State Role in Public Health Emergencies Division of

State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M. Núñez de Ybarra, MD, MPH Public Health Medical Officer III CA Department of Public Health (CDPH) Division of Communicable Disease Control (DCDC) Office of Workforce Development All Hazards Workshop – San Joaquin County August 2008

Purpose Provide a basic understanding of the State communicable disease control role as part of the overall State Public Health Emergency Preparedness and Response system in California.

PUBLIC HEALTH While health care is vital to each of us some of the time, public health is vital to all of us all the time. C. Everett Koop, M. D. , former U. S. Surgeon General • Mission: The fulfillment of society’s interest in assuring conditions in which people can be healthy. Institute of Medicine. • Functions: Assessment, Policy development & Assurance.

The Public Health System Process • a continuous cycle of gathering information, deciding, acting, evaluating • Public health is always evaluating the health of the community Columbia University Center for Public Health Preparedness

“System” • More than just the public health agency • “Public health system” – All public, private, and voluntary entities that contribute to public health in a given area. – A network of entities with differing roles, relationships, and interactions. – All entities contribute to the health and well-being of the community.

The Public Health System Police EMS Community Centers MCOs Home Health Churches Corrections Health Department Parks Schools Nursing Mass Transit Philanthropist Homes Environmental Civic Groups Health CHCs Fire Tribal Health Economic Laboratory Employers Drug Mental Development Facilities Treatment Health Doctors Hospitals Elected Officials

Public Health in America • • • Prevent epidemics and spread of disease Protect against environmental hazards Prevent injuries Promote and encourage health behaviors Assure the quality and accessibility of health services • Respond to disasters and assist communities in recovery Columbia University Center for Public Health Preparedness

Public Health Preparedness Threats and Emergencies 7 Core Capacities • • Workforce Information Systems Communication Epidemiology/surveillance Laboratory Policy and Evaluation Preparedness and Response Columbia University Center for Public Health Preparedness

California

Definitions

Workforce The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operations Columbia University Center for Public Health Preparedness

The Essential Public Health Services (1994) 1. Monitor health status 2. Diagnose and investigate health problems 3. Inform and educate 4. Mobilize communities to address health problems 5. Develop policies 6. Enforce laws and regulations 7. Link people to needed health services 8. Assure a competent health services workforce 9. Evaluate health services 10. Conduct

Information Systems Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information. Columbia University Center for Public Health Preparedness

Communication Public Health systems maintain communication mechanisms to: – Routinely translate scientific and health information for communities and policy makers – Provide timely, accurate public information and advice to policy makers during emergency events – Coordinate logistical communication within the response community. Columbia University Center for Public Health Preparedness

Epidemiology/Surveillance Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors. Columbia University Center for Public Health Preparedness

Laboratory Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage. Columbia University Center for Public Health Preparedness

Policy and Evaluation Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions. Columbia University Center for Public Health Preparedness

Preparedness and Response Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies. Columbia University Center for Public Health Preparedness

Communication with Your Family Your family may be concerned, involved and/or have their routines changed. Do you have a: • Family Disaster Plan? • Personal Emergency Plan? Columbia University Center for Public Health Preparedness

Family Disaster Plan Materials Source: FEMA: www. fema. gov

Example Personal Emergency Plans: During Working Hours After Working Hours NYC-DOH School Health Program Draft, August 2001 Columbia University Center for Public Health Preparedness

Remember…… Make provisions for: • Child(ren) • Spouse/Partner • Parents • Pets • Others Columbia University Center for Public Health Preparedness

COMPETENCY A complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization (Center for Public Health Practice, Emory University) Columbia University Center for Public Health Preparedness

Core Public Health Worker Competencies for Emergency Preparedness and Response Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert. Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team. Columbia University Center for Public Health Preparedness

In order to respond to any emergency/disaster, ALL public health workers should be able to: • • • IDENTIFY & LOCATE the emergency plan DESCRIBE the role of Public Health DESCRIBE the Chain of Command DESCRIBE & DEMONSTRATE one’s functional role RECOGNIZE deviations from the norm IDENTIFY limits to own authority DESCRIBE communication roles DEMONSTRATE use of communication equipment APPLY creative problem solving skills Columbia University Center for Public Health Preparedness

Role of the State Public Health Agency in Emergency Response • Collaborate with other agencies in policy decisions and actions (e. g. , request to Feds for Strategic National Stockpile) • Surveillance • Investigation • Public information Columbia University Center for Public Health Preparedness

