1. Module 3: Initial Response Actions
Supported by the United States Food and Drug Administration
Food Safety Modernization Act (FSMA)
Capacity Development Grant

2. Key Learning Objectives
Identify how the lead agency can change throughout the course of an investigation.
Identify key differences between lead and supporting agencies.
Identify and practice principles for an effective conference call.

3. Determining Lead / Coordinating Agency
Legal authority
Expertise
Resources
Responsibilities
Development of investigation action plan
Coordination of plan implementation
Serves as point of contact about the investigation
Adjusting the plan with partners as needed
Writing the final report
The coordinating office must have sufficient resources, expertise, and legal authority to collect, organize and disseminate data from the investigation.

4. Supporting Agencies Retain their authorities and responsibilities
Complete commitments as agreed
Timely notification of the lead agency when plans must be adjusted
Complete case interviews for persons within their jurisdiction
Take regulatory actions needed to control sources under their jurisdiction
Are still the lead in their jurisdiction.

5. Designating Lead Agencies: Human Health Investigation
The jurisdiction/county where the exposure occurred typically leads
Alternative: if majority of the ill reside outside the county where exposure occurred, another county or MDCH may lead
Multiple county exposure – MDCH will lead/coordinate LHD investigations
The MJO Guidance document identifies some general rules of thumb for identifying who the lead agencies are – these are consensus principles for managing outbreaks – allowing agencies need the flexibility to determine what roles and responsibilities will work best for a specific situation.
When the exposure is in one county and the majority of the ill reside in another county or are scattered around the state, the
Environmental Health staff in the county of exposure is responsible for the facility/exposure location investigation. The county with the majority ill may lead the epi investigation or MDCH may lead (or coordinate) due to geographic scattering or assist in surge capacity.
Examples of multiple county exposure - (e.g., commercially distributed food product or traveling tour bus) the MDCH typically
will lead/coordinate the investigation between the LHDs.

6. Designating Lead Agencies: Food Supply Investigation
Agency with jurisdiction over the source of exposure takes the lead
Food service establishment – LHD
Retail grocery, convenience store, food processor - MDARD
Incidents involving retail / food service establishments establishments in multiple counties – MDARD
Intrastate food distribution – MDARD
Interstate food – FDA or USDA FSIS

7. Surge Capacity Options Keys to success
Cross utilization of staff within the agency
Sharing staff from other branches of government
University students
Volunteers (e.g., medical Reserve Corps)
Keys to success
Current contact lists and protocols for contacting
Developing just-in-time training as appropriate
Regardless of which agency are playing the lead and supporting roles, all agencies face the reality that they are attempting to do more and increasingly complex work often with fewer staff.
Public health agencies emergency preparedness activities have focused on identifying practical options for tapping into surge capacity. Some common strategies:
Cross training staff from various disciplines
Sharing staff – example: MDCH Regional Epidemiologists, CDC EIS Officers
University students (PHAST/UM)

8. Lead Agencies Often Change As Outbreak Investigations Progress Through Stages
Incident
Detection
Incident
Resolution
Epidemiology / Communicable Disease
Outbreak investigations progress through phases of activity, and leadership of the investigation should reflect the focus of the investigation at the time.
Investigation lead agencies will typically host regularly scheduled meetings/conference calls for response partners to gather & share information and to develop investigations plans and priorities.
Environmental Health / Food Regulatory
Laboratory – Clinical and Food

9. Initial Informational Sharing
Face-to-face meetings are recommended if response personnel do not have pre-existing working relationships.
Conference calls are often used
Early calls focus on surveillance and epidemiological information
Later calls focus on food supply investigations of distribution systems and sources.
Face-to-face meetings can be more effective initially because they allow time to ask questions, ready body language and, avoid some of the limitations of conference calls that we will be discussing shortly.
Early response efforts focus upon the human illness (epidemiologic) investigation stage and typically led by public health communicable disease agencies.
Ask participants if food regulatory agencies (local, state, federal, and tribal) should be included on the early calls/ meetings? Yes – so they can contribute to the investigation with insights on potential exposures and they will also have a better understanding of the investigation methods, findings and conclusions so the implicated product(s) can be removed from the market as rapidly as possible.
Later response efforts focus on the food supply or environmental investigation – providing environmental/regulatory guidance and technical support as investigators seek to identify and control the sources of contamination.
Communicable Disease control and epidemiology staff should be included in these conference calls to provide updates on the ongoing epidemiologic investigations (Example: is their ongoing exposure)?

10. Example Video A conference call in real life

11. Conference Call Challenges
Technology glitches
Individual communication styles
Tendency to multi-task during calls
Unable to assess non-verbal communications
Challenging to work on complex issues with groups having diverse perspectives
Technology glitches include: dropped calls, poor phone reception, accessing call lines, incompatibility of systems (sharing graphics), …
Differences in communications – aggressive individuals can dominate the conversations, and passive or quiet personality types may not actively contribute
Non-verbal communications – tendency to multi-task during calls, easy to come unprepared to participate
Complex issues – some tough issues are best worked out face-to-face so participants can focus their attention for a dedicated period of time.

12. Guidelines for Conference Call Etiquette
Conference call host checklist
Provide an agenda
Maintain focus
Summary
Attendee etiquette
Come prepared to participate
Identify yourself
Use MUTE, not HOLD
MJO Appendix 5 contains guidelines that if used can increase the effectiveness of conference calls. A copy is included in your resource packet and we will be asking you to review them during your small group activity during this module.
The host is responsible for providing the structure for an effective call.
Agenda – topics and timeline. Start on time and end on time.
Maintain focus – this can be challenging. Need to identify what topics will be discussed on the call vs. discussed / addressed “off line”
Summarize what was discussed, and the action items coming from the call.
Attendee etiquette – you will be reviewing these in detail during module 3’s group activity . Here are some key points to consider.

13. The Incident Command System’s (ICS) Planning P
As an incident escalates in size and complexity, so does the need for a formalized planning cycle
Document decisions made
Clearly communicate current investigation objectives
Plan for the next operational period
Regularly scheduled conference calls often are the primary method used to coordinate multi-jurisdictional foodborne outbreak investigations.
While outbreaks don’t require activation of ICS systems Incident Management Teams, ICS principles can be used effectively in a wide range of responses. For example, the ICS Planning P outlines a systematic and formalized process for developing and implementing response plans. This steps can be helpful to staff who are developing the response plan for the next “Operational Period” of any MJO.

14. Scenario & Table Discussion
Small group discussion (30 minutes)
Read the scenario update
Use the “All Hazards Task List” to assess the situation and develop your table’s investigation plan.
Prepare 2 minute situational briefing for the upcoming conference call
Review “Guidelines for Conference Call Etiquette” & be prepared to actively participate
Report out and large group discussion (30 minutes)