January 2010 inside this issue:
Responding to novel H1N1 influenza ......................................1
What we accomplished together ..........................................1
Coping with success: Minnesota FluLine ............................2
Weekly H1N1 media briefings help manage intense interes2
Training 1400 MDH employeeson novel H1N1 influenza ..3
Partnerships in Action..........................................................3
Director’s Chair .......................................................................3
Technology and Preparedness..................................................4
Telework: Working from a remote location........................4
Good reasons to telework.................................................4
What is needed to telework? ............................................4
Telework resources ..........................................................4
Minnesota achieves PHIN certification in Direct Alerting ..4
MDH Division Preparedness News .........................................5
Research grant to focus on simulations and exercises for
educational effectiveness .....................................................5
Public health aspects of climate change...............................5
Public health lab receives new equipment for flu response .6
MN. TRAIN .........................................................................6
Contributors to this issue .........................................................7
Editorial Board.........................................................................7
Responding to novel H1N1 influenza
What we accomplished together
● Health care surge capacity
● Public communication
● Public health partner communication
An incredible amount of work was accomplished. Yet, many
may say that the greatest accomplishment was the partnerships
fostered throughout the process.
One of those partnerships was recently recognized during a
meeting at the department. This past summer, staff from
throughout the agency attended a three-day training session on
ICS 300: Intermediate ICS for Expanding Incidents at the
Bloomington Fire Station. There, Fire Chief Ulysses Seal used
his experience to relate a public health approach to ICS 300
and gave staff the tools needed to understand the structure and
role each person played in a response. Chief Seal taught three,
three-day sessions to MDH staff.
For this, Commissioner of Health Dr. Sanne Magnan
presented the Health Department’s first Big Heart for Public
Health award to Fire Chief Seal. The newly developed award
honors non-traditional public health partners.
Also joining in the recognition that day was Governor
Pawlenty who expressed his gratitude and applauded all
involved for their dedication and hard work during the H1N1
response, saying Minnesota takes comfort knowing the state
has a competent public health system.
It was April 29, 2009 when the Minnesota Department of
Health announced the first probable case of novel H1N1 in the
state. At the time there were so many unknowns. Looking
back, we will likely find a number of things we would do
differently or changes we plan to make in the future.
Still, we can be extremely proud of our accomplishments. In
the first influenza pandemic in over 40 years, local, state and
federal partners collaborated and put planning efforts to use.
Minnesota has been preparing for such an event since 1999,
but our plans and relationships have never been so tested. Now
that the pace has slowed, we have an opportunity to reflect and
apply the lessons learned on how we will work together in
future incidents.
To highlight our accomplishments, an H1N1 Response Update
(www.health.state.mn.us/divs/idepc/diseases/flu/basics/update.
pdf) summarized some of our successes:
● Antiviral distribution
● Vaccine distribution
● Disease surveillance
● Community mitigation
The Health Department held a meeting December 15 with incident
command staff, many of whom were trained by Chief Seal during a threeday ICS 300 course. Left: Minnesota Department of Health Commissioner,
Dr. Sanne Magnan, City of Bloomington Fire Chief, Ulysses Seal and
Governor Tim Pawlenty.
Based on our experiences over the past eight months (both the
good and the not so good), we should note how much we
accomplished together and carry forward the lessons for the
next incident that comes our way.
January 2010
Coping with success:
Minnesota FluLine
Weekly H1N1 media briefings help manage
intense interest
The Minnesota FluLine, the first hotline of its type in the
United States, drew immediate and overwhelming attention in
October when it opened. Free publicity proved so effective
and public interest was so high that the line was initially
swamped with calls. This required some public relations with
media and prompted the re-evaluation of advertizing plans,
enabling money earmarked for FluLine billboards to be
redirected to other flu-related public information needs.
Managing intense news media interest during any disease
outbreak is no small task. When the outbreak involves the first
pandemic influenza in more than 40 years, the task becomes
monumental.