Role of the State Public Health Agency in Emergency Response (cont’d) • Medical provider information • Reference laboratory support • Public health interventions (e. g. mass vaccinations) Columbia University Center for Public Health Preparedness

Role of the State or Local Office of Emergency Services (OES) Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations. Columbia University Center for Public Health Preparedness

Example of a Common Multi-level Scheme for Disaster Communication and Coordination DHS FEMA PRESIDENT HHS CDC GOVERNOR’S OFFICE STATE OES STATE DOH Office of Local Elected Official LOCAL OES LOCAL DOH Federal State Local Fire Police Columbia University Center for Public Health Preparedness Other

Federal, State and Local Coordination in California DISASTERS for Public Health PRESIDENT GOVERNOR’S OFFICE DHS/FEMA HHS/CDC/VA etc. Governor’s OFFICE OF EMERGENCY SERVICES (OES) SOC OES/REOC Admin & Mutual Aid Regions Local Official’s OFFICE OPERATIONAL Area EOC’s Cities, Counties, Special Districts Incident Command Federal FIRE-EMS State Local Media CDPH/EMSA JEOC RDMHC MHOAC LHJ Voluntary Health Sector Police Voluntary Agencies (ARC, etc. )

EMERGENCY PREPAREDNESS COMPETENCY • IDENTIFY limits to own knowledge/skills/authority and. . • IDENTIFY key system resources for referring matters that exceed these limits Columbia University Center for Public Health Preparedness

Role of Local Health Officers http: //www. cdph. ca. gov/programs/dcdc/Pages/default. aspx Health Officer Practice Guide for Communicable Disease Control in California

Examples • • • LIMITS TO OWN SKILLS OR AUTHORITY KEY SYSTEM RESOURCES Communication with media Legal authority Supervision of others Allocation of resources Clinical skills or decision making Policy decision • • • Columbia University Center for Public Health Preparedness Agency chain of command Web resources Logistics Officer Policy and procedure manual Disaster plan / protocols

Examples Public Health Nurse in the Shelter Setting: Limits • Treatment of the seriously ill • Providing information to the media • Re-assigning roles of other shelter staff Columbia University Center for Public Health Preparedness Resources • Local Emergency Room • DOH Public Relations (or Public Affairs Dept. ) • Shelter manager

Cultural and Linguistic COMPETENCE “A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations. ” Terri Cross, 1989 [From March 2005 Presentation by Dr. Melanie Tervalon, MD, MPH, Education Director, COE Nutritional Genomics]

Rationale for Cultural Competence • Responding to demographic changes • Eliminating disparities in the health status of people of diverse, ethnic & cultural backgrounds • Improving quality of services and outcomes Cohen E, Goode T. Policy Brief 1: Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural . Competence. Washington DC, 1999 [From March 2005 Presentation by Dr. Tervalon]

Rationale for Cultural Competence (cont. ) • Meeting legislative, regulatory, and accreditation mandates • Gaining a competitive edge in the marketplace • Decreasing the likelihood of liability/malpractice claims Cohen E, Goode T. Policy Brief 1: Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural Competence. Washington DC, 1999 .

Cultural Humility • • Self-reflection and life long learner Patient-focused interviewing and care Community-based care and advocacy Institutional consistency [From March 2005 Presentation by Dr. Tervalon]

Public Health for Emergency Preparedness and Response Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert. Columbia University Center for Public Health Preparedness

State of California – Executive Branch Voters GOVERNOR’S OFFICE Voters State Agencies Health and Human Services Depts. CDPH Columbia University Center for Public Health Preparedness

California Dept. of Public Health www. cdph. ca. gov

CDPH • VISION: Healthy individuals and families in healthful communities • MISSION: Dedicated to optimizing the health and well-being of the people in California.

CDPH • CCLHO • Advisory Cmte Center for Chronic Disease • Chronic Disease & Injury Control • Environmental & Occupational Disease Control Center for Infectious Disease Director’s Office Center for Family Health • OWH • OMH • OBBH • EPO Center for Healthcare Quality Center for Environmental Health • Food, Drug & Radiation Safety • Communicable Disease Control • Office of AIDS • Licensing • WIC & Certification • Maternal, Child & Adolescent • Laboratory Field Health Services • Genetic Disease Executive Centers Divisions Columbia University Center for Public Health Preparedness • Drinking Water & Environmental Mgmt.

CDPH through DCDC is responsible for investigating and controlling all communicable disease and conditions in the State of California.

