CDC Region 3 Bio-Emergency Health Official/Elected Official In-Service

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CDC Region 3 Bio-Emergency Health
Official/Elected Official In-Service

• Linda Drey, Health Planner

2004
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Objectives

• Describe the role of local public health in Iowa.
• Identify the role of the local board of health.
• Identify relationships to the Iowa Department of
  Public Health, local board of supervisors, local
  county attorney, and other partners.
• Understand the aspects of bio-terrorism and the
  role/responsibilities of local public health in
  the event of a bio-emergency.
• Become familiar with CDC Bioterrorism grant
  requirements for FY 03-04..

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Local Public Healths Role

• Protecting the Health
• of the Public!
• Public health is responsible to safeguard the
  communitys health through assessment, policy
  development and assurance.

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Public Healths Impact

• Public health is not a collection of programs for
  the poor.
• Has public health affected your life today?
• Public health affects everyone who drinks public
  drinking water, eats in a restaurant, buys milk,
  has an elderly relative who needs home care,
  needs emergency medical services, wants to avoid
  getting sick from an infectious disease, and is
  concerned about preparedness for natural or
  intentional disaster.

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Public Health vs. Hospital

• Local Public Health
• Is responsible for protecting and safeguarding
  the health of all people within its jurisdiction
• Public health touches every persons life every
  day
• Promotes physical and mental health
• Prevents disease and injury
• Prevents epidemics and spread of disease
• Promote healthy behaviors
• Respond to disasters
• Assures the quality and accessibility of health
  services for all

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Public Health vs. Hospital

• Hospital/Individual Provider
• Focus is on providing care to specific
  individuals seeking care for an illness/injury
• Makes decisions that are best for the respective
  patient and not necessarily the general public
• No emphasis/responsibility for the health and
  welfare of the general public
• Not required to provide treatment to all
  individuals requesting care with a few exceptions
  (ERs, etc.)

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Core Public Health Functions

• Assessment
• Policy Development
• Assurance

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Core Public Health Functions/Essential Services

• Assessment
• Monitor health status
• Diagnose and investigate health problems and
  health hazards in the community
• Evaluate the effectiveness, accessibility, and
  quality of personnel and population-based health
  services

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Core Public Health Functions/Essential Services

• Policy Development
• Develop policies and plans that support
  individual and community health efforts.
• Enforce laws and regulations that protect health
  and ensure safety.
• Research for new insights and innovative
  solutions to health problems.

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Core Public Health Functions/Essential Services

• Assurance
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable.
• Assure a competent public health and personal
  health care workforce.
• Inform, educate and empower people about health
  issues.
• Mobilize community partnerships to identify and
  solve health problems.

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For Local Communities

• Public health is an economic issue, because
  healthy workers are productive and a good public
  health system attracts business.
• Public health is an education issue because
  healthy children learn.
• Public health is the front line defense for the
  publics health promotion and protection.

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Local Public Health System Public Health
Providers

• Local Boards Of Health (County/City/District)
• WIC agencies
• Maternal Child Health (MCH) agencies
• Visiting Nurse Service (VNS) agencies
• And others..perhaps MANY others...

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10 Greatest Advances in PH

• Vaccinations
• Safer workplaces
• Safer and healthier food
• Vehicle safety
• Control of infectious diseases
• Family planning

• Advances in treatment and prevention of heart
  disease and stroke
• Decrease in tobacco use
• Better care for mothers and their babies
• Fluoridation of drinking water

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Local Boards of Health History

• In 1866 the Local Health Law was adopted.
• Designated mayor and town council or township
  trustee as LBOH.
• LBOH had authority to establish regulations for
  public health and safety, control nuisances, and
  regulate sources of filth and causes of sickness
  in communities.

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1967 New Local Health Act

• Chapter 137 of the Code of Iowa
• Each county required to establish a BOH - one
  member had to be a physician licensed by the
  State of Iowa.
• BOS to appoint other members.
• A city with a population of 25,000 could
  establish a city board of health.
• Counties and cities were also allowed to form
  district boards of health.

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LBOH Power and Jurisdiction

• Chapter 137of the Code of Iowa
• 5 members, one must be an Iowa licensed
  physician
• The BOH has autonomy over public health matters
  within the county. (IA Code137.5 137.6 137.7)
• Can write rules and employ persons for the
  discharge of its duties.

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LBOH Power Jurisdiction Cont.

• Boards of Supervisors have little authority over
  public health matters.
• The Board of Supervisors role is three fold
• appoint board of health members
• determine county funding portion of the local
  health budget and
• approve regulations adopted by board of health

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LBOH Roles Responsibilities

• IA Administrative Code 641-Ch.77
• Requires local BOH to carry out the three core
  functions and ten essential public health
  services.
• Required to meet at least quarterly.
• Required to comply with open meeting laws.
• LBOH must report to the IDPH on certain
  activities defined in IAC 641-77.5.

