April 2010 inside this issue:
H1N1 influenza update ............................................................1
New role calls for new resources .........................................1
Improvements for pandemic planning and response emerge
in review process .................................................................2
Partnerships impact planning and response .........................3
Director’s Chair .......................................................................3
MDH Division Preparedness News .........................................4
MDH has new Department Operations Center ....................4
U-SEEE grant uses innovative training methods for DOC
staff ......................................................................................4
MnWARN—Utilities Helping Utilities ...............................5
Public health lab newborn screening section involved in
multi-state collaboration ......................................................5
MN.TRAIN Did You Know? …..........................................5
New Training: Protecting Our Food System from
Intentional Attack ................................................................5
Upcoming Events.....................................................................6
Disaster Madness: Staying Calm in Chaos ..........................6
Contributors to this issue .........................................................6
Communications Quick Tips ...................................................6
It happens every spring, and we don’t mean baseball..........6
Editorial Board.........................................................................6
H1N1 influenza update
This article appeared in the March 10, 2010 newsletter
published by NACCHO (National Association of County &
City Health Officials).
New role calls for new resources
During the H1N1 pandemic, the Centers for Disease Control
and Prevention (CDC) and health departments were tasked
with distributing vaccine to where it was needed most. In spite
of this daunting task, and faced with delays in vaccine
manufacturing and delivery, efficient systems of storage and
distribution were put in place.
The Wright County Department of Health in Minnesota was
successful in finding efficient means of both storing and
distributing the vaccine using all resources available, from
computer spreadsheets to a closed-down jail facility. By
communicating with clinics and hospitals, and using
spreadsheets to keep a running tally of distribution numbers,
health officials there were able to distribute doses of vaccine
equally among the 117,000 county residents.
In September of last year, questions arose over exactly how
the vaccine distribution would work. At the same time, the
distribution itself got off to a slow start with early projections
and estimates uncovered as overly optimistic.
“We wanted to have equal distribution and therefore equal
availability of vaccine in our county, so we chose to have all
vaccine delivered to us and redistributed by us,” said Carol
Schefers, director of Wright County Public Health. “This was
an awesome task that we had never planned to take on, and
many lessons were learned.”
Perhaps most remarkably, since the health department had not
been required to store vaccine before, they had to use a closeddown jail facility as a storage unit. A fridge in the jail was
turned back on in order to serve as a storage place, and the
facility was kept on lock down so that only local health
officials could access the vaccine.
Collaborating to Overcome Problems
Like other health departments across the country, Wright
County was affected by delays in vaccine delivery, but
officials were able to resolve and communicate the issue.
After receiving an unexpectedly low number of vaccine doses
for their first mass clinics, the LHD immediately shifted focus.
Working with the area’s hospitals and clinics, they agreed to
offer the vaccine only to pregnant women and small children.
Information about the clinics was relayed through a public
hotline and the LHD’s Web site.
A positive outcome of the health department’s efforts has been
the banding together of stakeholders in the county’s health
industry. The county’s hospitals, clinics and public health
officials worked together closely during the pivotal moments
of the decision-making process.
“The ties that we forged with the hospitals and clinics will
keep us together in any kind of a medical emergency,” said
Schefers. “We had strong ties before this emergency, but this
only strengthened them. We all listened to each other and
there was not competition for vaccine—just a goal to keep our
community healthy.”
In some ways, the H1N1 pandemic was a trial of public health
preparedness and response capabilities. Recently, there has
been some bemoaning over how slowly vaccine was
distributed when demand was high. During a conference at the
Center for Biosecurity at the University of Pittsburgh Medical
School, Dr. Nicole Lurie shared her regret over the delays in
delivery of the H1N1 vaccine last fall.
April 2010
"The truth is for this pandemic we had about the longest
warning we might ever have for a potential biothreat," said Dr.
Nicole Lurie, who heads preparedness at the Health and
Human Services Department (HHS). "And yet we all lament
how long it took for vaccine to be made.”
