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Department of Health and Human Services Centers for Disease Control and Prevention Agency for Toxic

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Associate Director for Field Services. Office of ... Multidisciplinary and multi-level assignments. Strong training component: Preparedness 'Boot Camp' ... – PowerPoint PPT presentation

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Title: Department of Health and Human Services Centers for Disease Control and Prevention Agency for Toxic


1
Department of Health and Human ServicesCenters
for Disease Control and PreventionAgency for
Toxic Substances and Disease Registry
NGA Regional Bioterrorism WorkshopCDC
Perspectives
Glen Koops, M.P.H. Associate Director for Field
Services Office of Terrorism Preparedness and
Emergency Response May, 13-14, 2004 San
Francisco, California

2
Outline
  • Strategic Overview
  • Enhancing State Capacity
  • State Activities
  • Evaluation
  • Workforce Issues
  • Funding

3
  • Strategy

4
All-Hazards Approach
5
Dimensions of Public Health Readiness

1,000s 100,000s
Global
Command and control vital to assure containment
Activate community-wide mass care system manage
the dead
Manage high volume of data and information
Number of Cases
Deliver mass intervention call up reserve
workforce
Level of Effort
Resources
Communicate to stakeholders and public enhance
surveillance reporting
Report Mobilize Response Investigate
Prophylaxis
1
Assess Diagnose Isolate Treat Manage
Local
Time
6
Strategy DETECTION
  • Early detection/warning is critical to allow for
    early intervention.
  • The sooner we know the sooner we can intervene!

7
Strategy DETECTION
Current State
Law Enforcement
Environmental (BioWatch)
DoD VA
Border States
Pharmacy Data
Schools
Public
Employers
Media
Cargo/ Imports
Laboratory
Immigration
Clinicians
First Responders
International
Vital Records
Veterinary
Quarantine Stations
Hospitals
8
Strategy DETECTION
Key Services Efforts Detection
Desired State
DoD VA
Law Enforcement
Environmental (BioWatch)
Pharmacy Data
Border States
Public
Schools
Employers
Media
Cargo/ Imports
Laboratory
Immigration
Clinicians
First Responders
Hospitals
Veterinary
Vital Records
International
Quarantine Stations
9
Strategy DETECTION
  • Improving Connectivity for Diagnosis and
    Detection
  • 24x7 Clinical Information Hotline Media and
    public outreach
  • Clinician outreach and communication
    Blended-media educational programs
  • Epi-X (2-way communication network) Other
    critical channels and audiences
  • Health alerting MMWR Dispatch
  • Quarantine Stations
  • New York Chicago Miami Atlanta
  • Los Angeles San Francisco Seattle
    Honolulu
  • CDC Laboratories
  • Biological Antimicrobial resistance assays
    Continuity of Operations Plan (COOP) Throughout
    Capacity, BSL-4 containment lab, scientific depth
  • Chemical Rapid Toxic Screen (150 agents)
    Blood and Urine Samples State Labs
  • Improving Laboratory Diagnosis and Detection
    Capabilities
  • Smallpox Tularemia
  • Anthrax Radiation
  • - Plague
  • Botulinum Toxin
  • Chemicals in blood and urine

10
Strategy DETECTION
  • Laboratory Response Network (LRN)

11
Strategy CONTAINMENT
  • Strategic National Stockpile (SNS)
  • Repository of antibiotics, chemical antidotes,
    antitoxins, life-support medications, IV
    administration, etc.
  • Twelve, strategically located, 12-hour push
    packages
  • Tailored Vendor Management Inventory (VMI)
  • VMI deployable within 24 to 36 hours
  • Technical Advisory and Response Unit (TARU)
    support

12
Strategy CONTAINMENT
  • Directors Emergency Operations Center (DEOC)
  • 7,000 square feet 85 workstations 24x7 staff
    state-of-the-art communication technologies
  • Emergency Communications System (ECS)
  • Concept of Operations based on ICS Model
  • Continuity of Operations Plan (COOP)
  • Deployable Emergency Response Assets

13
Strategy CONTAINMENT
  • Environmental Microbiology
  • Water safety research
  • Detection and survival of select bacterial
    agents research
  • Research on remediation of environments and
    facilities
  • Exotic bacterial data collection with respect
    to the environment
  • Development of lab sampling methods and
    processes
  • Studies on the effect of common disinfectants
    on these agents
  • Smallpox Readiness
  • Vaccination of the medical frontline
    (healthcare, public health, etc.)
  • Pending licensed vaccine (for those who insist)
  • Early detection capacity
  • Rapid control and containment plans
  • Vaccination of population within 10 days

14
  • CDC Efforts to
  • Enhance State Capacity

15
CDC Efforts to Enhance State Capacity
  • Cooperative Agreement for 62 state, major city
    and territory health departments expands
    epidemiology and surveillance capacity to detect,
    investigate, and mitigate health threats. (2
    billion invested to date)
  • 31 Centers for Public Health Preparedness
    assisting state and local public health emergency
    preparedness by improving the quantity and
    quality of the public health and healthcare
    response workforce.
  • Increasing the number of state and local public
    health professionals (1,886) who use Epi-X to
    share intelligence regarding outbreaks and other
    emerging health events including those suggestive
    of bioterrorism.
  • Rapid assessment of surveillance capacities in 8
    priority cities.
  • Forensic Epidemiology training sessions for
    public health and law enforcement professionals.