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Local Boards of Health

• Powers of Local Boards of Health
• Refer to LBOH Guidebook page 9
• Legal Responsibility of Local Board of Health
• Refer to LBOH Guidebook page 10
• Working with the County Board of Supervisors
• Refer to LBPH Guidebook page 12...

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Local Boards of Health in Iowa

• 99 county Boards of Health
• 1 District Health Department
• Siouxland District Health Department
• 2 City Boards of Health
• Council Bluffs
• Ottumwa

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Bioterrorism/Bio-emergencies are Different

• Medical and public health systems are usually
  first to detect bioterrorism.
• A delay is likely between the release of the
  agent and the knowledge that the occurrence is a
  bioterrorist act.
• A short window of opportunity exists between the
  first cases and the second wave.
• Public health officials must determine that an
  attack occurred, identify the organism, and
  prevent more casualties.

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Local Public Health Bio-Emergency Planning

• Need to build the infrastructure of local public
  health across Iowa and the nation.
• In Iowa, the IDPH is the lead public health
  agency and coordinates the CDC Iowa Public Health
  Cooperative Agreement (public health BT grant)
• Each local health department charged with
  developing a bio-emergency plan by Aug. 2004.

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Public Health Infrastructure
PublicHealthResponse

• Bioterrorism
• Emerging Infections
• Other Public Hlth Programs

Essential Scientific Capabilities
Basic Infrastructure
Reference Public Health Practice Program Office
(PHPPO), CDC, 1999.
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BT Core Capacities 10/15/01

• Mission
• To protect the publics health and safety by
  developing the capacity of state and local public
  health systems to prepare for and respond to a
  bioterrorist act.

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BT Core Capacities Framework

• Surveillance and Epidemiologic Investigation
• Identification
• Communication
• Mobilization
• Public Health Interventions

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BT Core Capacities Framework

• Goals
• Pre-Event Objectives
• Event Objectives
• Indicators (pre-event and event)
• Planning/Policy Indicators
• Workforce/Training Indicators
• Evaluation/Quality Indicators

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BT Core Capacities Example

• Mobilization
• Pre-Event Objective Identify organizations that
  comprise the public health response system and
  integrate preparedness activities with partners
• P/P plans that define roles and responsibilities
• W/T train staff in response role within larger
  emergency response system
• E/Q review plans periodically and adjust

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Activation of Federal Assistance

• Major disaster
• Internal local and State resources
• State resources exhausted
• Governor requests President to declare disaster
• Federal Assistance- based on severity and need
• FEMA may request DOD or National Guard

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Federal Response Plan

• FBI leads on information release I crisis
  management
• FEMA leads on information release in consequence
  management
• Transfer from the FBI to FEMA by Attorney General
• Core Federal Responses
• DOJ/FBI DOE FEMA
• DOD EPA HHS

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Health and Human Services (HHS) Provides

• Medical supplies, drugs and vaccinations (SNS)
• Regulatory follow up (e.g. FDA)
• Outbreak/disease threat assessment
• Onsite safety
• Mass fatality management

• Technical support, personnel and equipment
• Disease detectives
• Agent identification collection and testing of
  samples
• Medical management

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CDC Bioterrorism Grant 03-04

• Focus Area A Planning Assessment
• Focus Area B Surveillance Epidemiology
• Focus Area C Laboratory Biological Agents
• Focus Area D Laboratory Chemical Agents
• Focus Area E Health Alert Network/IT
• Focus Area F Risk Communication
• Focus Area G Education Training
• Strategic National Stockpile (SNS)
• Smallpox

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Funding Formula for LPHA

• Base aware per LPHA 30
• Population 40
• Critical Assets 15
• Agricultural Value 15

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Funding
of Total Funding Total Funding
Local public health agencies 21 2,644,609
CDC Regions (6) 20 2,504,515
IDPH 21 2,669,579
Shared Capacity 21 2,594,892
UHL 17 2,188,378
TOTAL 100 12,601,973
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LPHA Grant Responsibilities

• By July 15, 2004 complete county bio-emergency
  plan and submit template checklist to IDPH.
• By July 15, 2004 complete mass dispensing plan,
  policies and procedures for smallpox/oral
  prophylaxis and submit checklist to IDPH.
• By July 15, 2004 submit improvement plan for
  reportable disease surveillance system for your
  county to IDPH.

