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January 2011 Inside this issue:
MDH addresses climate change from a public health
perspective ...........................................................................1
Hazards of snow-covered meter...........................................1
Director’s Chair .......................................................................2
MDH Division Preparedness News .........................................2
Postal Plan describes method to deliver antibiotics within
48 hours ...............................................................................2
Exercises help MDH staff to work in the Department
Operations Center (DOC) ....................................................3
Collaboration earns competitive award to study states’
ability to respond to emerging infectious diseases...............3
MDH hosts laboratory training for potential agents of
bioterrorism..........................................................................4
Healthcare System Preparedness .............................................4
Healthcare decisions: shelter, relocate or evacuate? ............4
MN Psychological First Aid video wins national award......5
Communications Quick Tips ...................................................5
Have I got news for you.......................................................5
Conference Notes.....................................................................5
Conference addressed community shelters during
emergencies .........................................................................5
Editorial Board.........................................................................6
MDH addresses climate change from a public
health perspective
According to scientific consensus (i.e., all major scientific
bodies in the United States whose members’ expertise bears
directly on climate change), the global climate is changing
with rising surface temperatures, melting ice and snow, rising
sea levels, and increasing climate variability. These global
phenomena are expected to cause wide fluctuations in climate
variables (e.g., temperature, precipitation) at regional and local
levels in the U.S. In the coming years, Minnesota will most
likely undergo significant climate change that will have
important implications for sustaining and improving the
public’s health. These changes may have both acute and longterm public health impacts, such as increases in morbidity and
mortality associated with extreme heat events (i.e., heat
waves), extreme weather events (e.g., floods, tornadoes,
hurricanes), air pollution, and vector-borne and other
infectious diseases.
Recent funding from the Centers for Disease Control and
Prevention (CDC) and the Association of State and Territorial
Health Officials (ASTHO) supports the Minnesota
Department of Health’s (MDH) efforts to address climate
change and its health impacts. The MDH is facilitating the
following activities to prepare for and adapt to climate change:
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Implement health impact assessments (HIAs) on
comprehensive plans and policies that effect climate
change and public health
Identify and map vulnerable populations to extreme heat
events. (MDH is pilot testing vulnerability maps with the
City of Minneapolis.)
Develop a local public health strategic plan for adapting
to climate change. (MDH is working with the State
Community Health Services Advisory Committee
(SCHSAC) to develop the plan)
Develop training for state and local public health agencies
on air and water quality issues related to public health and
climate change
Collaborate with other agencies to develop effective
measures and coordinate activities to support the public’s
health in the face of climate change
Additional information on climate change and health impact
assessments can be found at these MDH websites:
Climate Change:
http://www.health.state.mn.us/divs/climatechange/
Health Impact Assessments:
http://www.health.state.mn.us/divs/hia/
Hazards of snow-covered meter
Paula Bastian, legal secretary at the MDH Executive Office,
shared this event in December 2010.
“Last night, my neighbor’s gas line going into their house
blew a hole because the meter was deeply buried in snow and
ice. (I told them last week to dig it out; if only they had
listened.) I got home from work, smelled gas and literally
heard it leaking. I determined it was coming from my next
door neighbor’s meter. It was very scary, but due to training
and information shared at MDH, I knew what to do.
“I instructed my daughter to get out of the house, go down the
street to where she couldn’t smell the gas any longer and call
911 from her cell phone. I went to my neighbor’s house,
pounded on the front door, and yelled, “It’s Paula. This is
serious. Get out of your house now! Gas leak. Do not use your
phone or turn any switches on or off. Get out now. Hurry!
“My neighbor grabbed her eight-month old granddaughter,
and she and her husband fled the house. I had blankets ready
for them. The fire department came, assessed the situation,
said to stay out of the house, but it was OK to be in my house,
so they all came over where we waited. Xcel Energy replaced
the line and the meter, and told them they were very lucky.”
January 2011
Director’s Chair
MDH Division Preparedness News
Aggie Leitheiser, Director of Emergency Preparedness
Postal Plan describes method to deliver antibiotics
within 48 hours
Have you had your Spring 2011 pre-flood planning meeting
yet? Current predictions show considerable impact across
Minnesota, even in places that are not usually affected by
spring flooding. MDH staff met in early February to review
our response plans, informational resources, and staffing
needs. While we can all hope for the best, we need to be
preparing for the worst.
