October 2011 Inside this issue:
This is not a test: MDH COOP Activated ................................1
Director’s Chair .......................................................................2
The Preparedness Mindset ...................................................2
Local Public Health Preparedness............................................2
Rare Inhalation Anthrax Investigation .................................2
Mobile Medical Unit at Mahnomen .....................................3
Cooking Safely for a Crowd ................................................4
Healthcare System Preparedness .............................................4
Great Lakes Healthcare Partnership (GLHP) .......................4
MN.TRAIN Tidbit ...................................................................5
Retirement News ......................................................................5
Myrlah Olson Retires ...........................................................5
Office of Emergency Preparedness Reorganization .................5
OEP Staff Restructuring ......................................................5
Upcoming Events .....................................................................6
Editorial Board .........................................................................6
This is not a test: MDH COOP Activated
At the end of July, the
Minnesota Department of
Health (MDH) was notified by
the property management
company for its Golden Rule
facility in downtown St. Paul
that major repairs were needed
to the building’s power supply.
Though planned for over a
Golden Rule Building
weekend, the 36 hours of
repairs had a wide range of impacts on department employees,
services and infrastructure, including:
All power to the building would be shut off for the
duration of the repairs.
Electrical devices also had to be off for the duration of the
repairs, including all telecommunications, information
technology and heating, ventilating and cooling systems.
Some Web-based and other information sharing services
would not be available to customers over the weekend.
Employees would not be allowed to re-enter the building
until repairs were completed except in emergencies.
With only two weeks to plan for the impacts of the repairs,
MDH activated an incident management system to coordinate
its activities, with a division director from the Golden Rule
facility serving as incident manager. The incident
management team established both overall and specific
operational period objectives to guide department activities for
each phase of the repair work. For the duration of the event,
the team worked to keep employees informed, to plan and
implement facility and technology shutdown procedures, and
to determine contingencies if the work was not finished as
scheduled.
Fortunately, repairs were completed on time and department
technology and facility systems were recovered before
employees returned to work on Monday morning. Critical
department services provided by the Golden Rule facility were
maintained through all phases of the event and plans were
completed for emergency access to department assets in the
event public health emergency services needed to be activated.
An incident management system was successfully used for the
first time to coordinate a facility closure and information
technology shut down and additional employees were exposed
to the use of this system. The department shared messages
tailored to supervisors and to employees, including a checklist
to guide employees on steps they needed to take prior to the
start of the repair work and contingency plans for employees
to follow if the repair work was not completed on schedule.
As a result of this event, the department will strengthen its
continuity of operations plan and improve its training and
exercise program. Plans will be revised to capture the lessons
learned and planning outputs, including additional standard
operating procedures and equipment instructions, and
documentation on service, facility and technology
interdependencies. Many of the employees activated to serve
in an incident management team role had limited experience in
these roles and others who assisted in planning also had
limited experience working within an incident management
system. Additional training and exercises are needed for all
employees to clarify their roles and responsibilities during a
business interruption, using this event as a real world example.
Commissioner of Health
Incident Manager
Safety Officer
Information Officer
Operations Section
Planning Section
The public health
services provided
by the facility.
Facility and Office of
Emergency Preparedness
representatives.
Logistics Section
Facility, information technology
and human resources
representatives.
October 2011
Director’s Chair
Jane Braun, Director of Emergency Preparedness
The Preparedness Mindset
This past July, I spent
some time in Tanzania
crossing “African photo
safari” off my bucket list.
The vacation provided a
reminder that
preparedness ingrained
into your thoughts can
come in pretty handy.
budget changes at all levels, we are all challenged by the need
to set priorities and determine what we can no longer do.
That’s one reason the new PHEP grant duties include a
requirement for LHDs and tribes to make at least one
presentation each year to a community group that’s not a usual
preparedness partner.
It’s my hope that increased awareness of what we do may lead
to increased appreciation of its value.
Thanks for all you do for Minnesota. Despite going through
tough times, all of our agencies have a lot of smart people,
good experience, and many resources to keep doing well.
