• Identifies procedure for quarantine and
  isolation, if voluntary methods not adequate
• Voluntary efforts first
• Role of State Health Commissioner
• Least restrictive manner possible

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Public Health in Emergencies Isolation and
Quarantine

• Law enforcement has authority to enforce
  quarantine
• Due process provisions, and appeal process
• Can be applied to populations or geographic areas
• Quarantine by geographic area requires
  declaration of emergency

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Healthcare Community in Emergencies

• Healthcare delivery in mass casualty event
• Initial triage at site EMS
• Hospital/facility based
• Outpatient facilities and home based patients
  Keep those who are less ill out of hospitals
• Assist public health through communication,
  reporting and volunteer efforts
• Assist in education of public and media

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Special Needs Populations Emergency Planning
Issues

• Workgroup convened after Hurricane Isabel to
  address concerns
• Loss of power
• Loss of water
• Addressing healthcare needs equipment (including
  oxygen), medications, special treatments
  (dialysis)
• Safety of facilities
• Role of shelters/management of shelters

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Special Needs Populations Emergency Planning
Issues

• Identification of populations
• Non-English speaking
• Disabled
• Medically fragile, special medical needs
• Children, elderly
• Close collaboration local health dept, local
  emergency manager, local government, Red Cross,
  healthcare facilities
• Participation in local exercises to test plans

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Special Needs Populations Emergency Planning
Issues

• Special needs shelters, facilities
• Adequate back-up electrical supply
• Adequate food and water
• Transportation to/from facilities
• Plan for adequate medical supplies, working with
  equipment/pharmaceutical suppliers
• Adequate staffing
• Safety of facility
• Home based populations

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Volunteer Efforts

• Legislation in 2003 licensed health
  professionals can indicate interest in
  volunteering in times of emergency through
  Department of Health Professions (about 48 of
  gt100,000 licensed health care providers)
• Information on persons interested in volunteering
  provided to VDH, then forwarded to appropriate
  district health departments

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Volunteer Efforts

• 12 Medical Reserve Corps received funding in
  Virginia, with volunteer coordinators 4 other
  MRCs established without federal funding
• 15 through District Health Departments or
  localities
• 1 through UVA focus on healthcare students
• Other health departments establishing Medical
  Volunteer Corps
• Training provided or planned for volunteers
• Statewide volunteer coordinator within VDH

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Volunteer Efforts

• Local coordination
• Training
• Roles of volunteers in emergencies
• Registration and identification system for
  volunteers (ESAR-VHP Emergency System for
  Advanced Registration of Volunteer Health
  Professionals)
• Plans for just in time training Spontaneous
  Unregistered Volunteers (SUVs)
• Addressed liability issues for healthcare
  volunteers 2005 General Assembly

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Volunteer Issues Roles of Volunteers in
Emergencies

• Dispensing sites
• Community care sites
• Hospitals Issues of licensure, credentialing
• Local decision making on appropriate roles/
  coordination of volunteer activities
  collaboration of District Health Department,
  hospitals, other healthcare entities, local
  government
• Roles in mass casualty events

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Emergency Preparedness Challenges for the Future

• Culture change for rapid response and 24/7
  availability within public health
• 1-866-531-3068 for healthcare providers
• Role of public health in emergencies
• Bioterrorism
• Other infectious disease outbreaks
• Chemical, radiation, explosion emergencies
• Natural disasters (hurricanes, floods, tornadoes,
  fire, earthquakes)
• Collaboration/coordination with all emergency
  response agencies/organizations local, state,
  federal