January 2012 Inside this issue:
Special Delivery: Postal Plan Exercise May 5 and 6 ...............1
Director’s Chair .......................................................................1
Local Public Health Preparedness............................................2
Heightened Surveillance Identifies Influenza Strain (H1N2)
in Infant ................................................................................2
Pope Summer Storm ............................................................2
Let’s All Sing Like the Birdies Sing … ♫ tweet, tweet
tweet, tweet tweet.................................................................3
MnWARN: Utilities Respond in 2010 and 2011 Floods .....3
Suspicious Sample Collection and Sample Screening
Training ................................................................................4
Healthcare System Preparedness .............................................5
MMU Deployment to NE HSPP Region .............................5
Upcoming Events .....................................................................5
Editorial Board .........................................................................6
Special Delivery:
Postal Plan Exercise May 5 and 6
In September of 2009, President Obama issued an Executive
Order directing the establishment of a federal capability for
timely provision of medical countermeasures following a
biological attack. This order builds on a Memorandum of
Agreement from 2004 in which the Secretary of the U.S.
Department of Health and Human Services, the Secretary of
the U.S. Department of Homeland Security, and the
Postmaster General agreed to make United States Postal
Service (USPS) resources available to assist the residential
delivery of medical countermeasures in response to a
bioterrorism incident. This USPS offer of assistance became
known as the “Postal Plan.”
The Postal Plan was established to augment, not replace, the
distribution of oral antibiotics to the public via traditional
dispensing methods, such as mass dispensing sites. Plans call
for the delivery of an initial course of Strategic National
Stockpile medications and associated information sheets
within pre-determined ZIP codes. The Minneapolis/St. Paul
(MSP) metropolitan area served as the pilot city for the Postal
Plan development, and the MSP Comprehensive Postal Plan
was developed in collaboration with multiple federal, state and
local partners.
On May 5 and 6, MDH and Postal Plan partners will conduct a
full-scale exercise to test and validate the MSP Comprehensive
Postal Plan. The exercise will involve all departments,
agencies and personnel identified in the plan and will result in
the delivery of replica medical countermeasures and
information sheets to 43,000 addresses in the Minneapolis/St.
Paul metropolitan area. Preparations for the exercise have
been underway for several months, and planning efforts
include public health, law enforcement, emergency
management and public information stakeholders from over
15 federal, state, and local agencies.
Target capabilities being exercised include:
• Emergency Public Information and Warning
• Emergency Public Safety and Security
• Medical Supplies Management and Distribution
• Mass Prophylaxis
• Critical Resource Logistics and Distribution
An After-Action Report and Improvement Plan (AAR/IP) will
be developed to capture recommendations and to outline steps
to address issues identified during the exercise. The AAR/IP is
intended to be released as a resource for federal, state and
local planners.
Director’s Chair
Jane Braun, Director of Emergency Preparedness
Greetings to our many partners in keeping Minnesota ready
to respond to health emergencies!
The Assistant Secretary for Preparedness and Response and
the Centers for Disease Control and Prevention released the
new “Capabilities Planning Guide” on January 20,
representing a large first step in aligning the public health and
health care pieces of planning and response. The CPG builds
on the original 15 PHEP capabilities by adding eight
capabilities for healthcare, and three shared capabilities
between public health and health care. With this new
guidance, we have a good idea of where the federal agencies
plan to go over the next five years. We anticipate hearing in
about a month what our funding amounts will be and our
application for 2012-13 will likely be due around the
beginning of May. HHS and CDC assure us the application
won’t be the 800-page monster we completed last June, for
which we are very grateful.
January 2012
The State Community Health Services Advisory Committee
work group on Public Health Emergency Preparedness
continues to meet and serve as a wonderful collaborative
planning body and sounding board. In January, we walked
through the “policy statements” developed by the work group
following the 2010 H1N1 Summit in St. Cloud and identified
concrete action items to take on in the coming months. Our
February meeting will include specific assignments and
completion of some of the tasks. We also are looking for new
members to replace some whose terms are expiring after this
year, and I encourage you to let us know if you are interested.
