1. Public Health Emergencies Processes, Expectations, Responsibilities, and Relations to Risk Management Uei Lei, MPH, EMT-P Emergency Preparedness and Response Manager Multnomah County Health Department uei.lei@multco.us

2. Disease outbreaks – Novel, to the jurisdiction, diseases (e.g. Zika, Ebola) – Endemic diseases (e.g. STD, norovirus, influenza Intentional incidents – Bioterrorism (e.g. anthrax, plague, tularemia) Secondary to other emergencies – Wild fire, exacerbation of chronic asthma – Flooding, tetanus / diptheria 1 What are Public Health Emergencies?

3. A Few Givens Regardless of how much we plan and prepare, incidents will still happen; people will still get sick How “fewer” are sick and “less” sick become the reason for preparing. – For risk management, how much “less” workers lost, time lost, productivity reduced, public trust lost, etc. In a nutshell, “reducing the severity of impact” 2

4. A Few Givens Regardless of how much we plan and prepare, incidents will still happen; people will still get sick How “fewer” are sick and “less” sick become the reason for preparing. – For risk management, how much “less” workers lost, time lost, productivity reduced, public trust lost, etc. In a nutshell, “reducing the severity of impact” 3

5. Introduction to a few Processes For the novel / endemic disease, the process is generally as follows: 4 Disease State Occurs Ill Person Seeks Medical Attention Disease Diagnosed, Reported Public Health Receives Report Public Health Initiates Investigation Information and / or Intervention Return to Routine Monitoring

6. Processes Continued For disease outbreaks “elsewhere”: 5 Disease State Known Public Health initiates ACTIVE Surveillance Disease Diagnosed, Detected Public Health Initiates Investigation Information and / or Intervention

7. Processes Continued For intentional (bioterrorism) incidents: – Unclaimed (covert) incidents will follow the previous methods of detection and response – Overt incidents will involve simultaneous law enforcement and public health investigation ** Strategic National Stockpile, Medical Countermeasures 6

8. Strategic National Stockpile Centers for Disease Control and Prevention (CDC) SNS is a large quantity of medicines and medical supplies designed to be a “first response” to public health emergencies to augment local supplies Request for SNS starts from Local  State  Federal Receipt of SNS is in reverse – Federal  State  Local ** Subject to change – e.g. 2009 H1N1 7

9. Federal responsibilities – timely action on request, and delivery of SNS to State authorities State responsibilities – timely action on local request, receipt, inventory, prioritization, and redistribution to Locals Local responsibilities – initiate request, receipt, inventory, delivery to community A few “buzzwords” – RSS Warehouse – Receiving, Staging, and Storing Warehouse – EOC / ECC / AOC / DOC – Emergency Operations Center / Emergency Coordination Center / Agency Operations Center / Department Operations Center – POD / CPOD – Point of Dispensing / Closed Point of Dispensing – Cipro / Doxy – Ciprofloxacin / Doxycycline 8 Strategic National Stockpile Continued

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11. Some Resources https://public.health.oregon.gov/Preparedness/Part ners/Documents/MCM%20Docs%202014/Oregon_P OD_FOG.pdf https://public.health.oregon.gov/Preparedness/Part ners/Documents/MCM%20Docs%202014/Oregon_P OD_FOG.pdf http://www.cdc.gov/phpr/stockpile/stockpile.htm https://commons.multco.us/ https://commons.multco.us/incident-management- team https://commons.multco.us/incident-management- team 10

12. Identifying / Analyzing loss exposures; Examining the feasibility of risk management techniques / select appropriate technique; Implementing, monitor, adjust as needed Hazard Identification and Vulnerability Analysis Mitigation / Preparedness Planning Response / Recovery Planning Exercise / Reevaluate 11 Risk Management and Emergency Management

13. Confounders Authority, responsibilities, abilities, capabilities – Often, public health has authority and responsibilities but not the resources and personnel to execute Culture / “Other duties as assigned” – Unlike traditional responders, public health does not exist to respond to emergencies alone. Programmatic deliverables still have to be met Grant-based – Grant deliverables and administrative tasks may not directly lead to a “prepared” agency / personnel. How do we reconcile? 12

14. Questions, Concerns, Requests? Uei Lei uei.lei@multco.us