16
  • State Activities

17
State Activites Progress Report
  • Statutes and ordinances, timelines and
    assessments - updated
  • 24x7 system to receive and evaluate urgent
    disease reports
  • in place 49/50 have systems in place
  • Epidemiologic capacity enhanced
  • Information technology to assure rapid detection
    and reporting improving (i.e. BioWatch)
  • Effective working relationships between clinical
    and higher-level laboratories
  • Ongoing education and training of front-line
    public health and healthcare responders to assure
    recognition of the early signs and symptoms of
    unusual health events

18
State Activities -- Progress Report
  • State and Local Cooperative Agreement Program
  • 90 of states have response plans for
    anthrax(78 exercised)
  • 100 for smallpox (86 exercised)
  • 90 for plague (76 exercised)
  • 85 for botulinum toxin (46 exercised)
  • 92 for RDD/Nuclear events (91 exercised)
  • 75 for Nerve Agents (70 exercised)
  • 25/50 completed their state-wide response plans
  • 50/50 completed their interim SNS plans work
    needed!

19
  • Site visits by senior CDC management to
  • Florida
  • Nebraska
  • New Hampshire
  • New York State
  • Texas
  • Washington State

20
  • Florida
  • Developed critical institutional partnerships
    that will enable long-term readiness that is not
    dependent on current leaders
  • Investment in electronic disease mgmt system that
    will link disease detection-laboratory
    diagnosis-outbreak investigation-analysis.
  • Trained 500 lab staff in procedures for
    handling/transfer of critical agents
  • Conducted 4 exercises in collaboration with FBI ,
    HAZMAT, state/local law enforcement and
    fire/rescue
  • Emphasis on strong corrective action process
    following exercises
  • Vaccinated 4,000 persons who will implement mass
    smallpox vaccination, investigate cases and
    manage patients.

21
  • New York State
  • Contracts with local health depts have clear
    deliverables that cover all aspects of
    preparedness and response
  • Protocols for isolation and quarantine
  • Packaging/transport of lab samples
  • Processes for rapid diagnoses and agent
    confirmation
  • Plans to ensure rapid control and containment
  • Training of staff and reserve staff as events
    scale up
  • Plan linkage with state and regional plans
  • Partnerships with State Medical Society, Nurses
    Assoc, Healthcare Association, Community Health
    Center Assoc, Hospital Assoc, etc.
  • Developed sophisticated electronic communicable
    disease reporting and laboratory information
    systems
  • Can test for critical agents Variola major,
    vaccinia, tularemia, bot toxin, ricin toxin,
    brucellosis, glanders, Q fever

22
  • Texas
  • Partnerships include 12 Metropolitan Medical
    Response Systems, 22 councils of Governments,
    US-Mexico Border Health Commissions, FBI and
    state/local law enforcement
  • 3-member epidemiologic response teams assigned in
    each of the 8 regions
  • Relationships with 138 labs
  • Trained 60 Texas Medical Rangers a reserve
    corps of the Texas State Guard through the
    Center for Public Health Preparedness and
    Biomedical Research at UT-HSC in San Antonio.
    Plan to train a total of 1000
  • Conducted exercises to test ability to receive
    and distribute the SNS
  • Pre-event smallpox preparedness program
    vaccinated over 4,000 hospital and public health
    staff

23
  • Washington
  • Assessed all local health jurisdictions and
    hospitals to determine emergency preparedness and
    response capacity
  • Expanded public health workforce at the district
    level
  • A new emergency response planners in each of the
    9 districts
  • 9 new learning specialists to coordinate and
    evaluate preparedness training
  • 17 new epidemiology response and surveillance
    coordinators
  • Critical preparedness capacities are included in
    the comprehensive public health improvement
    planning process result is performance-based
    and outcome-driven planning

24
  • EVALUATION

25
  • Project to Define Performance Goals and
    Indicators . . .
  • Define what good looks like
  • Culmination year of work
  • Input from SMEs, Academics, Public Health
    Partners, other stakeholders
  • Validated information with extensive literature
    search

26
  • Project to Define Performance Goals and
    Indicators . . .
  • Performance Goals based on preparedness
    principles
  • Systems are connected pieces
  • Planning should be supported by evidence
  • Focus is State support of a local response

27
  • Project to Define Performance Goals and
    Indicators . . .
  • Evidence based approach focuses on areas that the
    literature indicates that there are problems

