June 2012: Inside this issue:
Full Scale Postal Exercise: Operation Medicine Delivery ......1
Operation Medicine Delivery...............................................1
Operation Medicine Delivery: Public Information Activities
.............................................................................................2
Director’s Chair .......................................................................2
Local Public Health Preparedness............................................3
A robust pre-event public information campaign was initiated
several weeks prior to the exercise in order to ensure residents
in the affected areas were aware of the planned deliveries.
Efforts included community outreach, media events, and
information mailers.
The exercise began at 7:00 AM on Saturday, May 5 with a
Strategic National Stockpile (SNS) activation and notification
drill. The state distribution warehouse was then activated to
test the receipt of SNS assets into the state and the distribution
of the assets to the Postal Service.
Minnesota Radiation Emergency Volunteers .......................3
MDH Prepares for Vector-Borne Disease Season ...............3
Center for Domestic Preparedness .......................................4
MIIC Vital Tool During Measles Outbreak n 2011 .............4
Healthcare System Preparedness .............................................5
Pediatric “Tool Kit” .............................................................5
Workspace Version Two ..........................................................5
Out with the Old and In with the New .................................5
PHEP and HPP Grant Status ....................................................5
Grant Application Update ....................................................5
Upcoming Events .....................................................................6
Editorial Board .........................................................................6
Full Scale Postal Exercise:
Operation Medicine Delivery
Operation Medicine Delivery
Delivery of simulated medical countermeasures (empty pill
bottles) to approximately 37,000 addresses began around 6:00
AM on Sunday, May 6. Residential addresses in four zip
codes within the cities of St. Paul, Minneapolis, Robbinsdale,
Crystal, and Golden Valley received deliveries from 40 teams
of law enforcement officers and letter carriers. Households
receiving the empty bottles were encouraged to recycle them.
A virtual joint information system was also tested during the
exercise and was used to develop exercise-related messages,
coordinate an external media event, and share information.
The MDH Department Operations Center (DOC) was fully
staffed for the duration of the exercise in order to develop an
incident action plan and maintain situational awareness. The
Incident Command System was used to support exercise
planning.
A thorough evaluation of the exercise is being conducted and
will result in the development of an improvement plan. An
after action conference is scheduled for early June. Operation
Medicine Delivery was completed with the assistance of a
grant from the U.S. Department of Health and Human
Services.
Operation Medicine Delivery, a full
scale exercise to test the
Minneapolis/St. Paul
Comprehensive Postal Plan, was
conducted on May 5th and 6th, 2012.
Multiple federal, state, and local
partner agencies contributed to the
success of the weekend event.
The Postal Plan is intended to minimize the initial surge on
public medication centers by using mail carriers to deliver
medical countermeasures door-to-door in a public health
emergency.
June 2012
Operation Medicine Delivery: Public Information
Activities
Director’s Chair
Jane Braun, Director of Emergency Preparedness
It’s a busy and productive time of year! Many items are
mentioned in more detail elsewhere in this newsletter, but here
are a few highlights-
Public Information Planning for Operation Medicine Delivery
(OMD) was primarily the responsibility of the Public
Information and Communications Committee (PICC), which
included representatives from the Minnesota Department of
Health (MDH), the U.S. Postal Service (USPS), the U.S.
Postal Inspection Service, participating local law enforcement
and public health agencies, letter carrier unions, and the U.S.
Centers for Disease Control and Prevention (CDC). Although
PICC had been active previously, it was reactivated on
November 21, 2011, to initiate planning for OMD.
Major activities of the PICC or participating PICC
organizations:
standard talking points for OMD participants
OMD brand name and identifiable logo created for
exercise
mailer/flyer distributed to all addresses in the OMD
Zip Codes
web materials posted by MDH, Hennepin County,
the City of Minneapolis and Ramsey County
web materials in multiple languages (flyers, videos,
recorded phone messages and other materials) posted
by ECHO for limited-English audiences
talking points for hotline volunteers
statewide news release from MDH on April 23
major media event on May 3 with participation by
MDH, USPS, ECHO, the U.S. Department of Health
and Human Services (DHHS) and others
media coordination during actual exercise
It was a very busy exercise, but with the help of so many, it
was extremely successful.