The FluLine, launched October 21, 2009, is a statewide
telephone number where people with symptoms of novel
H1N1 influenza A can get medical help. Callers are connected
with a FluLine nurse or a nurse at a triage line operated by
their own provider networks or health plans. The nurses
evaluate health concerns of callers and discuss treatment
options using consistent criteria to determine the appropriate
treatment for each person. People with limited English skills
are connected to interpreters. As of January 5, 2010, a total of
26,368 calls have been answered.
Publicizing the hotline statewide initially seemed like a job for
billboards. Costs and locations were studied; an ad was
designed. Then, a news release about the FluLine was carried
by radio, television and newspapers cross Minnesota and in
neighboring states. Web sites and Facebook pages belonging
to universities, school systems, cities, counties, state elected
officials, hospital associations and clinics posted it; various
organizations distributed wallet cards advertizing it. And
people paid attention.
The resulting surge of calls temporarily overwhelmed the
hotline and created long wait times the first few days, making
it clear billboards would be overkill. Some reporters criticized
the delays, ignoring the number of people being served and
initially dismissing that the FluLine was something new that
might have some kinks that needed smoothing. These issues
were addressed by MDH officials during a news conference,
and FluLine operations improved with experience. Subsequent
anecdotal evidence from callers to the FluLine indicated
satisfaction with the service.
As the second wave of the H1N1 outbreak began to wane, the
FluLine call volume dropped. Radio and TV public service
announcements (PSAs) were launched to remind people they
could call the FluLine if they had symptoms. These PSAs may
prove helpful if a third wave of H1N1 arrives. Meanwhile, the
FluLine continues to provide service to dozens of callers daily.
Ready to Respond Newsletter
At the height of the first wave of H1N1 last spring, the MDH
Communications Office received dozens of media calls every
day. It was a challenge to triage all of the calls, track down
answers to the wide range of questions, and coordinate
accurate, timely and consistent responses.
Although the call volume dropped off somewhat over the
summer months, it dramatically picked up again when the
second wave arrived in the fall. Calls were especially plentiful
on Wednesday afternoons, after the department published new
weekly H1N1 statistics on its Web site. The media wanted
more detail on school absenteeism, hospitalizations, deaths,
vaccine availability, calls to the FluLine and more. And they
needed a “voice” to quote in their stories. This ended up being
very time consuming, not only for the Communications
Office, but for the MDH subject matter experts who served as
spokespersons for the department.
After spending too many hours on three consecutive
Wednesday afternoons responding to individual media
requests, the H1N1 Incident Command Team (which includes
a public information officer from the Communications Office)
decided to try a new strategy. It would conduct media
briefings every Wednesday afternoon after the new statistics
were published. Media were invited to come to MDH or
participate by phone to get the latest information and have
their questions answered.
One major advantage of this approach was the ability to
address all of the questions in a shorter period of time. MDH
officials were able to address the media’s questions in about
30 to 45 minutes, instead of spending all afternoon conducting
individual interviews. Another advantage was that MDH
officials were able to deliver a consistent message to all
participating media at the same time. A third advantage was
that the briefings demonstrated the department’s commitment
to be as open and transparent as possible about H1N1 in
Minnesota.
Conducting regular media briefings during a prolonged event
is not exactly a new strategy. It has been used effectively to
communicate with the media during various emergency
situations, ranging from forest fires to floods to environmental
mishaps. MDH’s use of media briefings during the H1N1
pandemic has proven to be very effective. It will remain an
important tool in the toolkit for future public health
emergencies.
Page 2 of 7
Training 1400 MDH employees about novel H1N1
influenza
In the summer of 2009, the Minnesota Department of Health
(MDH) initiated an intense planning process in preparation to
respond to a moderate- to - severe novel H1N1 influenza
pandemic in the fall. The goal was to train all MDH staff
about H1N1 in a very short time.
A work group of MDH staff was convened and weighed the
varying education and training needs of 1400 staff, balanced
against their regular workloads. The work group drafted the
H1N1 Training Plan and submitted it for approval. The plan
was approved.