28
  • Project to Define Performance Goals and
    Indicators . .
  • Result
  • 42 Performance Goals
  • 47 Indicators

29
  • Example
  • Performance Goal 2
  • Internal Agency Staff Awareness of Public Health
    Role and of Other Community Responder Roles

30
Example Measure 2 Percent of a random sample
of Public Health Agency staff that have response
roles can
  • Describe their job functions during a response
    AND the description matches the employees role
    and responsibilities as written in the Agencys
    plan and the jurisdictions plan
  • Show documentation of training jointly with
    response partners whom they are likely to
    interact with as they carry out disaster role
    functions
  • Describe the role and responsibilities of
    response partners whom they are likely to
    interact with as they carry out disaster role
    function
  • Identify by name and/or job title whom they
    report to in a disaster
  • Demonstrate the correct use of equipment used in
    their emergency job function (e.g., conferencing
    equipment, blackberries, blast faxing, two-way
    radios)

31
Next steps
  • Field Test to provide input on validity,
    reliability, and feasibility
  • Oklahoma
  • Florida
  • Washington
  • Massachussets
  • Chicago

32
Next steps
  • Determine appropriate method/resources needed to
    test progress to goal
  • Random testing (who, how often)?
  • Self-reporting?

33
Exercises
  • System to design and proctor exercises
  • Conduct performance-based, interactive exercises
  • Develop system to identify, collect and analyze
    information about exercises
  • Develop recommendations for change

34
Exercises
  • CDC is working with various agencies to provide
    opportunities to exercise public health systems
  • NCEH
  • ODP
  • Performance Goals

35
Exercises
  • National Center for Environmental Health
  • Scenario and exercise development, implementation
    and evaluation
  • 16 grantees annually
  • Including injects that will measure performance
    goals
  • Including activities that test Incident Command
    principles

36
Exercises
  • Office of Domestic Preparedness
  • Will test every grantee (DHS) yearly
  • Working with NCEH to assure PH components are
    tested with traditional first responder activities

37
  • Workforce

38
Workforce Activities
Detection Reporting
Response Containment
Recovery
Preparedness
  • Contact tracking
  • Education
  • Quarantine
  • Response Coordination
  • Communicating with Clinicians, Public Health
    the General Public
  • Developing Interventions Therapies
  • Planning
  • Exercising
  • Partnering
  • Training
  • System Building
  • Testing
  • Surveillance
  • Clinician Training
  • Laboratory Diagnostics
  • Electronic reporting systems
  • Monitoring community mental health
  • Applying Lessons learned to continuously improve
    Response Containment

39
  • Background
  • State and Local authorities concern over their
    ability to recruit, hire, train, and retain
    qualified personnel to rapidly build public
    health preparedness systems
  • Assignment of CDC staff has been a successful
    model for CDC to assist state and local agencies
    with program planning and implementation

40
  • New CDC Initiative (Public Health Readiness Field
    Program to increase CDC field presence to . . .
  • 1. Rapidly enhance preparedness of state, local
    and territorial public health agencies
  • 2. Improve CDCs ability to respond to terrorism
    and other urgent health threats
  • 3. Address the long-range need for public health
    leaders at federal, state and local levels

41
  • Ideas we are exploring . . .
  • Multidisciplinary and multi-level assignments
  • Strong training component Preparedness Boot
    Camp
  • Assignments within State/Territorial and Local
    public health agencies
  • Foster the dual use concept
  • Mitigate the silo-effect of categorical programs
    at federal, state, and local levels
  • Cross-train all CDC assignees so that all have a
    Readiness Role
  • Pilot Project to out-place Senior Management
    Officials to improve coordination of Disease
    Prevention/Health Promotion/Community Protections
    grants, cooperative agreements and other CDC
    activities
  • Emphasize BT while also support an all-hazards
    approach
  • Make a dent in long range public health work
    force needs

42
  • FUNDING

43
Funding
FY04 Appropriation by Budget Line (1.16
Billion) (compared with 1.54 Billion in FY03)
The appropriation amount of 1.16 billion does
not include the rescission and indirect costs.
44
Funding
FY04 Funding Upgrading State and Local Capacity
  • Bioterrorism Cooperative Agreement 872 Million
  • Centers for Public Health Preparedness 29.4
    Million
  • Advanced Practice Centers 5.5 Million
  • Technical Assistance and Oversight 17.9
    Million
  • Epidemic Intelligence Exchange (Epi-X) - 1.8
    Million
  • Cooperative Agreement Technical Assistance
    13.8 Million
  • Public Health Field Readiness Program 2.2
    Million
  • Health Alerting 9.4 Million

Total 934.4 Million
45
Funding
  • Funding Concerns
  • 80 unobligated reported on FSRs (11/1/03)
  • Draw-down lag
  • Supplanting
  • Allocation formula change?
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