most of the regional emergency preparedness
meetings are going on, and we’ve tried to get several
OEP staff to attend these valuable partnership and
learning opportunities
we submitted the 660+ page Public Health
Emergency Preparedness/Hospital Preparedness
Program (PHEP/HPP) grant application, and we
await the grant award
the statewide communications exercise on April 30
tested a tremendous number of systems, methods, and
recipients, and resulted in many lessons learned and
corrections
the full-scale Postal Exercise in early May proved
that we could execute this novel approach to mass
dispensing if needed
OEP staff are working with MDH Financial
Management staff to get the grant awards out as
quickly as possible to avoid any gaps in funding
development of the HPP work plan is well underway
there have been at least three mass fatality exercises
in Minnesota in the past 10 days alone
our Resource Management and Partner
Communications Unit rolled out a new messaging
function on the Workspace that allows us to send
messages to exactly the people and locations who
need to receive them
we are moving along with preparing for our Strategic
National Stockpile State Technical Assistance
Review and our joint PHEP/HPP project officer site
visit, both coming up in September
In the next several months, we will be undertaking a couple of
initiatives to further the HPP/PHEP alignment, and to position
readiness in Minnesota to focus on priorities and deal with
fluctuations in funding. We plan to contract with an entity
familiar with the preparedness capabilities and state-level
planning to guide us through a process to look at strategic
planning, priority setting, and matching our structure with
functions. We also will be developing a combined HPP/PHEP
Senior Advisory Committee to provide high-level guidance to
MDH as we move forward with the alignment and our morefocused planning.
Thanks to you all for the great work you do to protect
Minnesotans.
Ready to Respond Newsletter
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Local Public Health Preparedness
Minnesota Radiation Emergency Volunteers
MREV members will be trained specifically for population
monitoring and reception center assistance in the event of a
major radiological incident. Because of the training and the
individual’s specific background, volunteers will be wellversed in the use of monitoring equipment and acute health
effects from radiation exposure.
Look for additional information and training opportunities in
the near future as MDH continues to build the MREV group.
A web link will be up soon. For additional information
contact Sherrie Flaherty, Supervisor, Radioactive Materials
Unit, at [email protected]
In the event of a major radiological incident, local radiation
response capabilities may be quickly overwhelmed by a large
number of citizens needing evaluation for contamination or
potential contamination. In order to address this need, the
Conference of Radiation Control Program Directors (CRCPD)
reached out to state and local agencies requesting assistance in
developing radiological professional volunteer corps by
offering ten grants. The Minnesota Department of Health
Radioactive Materials Unit is happy to announce it has
received one of these grants to establish and train a group of
radiation professionals able to assist in responding to a
radiological incident. The group, Minnesota Radiation
Emergency Volunteers (MREV), will support the needs
primarily of the reception centers during a radiological
incident through population monitoring and technical support.
MREV is currently recruiting and registering radiation
professionals from medical, academic, and industrial
backgrounds statewide. These professionals have highly
technical skills that will be invaluable to the emergency
response operations during a large-scale radiological incident
such as a nuclear power plant accident or a radiological
dispersal device incident.
In conjunction with Minnesota Responds, MREV will register
the volunteers through the Minnesota Reserve Corps system as
an affiliate. Working with other state and local agencies
Ready to Respond Newsletter
MDH Prepares for Vector-Borne Disease Season
After a mild winter and early spring thaw, the Minnesota
Department of Health is preparing for an active vector-borne
disease season. The mild winter means there will be a higher
number of insects in spring and summer, increasing the
potential of exposure to vector-borne diseases such as West
Nile virus (WNV) and the newly emerged tick-borne
Powassan virus (POWV). Other factors such as climate
change and global travel have the potential to bring new tick
and mosquito-borne disease threats to Minnesota as well. In
preparation, MN-Public Health Lab (MN-PHL) has developed
the capability to detect WNV, POWV and emerging threats
such as Eastern Equine Encephalitis (EEE), Western equine
encephalitis (WEE), Lacrosse Encephalitis (LAC), and St.
Louis encephalitis (SLE) through both molecular and
serologic methods. To monitor arboviral disease in
Minnesota, MDH-PHL along with their partners in the
Infectious Disease Epidemiology, Prevention and Control
(IDEPC) division work with hospitals to identify the cause.
Surveillance efforts in 2011 identified 11 confirmed cases due
to Powassan infection, 2 cases of WNV infection, one case of
LAC infection, and the first Minnesota case of Ross River
virus infection, a disease endemic to Australia.
Since vector control is one of the easiest ways to prevent
vector-borne disease, MDH-PHL also tests mosquitos
collected by the Metropolitan Mosquito Control District
(MMCD). If a mosquito harboring an arbovirus is found, then
mosquito control measures will be focused to areas from
which the mosquito was collected. Ticks are also tested for
the presence of Powassan virus and other agents of growing
concerns such as Anaplasma and Babesia.
The 2012 surveillance year will face many challenges. In
2011, western Wisconsin reported both human and animal
cases of EEE, and the virus has been found in mosquitos
collected in Minnesota. It is possible that Minnesota may
have human or animal EEE disease in 2012. All of this
increased activity is happening at a time of significant budget
limitations. Already tick testing activities have been
suspended this season and MDH-PHL is working to streamPage 3 of 6
line testing to save costs wherever possible to maintain its
capacity to detect these important agents and prevent human
disease.