Three key messages were identified:
1. Prepare to be ready to work
2. Complete training based on your response role
3. Manage and track your training through MN.TRAIN
The H1N1 Training Plan accelerated the completion of several
courses (e.g., ICS 300) that appeared in the 2009 MDH
Readiness Training Plan. All MDH staff were expected to
complete a one-hour course, H1N1 101 Overview. The course
provided a basic level of awareness about H1N1 influenza,
described MDH’s response role, and explained the
expectations of MDH staff in the H1N1 response. The course
was offered live twice and broadcast to all MDH building
locations, and a recorded version was available. The
instructors included MDH leadership (e.g., Commissioner of
Health, Director of Emergency Preparedness and the MDH
Behavioral Health Coordinator).
An evaluation process for the H1N1 101 Overview course used
an online link to a short anonymous survey. A total of 1221
MDH staff completed either the live or recorded course; 505
(41%) evaluations were received. The majority of responses
indicated increased knowledge after completing the course
(74% to 98%, an increase of 24%). Respondents were asked if
their understanding of how MDH is preparing to respond to
H1N1 increased; 81% said yes, and 88% of the respondents
indicated an understanding of their role as an MDH employee.
When asked if they knew how to reduce their and their
family’s risk of becoming infected with H1N1, 95% said yes.
Partnerships in Action
This last year has been stressful with the introduction of novel
H1N1 influenza. None of us would have weathered this
nearly as successfully as we did without strengthening old and
developing new partnerships as we continue to work with
H1N1. These partnerships occurred at all levels, from the
federal government, state and local agencies, and community
organizations. While challenges and trying times occurred,
each entity did its best during this time of uncertainty and new
challenges.
Ready to Respond Newsletter
One entity is Open Cities Health Center (OCHC), a non-profit
community healthcare clinic, whose mission is to see every
patient who walks through the door, regardless of the patient's
socio-economic status, ethnic make-up or racial affiliation.
Open Cities functions as a safety net and has always served
everyone, from individuals and families who are uninsured,
not working or those who cannot afford health care, to those
who have health insurance.
Open Cities, located in St. Paul, provided H1N1 information
to its clients. The clinic held 18 H1N1 vaccine clinics at
churches, community centers, cultural centers, adult
educational facilities, alternative educational facilities,
housing shelters, public housing, holiday events, and at Open
Cities Health Center. From November 30 - December 30,
2009, OCHC vaccinated over 3000 individuals and families in
Ramsey and Hennepin counties.
Early in the onset of H1N1, the MDH held an informational
forum for leaders and medical providers in geographic areas
that are typically underserved. After this meeting, a
partnership was developed with Open Cities and others that
lead to a highly successful vaccination campaign. The Open
Cities staff thanks all public and private organizations for
working hard to provide access, serve as an informational
source, and maintain the health of those in need.
Director’s Chair
The New Year brings many opportunities to reinvent yourself,
your work, your goals and plans. This newsletter highlights a
sample of the lessons learned from novel H1N1 influenza
response and points to several changes that will be made at
many levels as a result of our experience. The 2009-2010
response is the first response involving public health,
healthcare and related partners in a statewide sustained
response to a health issue. Many of our plans worked, some
of them can be revised based on experience, and others were
needed that hadn’t been developed before (for example, the
Minnesota FluLine – described elsewhere in this newsletter).
MDH staff are starting an internal review of our H1N1
response to better prepare for other types of hazards. 2010
will see many meetings, discussions and plans about keeping
what worked and adjusting what needs improvements. We
have gained a solid foundation for using our response tools
and plans. The training project in partnership with the
University of Minnesota will showcase new methods of
practicing response skills.
You will see some changes to the Office of Emergency
Preparedness staff. Bonnie Holz, Supervisor of the Local
Public Health Preparedness Planning Unit, “retired” and
returned in a part-time role. She will assist with evaluation of
the local health department Tiers Project and the H1N1
response, and provide technical assistance to resource typing
and planning for emergency and continuity incidents. We’re
glad she will bring her considerable expertise and experience
to these activities.