Local Public Health Preparedness
Rare Inhalation Anthrax Investigation
The source of the most terrifying 20
seconds of my life
We were having lunch at a breathtaking picnic site
overlooking the Tarangire River, and our guides mentioned
the propensity for baboons to try to steal food and cameras
from tourists, especially women. As we were eating, a few
random thoughts went through my head: Wow, look at the
family of elephants crossing the river. I wonder how long this
chicken has been out. A column of zebras is coming down to
drink! What might I do if a large aggressive male baboon
with incisors larger than a lion’s attacked our group? What
IS the filling in this sandwich anyway? This is one of the most
beautiful places, I’ve ever been in my life… Well, when a
large aggressive baboon suddenly charged at me [note to
self—don’t sit on the end of the table nearest the wild
animals], I had about a half second to react, and I used the
plan I’d formulated in my head. No one knows what would
have happened if I had not distracted the baboon, but had the
baboon fight that ensued been on our picnic table rather than
on the ground, it couldn’t have been good. (You know it’s
bad if your guide screams.) Something that struck me was a
comment from the person across the table from me: “I froze
and you acted.” The simple everyday lessons learned from
preparedness partners – take a quick look around for exits and
AEDs, scan for hazards, think about possible actions, watch
what’s going on—become a part of daily activity and can
really make a difference.
OEP has recently experienced the retirements of Myrlah
Olson, Bonnie Holz, Jo-Ann Champagne, and Steve Shakman.
Their combined experience, leadership, and good humor
cannot be measured. The end of PHER funding in July also
marked the painful departure of three valued OEP staff – Matti
Gurney, Sara Radjenovich, and Allyson Sheldrew—and IT
standout Mark Doerr has moved on. None of these eight will
be replaced. We appreciate your patience as we shift duties
among OEP staff, and as it just plain takes us longer to
respond to your concerns. As we adapt to the new realities of
Ready to Respond Newsletter
The Minnesota Department of Health has been a national
leader in public health for many years. The capacity built
through the availability of PHEP funding played an important
role in the success of the rapid detection, identification,
treatment, investigation, and information sharing for an
unusual naturally-occurring case of anthrax identified in a
traveler to Minnesota in August 2011.
The MDH Public Health Lab (PHL) and Infectious Disease
Epidemiology Prevention & Control (IDEPC) Divisions
responded to a very rare case of inhalational anthrax. The
patient was vacationing through several western states and fell
gravely ill toward the end of the trip in rural Minnesota. This
individual was admitted to a local hospital with a diagnosis of
chemical pneumonitis. On Friday, August 5, 2011 the hospital
laboratory determined that bacillus was growing in the
patient’s blood culture, and in accordance with emergency
response protocol, immediately sent a culture to the MDH
Public Health Laboratory (PHL) to rule out Bacillus anthracis.
On Saturday, August 6, MDH PHL confirmed Bacillus
anthracis.
Multiple notifications of the positive laboratory result were
immediately sent to the Centers for Disease Control and
Prevention (CDC) emergency operations center and
Bioterrorism staff, the MDH field epidemiologist, the hospital,
and the local public health agency. On Sunday, August 7 th due
to the patient’s declining health, the individual was airlifted to
a metro hospital. Later that evening this individual was
ventilated and Anthrax Immune Globulin (AIG) was ordered
from the CDC. On Monday, August 8th, the AIG and two
CDC staff arrived to assist the clinical team with the AIG
protocol.
MDH-PHL worked closely with the Minnesota National
Guard 55th Civil Support Team to screen numerous samples
taken from the patient’s rental car and personal effects. After
extensive testing, MDH-PHL did not recover anthrax from
any of the environmental samples.
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Because anthrax can be used as
a bioterrorism agent, the Federal
Bureau of Investigation (FBI)
was called to investigate. It was
quickly determined there was no
evidence to suggest it was a
criminal or terrorist act;
however, MDH epidemiologists
Culture plate of bacillus anthracis
isolated from a rare case of
continued to look for potential
inhalation anthrax
sources of exposure. They
found no suspicious or confirmed cases of animal and human
anthrax prior to the onset of this patient’s illness. While it is
not possible to pinpoint the exact source of infection, all
evidence suggests that the individual had been exposed to
naturally occurring anthrax in the environment.
The individual had multiple exposures to soil and animal
remains. Cases of anthrax in hooved animals occur yearly in
parts of the country including the Midwest and West as far
south as Texas, and up north to the Canadian border. What
makes this case interesting is that the exposure was likely
environmental, as opposed to prior cases in which exposures
were attributed to working with hides, drum skins, etc.
