State Role in Public Health Emergencies – Division of Communicable Disease Control

State Role in Public Health Emergencies – Division of

Communicable Disease Control

Jessica M. Núñez de Ybarra, MD, MPHPublic Health Medical Officer III

CA Department of Public Health (CDPH)Division of Communicable Disease Control (DCDC)

Office of Workforce DevelopmentAll Hazards Workshop – San Joaquin County

August 2008

Purpose

Provide a basic understanding of the State communicable disease control role as part of the overall State Public Health Emergency Preparedness and Response system in California.

PUBLIC HEALTH

While health care is vital to each of us some of the time, public health is vital to all of us all the time.

C. Everett Koop, M.D., former U.S. Surgeon General

• Mission: The fulfillment of society’s interest in assuring conditions in which people can be healthy. Institute of Medicine.

• Functions: Assessment, Policy development & Assurance.

The Public Health System Process

• a continuous cycle of gathering information, deciding, acting, evaluating

• Public health is always evaluating the health of the community

Columbia University Center for Public Health Preparedness

“System”

• More than just the public health agency

• “Public health system”– All public, private, and voluntary

entities that contribute to public health in a given area.

– A network of entities with differing roles, relationships, and interactions.

– All entities contribute to the health and well-being of the community.

The Public Health SystemThe Public Health System

MCOs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

Public Health in America

• Prevent epidemics and spread of disease

• Protect against environmental hazards

• Prevent injuries

• Promote and encourage health behaviors

• Assure the quality and accessibility of health services

• Respond to disasters and assist communities in recovery


Public Health Preparedness Threats and Emergencies

7 Core Capacities

• Workforce• Information Systems• Communication• Epidemiology/surveillance• Laboratory• Policy and Evaluation• Preparedness and Response


California

Definitions

Workforce

The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operations


The Essential Public Health Services (1994)

1. Monitor health status

2. Diagnose and investigate health problems

3. Inform and educate

4. Mobilize communities to address health problems

5. Develop policies and plans

6. Enforce laws and regulations

7. Link people to needed health services

8. Assure a competent health services workforce

9. Evaluate health services

10.Conduct research for new innovations

Information Systems

Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information.


Communication

Public Health systems maintain communication mechanisms to:

– Routinely translate scientific and health information for communities and policy makers

– Provide timely, accurate public information and advice to policy makers during emergency events

– Coordinate logistical communication within the response community.


Epidemiology/Surveillance

Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors.


Laboratory

Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage.


Policy and Evaluation

Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions.


Preparedness and Response

Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies.


Communication with Your Family

Your family may be concerned, involved and/or have their routines changed.

Do you have a:• Family Disaster Plan?

• Personal Emergency Plan?


Family Disaster Plan Materials

Source: FEMA: www.fema.gov

NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM

PERSONAL EMERGENCY PLAN

In the event that I am called upon to respond to an emergency as a Department of Health

employee I, _____________________________________, have made the following

arrangements to ensure that my family and pets are cared for while I am on duty:

My child(ren) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address

)

My pet(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

My parent(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

Example Personal Emergency Plans:

NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM

PERSONAL EMERGENCY PLAN

In the event that I am called upon to respond to an emergency as a Department of Health

employee I, _____________________________________, have made the following

arrangements to ensure that my family and pets are cared for while I am on duty:

My child(ren) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address

)

My pet(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

My parent(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

NYC-DOH School Health Program Draft, August 2001

During Working Hours After Working Hours


Remember……

Make provisions for:•Child(ren) •Spouse/Partner•Parents•Pets•Others


COMPETENCYA complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization

(Center for Public Health Practice, Emory University)


Core Public Health Worker Competencies for Emergency Preparedness and Response

Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.

Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team.


In order to respond to any emergency/disaster, ALL public health

workers should be able to:

• IDENTIFY & LOCATE the emergency plan

• DESCRIBE the role of Public Health

• DESCRIBE the Chain of Command

• DESCRIBE & DEMONSTRATE one’s functional role

• RECOGNIZE deviations from the norm

• IDENTIFY limits to own authority

• DESCRIBE communication roles

• DEMONSTRATE use of communication equipment

• APPLY creative problem solving skills


Role of the State Public Health Agency in Emergency Response

• Collaborate with other agencies in policy decisions and actions (e.g., request to Feds for Strategic National Stockpile)

• Surveillance

• Investigation

• Public information


Role of the State Public Health Agency in Emergency Response (cont’d)

• Medical provider information

• Reference laboratory support

• Public health interventions (e.g. mass vaccinations)


Role of the State or Local Office of Emergency Services

(OES)

Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations.