Center for Domestic Preparedness
In February, 29 healthcare and public health emergency
preparedness representatives from the Central and West
Central Healthcare System Preparedness Program (HSPP)
regions attended a four-day “Framework for Healthcare
Emergency Management” course sponsored by the
Department of Homeland Security’s Federal Emergency
Management Agency in Anniston, Alabama. The Center for
Domestic Preparedness (CDP) develops and delivers advanced
training for emergency response providers, emergency
managers, and other government officials. The group as a
whole was able to acquire several healthcare emergency
preparedness resources, use critical thinking strategies to work
through emergency response/management scenarios, and gain
confidence in their ability to respond to disasters and events
that require such skills. Mary Lannegran, New River Medical
Center, and course participant shared “…the instructors
challenged us to use our new skills and compared that to how
we responded prior to the training…networking with other
facility members was the high point of this training.” Janice
Springer, American Red Cross said,”…I think we are better
prepared for our “Gone With the Wind” exercise in June…we
all have a deeper appreciation for the knowledge and talents of
our regional partners.”
This is the second time the Central HSPP region has sent a
group to CDP.
MIIC Vital Tool During Measles Outbreak in
2011
The Minnesota Immunization Information
Connection (MIIC) proved to be a vital public
health response tool during the 2011 measles
outbreak in Hennepin County
Ready to Respond Newsletter
The Minnesota Immunization Information Connection (MIIC),
Minnesota’s statewide immunization registry, was used by
organizations working directly with those exposed to track
each individual’s immune globulin and MMR vaccination
status. Resulting MIIC reports enabled targeted interventions
to be implemented for every individual identified to be at risk.
MIIC information was also available to clinics as they
followed up with those members of the larger population
recommended for vaccination by the Minnesota Department of
Health (MDH). Because staff working with the exposed
population had very limited resources, the availability of MIIC
allowed them to efficiently evaluate a large amount of data at
one time instead of looking up each individual.
As the outbreak continued, MDH expanded their
recommendations for MMR vaccination to members of the
larger population in Hennepin County. At this time MIIC was
used again by clinics to run reports so they could recall
patients who were overdue for MMR vaccine. Since most
sites stated that they were not able to easily extract this
information from their own Electronic Health Record (EHR),
MIIC become an invaluable tool so they could reach many
more people than would have otherwise been possible.
Use of the Minnesota Immunization Information
Connection (MIIC) by Children’s Hospitals and Clinics
during the 2011 measles outbreak in Hennepin County.
In 2011, Minnesota saw more cases of measles than any other
state in the U.S. It was a 15 year high for measles with 26
cases in the state, 21 of which were associated with the
outbreak in Hennepin County. Most of the cases were young
children, and Children’s Hospitals and Clinics admitted 14 of
the patients, one of whom spent 15 days on a ventilator in the
pediatric intensive care unit.
Because measles is so contagious, patients who were
infectious with measles but not yet diagnosed exposed over
788 other patients at Children’s in the Emergency Department
clinics and inpatient units. Because measles virus is tiny and
can stay aloft in the air, the exposure definition used at
Children’s includes sharing the same air space at the time the
patient is in the same unit plus two hours after the infectious
patient has left. In one of the busiest Emergency Rooms
around, the numbers of exposed added up quickly.
Using tools such as the electronic medical record (EMR) to
identify the exposed and the Minnesota Immunization
Information Connection (MIIC) to determine who is most
vulnerable based on their vaccine status, the Infection
Prevention team then promptly set out to triage and care for
the contacts. For each case, MIIC helped us quickly identify
their MMR vaccine history which in turn helped determine the
necessary plan for each patient.
At Children’s, MIIC is an integral part of our patient care and
is built directly into the EMR. In years past, we would have
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had to pull the patient chart, or call their primary clinic if
different from ours, or rely on the parent’s knowledge of their
child’s vaccine history – all problematic approaches in
attempting to get accurate vaccine information quickly. MIIC
was a reliable, quick, and very accurate source of information
when time was of the essence and is a tool we cannot imagine
caring for children without.
Healthcare System Preparedness
Pediatric “Tool Kit”
Children comprise approximately 24% of Minnesota’s
population, yet much of healthcare is geared towards the
delivery of care to adults. Most pediatric beds within
Minnesota are located in the Twin Cities and other more
populated areas leaving gaps in the ability to provide care in
Greater Minnesota. Even with the majority of pediatric beds
residing in the more populated areas, there are still times under
normal conditions when access to pediatric beds can be
strained. Considering times of crisis, disaster, and possible
medical events, the very real possibility exists that the
availability of pediatric beds and resources can be
dramatically limited.