This unusual case highlights the strong relationship that
MDH-PHL has with hospital laboratories throughout the state
as part of the Laboratory Response Network (LRN). As
Sentinel laboratories in the LRN, most hospital-based and
some clinic-based diagnostic laboratories in the Minnesota
Laboratory System (MLS) serve as the front line of detection
and reporting of biothreat agents, such as B. anthracis,
following an outbreak or 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, the LRN Reference laboratory for
Minnesota. MDH-PHL also provides training for clinical
laboratories in these methods. Laboratorians at the hospital
that referred the isolate to MDH-PHL specifically credited this
training for enabling them to rapidly and accurately perform
the LRN Sentinel protocols and refer the isolate to MDH-PHL
for identification.
One thing that MDH contemplated was whether we should
inform the media. “My first inclination was that we didn’t
need to go to the public because it was an isolated case and the
anthrax was naturally occurring,” John Stieger, MDH
communications director said. This view soon changed.
As more and more agencies got involved, it seemed likely that
word about the case would circulate.
“Anthrax is a scary thing that conjures up all sorts of bad
images for people,” Stieger said. “We were afraid that pretty
quickly someone would call media asking questions, not just
about the anthrax case, but about why we didn’t alert the
public.”
Ready to Respond Newsletter
MDH ultimately decided to go public to prevent accusations
of secrecy, which can damage credibility even when
unfounded, and to advise people that they were safe.
“Because we went out proactively right away and explained
exactly what we knew, the media and the public response was
rather muted,” Stieger said.
We are all challenged by the current situation for maintaining
the capacity to respond quickly and appropriately, as we deal
with staff turnover, expiration of reagents, obsolescence of
equipment, and the need to conduct frequent exercises to
refine our plans and keep our staff trained. This investigation
clearly illustrates the critical role played by development and
sustainment of infrastructure within the public health system.
We all plan for a variety of emergencies and hope that when
the time comes we will be ready to respond. Saving a man’s
life is ample evidence that our investment of time and effort in
planning and collaboration with our local, state, and federal
partners does pay off. We were fortunate that this scare of
anthrax was not related to bioterrorism, and we need
continued strong support of all the PHEP capabilities to ensure
we are able to quickly make a determination and mount an
appropriate response. We are happy to report that the patient
in this article has recovered and has been reunited with family.
Mobile Medical Unit at Mahnomen
MMU…MFMT…MRC
other than acronyms that
begin with M, what do
these things have in
common? The MMU is
the Mobile Medical
Unit, the state-owned
semi-trailer that can
provide sophisticated
Mobile Medical Unit in
Mahnomen
medical resources when
needed during a disaster
response. An MFMT is a Mobile Field Medical Team, a
trained group of responders who can travel to areas in need of
medical assistance and set up shop to provide care. The MRC
is the Medical Reserve Corps, Minnesota’s version of the
federal Emergency System for Advance Registration of
Volunteer Health Professionals, a program to recruit, train,
credential, and mobilize health care volunteers to answer calls
for help.
On September 29 and 30 at the Shooting Star Casino in
Mahnomen, all three of these entities gathered to explore the
ways each interacts with the others, to raise awareness of the
capabilities of each, to recruit new members, and to exercise
the request procedures for these state assets. Members of the
Northwest-West Central Regional Trauma Advisory
Committee (WESTAC) met to learn about the MMU and
MFMT capabilities. They also had the chance to volunteer for
training that will allow them to work with the resources if and
when they are deployed to deliver disaster care. Becoming a
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member of a Mobile Field Medical Team is the primary way
people can be assigned to work with the MMU.
However, MFMTs can work independently from the MMU.
Central Region’s MFMT has been in place for several years.
A team of approximately 25 people, coordinated through
CentraCare Hospital in St. Cloud, responded in the 2009 flood
in the Fargo-Moorhead area, providing care to long-term care
residents threatened in the Red River Valley. The recent event
in Mahnomen raised awareness of the team’s capabilities and
recruited new members.
Another group of regional partners discussed in a tabletop
exercise the request procedures for these state assets. Using
the community of Crookston and Riverview Health in a
tornado scenario, Rob Carlson from MDH facilitated a
discussion with local, regional and state representatives.
On September 30, in conjunction with the annual Greater
Northwest Emergency Medical Services conference,
representatives from the MMU were available to meet and talk
with conference goers. Understanding what assets are
available to local communities, knowing how to request and
use those assets, and understanding the community
expectations for these assets, are key components to effective
disaster response. More than 200 people had the opportunity
to see the MMU and learn about volunteer programs during
the two days in Mahnomen.
Cooking Safely for a Crowd
Emergency preparedness and response includes preventing
foodborne illness when feeding large groups of people.