We are anxiously awaiting the new CDC grant guidance
which will shape the next five years of public health
preparedness planning. While we haven’t seen the drafts yet,
we have been told they are based on the Target Capabilities
and will include more performance measurement. We expect
to see the documents by mid-March.
The State Community Health Services Advisory Committee
(SCHSAC) Emergency Preparedness Workgroup has been
busy reviewing the input from the various response activities
from H1N1, including the Policy Summit and regional
hotwashes. They developed several policy statements in
response to some of the recommendations and will next turn
their attention to measurement or accreditation, structure, and
funding issues. The final report of the Workgroup will be
presented to the May 20 SCHSAC meeting.
February starts our internal MDH meetings to review
individual Division or Office preparedness and response
issues, including continuity of operations plans. These
meetings provide a means of understanding the priority
activities and issues of each program and support area in the
Department and how to include those issues in our planning
and resource preparation.
January turned out to be the “month of audits”. The
Healthcare System Preparedness Program hosted auditors for a
full week, the FEMA related auditors were here for a day
reviewing use of those funds, the Office of the Inspector
General is reviewing our radiation preparedness efforts, and
the annual Office of the State Legislator audit began. While
we all have many things in place, we are learning about
tracking and reporting that could be improved.
On February 18, 2004, the Secretary of Health and Human
Services, the Secretary of Homeland Security, and the
Postmaster General signed a Memorandum of Agreement
(MOA) to make resources of the United States Postal Service
(USPS) available to help dispense oral antibiotics in response
to a biological terrorism incident of widespread anthrax
exposure. The offer of USPS assistance is called the Postal
Plan. The Postal Plan is now part of a medical
countermeasure deliverable in Presidential Executive Order
13527.
The Postal Plan describes the distribution procedures to
deliver oral antibiotics using the United States Postal Service
during an anthrax incident and is one method of antibiotic
delivery intended to reach the general population within 48
hours of the decision to do so. Achieving the 48 hour goal is
critical to save lives. In conjunction with local emergency
response plans, the Postal Plan will augment, not replace, the
dispensing of oral antibiotics via Mass Dispensing Sites also
known as Points of Dispensing (PODS). Mass Dispensing
Sites involve the distribution of medicine to the public.
The Minnesota Department of Health, in conjunction with
local public health, local law enforcement, Department of
Health and Human Services and the USPS have completed
strategic and operation level postal planning. Minnesota is the
first state in the United States to have implemented its Postal
Plan.
On January 12, 2011 the Minnesota Department of Health
hosted a tabletop exercise. The Department of Health and
Human Services facilitated the exercise which included
participants from federal, state, and local agencies. The 125
participants and observers were from public health, law
enforcement, the United States Postal Service, and emergency
management. The tabletop exercise was the initial step to
refine the plan before moving into a full-scale exercise at a
later date.
I want to take just a minute to thank our retiring editor of this
newsletter – Marcia Robért, who developed the concept and
made the newsletter a resource for MDH staff and partners.
Best wishes for a rewarding and relaxing retirement.
.
In an aerosolized anthrax attack, under the Postal Plan, the United States
Postal Carriers would deliver one bottle of doxycycline per household in
identified zip codes within the Twin Cities Metropolitan Area.
Ready to Respond Newsletter
Page 2 of 6
Exercises help MDH staff to work in the
Department Operations Center (DOC)
Exercises at the Minnesota Department of Health (MDH)
provide opportunities to review plans and procedures, and
allow staff to gain experience in managing information,
coordinating resources and documenting actions during an
incident response. In the spring of 2010, the MDH initiated a
more structured exercise program for MDH staff assigned to
Command and General (C&G) roles in the DOC. This is part
of the regular MDH exercise program, as well as the U-SEEE
research grant (see next column).