Page 3 of 7
Pat Tommet, Healthcare System Preparedness Program
Supervisor, is retiring the end of January. Pat has been the
driving force and visionary leader of the preparedness and
response planning for hospitals and other parts of the
healthcare program since the program started in 2002. She
managed the federal grant to MDH, oversaw the regional
program contracts, served on the national executive committee
for the program, and led numerous projects to develop the
tiered healthcare response used in Minnesota. Those plans,
relationships and efforts paid off most recently in the NW
Spring flood response and the H1N1 influenza response. We
will miss her greatly and wish her a happy and busy
retirement.
Access documents to do your work: A Virtual Private
Network (VPN) provides a secure method to obtain
documents from a remote location. If your organization
doesn’t provide VPN, print the documents you need and save
them to a removable device, such as a flash drive. If the
documents contain non-public information (e.g., home phone
numbers, patient identifying information or response plans),
the removable device must be encrypted. Check with your IT
staff to make sure you have an encrypted device.
Aggie Leitheiser, Director of Emergency Preparedness
Good communication: The Telework Research Network
(http://undress4success.com) reports that while 75% of
managers say they trust their employees, a third would like to
see them, just to be sure.
Develop a communication plan for remote working prior to
the need. Check-in with your team. How can you be reached?
Is your calendar up to date? During an emergency when staff
are working remotely, it’s very important to keep track of
where people are and what they might need to do their work.
Technology and Preparedness
Telework: Working from a remote location
Good reasons to telework
1. The work you do--responding to the emergency--is best
done if you’re closer to the event, at a Multi-Agency
Coordination Center (MACC) or an MDH District Office.
2.
You can’t get to your office. This scenario is familiar if
you’ve been involved in Continuity of Operations
Planning (COOP).
3.
Weather makes travel hazardous. Adeel Lari from the
Hubert H Humphrey Institute of Public Affairs says “it
doesn’t particularly make sense to send out whole
workforces during blizzards or to drive on ice rinks when
we have options like telework.” http://www.eworkplacemn.com/Questions/eWorkPlaceBlog/tabid/289/PostID/26/
Default.aspx
4.
Telework, or telecommuting, can reduce our carbon
footprint and road congestion. “If 2,700 Minnesotans
teleworked just one day per week, more than 1,000 rush
hour trips on Twin Cities’ highways each day would be
eliminated,” said Nick Thompson from the Minnesota
Department of Transportation. http://www.dot.state.mn.us
/newsrels/09/06/01-telework.html
5.
And it goes without saying, after the last eight months,
working remotely decreases the spread of infection.
What is needed to telework?
All these procedures should be tested prior to your need to
work remotely.
Access to e-mail: Many organizations provide access to their
in-house e-mail from the Web. If you have an Internet
connection, a device that accesses the Web (computer or
mobile device like a Blackberry), the URL and your password,
you can receive and send emails and manage your calendar.
Ready to Respond Newsletter
Phone: Forward your work phone to a phone number at your
remote location or cell phone, or access your voice mail
remotely throughout the day.
Do you have success stories or lessons learned about telework
to share in this newsletter? Contact
[email protected]
Telework resources
eWorkPlace (http://www.eworkplace-mn.com/) is a
Minnesota-state sponsored program for Twin Cities metro area
employees.
Minnesota achieves PHIN certification in Direct
Alerting
By using the Public Health Information Network (PHIN)
standards and security criteria, the Minnesota Department of
Health has achieved certification in Direct Alerting from the
Centers for Disease Control and Prevention (CDC). Direct
Alerting is part of the Health Alert Network (HAN) system.
This Web-based communication tool enables public health
staff, tribal governments, healthcare providers, emergency
workers, and others working to protect the public, to exchange
information during a disease outbreak, environmental threat,
natural disaster or act of terrorism.
In the official notice of certification, Glenn Moore, CDC’s
Associate Director of Technology, wrote “Minnesota's efforts
and willingness to successfully complete this task is
noteworthy, and should be commended. While the PHIN
Certification Criteria validated your ability
to send direct alerts to the CDC using PHIN standards and
security, this accomplishment has broader implications. It
demonstrates Minnesota’s commitment to implement PHIN
standards and practices that improve your overall capacity to
exchange electronic public health information across
jurisdictional lines, a benefit during both emergency and dayto-day operations.”
