May 2014
In this issue:
Making Lemonade out of...a Leaky Lab ..................................1
Director’s Chair .......................................................................2
Building a Base ....................................................................2
Local Public Health Preparedness............................................3
Minnesota plans for emergency, prepares for pandemic
response ...............................................................................3
“A Community Approach to addressing the Functional
Needs of Unique Populations” .............................................3
Food, Pools, and Lodging Services (FPLS) Water
Emergency Response Protocol Template .............................4
Healthcare System Preparedness .............................................4
Crisis Standards of Care .......................................................4
Upcoming Events .....................................................................5
This incident
posed
numerous
response
challenges:
logistics,
safety,
continuity of
operations,
infrastructure,
financial and
communications. Internal and partner communication issues
became evident quickly. MDH devised a number of creative
solutions to some problems, including relocating one work
section to a different building and giving them surplus
equipment. Telecommuting was an option for some; however,
MDH already had a large number of employees
telecommuting because of severe cold, and additional lab staff
attempting to log in slowed the system to a walk, or even
locked some people out.
Editorial Board .........................................................................5
Making Lemonade out of...a Leaky Lab
When water started falling
from the Public Health
Laboratory ceiling that January
Monday morning, Carrie Wolf
and coworkers knew they had
an emergency – and a crisis –
on their hands. Laboratory
staff quickly rallied to protect
valuable equipment they
treasured and within minutes
established an incident
command system to manage
the crisis.
A faulty exhaust fan had
caused some of the water pipes
for the heating, cooling and sprinkler systems to freeze
overnight Sunday. When staff turned up the heat Monday
morning, the thawing pipes burst, cascading water down
through three floors of the Public Health Laboratory building.
For the next two days, facilities staff would play whack-amole, solving one leak only to have another one pop open
somewhere else.
Broader public communication issues were less clear.
Initially, it seemed that as long as the lab was communicating
with its usual lab partners, nothing else was needed. But as
events unfolded, staff soon realized that some testing would be
delayed indefinitely, meaning some partners, such as health
care providers, would not get results back in the usual amount
of time (with the exception of newborn screening); MDH
might be unable to detect disease outbreaks as quickly as
usual; and without influenza testing results, staff wouldn’t be
able to provide the Weekly Influenza Activity update to the
press and public as usual.
Rather than let work of the lab situation leak out, leadership
decided to go public and contact media. Not only did this give
MDH an opportunity to manage expectations, it proved to
have a media relations/public relations benefit.
The Communications Office issued a news release late
Monday afternoon describing the situation, explaining what
was and what was not known, and sharing what was
anticipated. MDH was reassuring on some things, such as
newborn screening, as much as possible.
The release generated significant media interest, in part
because of the impact of the “disaster” but also because it was
yet another example of the severely cold weather’s impact –
and media were looking for any new twist to that story.
Requests to shoot video footage of the destruction in the lab
poured in.
May 2014
Director’s Chair
Jane Braun, Director of Emergency Preparedness
Building a Base
Initially, these requests had to be denied because the area was
unsafe. But by Tuesday, some areas had been secured, and
MDH issued an update along with an offer to provide lab tours
to media. A designated period was set to minimize
interruption to staff and recovery workers and to limit hazards
to media. All four Twin Cities television news outlets seized
the offer, as well as some print.
The lab tours were an eye-opener for both reporters and
camera operators. They were impressed with the scale of
damage, of course. But they also seemed impressed with the
scale, variety and importance of the different lab functions –
and the effectiveness of the response so far; by Tuesday
afternoon, some areas were already partially operational.
Through some timely media relations, MDH was able to make
something sweet out of a lemon situation.
Some communications issues worth considering before an
emergency:
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If you need to tell employees/staff to not report to
work because their work areas are hazardous, how
will you do that?
Once you have stopped them from coming to work,
how will you communicate with them about returning
or to provide them situation updates? Can you
provide accessible instructions that tell them how to
check email and voicemail from home?