DCDC, through its Branches, works in partnership with local, national and international health officials, health care providers, and the public to: – monitor health, – identify and investigate existing and potential health problems, – develop and implement prevention strategies, – conduct research, – provide education and training, – and formulate and advise on public health policy

DCDC Branches • Infant Botulism Treatment and Prevention Program • Infectious Diseases Branch • Immunization Branch • Sexually Transmitted Disease Control Branch • Tuberculosis Control Branch • Microbial Diseases Laboratory Branch • Viral & Rickettsial Disease Laboratory Branch

Epidemiology/Surveillance Roles and Responsibilities in Emergency Response • • Provide background info on emergency surveillance data Conduct field epidemiological investigations (prn) Monitor existing surveillance systems Establish new surveillance system - Assemble field teams - Develop questionnaires/forms - Liaison with hospital/field personnel - Collect data - Develop recommendations for policy Columbia University Center for Public Health Preparedness - Establish databases - Enter data - Analyze data

Laboratories Roles and Responsibilities in Emergency Response • Provide recommendations for specimen types and handling • Accept specimens for testing • Ensure rapid transports to reference labs • Perform testing • Coordinate with epi/surveillance re: data entry • Liaison with Laboratory Response Network (LRN) i. e. , outside labs re: testing and data reporting Columbia University Center for Public Health Preparedness

Operations Roles and Responsibilities in Emergency Response • Provide resources to facilitate others’ activities • Transportation • Communication • Facilities • Security • Personnel • Printing • Coordinate hotlines for public & providers Columbia University Center for Public Health Preparedness

Environmental Roles and Responsibilities in Emergency Response • Research specific topic • Provide background information • Prepare recommendations re: -Public health threat -Sample collection -Evacuation/reoccupation • Collect samples • Collaboration w/ Hazmat Columbia University Center for Public Health Preparedness

Medical Information Systems (MIS) Roles and Responsibilities in Emergency Response Facilitate computing issues during emergencies -Field to Headquarters data transmission -Database management -Mapping/GIS Columbia University Center for Public Health Preparedness

Local Medical/Clinical Roles and Responsibilities in Emergency Response • Prepare recommendations on clinical aspects of emergency -Public safety issues -Occupational safety issues -Develop prevention & treatment message -Training of community MDs -Disinfection/decon issues • Establish and staff prophylaxis/treatment distribution centers • Staff DOH clinics involved in emergency • Liaison with Coroner regarding mortuary issues • Supplement clinical backup to school health program sheltering activities Columbia University Center for Public Health Preparedness

EMERGENCY PREPAREDNESS COMPETENCY APPLY creative problem solving and flexible thinking to unusual challenges within functional roles and responsibilities and EVALUATE the effectiveness of all actions taken. Columbia University Center for Public Health Preparedness

CREATIVE PROBLEM SOLVING What situations requiring creative problem solving and flexible thinking can you imagine occurring? • • Telephone system fails? Expected supplies are not delivered? Agency facility is inaccessible? Other types of problems? ? ? Columbia University Center for Public Health Preparedness

CREATIVE PROBLEM SOLVING What situations requiring creative problem solving and flexible thinking can you imagine occurring? Columbia University Center for Public Health Preparedness

Evaluation How would you evaluate the effectiveness of all actions you took? • Were the issues you referred to others acted upon? • Was the issue that you addressed resolved? • After the situation, evaluate the effectiveness of the plan. Columbia University Center for Public Health Preparedness

QUESTIONS? Columbia University Center for Public Health Preparedness

Acknowledgement Special thanks to the Columbia University Center for Public Health Preparedness upon whose Public Health Emergency Preparedness and Training Program this Presentation has been based. Website: http: //cpmcnet. columbia. edu/dept/sph/CPHP/index. html

Resources • American Public Health Association www. apha. org • Association of State and Territorial Health Officials www. astho. org • Centers for Disease Control and Prevention http: //www. cdc. gov/

Resources • National Association of County and City Health Officials www. naccho. org • National Association of Local Boards of Health www. nalboh. org • National Network of Public Health Institutes www. nnphi. org • Public Health Foundation www. phf. org

Contact Information Jessica M. Núñez de Ybarra, MD, MPH jnunez 2@cdph. ca. gov Phone: 916 650 -6875 Fax: 916 552 -8973 California Department of Public Health Division of Communicable Disease Control 1616 Capitol Avenue, MS 7300 PO Box 997377 Sacramento, CA 95899 -7377

Thank You