Spring brings the vast majority of the regional preparedness
meetings. Many OEP and other MDH staff attend these
workshops as their schedules permit, and we are always
impressed with the depth and variety of topics, as well as the
great collaboration between regional partners. One can never
overestimate the value of meeting with partners and
confirming capabilities, roles and expectations.
Finally, a reminder of the importance of keeping your 24/7
contact information up to date on the Workspace. When the
chemical spill occurred at the Prairie Island nuclear plant
during the early morning hours on January 5, MDH staff
needed to make calls to several health care, LHD and tribal
partners. Fortunately, the Workspace had most of the
information we needed, and we were able to reach the proper
people after calling several of the numbers on the list. Please
make sure you have the correct people listed for your agency
and that you include multiple phone numbers for each.
Wishing you all a smooth transition from “where is winter?”
to “is it almost spring?”
Local Public Health Preparedness
Heightened Surveillance Identifies Influenza
Strain (H1N2) in Infant
A Minnesota case of human influenza associated with swineorigin influenza viruses was identified on December 5, 2011;
this is just the fifth Minnesota case in approximately five
years. In late October, a previously healthy infant from the
Twin Cities area developed fever and cough. Rapid testing
identified influenza A, and the child completely recovered. As
part of routine MDH influenza surveillance, the specimen was
further tested at the MDH Public Health Laboratory and the
U.S. Centers for Disease Control and Prevention. On
December 5, the specimen was identified as a strain of H1N2.
This specific influenza strain has recently been identified in
swine from the Upper Midwest; however, similar strains have
been circulating in swine since the early 1990’s. While the
family did not have contact with swine, a child who had
contact with the infant had a fever and cough a few days prior
to the onset of the infant’s symptoms. No family members or
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other contacts have subsequently developed symptoms, and
surveillance in the subsequent month has not identified other
cases due to this virus.
Cases of human influenza associated with swine-origin
influenza viruses are likely occurring on a regular basis.
However, heightened influenza surveillance has most probably
led to the identification of these swine-origin viruses in the
last few years. Swine-origin influenza has demonstrated
limited person-to-person transmission. Also, it has not been
shown to be transmissible to people through eating properly
handled and prepared pork or other products derived from
pigs.
The H1N2 swine-origin influenza virus does not contain genes
associated with 2009 pandemic H1N1. However, the
occurrence of this virus serves as a reminder of the importance
of influenza surveillance and the collection of information
about persons who are hospitalized with influenza-like illness
(ILI) or clinical suspicion of influenza OR deceased following
ILI or clinical suspicion of influenza.
For more information on current influenza surveillance, see:
http://www.health.state.mn.us/divs/idepc/diseases/flu/stats/ind
ex.html
Pope Summer Storm
The morning of August 1, 2011, Pope County residents
experienced a fast moving violent storm characterized as
straight line winds in excess of 80 mph, accompanied by
torrential rains. In less
than half an hour, the
storm moved through
the county causing
significant tree and
property damage and
bringing down
numerous power lines.
It’s said every cloud
has a silver lining. The
silver lining in this
Downed Power line – State Hwy 55
incident was no loss of
life and the
partnerships exemplified in the response.
The EOC opened at 7:45 am, approximately 45 minutes after
the storm hit. Utilizing and building on agency and individual
strengths was evident throughout the response as city and
county responders and power line personnel worked to clear
roads and secure power lines. Residents on home oxygen and
other high risk residents were identified and followed up with
by local EMS. Public Health contacted nursing homes and
community living group home settings to assess needs.
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Day two
exemplified
partnerships as
home safety checks
were implemented
in apartment
complexes in
Glenwood, Starbuck
and Lowry, reaching
many seniors and
families with young
Marina Mess - Glenwood
children. Law
enforcement identified
facilities and Public Health and MN Responds volunteers
provided door to door checks, distributing a hotline number
established by the local EMS system and assessing and
reporting back unmet needs. More than 600 checks were
provided in twenty-eight complexes.
committee that “our success in fulfilling our mission at FEMA
is highly dependent upon our ability to communicate with the
individuals, families and communities we serve. For that
reason, social media is extremely valuable to the work we do.”
