Environmental Health and Public Health Preparedness

                                                                                                                                                                                                                                                                                                                                                                                                                                                                    NACCHO, in collaboration with the Centers for Disease Control and Prevention (CDC). Disseminate lessons and best practices to the broader public health community.

Overall Outcomes Collaboration between Hennepin County, Ramsey County and City of Minneapolis Improved environmental health capacity at the local level to respond to public health emergencies Established systems that will support a coordinated and effective regional response Model plans, tools, templates that can be shared

Nine Grant Goals EH Emergency Response Plans Trained EH Staff Food operators better prepared Food safety alert system Shared data access and EH databases EH Resource Kit ECHO Sharing best-practice information Mass Care plan with American Red Cross

Focus on Four Goals--in year one EH emergency preparedness plans Trained EH staff Food operators better prepared Risk communication to limited English populations

Goal 1 EH Preparedness Plans Expand all-hazards Environmental Health Emergency Preparedness Plans to reflect common approaches for a regional response Technical Background Information Revised preparedness plans Different models of plans Job action sheets Mutual aid agreements, as appropriate Sharing information Describe general and specific response actions that EH personnel would be responsible for in an event

Environmental Health Emergency Guidance Document Work in Progress Display Only Prepared by Twin Cities Metro Advanced Practice Center

EH Emergency Guidance Document Describes general and specific response actions that EH personnel would be responsible for in an emergency Each topical area includes: Introduction Emergency Response Objectives Priority Activities Practical Guidance Information

Goal 2: Trained EH Staff Train environmental health staff within Hennepin and Ramsey Counties with requisite knowledge to effectively respond to an environmental health emergency, and test that training

Principles of Environmental Health Promote health and quality of life Protect the public from health hazards Protect the environment from contamination

Training Format Emergency Preparedness and Response Fundamentals Overview of Environmental Health Principles Communicating as a Key Role for EH Professionals Responding to Emergency Events Minimizing Health Implications Putting Principles into Practice Scenario #1 - elemental mercury contamination. Scenario #2 - an ammonia release. Scenario #3 - a natural disaster (i.e., a tornado).

Goal 2: What’s next? Roll out initial training Develop 1-2 advanced training curricula Provide advanced training Exercises to test training

Goal 3: Prepared Food Operators Increase capacity within food establishments (retail and restaurants) to identify and respond to public health emergencies affecting food safety Developed practice recommendations Survey of food establishments Emergency Handbook for Food Managers Tested materials and distribution Training on food security

Benchmark Survey: Purpose Assess food establishments’ emergency preparedness; Evaluate needs for emergency training content and delivery formats (including language options); Evaluate means of emergency info dissemination to food managers; Establish baseline measurements, to be used in measuring the effect of APC on food establishments’ emergency preparedness.

Survey Methods Phone survey of 379 establishments conducted 20 February to 07 April 2005 Questionnaire developed by collaborative effort between Metro Team and Vashé Research Statistically designed; stratified random sampling

Emergency Prep & Reporting Processes-Survey Results 1/2 of all restaurants and grocery stores claim to have an emergency plan in place Most establishments claim to inspect food deliveries for evidence of tampering. However, primary focus is on inventory control/theft, rather than food safety. 2/3 of establishments admit to have never had a fire drill. Food establishments have an overall preference for written materials for training. Almost all establishments want training materials in English, 42% of respondents would also like to have such materials in Spanish.

Types of Emergencies to be Notified About Twin Cities Metro Area Total Food establishments are mostly interested in alerts pertaining directly to the food and water supply. Type of emergencies respondent would want to hear about n=362 Food contamination information Food borne outbreaks Acts of terrorism that affect the food or water supply Food recalls Information about how to manage an emergency Floods, storms and other natural disasters Power outages Q13. Which of the following types of emergencies would you like to be notified about if such a system were created? Base: Total respondents.

