1. Introduction to NC Epi Teams

2. Presentation Overview What is an Epi Team? Who belongs to an Epi Team? What are the responsibilities of an Epi Team? How does an Epi Team function? What are some examples of Epi Team investigations?

3. Learning Objectives List the roles on a local health department Epi Team Describe the four (4) primary responsibilities of an Epi Team Give an example of a successful NC Epi Team investigation

4. What is an Epi Team? Multi-disciplinary public health team “The purpose of an Epi Team is to prevent, respond to, and recover from disease outbreaks and other public health threats identified in the community.”

5. Epi Team Roles Team Leader Epidemiologist Microbiologist Environmental Health Specialist Interviewer(s) Clinician Media Spokesperson

6. Team Leader Description –Experience in outbreak investigation and epidemiology –Leader may be different for different outbreaks –Role can be filled by: County health director Public health nurse Epidemiologist Environmental health specialist

7. Team Leader Responsibilities –Convenes Epi Team –Provides oversight for investigation –Assigns tasks to other team members –Serves as contact with other agencies –Conducts regular meetings –Facilitates outbreak interventions –Reports outbreaks

8. Epidemiologist Description –Expertise in field epidemiology methods –Experience developing case definitions and questionnaires

9. Epidemiologist Responsibilities –Tracks surveillance data –Creates case definitions –Maintains line listing of cases –Trains team members on case finding and follow-up –Provides daily reports on case finding and case counts –Ensures data quality

10. Clinician Description –Training in medicine, nursing –Knowledge of disease prevention and treatment –Experience in health education

11. Clinician Responsibilities –Consults regarding disease signs and symptoms, transmission, incubation period, and treatment –Administers vaccines and prophylaxis –Collects clinical specimens –Educates cases and contacts –Visits health care providers –Monitors contacts for symptoms

12. Environmental Health Specialist Description –Experience with environmental field investigations –Knowledge of food and water safety regulations –Knowledge of environmental sampling

13. Environmental Health Specialist Responsibilities –Monitors environmental surveillance data –Conducts field investigations and traceback investigations –Collects environmental samples –Provides guidance on food and water safety regulations and engineering –Implements facility-related control measures

14. Public Information Officer Description –Experience developing media messages –Knowledge of risk and crisis communication

15. Public Information Officer Responsibilities –Reviews provider and public alerts, fact sheets, and reporting reminders –Prepares/reviews press releases –Responds to media inquires –Ensures availability of appropriate educational materials

16. Laboratorian Description –Expertise in laboratory testing –Knowledge of proper specimen collection and transport procedures

17. Laboratorian Responsibilities –Provides information on proper collection and transport of clinical specimens –Coordinates submission of specimens to State Laboratory of Public Health

18. Administrator Description –Knowledge of local health department policies and procedures –Experience handling staff expenses

19. Administrator Responsibilities –Distributes meeting agendas –Records minutes and keeps records of meetings –Tracks staff expenses (overtime, travel reimbursement) –Assures after hours building and cell phone access

20. IT Specialist Description –Knowledge of local health department computer system –Experience with database development and management

21. IT Specialist Responsibilities –Assists in database development, modification, and maintenance –Provides technical support –Assists with data entry –Equips team with necessary equipment

22. Responsibilities of an Epi Team Coordinate disease surveillance activities Conduct epidemiologic investigations Gather and analyze information from investigation Implement public health control measures Educate the public

23. Coordinate Disease Surveillance Monitor routine surveillance data Compare expected to observed numbers and rates Investigate reports from healthcare providers Confirm or refute rumors of outbreaks

24. Conduct Epidemiologic Investigations Define cases Find cases Collect data Analyze data Report findings

25. Gather and Analyze Information

26. Implement Public Health Control Measures Decide upon appropriate control measures Work with community partners to implement control measures Communicate necessity of control measures to affected groups

27. Educate the Public Assist hospitals or other healthcare facilities with outbreak management Provide guidance to agencies dealing with outbreaks –Institutional settings (e.g. long-term care facilities, correctional facilities)

28. How Does an Epi Team Function? Communication Logistics Incident Command Structure Coordination with PHRST and DPH Resources

29. Epi Team Contact Information Maintain database of all team members –Name, specialty, best way to contact –Phone Numbers (work, home, cell) –Pager Number –Email Address –Emergency Contact Distribute to all team members Update regularly

30. Internal Communication Information flows in both directions –Leader should update Epi Team via meetings, conference calls, or email –Members provide regular updates to team leader Acts as tool for measuring progress Enables leader to provide feedback and direction to team members

31. Document Investigation Progress Keeps team members up to date Provides material for communication with external partners Can be used final report

32. Maintain Daily Log All steps taken in the investigation Decisions made and rationale Contacts: name, position, contact information Meeting Documentation –Minutes –Follow up actions and those responsible Photographs

33. External Communication Provide regular updates to external partners –NC Division of Public Health –Public Health Regional Surveillance Team –Local stakeholders – hospitals, healthcare providers, other government leaders/agencies, community organizations –General public Maintain routine communication

34. Epi Team Logistics

35. Incident Command Structure

36. How To Work in A Team Know what is expected –Team member responsibilities –Team member expertise –Resources available for tasks Know your role Know who is in charge

37. Delegation Team leader will delegate tasks to appropriate team members Other team members may also need to delegate tasks when overwhelmed Assign an alternate team leader as a back-up

38. Stress Triggers Long hours, lack of rest Personal health and safety concerns Local sensitivities Unexpected or traumatic event Legal concerns Intense pressure to investigate quickly Interaction with multiple agencies Security concerns

39. Stress Management Strategies: –Enough sleep, good nutrition –Strategic pauses –Using humor –Talking to someone –Visualization –Self-talk –Massage –Debriefing

40. After-action Discussions and Reports / Evaluation Identifies what worked Identifies what did not work Creates a record Can be used as a reference

41. Resources for Investigation Personnel Equipment Physical space

42. NC Epi Team Investigation DESCRIBE A SUCCESSFUL INVESTIGATION OF ONE OF NC’S EPI TEAMS – INCLUDE MISTAKES AND LESSONS LEARNED

43. NC Epi Team Investigation 2 DESCRIBE A SUCCESSFUL INVESTIGATION OF ONE OF NC’S EPI TEAMS – INCLUDE MISTAKES AND LESSONS LEARNED

44. Conclusion Working as a team requires: –A wide range of expertise –Clear communication –A rapid but careful and systematic approach in dealing with outbreaks

45. References Butler JC, Cohen ML, Friedman CR, Scripp RM, Watz CG. Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response. Emerg Infect Dis 2002;8(10):1152-6. Frace RM, Jahre JA. Policy for managing a community infectious disease outbreak. Infect Control Hosp Epidemiol 1991;12(6):346-7. Sobel J, Griffin PM, Slutsker l, Swerdlow DL, Tauxe RV. Investigation of multistate foodborne disease outbreaks. Public Health Rep 2002;117(1):8-19.