When the Salvation Army requested a kitchen for food prep,
the perfect pairing was with the Pope County Senior
Coordinator, whose connection with the local senior center
garnered building access and volunteers. In the space of an
hour, 125 sack lunches were put together. The Sheriff’s Posse
distributed these to individuals identified in need. Utilizing
maps developed by emergency managers, identifying hardest
hit areas, the Salvation Army Canteen continued to deliver
water and food to those engaged in cleanup over the next two
days.
Although MDH already maintains a Twitter page, tweeting
during emergencies takes advance planning. Currently in
discussion at MDH are such things as guidelines for sending,
monitoring and responding to tweets; pre-scripting tweets for
rapid dissemination during all types of emergencies; methods
for coordinating tweets between the Joint Information Center
and the State Emergency Operations Center; space, equipment
and location requirements; message approval processes; the
extent to which existing staff can cover Twitter during
emergencies, and record retention.
Additional pairings included public health, hospital and
nursing home personnel working to arrange short-term nursing
home admission for four individuals who’d been taken to the
hospital because of combinations of anxiety/respiratory issues
who didn’t need hospitalization but couldn’t be home due to
issues with heat and no electricity.
From road clearing to home checks, the response did not go
unnoticed by the community. In the words of one gentleman,
“I’ve been in the “old” category for 30 years. No one has ever
come to the door just to ask if I was okay. Thank you.”
Let’s All Sing Like the Birdies Sing … ♫ tweet,
tweet tweet, tweet tweet
The Federal Emergency Management
Agency (FEMA) is just one of a growing
number of government agencies that
“tweets” during emergencies to keep partners and the public
informed. The Minnesota Department of Health (MDH) is
currently looking at the feasibility of joining these ranks.
Twitter is a free online social networking and micro blogging
service that enables users to send text-based posts of up to 140
characters, known as “tweets,” that can be read via mobile
devices and computer Web browsers. In a written statement in
May, Craig Fugate, FEMA administrator, told a senate
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Twitter is potentially a useful, rapid, two-way emergency
communication tool. For example, an MDH employee was
able during the floods in Pennsylvania to monitor tweets from
officials and citizens there to help a relative in Pennsylvania
avoid washed out roads on the way to work. Citizens at
ground zero in an emergency can tweet vital information
before first responders arrive and can augment official
information after emergency crews arrive. Meanwhile,
agencies can push out information, as well as respond to
trends culled from citizen tweets, answer questions raised and
clear up misconceptions and misinformation. The drawback is
that it takes staffing to monitor and respond to tweets around
the clock.
MnWARN: Utilities Respond in 2010 and 2011
Floods
The Minnesota Water/Wastewater
Agency Response Network
(MnWARN) is a network of
“utilities helping utilities.” Water,
wastewater and storm water
utilities voluntarily respond to
help each other recover from
physical damage due to natural
disasters and human-caused
emergencies.
MnWARN Mission: To
promote and support a
statewide response to
utility emergencies and
disasters through mutual
assistance for water,
wastewater and storm
water utilities in
Minnesota.
Four water/wastewater utility
leaders initiated the MnWARN in 2008 with technical
assistance from the MDH Environmental Health Division’s
Drinking Water Protection Section and the League of
Minnesota Cities. Since then, membership has steadily grown
to include 245 public utilities of all sizes across Minnesota.
The MnWARN partners have activated twice, each time
because of flooding. Members demonstrated their partnership
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for the first time in southeastern Minnesota on September 23,
2010, due to high floodwater. A few months later, on March
21, 2011, the City of Brownton, located in McLeod County
about 60 miles west of Minneapolis, initiated a MnWARN
event. Brownton received pumps and trained personnel from
the MnWARN partners within hours.