For those that may be able to report to work but their
desk computers are down, how will management
communicate with them, and how will they
communicate with each other and with external
partners?
Can your VPN system handle a surge in normal
capacity?
Who, outside of your agency, would be interested in
your situation, and what would you tell them about
it?
Look for the silver lining and the opportunity to tell a
broader story about the good work you do.
Ready to Respond Newsletter
One of the goals of National Public Health Week, which was
celebrated April 7-14 this year, is to foster understanding,
engagement and support for key public health issues. Most of
us who work in public health and healthcare readiness
capacities conduct a large number of critical activities that
many people never know are happening. When our work is
largely invisible, it’s more difficult for people to value what
we do, and it becomes more important for us all to use every
available opportunity to increase awareness.
The April State of Public Health Forum included a panel of
Commissioners from Health, Agriculture, Corrections, and
Ramsey County who all talked about connections between
work efforts that at first glance seem unrelated. It provided an
opportunity to discuss ways that health influences or is
affected by almost all disciplines, and how to have the
conversations needed to keep our efforts in the forefront.
The recent case of imported Lassa Fever in Minnesota and the
MERS-CoV cases in Indiana and Florida demonstrate the need
for and the effectiveness of a strong readiness infrastructure—
an astute clinician, advanced laboratory capacity,
epidemiologists, communications specialists, and many others.
Each element needs to be in place, to understand its role in
relation to the others, to have access to training and tools, and
to know the system well enough to act quickly and effectively.
When we are working with the general community, the
approach is slightly different. Finding a way to have our
partners aware and engaged means paying attention to making
sure the language we use resonates with them, figuring out
how our goals fit with others’ priorities, and looking for
opportunities to influence policies to promote health
preparedness in issues that may seem unrelated. During times
of declining resources, the connections become even more
acutely important.
This Issue of the Ready to Respond newsletter discusses
several instances where these structures were either being built
or used in recent months. The continuity of operations
challenge with the water leaks in the MDH lab, the training
undertaken by the Northeast Healthcare Preparedness
Coalition, the new protocols for water main breaks, the
training on functional needs in the SW region, and the
statewide seminar on Crisis Standards of Care all illustrate the
need to plan and train with those we will count on during
emergencies.
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By working with both our usual partners and with
Minnesotans at large, we can increase the base of support
needed to keep health readiness strong.
Local Public Health Preparedness
Minnesota plans for emergency, prepares for
pandemic response
Disasters and preparing for pandemic events addresses
burdens on operations, security, and many other services and
infrastructure critical to health systems and law and order.
Minnesota is taking the steps to address their ability to
identify, contain, treat affected survivors and have plans in
place for communities to recover quickly.
“Training and networking as a large group from a single
region will help our communication during an incident,” said
Cluka. “The state of Minnesota benefits greatly from this
training, through more experience among its healthcare
coalition members and the concentration on planning and
preparedness.”
“This course gives us solid baseline information to compare
plans and raise them to the next level,” said Hilde Perala, a
hospital Emergency Preparedness Program Manager. “The
classroom conversations and information sharing will make a
difference as we plan more closely in the future.”
Forty people from Minnesota’s Northeast Healthcare
Preparedness Coalition (NHPC) recently attended the
Pandemic Planning and Preparedness (P3) course at FEMA’s
Center for Domestic Preparedness (CDP). Students
represented twenty partnering agencies including: healthcare
facilities, local and tribal public health; public safety;
emergency management; the Air National Guard; and regional
healthcare, public health, and emergency management
coordinators.
According to Marilyn Cluka, Public Health Preparedness
Consultant with the Minnesota Department of Health,
“Although this course focused on a pandemic response, the
training can be applied to any disaster. We gained a better
understanding of the Incident Command System and how we
work together with different organizations within an
Emergency Operations Center.”
Planning constitutes a large portion of the P3 training. Jo
Thompson, Regional Healthcare Preparedness Coordinator
says, “We have a lot of front line personnel here from many
agencies and facilities. Hopefully attendance at this course
will help raise awareness with leadership about the planning
that needs to take place when preparing for a disaster. This
course benefits our communities because we are better
prepared to serve the public during and after a disaster or
pandemic.”