The government is investing in more advanced vaccine
production technology in order to avoid such delays in any
future public health emergencies.
Improvements for pandemic planning and
response emerge in review process
Different types of process improvement have traditionally
been used in organizational development to identify, analyze
and improve the way of doing things in order to be more
successful.
Similarly, the Homeland Security Exercise and Evaluation
Program (HSEEP) is a national standard used for all
exercises and improvement planning. The advantage of this
program is that it can be used to not only improve upon a
response after an exercise, but after a real incident as well
(e.g., novel H1N1 influenza pandemic).
In order to meet the requirements for federal funds, the
Minnesota Department of Health (MDH) applies the
standardized methodology and terminology when compiling
the After Action Report and Improvement Plan (AAR/IP) after
an exercise or incident. Read more about the two components
here. (Link: https://hseep.dhs.gov/pages/1001_HSEEP5.aspx)
MDH AAR/IP update
Gathering the detail needed to accurately capture what
happened during a response, especially one with a prolonged
duration such as a pandemic, proves to be quite a process. To
meet the HSEEP standard, the AAR/IP needs to be completed
within 60 days after the end of an incident’s response. The
AAR/IP for the second wave covers the Department’s
response from June 11, 2009 to February 24, 2010.
To begin, MDH conducted a number of internal hotwashes,
both within the Incident Command Structure (ICS) Sections
and with all response staff. Next, a survey was sent to
Department employees and response partners. This
information was weighed as heavily as the feedback from the
internal hotwashes and was then categorized by capability and
reviewed in an AAR/IP conference. The raw comments
collected from the hotwashes and surveys are being heard and
reviewed closely as the final draft of the AAR/IP is written.
Once a task force has completed the draft AAR/IP, the report
and improvement plan recommendations will be presented to
an executive committee for approval. Staff then have 180 days
to complete and test the items identified in the improvement
plan (see timeline below). After all this, the AAR/IP process
for the H1N1 response will be complete.
At this point it is too soon to know exactly how the AAR/IP
will impact what MDH does during a pandemic response;
however, the information gathered and the process for
improving upon what we do is invaluable. Once the
Department has finalized the AAR/IP, a process for
distributing the report will be identified. How and when
exactly this will be done has not been determined, but the
process will be transparent and the report will be accessible to
the public.
Source of above image
https://hseep.dhs.gov/pages/1001_HSEEP7.aspx.
To learn more about the HSEEP process, visit the Homeland
Security Web site (http://hseep.dhs.gov) for details regarding
policy and guidance.
Homeland Security Exercise and Evaluation Program (HSEEP) Timeline
60 days
180 days
__________________________________________________________
Incident ends/
*Conference. IP recommendations
*IP actions completed
After-Action process
reviewed and corrective
and tested
begins one day after
actions assigned
*IP – Improvement Plan
Ready to Respond Newsletter
Page 2 of 6
Partnerships impact planning and response
Staff working on the Pan Flu Healthcare Collaborative Grant
developed methods to coordinate essential healthcare delivery
resources and to maintain delivery of essential services while
providing care for large numbers of influenza patients during a
pandemic. We are grateful for the contributions of both new
and existing partners who impacted several grant projects
described below.
Flu Centers provided a community resource for the
assessment, referral and treatment of people with influenzalike-illness (ILI). Flu Centers are considered a community
safety valve because they allow acute care facilities to care for
more critically ill patients during a pandemic. This past year,
many local public health agencies submitted outstanding plans
demonstrating strong partnerships between healthcare, local
public health, emergency medical services, emergency
management and other community agencies. During the fall
2009 H1N1 outbreak, six flu centers were activated to assess,
refer and treat people with ILI.
A new public-private partnership between the Minnesota
Department of Health and nurse lines contributed to the
success of the MN FluLine. This phone line was available
toll-free, 24 hours a day, seven days a week to insured and
uninsured residents of Minnesota. The nurse lines of health
plans and health systems worked together to provide this
phone service. Between October 21, 2009 and February 2010,
more than 20,000 people with ILI received telephone
assessment, treatment and/or referral to appropriate medical
care. Nurses spent 10-12 minutes with each symptomatic
caller providing information and self-care education. A total
of 392 prescriptions for antivirals were provided by phone.