“MnWARN’s rapid response with equipment and personnel
during the flood saved critical infrastructure in several
communities; it enabled a much quicker recovery effort,”
states Mark Sloan, water certification officer, Minnesota
Department of Health. The number of areas that needed
equipment with experienced operators expanded rapidly.
MnWARN facilitated efficient use of resources where most
needed and best used. The easy process to join MnWARN was
very helpful to water utility systems that needed assistance
ASAP.”
The MnWARN is a formal emergency response program
based upon a written agreement to provide voluntary
emergency assistance across jurisdictional boundaries. The
mutual aid agreements complement local and regional joint
planning, clarify liability and reimbursement issues and
provide efficient procedures for requesting and receiving aid.
Agreements and procedures for sharing resources facilitate
timely response with specialized utility resources. Aid
includes responses such as the following:
1) emergency equipment such as pumps, generators and
chlorinators;
2) trained water and wastewater operators; and
3) materials and associated services.
The MnWARN also facilitates aid requests to state and federal
agencies. When Minnesota’s State Emergency Operations
Center (SEOC) activates during emergencies, the MnWARN
has a voice at the SEOC table. The MnWARN’s involvement
with the SEOC provides a significant line of communication
to request state resources beyond the MnWARN relationships.
When local flooding became regional in 2010, the MnWARN
mutual aid agreement facilitated reporting of needs to the
Federal Emergency Management Agency (FEMA).
Participation in the MnWARN is voluntary. Members have no
obligation to respond, and there is no cost to participate.
Volunteers support MnWARN and its response activities. For
more information, visit the MnWARN website at
www.mnwarn.org.
Suspicious Sample Collection and Sample
Screening Training
The Minnesota Department of Health, Public Health
Laboratory (PHL) is the primary receipt laboratory for
suspicious substances suspected of being biological, chemical
or radioactive weapons of mass destruction (WMD). The PHL
has a state of the art “All Hazards Receipt” area within the
Ready to Respond Newsletter
laboratory
building where
these substances
can be safely
opened and
examined
without risk of
releasing the
unknown
material. A team
of trained
scientists serve
as the
emergency
response on-call
team. These individuals regularly practice the process for
safely handling and processing these types of samples.
In addition to the training and practicing that the PHL
emergency response team staff receives, this team is also
accountable for providing training to the first responder
community that is in charge of responding to the potential
release of these materials. The PHL has worked closely with
first responders and clinical laboratory scientists for many
years and has provided ongoing training on a variety of topics,
including recognizing the signs and symptoms of WMD
exposure, understanding how to identify biological threat
agents in the clinical laboratory and how to properly collect
and ship specimens from individuals exposed to WMDs.
The PHL will be continuing additional educational outreach
this winter and spring by offering a “Suspicious Sample
Collection and Field Screening” course to the state hazardous
materials Chemical Assessment Teams (CATs), National
Guard’s 55th Civil Support Team, the FBI’s Hazardous
Materials Response Team (HMRT) and other specialized
hazmat teams around the state.
The PHL has developed a four-hour long training program that
will provide the state hazmat teams with instructions on how
to properly collect, screen and transport a sample to the PHL.
It is important for the safety of the receiving personnel at the
laboratory that certain tests be conducted on the sample before
it is delivered to the laboratory; specifically radiation and
explosives testing. It is also very important that the sample is
collected properly before transport to the laboratory. Ensuring
that the chain-of-custody is properly filled out, that the correct
volume of sample is collected and that the outer transport
container is decontaminated is crucial to protect the safety of
the on-call staff.
This training incorporates best practices that have been
learned through years of experience and from other responders
and public health laboratories from around the country. The
PHL will be supplying the teams with sample collection kits
that were assembled at the PHL. The teams will have the
opportunity to practice collecting a variety of samples using
the provided supplies. This training will also cover techniques
for the screening of acute hazards in the field such as
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explosives; flammable liquids, gases and vapors; corrosives;
water reactive materials; radioactivity and some acutely toxic
substances. The participants will be given proper personal
protective equipment and all of the materials and equipment to
practice these tests.
assess the effectiveness of integrating clinicians from
diverse organizations into a single medical incident
response structure,
and assess communications among diverse
organizations brought together in a major response
As with any preparedness activity the actual training is only
part of the goal. The staff who will be providing this training
are looking forward to the opportunity to meet and interact
one-on-one with responders from around the state. Building
and strengthening these relationships is invaluable to ensuring
a coordinated and smooth response should a WMD event
occur in our state.