Example of a Common Multi-level Scheme for Disaster Communication and Coordination

PRESIDENTDHS FEMA

GOVERNOR’S OFFICE

Police

STATE OES STATE DOH

HHSCDC

Office of LocalElected Official

LOCAL OES LOCAL DOH

Fire OtherState

Federal

Local


Federal, State and Local Coordination in California DISASTERS for Public Health

Media Voluntary Agencies(ARC, etc.)

Police

DHS/FEMA

Governor’s OFFICE OF EMERGENCY SERVICES (OES)

SOC

State

Federal

Local

FIRE-EMS

Voluntary Health Sector

Local Official’sOFFICE

PRESIDENT HHS/CDC/VA etc.

MHOACLHJ

CDPH/EMSA JEOC

GOVERNOR’SOFFICE

OPERATIONAL Area EOC’sCities, Counties, Special Districts

RDMHCOES/REOCAdmin & Mutual Aid Regions

Incident Command

EMERGENCY PREPAREDNESS COMPETENCY

• IDENTIFY limits to own knowledge/skills/authority and..

• IDENTIFY key system resources for referring matters that exceed these limits


Role of Local Health Officershttp://www.cdph.ca.gov/programs/dcdc/Pages/default.aspx

Health Officer Practice Guide for Communicable Disease Control in California

http://www.cdph.ca.gov/programs/dcdc/Pages/default.aspx

Examples

LIMITS TO OWN SKILLS OR AUTHORITY

• Communication with media

• Legal authority

• Supervision of others

• Allocation of resources

• Clinical skills or decision making

• Policy decision

KEY SYSTEM RESOURCES

• Agency chain of command

• Web resources

• Logistics Officer

• Policy and procedure manual

• Disaster plan / protocols


Examples

Public Health Nurse in the Shelter Setting:

Limits• Treatment of the

seriously ill

• Providing information to the media

• Re-assigning roles of other shelter staff

Resources• Local Emergency Room

• DOH Public Relations (or Public Affairs Dept.)

• Shelter manager


Cultural and Linguistic COMPETENCE

“A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.”

Terri Cross, 1989

[From March 2005 Presentation by Dr. Melanie Tervalon, MD, MPH, Education Director, COE Nutritional Genomics]

Rationale for Cultural Competence

• Responding to demographic changes• Eliminating disparities in the health status of

people of diverse, ethnic & cultural backgrounds• Improving quality of services and outcomes

Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural

Competence. Washington DC, 1999. [From March 2005 Presentation by Dr. Tervalon]

Rationale for Cultural Competence (cont.)

• Meeting legislative, regulatory, and accreditation mandates

• Gaining a competitive edge in the marketplace• Decreasing the likelihood of liability/malpractice

claims

Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural

Competence. Washington DC, 1999.

Cultural Humility

• Self-reflection and life long learner

• Patient-focused interviewing and care

• Community-based care and advocacy

• Institutional consistency

[From March 2005 Presentation by Dr. Tervalon]

Public Health for Emergency Preparedness and Response

Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.


State of California – Executive Branch

Voters

GOVERNOR’S OFFICE

CDPH

Health and Human Services

State

Voters

Agencies


Depts.

California Dept. of Public Health www.cdph.ca.gov

CDPH

• VISION: Healthy individuals and families in healthful communities

• MISSION: Dedicated to optimizing the health and well-being of the people in California.

CDPH

•CCLHO•Advisory Cmte

Director’s Office

Center for Chronic Disease

Center for Infectious Disease

Center for Environmental

Health

•OWH•OMH•OBBH•EPO

•Chronic Disease & Injury Control

•Environmental & Occupational

Disease Control

•Communicable Disease Control

•Office of AIDS

•Food, Drug & Radiation Safety

•Drinking Water & Environmental

Mgmt.

Centers

Executive

Divisions


Center for Family Health

Center for Healthcare

Quality

•WIC•Maternal, Child

& Adolescent Health

•Genetic Disease

•Licensing & Certification

•Laboratory Field Services

CDPH through DCDC is responsible for investigating and controlling all

communicable disease and conditions in the State of California.

