1. Local Emergency Management Roles in Communicable Disease Outbreaks: A Dialogue with Public Health North Carolina Emergency Management Association March 24, 2015 Harrah’s Cherokee Casino Resort

2. Objectives Define communicable disease outbreak Compare and contrast local EM incident response and local PH communicable disease (CD) response List potential local EM roles in CD response using scenarios

3. Quick quiz... What is an outbreak?

4. Quick quiz... What is an outbreak? What is communicable disease?

5. Quick quiz... What is an outbreak? What is communicable disease? What is epidemiology?

6. What are some characteristics of an outbreak? Usually, there is no “scene” Happens over time—sometimes weeks or months Different/same diseases behave differently/ the same Ill persons may not be obvious, may not seek care Often self-limiting and not detected/ reported Symptoms by definition are subjective

7. Steps of CD investigation First… situational awareness/ size-up How do you do your size-up?

8. Steps of CD investigation First… situational awareness/ size-up How do you do your size-up? “Everyday operations” vs. “incident”

9. Steps of CD investigation 1. Identify investigation team and resources 2. Establish existence of an outbreak 3. Verify diagnosis 4. Construct case definition 5. Find cases and list them 6. Perform descriptive epidemiology/ develop hypotheses 7. Evaluate hypotheses/ perform additional studies 8. Implement control measures 9. Communicate findings 10. Maintain surveillance

11. What are some similarities between PH CD investigation and EM’s approach to incidents? Some differences?

12. How can EM participate and support? ICS EOC ICS-EOC interface MACS Resource management Pre-scripted IAPs Communication: tactical and public

13. Scenario August, 2015: There is a new water park in your jurisdiction that opened Memorial Day, with large and small all-ages pools, kiddie pools, and a large whirlpool/jacuzzi. It’s August, with temperatures in the 90s, and the park is jammed with locals and tourists. At 4 pm Friday afternoon: Dispatch starts getting calls from people with vomiting and bloody diarrhea Ditto the health department The hospital ED is starting to see multiple people of all ages with these symptoms

14. We know what the health department is doing. What could EM be doing?

15. Scenario Part 2 It is the following Tuesday morning. Now we have: 45 people 1 year-65 years reporting symptoms Lab results positive for Shigella Kiddie pool, jacuzzi and locker room positive for Shigella By Wednesday, there are over 60 cases from your jurisdiction, 3 surrounding counties and the Tribe; the hospital is full and there are reports of cases at the nursing home

16. Would your local resources be overwhelmed? How could EM help with incident response organization and resource management?

17. Another scenario It’s April 2016, and the local Health Department gets a call that a strain of influenza, recently identified in Canada and highly virulent, is spreading from Canada to the US. Cases have been identified in 12 states, including NC, with several deaths in young, previously healthy adults. The virus responds to available antiviral oral medications, and, remarkably, last season’s flu vaccine seems to have a moderating effect on symptoms.

18. When will EM know about it? What would you do in your jurisdiction to help stand up, scale, and maintain a response?

19. How can EM participate and support? (Take 2) ICS EOC ICS-EOC interface MACS Resource management Pre-scripted IAPs Communication: tactical and public

20. Questions? Comments? Thanks for joining us! WNC Public Health Staff Martha Salyers martsaly@nc-cherokee.com -- EBCImartsaly@nc-cherokee.com Philip Anderson -- Cherokee County Alison Cochran -- Swain County Health Director Misty Lewis -- Swain County Ashley McGugan – Swain County Shelia Metcalf -- Madison County Robin Wallin -- Madison County