Other resources in the deployment included the Minneapolis–
St. Paul Airport multiple casualty incident bus (ambulance),
SW EMS Strike Team and Base of Operations (BOO) tent and
facilities, Metro Region EMS Command and Communications
trailers and private ambulances. The regional volunteers who
completed the MMU clinical orientation were engaged as
clinicians in the MMU and EMS BOO triage area to receive
and treat moulaged victims from EMS Strike team personnel
in a 3 Echo exercise. The exercise involved a bus explosion
with active shooters at a middle school and a young student
with an explosive device that detonated in the BOO triage
area. Clinicians pulled actual supplies and equipment and
requested lab tests and pharmaceuticals to enable post exercise
assessment of supply and resource utilization. The post-event
hot wash included all exercise parties who indicated a very
favorable response to the pre-event training, exercise and
overall deployment. In addition, the MMU staff conducted
500 to 600 tours, provided five training sessions for 60
clinicians, had 180 hours of volunteer time and gave four
media interviews.
For further information please contact:
Stefan Saravia, MPH, CIH, CHMM
Chemical Threat Preparedness Coordinator
Minnesota Department of Health
Public Health Laboratory
651-201-5579
[email protected]
Health Care System Preparedness
Mobile Medical Unit Deployment to NE Region
Health Care System Preparedness Program
The Mobile Medical
Unit (MMU) was
deployed to the NE
HSPP Region and
Arrowhead EMS
Conference January
17 through 22. The
multifaceted
deployment was held
inside the Duluth
Entertainment and
Convention Center.
Objectives for the
deployment were to:
conduct a full scale exercise and deployment of the
MMU,
promote awareness and understanding on the
appropriate role and uses of the MMU,
provide a training and development opportunity for
the MMU Technical Operations Team,
provide the opportunity to work with and train
members of the NE Regional Trauma Advisory
Committee (NERTAC) and NE HSPP Region MRC
volunteers in a field medicine environment utilizing
the MMU,
participate in the 3 Echo exercise with Metro and SW
EMS Strike Team personnel,
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In conclusion, all parties involved were thrilled that this event
was so successful. An after action report will be prepared to
highlight lessons learned. Our goal was to train, form new
partnerships, exercise and raise awareness of this very
important resource for Emergency Preparedness, and we did
it!
Upcoming Events
February 14 through 16, 2012 Governors Conference on
Homeland Security and Emergency Management
February 20 through 24, 2012 Public Health Preparedness
Summit (Anaheim, CA)
February 21, 2012
March 8, 2012
March 15, 2012
SE Regional Training and Presentations
HSPP Quarterly Meeting (St. Cloud)
Regional Emergency Preparedness Meeting
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Editorial Board
Editorial Board members include representatives from MDH
divisions that receive preparedness funds.
Jane Braun, Director of Emergency Preparedness
Chris Everson, Infectious Disease Epidemiology, Prevention
& Control
Kirsti Taipale, Office of Emergency Preparedness
Lynne Markus, Environmental Health
Nancy Torner, Communications Office
Nathan Kendrick, Public Health Laboratory
Steven Dwine, Office of Emergency Preparedness
Tina Firkus, Editor, Office of Emergency Preparedness
Contributors to this issue
Chris Everson, Infectious Disease Epidemiology, Prevention
& Control
Stefan Savaria, Public Health Laboratory
Nancy Torner, Communications Office
Mark Sloan, Environmental Health
Lynne Markus, Environmental Health
John Urbach, Office of Emergency Preparedness
Shelley Svec, Pope County Public Health
Jane Braun, Office of Emergency Preparedness
Maura Prescher, Office of Emergency Preparedness
Ready to Respond Newsletter
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