Foodborne illness is caused by consuming food or beverages
that are contaminated by disease-causing microbes or
pathogens. Licensed kitchens and trained food service
workers help prevent foodborne disease outbreaks. Food
safety training is also important for volunteers who plan to
volunteer at feeding areas set up during and after emergencies
and at local events.
A useful safety resource is the Cooking Safely for a Crowd
Workshop and Video Conference that was conducted by the
University of Minnesota Extension Service and MDH at 25
sites for almost 700 individuals, at no charge, on October 18,
2011. The workshop included these topics:
Planning to manage a large volume of food
Foodborne illness: causes, concerns and past outbreaks at
community events
Personal hygiene and handwashing
Times and temperatures
Purchasing, storing, and preparing foods safely
Heating and reheating; cooling, holding and serving safe
food
Managing leftovers
New legal requirements for unlicensed kitchens effective
August 1, 2011
Ready to Respond Newsletter
The October 18th Cooking Safely for a Crowd training is
available for three months at this video archive:
mms://stream2.video.state.mn.us/MDHVC/cookingsafelyforac
rowd101811.wmv.
The University of Minnesota Extension Service’s Food Safety
Resource Sheet and participant Q & A and Workshop
presentations are on the MDH Web site at:
http://www.health.state.mn.us/divs/eh/food/pwdu/fsp/.
There are many other sources of food safety training in
Minnesota. University of Minnesota Extension Food Safety
Educators and many others teach ServSafe and Food Manager
Certification courses. Food Manager Certification Training
courses are listed on this MDH Web site:
http://www.health.state.mn.us/divs/eh/food/fmc_training/inde
x.cfm.
To find other classes, Google “Serv Safe” or refer to the
University Extention website at:
http://www1.extension.umn.edu/food-safety/.
Healthcare System Preparedness
Great Lakes Healthcare Partnership (GLHP)
The Minnesota Department of Health actively participates in
the Great Lakes Healthcare Partnership (GLHP), a coalition of
FEMA Region V states (Illinois, Indiana, Michigan,
Minnesota, Ohio and Wisconsin) and the city of Chicago. The
GLHP was established in 2005 to promote multi-state and
intra-regional cooperation to identify healthcare surge issues
that could quickly overwhelm existing state resources during
an incident and to develop operational plans and resource
databases to address those issues.
Interstate coordination is necessary because few states possess
the full range of resources needed to respond to all types of
emergencies. The capability to get resources to areas of
greatest need, hazard impacts that do not respect state
boundaries, and the mobile workforce in the United States
raise the probability that the onset of certain delayed hazards
(e.g., biological, chemical, or radiological agents) may
actually manifest more prominently in victims who live
outside the area of immediate impact.
Interstate medical surge planning provides a mechanism to
leverage limited medical resources and expertise during
situations when the ability of health care organizations to
manage patients requiring unusual or very specialized medical
evaluation and care is overwhelmed.
In disaster situations, the planning work of the GLHP will
facilitate interstate mutual aid within Region V through the
Emergency Management Assistance Compact (EMAC).
Recent initiatives undertaken by the GLHP have focused on
developing protocols for burn surge planning, pediatric surge
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planning, interstate medical communications, healthcare
resource identification and typing, and healthcare emergency
management training
MN.TRAIN Tidbit
New information to all those who are Medical Reserve Corps
(MRC) Unit Leaders: MRC-TRAIN is currently creating
organizational accounts for each local MRC unit. This is being
done to improve administrative access. These new MRCTRAIN Unit organizational accounts are meant to be used by
MRC Unit leaders for managing their local MRC Unit
training. In order to ensure that only the appropriate unit
leaders for each unit obtain access to the organizational
account, the MRC-TRAIN Support Desk will be emailing Unit
Leaders listed on the Medical Reserve Corps website with
account access information. If you require account access
prior to receiving an email, please contact the MRC-TRAIN
Support Desk at [email protected] or 202-218-4426. If
you have any questions, please email ([email protected])
or call (202-218-4426) the MRC-TRAIN Support Desk.
Retirement News
Myrlah concluded she hopes that preparedness will dig a little
deeper on the public health implications of climate change.
She also hopes that we can focus on community resilience
because it is consistent with a philosophy of building
preparedness and response capabilities at a local level,
something Minnesota is very good at.
Myrlah, we salute you for a job well done! Best wishes on
your retirement.
Office of Emergency Preparedness
Reorganization
OEP Staff Restructuring
Myrlah Olson Retires
Are you a techie geek? Not at all!