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Changes to the Minnesota Ready to Respond
Conference
Grant activities will enhance training for MDH staff assigned
to command and general roles in the MDH Department
Operations Center (DOC). The first year focused on
developing metrics, identifying comparison and treatment
teams, and developing exercise scenarios.
The Minnesota Department of Health (MDH) and the
University of Minnesota (U of M) will not be hosting a
statewide Ready to Respond Conference this year.
Feedback from past conference participants, as well as
surveys of local public health and healthcare partners
conducted last year, indicated MDH and the U of M could
best serve public health and healthcare preparedness
conference needs by supporting regional and local
conference and educational efforts.
Three “teams” are participating in this research project: the
treatment group, the didactic only group, and the control
group. Participants have been randomly assigned to a team.
During the exercises, emphasis will focus on team dynamics
rather than individual performance. In late February, 2010, the
first training exercises, using an ice storm scenario, will be
conducted
The MDH will be contacting regional Public Health
Preparedness Coordinators (PHPC’s) and Regional Health
Preparedness Coordinators (RHPC’s) to determine how to
best support those efforts.
The grant provides MDH with an opportunity to be an
instrumental part of research that may change and advance the
field of emergency preparedness. The MDH is the first health
department in the U.S. to use this unique type of team training.
Public health aspects of climate change
MDH Division Preparedness News
Research grant to focus on simulations and
exercises for educational effectiveness
The Minnesota Department of Health (MDH) is a subrecipient of a grant awarded to the University of Minnesota
School of Public Health (UMN-SPH) from the CDC-funded
Preparedness and Emergency Response Research Centers
(PERRCs). The MDH and the UMN-SPH are working on a
project called University of Minnesota: Simulations and
Exercises for Educational Effectiveness (U-SEEE) -- Creating
High Reliability Teams for Public Health Preparedness.
Grant activities are in year two of the five year funding.
Extreme heat and extreme weather,
vector-borne diseases,
and vulnerable populations…
how prepared is public health to respond to these aspects of
climate change?
The Minnesota Department of Health (MDH) is developing
information and training regarding these topics. The
Association of State and Territorial Health Officials (ASTHO)
awarded a one-year, $90,000 grant to five states, including
Minnesota, to improve their capacity to respond to public
health impacts from climate change. ASTHO grant funds
support these MDH activities:
•
Development of a Web-based training for public health
officials to better understand and respond to climate
change impacts on public health in Minnesota. The
training will focus on:
o Basic information on climate change and its effects
on public health in Minnesota
o Extreme heat and extreme weather
o Vector-borne diseases (e.g., immigrating mosquitoes
and ticks)
o Vulnerable populations
•
Creation of a Web-based survey to assess the current
knowledge and attitudes of MDH staff regarding potential
impacts on public health from climate change.
•
Establishment of Web pages regarding climate change
information for use by public health officials.
•
Assembly of key personnel to develop a five-year
strategic plan for the agency to address public health
aspects of climate change.
The premise of the grant is to adapt simulation training that
has been used successfully in the airline industry to train pilots
and in the hospital setting to train obstetrics teams of health
professionals. The training, called in situ simulation, will help
identify best practices used to improve and sustain high-level
performance of the public health preparedness system
“The major goals of this study are to identify best practices
(e.g., design, usability, modalities) for the conduct of training
and to identify metrics for measuring the dimensions of
effectiveness and efficiency in improving and sustaining highlevel performance of the public health preparedness system.
“The theme underlying this application is highly significant to
the practice of public health systems research, and the project
will significantly add to the evidence base in public health,
especially in the area of exercises and training. This is a highly
innovative application because of the proposed
methodological approaches and also because of the
substantive area of research on training in public health
settings.” (Source: CDC grant reviewers’ summary
comments.)
Ready to Respond Newsletter
Page 5 of 7
The MDH contacted local public health representatives and
other state agency partners to collaborate. Support from
entities listed below demonstrates broad interest in improving
public health readiness to respond to climate change.