“This course has been a confidence boost,” said Kelvin
McCuskey, Installation Emergency Manager, with the 148th
Minnesota Air National Guard. “We’re going home to look at
how our plans can be more useful and how they integrate with
other agency plans within our region.”
Ready to Respond Newsletter
“By removing us from the distractions of our normal everyday
operations, retention of the course materials was greatly
enhanced. Due to the healthcare specific setting, it also
provided a more effective learning environment as compared
to a mobile course hosted back home,” Adam Shadiow,
Regional Healthcare Preparedness Coordinator.
The CDP’s pandemic training course encompasses techniques
for jurisdictions to plan and prepare for pandemic emergencies
and also addresses procedures that relate to other disasters
caused by weather, accidents or human-caused hazards.
Minnesota is taking important leaps in pandemic and disaster
preparedness and the CDP’s pandemic planning course
provides effective planning classes for emergency response
personnel in a variety of situations.
The CDP P3 course is fully funded for tribal, state, and local
response personnel. Round-trip air and ground transportation,
lodging, and meals are provided at no cost to responders or
their agency or jurisdiction. The CDP plans a leading role in
preparing state, local and tribal responders to prepare for and
respond to human-caused events or major accidents involving
mass casualties. To learn more about Center for Domestic
Preparedness, visit http://cdp.dhs.gov or call 866-213-9553.
The CDP can also be found at www.facebook.com/cdpfema
or at Twitter at www.twitter.com/cdpfema.
“A Community Approach to addressing the
Functional Needs of Unique Populations”
On Thursday, March 20th Homeland Security and Emergency
Management (HSEM) and Southwestern Center for
Independent Living (SWCIL) hosted a forum on Emergency
Preparedness “A Community Approach to addressing the
Functional Needs of Unique Populations” in Marshall, MN.
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Barb Fonkert, Individual and Functional Needs Coordinator
(HSEM) and additional panel members provided the audience
with some basic information to consider when planning for
people with functional needs. Barb touched on the following
five critical functional needs (CMIST)
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Communication
Maintaining health
Independence
Supervision, safety, support
Transportation
The top five emergency functions with the greatest impact on
people with access and functional needs include: notification
and warning, evacuation, emergency transportation, sheltering
and effective communication.
Additional information was shared by the panel of subject
matter experts. Notifying and communicating with deaf or
hard of hearing individuals may be done through Amber Alerttype messages, email, or texting. Communicating with
individuals who are blind or visually impaired may include
tactile signing in the hand or texting. Apple products have
many built in features that can assist individuals with
communications. Planning that allows service animals to
evacuate with their owner is important for maintaining
independence. The panel also shared that making a big ‘x’ on
a person’s back tells people to ‘come with me, I’ll explain
later.”
The take away from the forum for all of us is to remember to
include all members of the community when planning for all
hazard planning, and to think about how to target messages
for personal preparedness.
Functional Needs Planning Toolkit for Emergency Planners –
link https://dps.mn.gov/divisions/hsem/all-hazardsplanning/Pages/default.aspx
Food, Pools, and Lodging Services (FPLS) Water
Emergency Response
Protocol Template
The Water Emergency
Response Protocol template
was developed with the
assistance of MDH staff and
staff from local delegated
programs after several
incidents that involved water
main breaks. The Water
Ready to Respond Newsletter
Emergency Response Protocol template is for MDH Food,
Pools, and Lodging Services (FPLS) Program and local
agencies with MDH-FPLS delegated authority. It may be
customized to guide and document water emergency responses
and communications inside and outside an agency.
The template includes the following information: types of
emergency situations and public health concerns, types of
public communications advisories, core incident objectives
that need to be addressed immediately, expectations for
priority services during and after an incident that poses a
threat to safe water or food, website link to fact sheets and
other resources, and form fields for information that should be
collected during and after an incident.