Emergency Handbook for Food Managers – 3 Part Format Educational booklet for food managers Discussion guide plus photo lessons (multiple languages) for training food workers Discard or salvage guide Food security self inspection checklist Food safety self inspection checklist Employee illness log

Emergency Handbook for Food Managers-Goals Practical, relatively simple and low cost steps to keep food safe Who to call Steps to take first and recovery after an emergency

Available in: Multiple languages Hardcopy Online CD

Emergency Handbook for Food Managers-Topics Addressed Power Outage Fire Flood or Sewage Water Disruption Tornado & Wind Bioterrorism Dirty Bomb Chemical Incident Solid Waste Service Disruption Pest Control Maintain Food Safety in a Disaster Clean Up After Disaster Food Security Checklist

Conducting On-site Technical Assistance in Food Security Management Products Personnel Property Overwhelmingly receptive Most never consider food security Every restaurant has one or two areas needing improvement

Food Security Risk Management based on FDA guidelines for food retail and food service establishments. Voluntary self evaluation Create awareness among diverse groups to identify low cost, practical steps to improve food security.

Progress on Food Security Conducted 115 self evaluations with Food Managers Introduced the topic of food security to 950 Minneapolis food establishments. Met with local and state officials to introduce our approach to food security. Met with food trainers and nutritionists to create awareness and introduce our approach to food security.

Results From Food Manager Survey Ranked themselves high for: Purchasing from Commercial suppliers Keeping records for product trace back Restricting Customers to public areas Having proper lighting Monitoring truck shipments Having alarms and security cameras as appropriate Ranked themselves low for: Establishing a Food Security plan Training employees in food security and tampering Restricting personal items in food preparation areas Locking and labeling hazardous materials Placing “Employees Only” signs on restricted areas Monitoring for unusual activity or packages

Goal 7: ECHO [Emergency Community Health Outreach] Enhance capacities to provide rapid and appropriate risk communication to limited English-speaking populations regarding environmental health emergencies Phone line Fax TV show Community involvement What’s next? Liasions between the public health reisk communicators and the target communities Establish a multicultural/multilingual message ECHO phone line Educate key LPH leadership staff, environmental health staff and other risk communications spokespersons on environmental health emergency preparedness issues and messages

Other Goals 4. Food safety alert system 5. Shared EH databases & common inspection data 6. EH Resource Kit 8. Sharing 9. Mass Care plan with Red Cross .

Goal 4: Food Safety Alert System Develop a common methodology to provide food establishments with time-sensitive public health emergency information. Convened IS staff from Minneapolis, Hennepin and Ramsey Completed inventory of basic EH data systems and types fpr all EH jurisdictions Examining common databases

Goal 5: Shared databases Develop protocols and obtain tools and equipment to allow shared access to EH databases of food service establishments to facilitate mutual aid Examine the benefits of common software program for EH inspections across the target service area to facilitate mutual aid and use of shared staff during an emergency response.

Goal 6: EH Resource Kit Develop an Environmental Health Resource Kit of technical information for emergency response. Include resource materials and website locations with specific technical information for supervisors and field staff regarding potential scenarios. Capture information that already exists into one place, and develop new information, when needed. Scope of the proposed resource kit Scan for existing information I Convene an advisory panel Prepare technical information Compile and distribute the EH Resource Kit. Establish and document a system for keeping the EH Resource Kit information updated

Goal 8: Sharing Share newly created best practice information and materials for environmental health preparedness and response with others. Finished materials available thru NACCHO Poster at ASTHO/NACCHO Presentations at other meetings CDs available Handbook to be distributed to all high risk food establishments in Hennepin and Ramsey

Goal 9: Mass Care Plan Prepare a Mass Care plan jointly with the local American Red Cross chapter(s) Prepare a coordinated mass care plan Develop Memorandums of Agreement with the ARC, as appropriate. Document the Mass Care plans jointly with the ARC

How to Link EH and EP Clarify and describe roles for EH professionals Provide training for EH professionals Write EH emergency response plan integrated into county’s public health emergency response plan & the county’s emergency response plan Engage EH front line staff in preparation and development of the EH emergency response plan Write topic specific incident action plans Plan for and conduct tabletops exercises & drills with emergency management staff and other response partners

Further Information Hennepin County Saint Paul – Ramsey County Susan Palchick Brian Golob Saint Paul – Ramsey County Zack Hansen Cheryl Armstrong City of Minneapolis Curt Fernandez Susan Kulstad