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LPHA Progress Report

• Two progress reports are due to IDPH from each
  local public health agency as a part of the CDC
  grant.
• Due April 10, 2004
• September 10, 2004

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LPHA Regional Responsibilities

• Submit county information for Regional Resource
  Directory for reports due Jan. 5, April 1, and
  July 1.
• Submit the of trained staff in advanced
  epidemiology/surveillance for Aug. 1 report.
• Submit the of trained staff in EPI-INFO for
  Aug. 1 report.

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Regional Grant Reports

• As a member of Region 3 (16-county area of
  northwest Iowa) each county must submit requested
  information in addition to what is asked for in
  the regional resource directory for a regional
  report compiled by the regional planner.
• The report is due
• April 10, 2004
• September 10, 2004

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WELCOME TO BIOTERRORISM BASICS
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Objectives

• Upon completion of the course, learners should be
  able to
• Define terrorism using the B-NICE model
• Define the role of public health in dealing with
  a terrorism attack
• List three or more messages that should be sent
  to the general public regarding terrorism

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Terrorism

• Terrorism is the unlawful use of force or
  violence against persons or property to
  intimidate or coerce a government, the civilian
  population, or any segment thereof, in
  furtherance of political or social objectives.
• FBI Definition from 28 CFR Section 0.85.

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PSYCHOLOGICAL IMPACT
of terrorintrusive thoughts, nightmares and
sleeping difficulties, anxiety or fear,
alienation from people, jumpiness, emotional
numbness and problems with social relationships
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Objectives of Terrorism

• Bring down a government or regime
• Attack those who attack their religion
• Cause a Change!!!

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Countermeasures to Terror

• Awareness of terrorism objectives
• Deny the objective of the attack
• President Bush
• Keep shopping, keep traveling
• Subsidies for airlines, insurance industry to
  keep working

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Public Healths Role in a Bio-Emergency

1. PREPARE
2. RESPOND
3. MITIGATE
4. RECOVER

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Why Iowa?

• Nearly 1000 interstate bridges
• More than 100 dams
• Greatest concentration of hog lots in the
• nation
• Critical rail links
• Over 3000 miles of pipelines (natural gas,
• gasoline, etc.)
• Iowa is a symbol of stability
• Not In My Back Yard Syndrome

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Types of Terrorism B-NICE

• Biologic
• Nuclear
• Incendiary
• Chemical
• Explosive

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Bioterrorism

• Since 1985, the number of terrorist incidents
  involving the threatened or actual use of
  chemical, biological, radiologic, or nuclear
  materials has risen sharply (Tucker, 1999)
• The threat to the nation from biologic weapons is
  no longer a debate issue. (Russell, 1997)

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Why Bioterrorism?

• Poor mans nuclear bomb
• Cheap
• Easily available
• Compact
• Deadly
• Psychological Impact
• Stealthy

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Ease of Dissemination
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Mortality Rates
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CDC Assistance
Local level needs CDC help to identify Category B
and Category C diseases/agents.
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Describe the public health role in emergency
response in a range of emergencies that might
arise.
Public Health Staff Roles

• Describe the chain of command in emergency
  response
• Identify and locate the agency emergency response
  plan

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Public Health Staff Roles Cont.

• Describe your functional role in an emergency
  situation
• Demonstrate correct use of all communication
  equipment used in an emergency

• Describe communication role(s) in emergency
  response
• Recognize unusual events that might indicate an
  emergency and describe appropriate action

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Public Healths Message to the Community
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Preparation

• Communities prepare for a number of disasters
  including
• Ice Storms
• Tornadoes
• Chemical spills
• And nowterrorism

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Be Alert and Stay Calm!

• Report suspicious activity
• Use common sense
• Dont approach
• Write down a description
• First responders are trained to protect lives and
  property.
• Stay tuned to local radio stations for emergency
  messages.

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Are You Prepared Personally?

• Have a family emergency plan that includes
• Phone tree or notification plan for all family
  members.
• Identify a family meeting place
• Know school and workplace procedures
• Battery powered radio, flashlights and batteries
• First aid kit and other special needs
• Basic supplies for 72 hours

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Actions You Can Take

• You as a member of the public health community
  may play a critical role.
• Be prepared to identify possible incidents.
• Be prepared to respond appropriately and rapidly.
• If a bio-emergency happens, it wont be business
  as usual for any member of the public health
  team.

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Contact Information

• Linda Drey Health Planning Development
  Coordinator
  Siouxland District Health
  Department Phone
  712-279-6119
  Cell 712-490-5937
  Fax
  712-255-02604
• Kevin Grieme Health Planner
  
  Siouxland District Health Department
  Phone [phone]
  Cell
  712-898-5176
  Fax [phone]