Information provided on the completed form will help an
incident Manager complete the ICS Form 201 Incident
Briefing to be shared at the initial briefing if a response
structure is
activated. The
template was
distributed to
FPLS staff and
FPLS delegated
authorities for use
during future
water related
emergencies.
Healthcare System Preparedness
Crisis Standards of Care
On February 27, 2014, the MDH, Office of Emergency
Preparedness (OEP) hosted a statewide Informational Session
on Crisis Standards of Care. The session was coordinated
through the OEP – Healthcare System Preparedness Program,
and featured Dr. John Hick and Dr. Dan Hanfling. Both
Session coordinators are Institute of Medicine, Crisis
Standards of Care committee members, and experts in the
field of preparedness medicine and Crisis Standards of Care.
The session was considered a next step in Minnesota for
developing a state Crisis Standards of Care plan and
preparedness partners throughout Minnesota were able to
understand what Crisis Standards of Care are, what the legal
environments is, and what other states have been able to
implement. Session attendees participated in breakout
sessions that focused on how specific emergency preparedness
areas of emergency management, public health, EMS, and
hospitals would be impacted by Crisis Standards of Care
events, and what steps they could take in response. Notable
accomplishments in this area include:
Page 4 of 5
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In 2005, the Minnesota Department of Health began
coordinating a group of clinical experts in developing
“Patient Care Strategies for Scarce Resource
Situations”, which can be used as clinical guidance
for healthcare providers following a disaster. The
most current guidance can be found at:
http://www.health.state.mn.us/oep/healthcare/standar
ds.pdf
In 2009, the Institute of Medicine (IOM), at the
request of the U.S. Department of Health and Human
Services (HHS), formed a committee to develop
guidance that health officials and healthcare
providers could use to establish and implement
standards of care during disasters. The IOM Crisis
Standards of Care committee defined, “crisis
standards of care” (CSC) as a substantial change in
health care operations and the level of care that can
be delivered in a public health emergency, justified
by specific circumstances. During disasters, medical
care must promote the use of limited resources to
benefit the population as a whole. The IOM
committee further recommended that all state
agencies work to implement policies that support the
continuation of healthcare delivery following a
disaster that creates scarce medical resources.
Persons interested in learning more about Crisis
Standards of Care planning, can go to the Institute of
Medicine website at
http://www.iom.edu/Reports/2012/Crisis-Standardsof-Care-A-Systems-Framework-for-CatastrophicDisaster-Response.aspx
Upcoming Events
May 29-30, 2014
SWEPT Conference
Editorial Board
Editorial Board members include representatives from MDH
divisions that receive preparedness funds.
Jane Braun, Director of Emergency Preparedness
Kris Ehresmann, Infectious Disease Epidemiology, Prevention
& Control
Gloria Riggs, Office of Emergency Preparedness
Steven Diaz, Environmental Health
Nancy Torner, Communications Office
Maureen Sullivan, Public Health Laboratory
Steven Dwine, Office of Emergency Preparedness
Tina Firkus, Editor, Office of Emergency Preparedness
Contributors to this issue
Jane Braun, MDH Office of Emergency Preparedness
Gloria Riggs, Office of Emergency Preparedness
Doug Schultz, MDH Communications Office
Denise Schumacher, MDH Environmental Health
Marilyn Cluka, MDH Office of Emergency Preparedness
Julie Johnson, MDH Office of Emergency Preparedness
In 2010, the Minnesota Pandemic Ethics Project
published an article “Implementing Ethical
Frameworks for Rationing Scarce Health Resources
in Minnesota During Severe Influenza Pandemic.”
The activity was sponsored by the Minnesota
Department of Health, and has provided an ethical
framework that healthcare providers could follow
when faced with diminishing resources during a
pandemic or other disaster situation. The full report
can be found at:
http://www.health.state.mn.us/divs/idepc/ethics/imple
ment.pdf
Persons interested in obtaining additional information
regarding the Crisis Standards of care project, should email
[email protected], or call the Office of Emergency
Preparedness at 651-201-5700.
Ready to Respond Newsletter
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