DCDC

DCDC, through its Branches, works in partnership with local, national and international health officials, health care providers, and the public to:

– monitor health, – identify and investigate existing and potential health

problems, – develop and implement prevention strategies, – conduct research, – provide education and training, – and formulate and advise on public health policy

DCDC Branches

• Infant Botulism Treatment and Prevention Program

• Infectious Diseases Branch• Immunization Branch• Sexually Transmitted Disease Control Branch• Tuberculosis Control Branch• Microbial Diseases Laboratory Branch• Viral & Rickettsial Disease Laboratory Branch

Epidemiology/SurveillanceRoles and Responsibilities in Emergency

Response

• Provide background info on emergency surveillance data • Conduct field epidemiological investigations (prn)• Monitor existing surveillance systems• Establish new surveillance system

- Assemble field teams - Establish databases

- Develop questionnaires/forms - Enter data

- Liaison with hospital/field personnel - Analyze data

- Collect data

- Develop recommendations for policy


• Provide recommendations for specimen types and

handling

• Accept specimens for testing

• Ensure rapid transports to reference labs

• Perform testing

• Coordinate with epi/surveillance re: data entry

• Liaison with Laboratory Response Network (LRN) i.e.,

outside labs re: testing and data reporting

LaboratoriesRoles and Responsibilities in

Emergency Response


• Provide resources to facilitate others’ activities

OperationsRoles and Responsibilities in

Emergency Response

• Transportation

• Communication

• Facilities

• Security

• Personnel

• Printing

• Coordinate hotlines for public & providers


• Research specific topic• Provide background information• Prepare recommendations re:

-Public health threat

-Sample collection

-Evacuation/reoccupation

• Collect samples• Collaboration w/ Hazmat

EnvironmentalRoles and Responsibilities in

Emergency Response


Facilitate computing issues during emergencies

-Field to Headquarters data transmission

-Database management

-Mapping/GIS

Medical Information Systems (MIS)Roles and Responsibilities in Emergency

Response


• Prepare recommendations on clinical aspects of emergency-Public safety issues -Training of community MDs

-Occupational safety issues -Disinfection/decon issues

-Develop prevention & treatment message

• Establish and staff prophylaxis/treatment distribution centers

• Staff DOH clinics involved in emergency

• Liaison with Coroner regarding mortuary issues

• Supplement clinical backup to school health program sheltering

activities

Local Medical/ClinicalRoles and Responsibilities in

Emergency Response


EMERGENCY PREPAREDNESS COMPETENCY

APPLY creative problem solving and flexible thinking to unusual challenges within functional roles and responsibilities and

EVALUATE the effectiveness of all actions taken.


CREATIVE PROBLEM SOLVING

What situations requiring creative problem solving and flexible thinking can you imagine occurring?

• Telephone system fails?

• Expected supplies are not delivered?

• Agency facility is inaccessible?

• Other types of problems???


CREATIVE PROBLEM SOLVING

What situations requiring creative problem solving and flexible thinking can you imagine occurring?


Evaluation

How would you evaluate the effectiveness of all actions you took?

• Were the issues you referred to others acted upon?

• Was the issue that you addressed resolved?

• After the situation, evaluate the effectiveness of the plan.


QUESTIONS?


Acknowledgement Special thanks to the Columbia University Center

for Public Health Preparedness upon whose Public Health Emergency Preparedness and Training

Program this Presentation has been based.

Website: http://cpmcnet.columbia.edu/dept/sph/CPHP/index.html

Resources

• American Public Health Association www.apha.org

• Association of State and Territorial Health Officials www.astho.org

• Centers for Disease Control and Prevention

http://www.cdc.gov/

http://www.apha.org/

http://www.astho.org/

http://www.cdc.gov/

Resources

• National Association of County and City Health Officials www.naccho.org

• National Association of Local Boards of Health www.nalboh.org

• National Network of Public Health Institutes www.nnphi.org

• Public Health Foundation www.phf.org

http://www.naccho.org/

http://www.nalboh.org/

http://www.nnphi.org/

http://www.phf.org/

Contact Information

Jessica M. Núñez de Ybarra, MD, [email protected]: 916 650-6875

Fax: 916 552-8973California Department of Public Health

Division of Communicable Disease Control1616 Capitol Avenue, MS 7300

PO Box 997377Sacramento, CA 95899-7377

mailto:[email protected]

Thank You

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State Role in Public Health Emergencies – Division of Communicable Disease Control

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