•
Hennepin County Human Services and Public Health
Department –Epidemiology and Environmental Health
•
•
•
•
•
•
Local Public Health Association of Minnesota
Minneapolis Department of Health and Family Support
Minnesota Office of Energy Security
Minnesota Pollution Control Agency
St. Paul – Ramsey County Department of Public Health
University of Minnesota Extension Service
For more information, contact Lynne Markus at 651-201-4498
or [email protected]
The bench-top ABI 7500 Fast Dx instrument amplifies and
detects nucleic acid in microliter volumes from 96 samples
simultaneously.
Public health lab receives new equipment for flu
response
The MDH Public Health Laboratory (MDH-PHL) received
five new molecular diagnostic instruments as part of the
response to the 2009 novel H1N1 influenza virus pandemic.
During the initial surge of H1N1 cases and again during the
second wave later in the year, MDH-PHL faced a potentially
overwhelming number of clinical specimens for molecular
testing for viral RNA by a process called Real-time
Polymerase Chain Reaction (RT-PCR).
The first step in RT-PCR is a labor-intensive process that
extracts viral nucleic acid from each specimen. In order to
expand testing capacity to meet the increased demand, MDHPHL first validated the Corbett X-tractor Gene automated
extraction instrument, and then purchased a MagNA Pure LC
instrument. Both of these instruments robotically extract
nucleic acid from 32 to 96 samples in about two hours.
The Molecular Epidemiology and Emergency Preparedness
and Response Units of MDH-PHL also initially shared a
single ABI 7500 Fast Dx, an RT-PCR instrument that
amplifies and detects viral nucleic acid in 96 samples at once.
Using Federal response funds, MDH-PHL acquired three
additional RT-PCR instruments, effectively quadrupling its
molecular testing capacity for flu specimens. The lab also
obtained a Qiagen Q24 pyrosequencer that can rapidly identify
the sequence of a small fragment of nucleic acid to detect
genetic mutations that make the virus resistant to oseltamivir
(Tamiflu®).
As the pandemic subsides, the Molecular Epidemiology and
Emergency Preparedness and Response sections plan to
expand use of the pyrosequencer to include screening for drug
resistance in TB and identification of Brucellae. Altogether,
the five instruments represent a significant expansion in the
ability of MDH-PHL to respond to future outbreaks of
influenza and other diseases.
Ready to Respond Newsletter
The MagNA Pure LC extraction robot reduces turn-around
time and expands MDH-PHL processing capacity.
MN. TRAIN
Did You Know? you can e-mail your questions about
MN.TRAIN to a monitored MN.TRAIN e-mail account?
[email protected] is a general e-mail address that is
monitored by several trained staff in the Office of Emergency
Preparedness. They can help you with your MN.TRAIN
questions or needs. Log in to MN.TRAIN at
http://mn.train.org to see an announcement with more
information.
Page 6 of 7
Contributors to this issue
Aggie Leitheiser, Office of Emergency Preparedness
Don Sheldrew, Office of Emergency Preparedness
Janice Maine, Office of Emergency Preparedness
Jessica Herrgott, Infectious Disease, Epidemiology,
Prevention and Control
Jody Braaten, Office of Emergency Preparedness
John Steiger, Communications Office
Judy Marchetti, Office of Emergency Preparedness
Lynne Markus, Environmental Health
Marcia Robért, Office of Emergency Preparedness
Mickey Scullard, Office of Emergency Preparedness
Myrlah Olson, Office of Emergency Preparedness
Nancy Torner, Communications Office
Nathan Kendrick, Public Health Laboratory
Roxanne Tisdale, Open Cities Health Center
Samantha Herrington, Office of Emergency Preparedness
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
Cindy Borgen, Office of Emergency Preparedness
Jessica Herrgott, 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
Office of Emergency Preparedness
625 North Robert Street
P.O. Box 64975
St. Paul, MN, 55164-0975
Phone: 651- 201-5700
www.health.state.mn.us
Ready to Respond Newsletter
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