In the past two years, real responses (e.g., floods, H1N1,
Republican National Convention) took a lot of staff time,
resulting in a lack of time for routine exercises. While many
C&G staff were involved in the responses, staff turnover and
staff new to the area of preparedness had limited experiences
with the Incident Command System (ICS), preparedness/
response policies and procedures, and working in the DOC.
Since May 2010, most staff with C&G roles have participated
in six exercises. The exercises last one hour, with ½ hour prior
to the exercise to get acclimated to the DOC and ½ hour post
exercise to participate in a Hotwash. The exercises provide
time for staff to strengthen their understanding of their ICS
roles, improve DOC procedures, and increase their knowledge
of MDH response capabilities and resources.
Each exercise team includes:
 Incident Manager and Deputy Incident Manager
 Public Information Officer
 Safety Officer
 Liaison and Assistant Liaison Officer
 Finance and Administration Chief
 Logistics and Deputy Logistics Chief
 Operations and Deputy Operations Chief
 Planning and Deputy Planning Chief
 Situation, Documentation, and Resource Unit Leads
Additional MDH staff (two evaluators and four exercise
controllers) help make the exercise work for the participants.
The exercise scenarios focused on tornadoes, floods, winter
storm and a major political event.
While staff were initially reluctant to exercise so often, they
now appreciate having this increased opportunity to exercise.
Many state they are less nervous when they arrive at the DOC.
Participants are able to focus on their roles within a response.
The frequent, regular exercising allows exercise staff to
rapidly apply improvements to the DOC setting, templates,
and prioritize policy and procedure changes that are needed.
Ready to Respond Newsletter
These exercises are part of an applied research grant from the
Centers for Disease Control and Prevention, MDH and the
University of Minnesota: Simulations and Exercises for
Educational Effectiveness. In its third year, the grant examines
factors that improve team functioning, response capacity and
capability.
Collaboration earns competitive award to study
states’ ability to respond to emerging infectious
diseases
Staff from the Minnesota Department of Health (MDH) and
University of Minnesota (U of M) were recently awarded a
highly competitive grant from the Robert Wood Johnson
Foundation (RWJF) Public Health Law Research Project, an
achievement to note as only 13 of the 154 applications were
ultimately funded.
The proposal itself is a collaborative approach between former
Commissioner of Health and current University of Minnesota
Public Health Law Professor Anne Barry, and Department of
Health Deputy State Epidemiologist Richard Danila. The two
are co-investigators of the project which seeks to examine the
strength of each state’s infectious disease reporting laws and
whether differences in those laws impact the state’s ability to
respond to an emerging disease threat. The 2009 H1N1
influenza pandemic will be used as a case study.
Specifically, the project will look at the following:
1.
What is the state or territory’s ability to mandate the
reporting of a rapidly emerging infectious disease?
2.
Is the reporting centralized or regionalized/localized?
3.
What data did each state or territory collect on novel
H1N1 influenza in each wave of the pandemic?
4.
To what extent did different reporting laws/structures
affect states’ ability to collect data for novel H1N1
influenza cases?
5.
Did the data collected during the novel H1N1 influenza
pandemic impact public health recommendations (statespecific and national)?
The project is planned to begin with a three-month pilot study
of six states. The overall project is funded for the next 2 1/2
years. Additional staff involved with this project are Ellen
Laine, Franci Livingston and Kathy Como-Sabetti from MDH
and Kelli Johnson from the U of M.
Page 3 of 6
MDH hosts laboratory training for potential
agents of bioterrorism
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As part of its ongoing program of bioterrorism preparedness,
the MDH Public Health Laboratory (MDH-PHL) recently
provided training for clinical laboratories in methods for
ruling out or referring potential agents of bioterrorism. Rapid
and accurate identification of these agents enables timely
patient treatment and public health responses. As Sentinel
laboratories in the Laboratory Response Network (LRN),
clinical diagnostic laboratories in the Minnesota Laboratory
System (MLS) serve as the front line of detection and
reporting of these agents following a covert biological
weapons attack. LRN Sentinel laboratories use standardized
protocols to rule out unusual isolates from microbiological
cultures, or refer these isolates to MDH-PHL, which acts as
the LRN Reference laboratory for Minnesota.