The Healthcare System Preparedness Program (HSPP) along
with partners recognized that, in a large-scale medical
emergency, critically ill or injured children may present a
challenge to any hospital in the state. The HSPP program has
brought together pediatric experts and others to create a
“pediatric toolkit” that can be used for both short-term acute
care and more definitive management of pediatric patients
during such times.
Information in the toolkit will contain suggestions for
managing the medical and psychosocial sequelae of children
for medical professionals. The timeline for the development
of the toolkit is to have it done by the end of 2012 and to the
regions by 2013. This information then can be delivered to
the hospitals in the regions by the regional preparedness
programs and their partners. This document is intended to
serve as a resource template to augment the facilities’ current
Emergency Operations Plans and to help provide some
structure in planning for an incident that involves children.
Workspace Version Two
Out with the Old and In with the New
On April 17, 2012, the final parts of the new Workspace went
live: messaging and 24/7 contact report. That marked the end
of the old Workspace.
Workspace was built very quickly in 2002, in response to 9-11
and the influx of preparedness funding. In order to deploy it
faster, it was deployed before it was quite done, leading to
frustration that stayed with that version its entire life. Nonethe-less, Workspace version one served Minnesota’s
preparedness community faithfully for ten long years,
providing a platform for health alerts, general messages, and
the development of the public health directory. We salute its
contribution.
Workspace version two took over the bulk of the work from
version one in September 2010, providing a new password
protected environment to share documents and other
information. It currently houses approximately 3,500 people
into useful roles, groups and organizations, used for general
messages, notifications, and health alerts.
With this latest upgrade, Directory got several new features –
all users can now be searched by name, organization, group or
role.
There is also a 24/7 PDF report that is always populated with
the latest information. But the biggest change was in the new
Messaging system. Messages are now sent directly from the
new environment, and can be sent to a wider range of role,
group and organization combinations. Multi-device messages
can also now be sent right from the Workspace, which will
make that feature much easier to use.
If you have any questions about Workspace, or would like to
take advantage of some of these new features, don’t hesitate to
contact Workspace staff at [email protected] It’s here
for you.
PHEP and HPP Grant Status
Grant Application Update
Over fifty MDH staff contributed a combined 1000+ hours to
write, edit, determine activities and create a budget for the
new five year aligned PHEP and HPP grant (called HSPP in
Minnesota). In addition to the MDH staff time, the State
Community Health Services Advisory Committee (SCHSAC)
Ready to Respond Newsletter
Page 5 of 6
PHEP Oversight Group worked closely with OEP staff to
identify the list of grant duties for local health departments.
The HSPP program met with representatives from all eight
health regions and conducted a strategic planning workshop
that helped guide the development of the five year HSPP grant
activities. Together, the state and local representatives
contributed to the development of the 669 page application,
which was submitted to the CDC on May 1, 2012.
The federal government has begun the alignment of PHEP and
HPP. One of the first visible alignment activities is the
submission of one grant application for both programs.
Although it was one grant, activities were written separately
for each program based on the PHEP and HPP capabilities.
This was HSPP’s first year crafting their grant application
around capabilities, and PHEP’s second year. Activities for
both grants were reviewed to ensure consistency between the
two programs.
This year, more effort was placed on prioritizing the work
over the five year grant cycle to maximize staff time and grant
funds. In practical terms, this means that we don’t have to try
to address all eight HPP and 15 PHEP capabilities every year
at the same time. The CDC and ASPR encouraged states to
prioritize the capabilities and identify which capabilities they
would address in the first of the five year grant cycle, and
which ones would be addressed in the remaining four years.
PHEP is choosing to defer activities around mass care and
medical surge until later in the five year cycle and work
intensively on fatality management during the first year but
less during the remaining four years. The other PHEP and
HPP capabilities will move forward during the first year, but
additional work will occur to better prioritize the capabilities
in the remaining four years.
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
Jane Braun, MDH Office of Emergency Preparedness
Buddy Ferguson, MDH Communications Office
Maura Prescher, MDH Office of Emergency Preparedness
Sherrie Flaherty, MDH Environmental Health Division
Nathan Kendrick, MDH-Public Health Laboratory
Tina Neary, MDH Office of Emergency Preparedness
Kim Gulliver, Hennepin County Public Health
Don Sheldrew, MDH Office of Emergency Preparedness
Toby McAdams, MDH Office of Emergency Preparedness
Mickey Scullard, MDH Office of Emergency Preparedness
Upcoming Events
June 7
June 14
June 20/21
Footprint of Disasters; When the Dust Settles
HSPP Quarterly Meeting, St. Cloud
Operation Gone With the Wind
Ready to Respond Newsletter
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