1. Public Health 101 for First Responders Tarrant County Public Health Public Health Preparedness Division & Southwest Center for Advanced Public Health Practice 2011

2. Target Audience Law enforcement EMS Fire Emergency Management

3. Course Outline I.Introduction to Public Health II.Public Health Preparedness III.Incident Command System (ICS) IV.Public Health Response to Emergencies V.Strategic National Stockpile (SNS) VI.Introduction to Epidemiology VII.Isolation and Quarantine

4. Course Objectives Identify the basic roles and responsibilities of a local public health agency Discuss the importance of collaboration between public health and first responders in the event of an emergency Provide examples of events that are within the scope of public health preparedness Explain and demonstrate how public health utilizes ICS during emergencies Describe functions of public health surveillance and alerting system for law enforcement/first responders Describe several of the main steps in an outbreak investigation

5. What is Health? Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.

6. Public Health vs. Medicine Public HealthMedicine PatientEntire PopulationsIndividuals InterventionAssess, Policy Development & Assurance Medical Treatment ProcessSystem ManagementPatient Management OutcomeHealthy CommunityHealing

7. Public Health Objectives Prevent epidemics and the spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities in recovery Assure the quality and accessibility of health services The American Public Health Association http://www.apha.org/ppp/science/10ES.htm

8. Public Health Services Personal Health Services (clinical services) –Immunizations –STD/HIV testing and counseling –Chronic disease counseling –Tuberculosis services –Family planning and maternal & child health services –Travel health services Providing direct clinical services is only one part of the mission of a local health department

9. Population Based Public Health Services Environmental Health Infectious Disease Control and Investigation Laboratory Services Health Education Services

10. The Public Health System Federal Agencies State Agencies Local Agencies

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

12. Which level of government is responsible for protecting public health? 10th Amendment to the U.S. Constitution: –All powers not delegated to the Federal government shall be reserved for the state governments States are responsible for protecting public health

13. What is Public Health Preparedness? “Plans, procedures, policies, training, and equipment necessary to maximize the ability to prevent, respond and recover from major events.” (HSPD-21)

14. Public Health Preparedness Builds Infrastructure for: Public Health Emergencies Bioterrorism, pandemics Everyday health threats Infectious & foodborne diseases

15. Preparedness and Bioterrorism What is bioterrorism??? -- The use of...  Bacteria  Viruses  Parasites  Their by-products …in a terrorist act.

16. Preparedness and Bioterrorism Possible agents of bioterrorism –Anthrax –Smallpox –Plague –Botulism

17. Preparedness and Bioterrorism What might an attack of bioterrorism look like? –Not necessarily explosions or plumes of smoke –May not be readily apparent and detectable –Sick people arrive at hospitals or doctors’ offices –Delayed recognition and diagnosis –Population panic

18. Why is Public Health a Responder? Public health has been involved with preparedness issues long before 9/11/2001 Public health preparedness involves more than just bioterrorism

19. Roles in Preparedness Examples: –Outbreaks from contaminated food or water, infectious diseases, etc. –Natural disasters: hurricanes, floods, fires

20. Roles in Preparedness Planning Coordination/Collaboration Training and Exercise Response Evaluation and Corrective Action Collaboration is critical to success!

21. Roles in Preparedness Examples of public health roles: –Health threats investigator –Public service/media –Post-event tracking –Environmental investigators

22. Early Detection of Health Threats PRIMARY SURVEILLANCE TARGET: Covert Health Threats KEY GOAL: protecting community assets and reducing illness and death HSPD-21 defines key directive for state and local biosurveillance Collaboration on detection response critical to achieving key goal Initial detection and response is LOCAL

23. Public Health Biosurveillance Systems Automated collection from 56 hospitals in NC Texas, 16 ISDs and pharmacies 24/7/365 Automated alerting Local initial response Special secure web-based communication system

24. Incident Command System Allows a more effective, efficient response to emergencies Examples: –HazMat incidents –Terrorist incidents –Natural disasters –Incidents involving multiple casualties

25. Incident Command LHD’s use ICSCommand & Control PH Resources & Personnel Communicate to partner agencies

26. Incident Command & Public Health In the event of a public health emergency the public health director will interact with the local EOC or incident command post. The public health Department of Operations Center (DOC) may be activated to facilitate tactical communications.