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In November 2010, the MDH-PHL provided Sentinel training
for 47 laboratory professionals representing 27 Sentinel
laboratories in every region of Minnesota. The training
consisted of a day-long, hands-on workshop held at the MDH
Training Laboratory in St. Paul. During the workshop,
participants first learned about the history, risk factors, culture
characteristics, and LRN Sentinel level laboratory methods for
seven potential bioterrorism agents, as well as basic biosafety
principles for handling them safely in the laboratory. Agentspecific information included anthrax, plague, and botulism,
among several others. Next, participants performed Sentinel
level testing on a series of “unknown” cultures to either rule
out a potential bioterrorism agent, or refer it to MDH-PHL for
further testing.
This was the fifth LRN Sentinel training provided by MDHPHL since 2004. Although there are multiple training
opportunities available for LRN Sentinel laboratories, the
hands-on workshop offered by MDH-PHL is consistently in
high demand among Minnesota’s Sentinel laboratories. The
workshop format allows laboratory professionals to work with
real culture isolates and gain practical bench-level
microbiology skills that can applied in their own laboratories.
MDH-PHL also plans to offer the LRN Sentinel training again
in 2011.
Healthcare System Preparedness
Healthcare decisions: shelter, relocate or
evacuate?
The evacuations of hospitals and long-term care facilities
during the Red River flooding in 2009 prompted MDH to
convene an evacuation workgroup to look at decision-making
and process of evacuations. This group identified several
problems:
Ready to Respond Newsletter
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Lack of standardized decision-making regarding
evacuation
Inconsistent and confusing terminology (evacuation may
mean a unit within a facility or the entire facility)
Lack of standardized processes and tagging/tracking of
patients
Inconsistency regarding the types and quantity of
information sent with the patient
Differences between hospital and long-term care settings
Through several meetings and drafts, the workgroup
developed the MDH Emergency Sheltering, Relocation and
Evacuation for Healthcare Facilities, which hopefully will
address these issues. The draft document was prepared in
2010 and includes the base annex (designed to be customized
by facilities), educational materials, informational sheets,
support documents, a training matrix, and PowerPoint
presentations for training.
The document provides consistency in terminology, defines
differences between sheltering in place, relocation and
evacuation. Included as part of the template is a ‘decision tree’
which describes a process of deciding what decision to make,
if needed. Main themes of the template include terminology
and definitions, decision making, evacuation initiation, triage,
staging, tracking, and transportation.
This document is intended to be used by health care facilities,
(hospitals or skilled nursing facilities). We are proud of the
collaboration in creating this template. In April, Mark Lappe
(Hennepin County Medical Center) and Don Sheldrew (MDH)
will describe the template at the Joint Commission Emergency
Preparedness Conference in Washington D.C.
Understanding when to do what, who has authority to make
decisions, and understanding roles and responsibilities allows
for a smoother transition during crisis and ultimately whether
or not patients, residents, and staff remain safe.
MN.
DID YOU KNOW …you can use MN.TRAIN to help
promote and track registrations for your conference,
exercise or any trainings you host? The Minnesota
Department of Health manages the MN.TRAIN system and
encourages you to list your training, conference or exercise in
the MN.TRAIN system. You can track registrations, measure
learners’ increase in knowledge, and share conference
materials all in one place: http://mn.train.org/. Local health
departments and healthcare institutions are using MN.TRAIN
more and more every day. For help in posting your event in
MN.TRAIN, contact [email protected] or call the
Office of Emergency Preparedness at 651-201-5700.
Page 4 of 6
MN Psychological First Aid video wins national
award
The National Association of Telecommunications Officers and
Advisors (NATOA) honored winners of the 25th Annual
Government Programming Awards during a gala event in
September 2010 at The Washington Court Hotel in
Washington, DC. The awards program honors excellence in
broadcast, cable, multimedia and electronic programming
produced by local government agencies.
This year, NATOA received more than 730 entries submitted
by local governments in 26 states across the country and
Canada. The Minnesota Psychological First Aid Just-In-Time
training video won first place in the Instruction/Training
Category. The City of Minneapolis Media Department
submitted the video.
