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Emergency Preparedness and Response: Public Health and Healthcare

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Title: Emergency Preparedness and Response: Public Health and Healthcare


1
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

2
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

3
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

4
Funding for Health Department Emergency
Preparedness
  • CDC funding 18.5 million in 06-07
  • 5.45 million additional for pandemic influenza
    planning
  • Public health preparedness
  • Initial focus on bioterrorism
  • Now an all-hazards approach
  • HRSA funding 11.4 million in 06-07
  • Emergency preparedness for healthcare delivery
    system
  • Initially focused on hospital preparedness
  • Now includes other health care providers, EMS,
    mental health

5
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6
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

7
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

8
VDH Planning Initiatives Family of Plans
(including disease-specific plans)
  • ESF 8 component Virginia Emergency Operations
    Plan (public health and healthcare)
  • VDH Emergency Coordination Center (ECC)
  • Strategic National Stockpile (SNS) Plan
  • CHEMPACK
  • Cities Readiness Initiative (CRI)
  • District and Regional Plans
  • Surge Planning

9
VDH Planning Initiatives Family of Plans
(including disease-specific plans)
  • Biowatch
  • USPS Bio Hazard Detection System (BDS)
  • 24 Medical Reserve Corps (MRCs)
  • Pre-event Smallpox Vaccination Program
  • Statewide Exercises all hazards
  • Suspicious Substance Management
  • Surge planning
  • Hurricane/natural disaster plans
  • Disease specific plans smallpox, monkeypox,
    SARS, pandemic influenza

10
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)

11
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

12
National Capital Region
13
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

14
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)

15
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

16
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)

17
CHEMPACK Program
  • Concept of forward placement of nerve agent
    antidotes
  • Contain atropine, pralidoxime, valium
  • Containers placed in sites throughout Virginia
  • State decision where to place containers
  • Require security/controlled substance
    requirements
  • Locations most useful in emergency event with
    release of nerve agents

18
Exercises in 2003-2006
  • 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

19
Exercises in 2003-2006
  • 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

20
Exercises in 2003-2006
  • 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

21
Exercises in 2003-2006
  • October, 2006 Pandemic Influenza Exercise
  • All health districts participated
  • 29 health districts dispensing site exercises
  • All acute care hospitals test of surge plans
  • Community containment issues closure of schools,
    cancellation of public events
  • SNS delivered to Northern Virginia, collaboration
    with Maryland and Washington D.C.
  • Many state agencies participated in VEOC

22
Real Events as Preparedness Exercises 2003-2006
  • 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

23
Real Events as Preparedness Exercises 2003-2006
  • 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

24
Real Events as Preparedness Exercises 2005-2006
  • 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
  • 2006
  • Tropical storm Ernesto
  • Other flooding events throughout Virginia

25
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
  • Mumps
  • Salmonella

26
EPR Program Epidemiology
  • Planning for pandemic flu, SARS
  • Use of incident command for large TB exposure in
    Virginia Beach
  • Rapid determination of lack of outbreak
    increased number of deaths in children
  • Syndromic surveillance (NCR, Eastern Region)
  • Electronic reporting (NEDSS)

27
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

28
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

29
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
  • Public Inquiry Center during emergencies

30
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

31
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
  • VDH news and information, including pandemic flu

32
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

33
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34
HRSA - Hospital Preparedness Cooperative Agreement
  • Stable HRSA funding, with changing grant
    requirements
  • Focus on special needs populations (children,
    elderly, disabled, non-English speaking)
  • Mental/behavioral health response to emergencies
  • EMS, other providers
  • Healthcare volunteer registry/network
  • Focus now on response system approach

35
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

36
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

37
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

38
Public Health in Emergencies
  • Rapid notification
  • Public through media
  • Healthcare providers through Health Alert
    Network phone, FAX, pager, e-mail notification
    of public health, healthcare and other partners
  • Disease surveillance, tracking and prevention

39
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

40
Public Health in Emergencies Isolation and
Quarantine
  • Legislation in 2005 diseases of public health
    threat, easily transmissible SARS, influenza
  • Identifies procedure for quarantine and
    isolation, if voluntary methods not adequate
  • 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

41
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

42
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

43
Special Needs Populations Emergency Planning
Issues
  • Special medical 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, including medical, nursing,
    pharmacists
  • Safety of facility
  • Home based populations

44
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

45
Volunteer Efforts
  • 24 Medical Reserve Corps in Virginia
  • Most 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

46
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

47
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

48
Pandemic Influenza Planning
  • Gradual onset
  • Long term emergency, up to 2 years
  • Impact to community in waves of 6-8 weeks
  • Shortage of resources antivirals, supplies,
    equipment, personnel
  • 4-6 months until development of vaccine
  • Community containment prior to vaccine
  • Public communications essential at all stages

49
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
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