27. Notifying Public Health Public health is a valuable & relevant partner Public health is available 24/7 System in place to triage calls during business & non- business hours

28. Public Health Preparedness Summary Build public health infrastructure to respond to threats from: –Bioterrorism –Natural disasters & disease outbreaks Requires collaboration between agencies: –Planning –Training & exercises –Response –Communication –Management of resources

29. Strategic National Stockpile (SNS) A national stockpile available in the event of a major terrorist attack against the civilian US population National repository consisting of: –Pharmaceuticals (i.e., antibiotics and vaccines) –Antidotes and antitoxins –Medical and surgical supplies

30. Strategic National Stockpile SNS is a federal asset deployed locally after a major disaster –The governor of the affected state requests deployment of SNS from:

31. Strategic National Stockpile Delivered within 12 hours of federal decision to deploy SNS assets –12-hour “Push Package” –Push packages are warehoused in strategically- positioned locations around the US

32. Local Response to Strategic National Stockpile SNS deployment is a large-scale event requiring adequate: Security Pre–determined Points of Distribution Crowd control Traffic control

33. Local Response to Strategic National Stockpile Essential that First Responders and others in contact with exposed civilians are the first to be medicated

34. Local Response to Strategic National Stockpile Must prepare to dispense medicine to a huge number of people in a relatively short time span

35. Local Response to Strategic National Stockpile Expect to work with Public Health: Work collaboratively Implement emergency response according to prior planning Have conducted prior training and exercises Interagency Cross-Training

36. Local Response to Strategic National Stockpile Remember the 5 P’s... Prior Planning Prevents Poor Performance

37. And What Type Of A Planner Are You Going To Be?

41. What is Epidemiology? Study of the spread and causes of diseases or events in specified populations, and the control of health problems.

42. Epidemiology concerned with OUTBREAKS An adverse health event involving an unusual increase in cases among a certain population of individuals, within a certain period of time, in a certain location

43. Areas of Epidemiology Infectious diseases Environmental Behavioral Forensic Disaster

44. Person Place Time Key Elements in Epidemiology

45. Epidemiology Study Examples (risk or exposure outcome) Smoking (exposure) increases the risk of developing Lung Cancer (outcome)

46. Epidemiology Study Examples (risk or exposure outcome) Eating undercooked hamburger (exposure) increases the risk of infection with the bacteria E. coli (outcome).

47. Getting a flu shot (exposure) decreases the risk of becoming ill with the flu (outcome). Epidemiology Study Examples (risk or exposure outcome)

48. Simplified Steps in an Outbreak Investigation 1.Confirm outbreak and verify diagnosis 2.Perform field work and complete study 3.Implement control and prevention measures 4.Communicate findings

49. Disease Reporting: Notifiable Diseases Texas healthcare providers are required by law to report patients with certain diseases and conditions: –Report immediately Potential BT agents (anthrax, smallpox, plague) Botulism (foodborne) Viral hemorrhagic fever, including Ebola Other selected contagious serious diseases that may affect children and immune compromised or un-protected victims

50. Isolation and Quarantine Protocol Tarrant County Public Health

51. History of Quarantine In the fourteenth century, to protect cities from plague epidemics, ships arriving in Venice from infected ports had to sit at anchor for forty days before landing. “Quarantine” is derived from the Latin word quaresma, meaning forty.

52. Definitions:

53. Isolation: The separation of someone who’s infected or contaminated from others so that the infection or contamination is not spread

54. Quarantine Limitation of freedom of movement of a well person who’s been exposed to an infectious agent

55. What Does it Mean to be Isolated or Quarantined? No contact with any new people Can not leave home or place of containment For evaluation and verification purposes patient needs to check in with Public Health every day

56. What is Voluntary Compliance? Voluntary compliance with isolation, quarantine or other control measures means a patient cooperates and complies with Public Health’s instructions to comply with the recommended control measures in order to prevent the spread of disease.

57. What is Involuntary Detention? This is what Public Health will pursue if an individual does not voluntarily comply with an ordered control measure.

58. What is the Health and Safety Code? This is the law of the State of Texas regarding various “control measures.” This is codified as Chapter 81

59. To What or Who Can “Control Measures” be Imposed? Person (s) Groups (5 or more individuals) Area (city block, ZIP code, county) –Buildings (hospital, hotel, business)* –Common Carrier (plane, bus, train)*

60. Who Can Enforce these Rules? Local law enforcement must enforce an order issued by local health authority.

61. Questions?

62. Contact Information Kay Sanyal-Mukherji – APC Workforce Development Specialist Ksanyal-mukherji@tarrantcounty.com Teresa Bates – SNS Coordinator tjbates@tarrantcounty.com