The video is available at:
mms://stream2.video.state.mn.us/mdh/psyfirstaid.wmv
Contact Nancy Carlson ([email protected] or 651201-5707) for more information.
meeting void creates an opportunity to promote news stories to
reporters, even on topics that might never get covered.
Media must fill broadcast news time slots every day of the
year; newspapers need to fill their pages nearly as often. Only
skeletal news teams work holidays, and editors hold special
meetings ahead of time to learn from reporters what stories
they can count on in advance. Then they calculate how much
time and space they must fill on a given day.
This puts pressure on journalists to work ahead to ensure more
than enough material is ready to run if needed. This explains
why you might find reporters on the other end of your
telephone close to a public holiday, either fishing for stories or
trying to make news out of otherwise non-newsy material.
Instead, you might reach out to reporters around holidays with
story ideas they can research prior to and use during the lull.
The pitch must have legitimate news value, and a routine topic
needs a new twist. For instance, you might try promoting
stockpiling emergency supplies by leading with the length of
time some Minnesota homes went without electric service
during the previous storm or winter and offering tips on what
supplies to stock and actions to take to get through such an
event. Besides informing the public, the goodwill this might
generate with journalists may benefit you in the future.
Conference Notes
Conference addressed community shelters during
emergencies
More than 170 people attended the conference Community
Emergency Sheltering 2011 at the Duluth Entertainment
Convention Center (DECC) on January 25 and 26 to discuss
the requirements to provide community shelters in response to
emergencies. The Northland Chapter of the American Red
Cross (ARC), the Community Health Information
Collaborative and the DECC sponsored the two-day
conference.
Communications Quick Tips
Have I got news for you
Check the availability around major holidays of any
workplace room where meetings are held. Most likely the
room’s appointment calendar is empty because many people
are on vacation and others are busy picking up the slack. Since
discussions are held and decisions are made in meeting rooms,
journalists often look for news and feature stories. The
Ready to Respond Newsletter
Subject matter experts from multiple disciplines addressed
planners, responders and volunteers about various issues
associated with providing safe, efficient, well-organized
community shelters. Amy Green from the national American
Red Cross announced a change in policy that now combines
at-risk populations and general populations into the same
shelters. Previously the groups were served in separate
shelters.
Kevin Leuer from the Minnesota Department of Homeland
Security and Emergency Management told conference
attendees about an HSEM initiative to create plans across the
state to provide shelter for up to 5000 people for 10 days in the
Metro area, and up to 3000 people for 10 days in the five
HSEM regions in greater Minnesota.
Page 5 of 6
Other speakers discussed when to open a shelter, the history of
sheltering in the Twin Ports, functional needs planning, and
federal assets that can be used to augment local capabilities
when setting up community shelters. Dr. Gary Goerman,
DVM, provided insight into the growing interest in including
the needs of pets when planning for emergency shelters. As is
often the case at conferences devoted to disaster response, the
theme of building strong relationships with response partners
was emphasized several times during the event.
Editorial Board
Editorial Board members include representatives from MDH
divisions that receive preparedness funds.
Aggie Leitheiser, Director of Emergency Preparedness
Marcia Robért, Editor, Office of Emergency Preparedness
Jessica Southwell, Infectious Disease, Epidemiology,
Prevention and 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
Contributors to this issue
Aggie Leitheiser, Office of Emergency Preparedness
Dawn Ginzl, Office of Emergency Preparedness
Don Sheldrew, Office of Emergency Preparedness
Elizabeth (Jane) Tangwall, Office of Emergency Preparedness
Janice Maine, Office of Emergency Preparedness
Jessica Southwell, Infectious Disease, Epidemiology,
Prevention and Control
Kristin Raab, Environmental Health
Lance Bernard, Environmental Health
Marcia Robért, Office of Emergency Preparedness
Mickey Scullard, Office of Emergency Preparedness
Nancy Carlson, Office of Emergency Preparedness
Nancy Torner, Communications Office
Nathan Kendrick, Public Health Laboratory
Paula Bastian, Executive Office
Richard Danila, Infectious Disease, Epidemiology, Prevention
and Control
Samantha Morgan, Office of Emergency Preparedness
Steve Dwine, Office of Emergency Preparedness
Ready to Respond Newsletter
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