The next few years staff kept track of which counties
responded to Health Alerts by checking off their names on a
piece of paper. “I still remember how thrilled I was when we
got our first 100 percent response rate.” Unfortunately, a
better system was needed. The Workspace was the first task
charged to Myrlah’s team in OEP. Workspace was released in
2003, just in time to help with the smallpox response. In
2010, OEP released Workspace version 2, which has proved to
be more effective and efficient system.
Myrlah Olson retired from
OEP on October 21, 2011.
Before Myrlah left, Toby
McAdams had the privilege
of sitting down with her and
learning some of the history
she leaves behind while
serving as the Partner
Alerting & Communication
Team Supervisor.
Myrlah started her career as a nurse and later completed her
MPH. In 1996, she came to MDH to work on the Got Your
Shots! Provider Guide project. Toby asked Myrlah if she was
the “techie geek type?” Her response was “Not at all.” But, in
1999, MDH got a small preparedness grant to work on the
Health Alert Network (Focus Area E) and Myrlah stepped up
to the challenge.
With present and future budget cuts, new federal grant
guidelines and Myrlah’s retirement, OEP Management Team
was faced with the difficult decision to reorganize OEP staff.
Jane Braun, Director of Emergency Preparedness, indicated
that “change is hard and there’s always anxiety.”
Restructuring can be a painful process, but it is necessary so
that we are able to continue with planning, preparing,
exercising and building capability to ensure that Minnesota is
Ready to Respond to public health emergencies.
The reorganization process began in February and included
several meetings and input from OEP staff. In addition to the
new unit structure, OEP is implementing a number of
cross-functional teams to ensure that we work more closely
together to increase efficiency, and avoid gaps and overlaps.
The new OEP organizational chart can be found on page 6.
Myrlah remembers the first Health Alert sent. “It was the
early winter of 2000, some family planning clinics on the East
coast were receiving letters with white powder along with
threats. The first Health Alert was an email sent to our
contacts at local health departments. We asked them to
forward the information to family planning clinics in their
areas. We managed a fifty percent response rate to that first
email – after about a week!”
Ready to Respond Newsletter
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OEP Organizational Chart
Effective October 24, 2011
Editorial Board
Organization
Services Unit
Jane Braun
Director
Grants
Management Unit
Tina Firkus
Kim Vicars
Arden Fritz
Vacant
Deputy Director
Elisabeth Atherly
Carolyn Hoel
Esther Ashley
Education,
Exercises &
Planning Unit
Healthcare System
Preparedness Unit
Local Public Health
Preparedness Unit
Resource
Management &
Partner
Communications
Cheryl Kroeber
Nancy Carlson
Barbara Lundgren
Janice Maine
Bill Schmidt
Mickey Scullard
Jane Tangwall
David Wulff
Judy Marchetti
Rob Carlson
Angie Koch
Tammy Peterson
Deb Radi
Don Sheldrew
Kirsti Taipale
John Urbach
Brooke Wodziak
John Hick
Cindy Borgen
Marilyn Cluka
Steven Dwine
Geri Maki
Karen Moser
Tina Neary
Jacob Owens
Kristin Windschitl
Dan Berg
Judy Bifulk
Jody Kane
Toby McAdams
Maura Prescher
Mike Ring
Megan Thompson
Kevin Sell
Italics=Consultant
Upcoming Events
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
Judy Marchetti, Office of Emergency Preparedness
Jane Braun, Office of Emergency Preparedness
Deborah Durkin, Environmental Health
Lynne Markus, Environmental Health
John Stieger, Communications Office
Nancy Torner, Communications Office
Nathan Kendrick, Public Health Laboratory
Toby McAdams, Office of Emergency Preparedness
Tina Firkus, Office of Emergency Preparedness
Risk Assessment Web Ex – Mid January
PHEP RALLY:
Registration is now open for the “PHEP Rally.” The Planning
Committee has worked hard to create a Grantee Workshop
that will address grant duties in a practical way and provide
statewide consistency about the new direction in public health
emergency preparedness.
You can find more detailed registration information and the
preliminary agenda on Workspace.
The PHEP Rally Planning Committee conists of local health
department representatives, local elected official, and MDH
staff.
GAME DAY:
December 2, 2011
GAME TIME: 9:00 a.m. – 3:30 p.m.
HOME FIELD: River’s Edge Convention Center
Opportunity Suite
10 4th Avenue South
St. Cloud, MN 56301
REGISTRATION: Use MN.TRAIN (Course ID 1030537)
Ready to Respond Newsletter
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