Another project still in development is an “essential services
planning and reporting tool” for hospitals and other healthcare
agencies. This spreadsheet will facilitate the identification of
a provider’s essential services and the required staffing to
continue to provide those services during a pandemic. The
inspiration for this tool started with the sharing of projects by
other pan flu healthcare collaborative grant partners.
To learn more about the resources developed through the Pan
Flu Healthcare Collaborative Grant, visit
http://www.health.state.mn.us/oep/healthcare/flucenter/index.h
tml
Director’s Chair
Welcome to early spring in Minnesota! We are all grateful
that the predictions for severe flooding didn’t happen.
Although there was considerable flooding in many parts of the
state, we did not see the need for evacuations or the threats to
healthcare and other important resources that we saw in 2009.
While we did not need to respond to many issues, the lessons
learned from the 2009 floods and our H1N1 response helped
us be better prepared. We have more skills, tools, and
expertise to draw on.
The H1N1 pandemic outbreak appears to be over (at least for
now – some experts caution that it could come back in another
wave). Across the state, vaccination clinics and watching for
outbreaks continues. As described in an article in this
newsletter, attention now turns to capturing information about
the response in our individual and shared After Action Reports
and deciding on the contents of our Improvement Plans. I
have had the opportunity to attend several regional discussions
about the response and read the many pages of comments
from the on-line survey. Thanks to everyone who is helping
to review the response, provide thoughtful comments on what
was useful and what wasn’t and give advice on making our
system stronger. We look forward to working with you to
implement our improvements in the months ahead.
Our sincere appreciation as well for the many thoughtful
comments we received from our “weekly question.” Local
health departments and tribal governments provided us many
insights into daily operations, concerns, and ideas and we will
share some summaries from those responses in the near future.
I hope you are all able to take some time to enjoy our unusual
spring weather to rest and recover from the many hours of
response to H1N1 and more local incidents. While we can all
be grateful the pandemic was not more severe, we can be
proud of our increased capacity and capability we have gained
over this past year.
Nichole Beauchane, information systems specialist at
RiverView Health in Crookston MN, assisted with patient
registration.
Aggie Leitheiser, Director of Emergency Preparedness
April 2010
MDH Division Preparedness News
MDH has new Department Operations Center
The MDH DOC is activated for the efficient coordination of
information and resources that support MDH response and
recovery activities. During an emergency, staff working in the
DOC use the Incident Command System. Response duties are
assigned roles based on the MDH All-Hazards Plan. It’s
important for this room to have enough space for computers,
telephones, maps, white boards and supplies. In the fall of
2009, the MDH Department Operations Center was re-located
to a different area that has more space.
The DOC is outfitted with laptops, phones and other tools to help emergency
response staff do their work.
U-SEEE grant uses innovative training methods
for DOC staff
The University of Minnesota School of Public Health (UMNSPH) and the Minnesota Department of Health are proceeding
with year two activities of the grant University of Minnesota:
Simulations and Exercises for Educational Effectiveness
(U-SEEE) -- Creating High Reliability Teams for Public
Health Preparedness.
The Department Operations Center has ample wall space for displaying
planning tools. The Planning “P” is an important tool for Command and
General Staff. It sets the agenda for an operational period in the DOC.
On March 16 and 17, 2010, a Team Dynamics training was
held for MDH staff who have a role in the Department
Operations Center (DOC). Medical Teamwork Consultants,
LLC held the training for the didactic and treatment groups
within the study. The consultants are master trainers of the
Strategies and Tools to Enhance Performance and Patient
Safety (STEPPS) program given by the Agency for Healthcare
Research and Quality (AHRQ).
http://www.ahrq.gov/downloads/pub/advances2/vol3/Advance
s-King_1.pdf
This training, called in situ simulation, identifies best practices
used to improve and sustain high-level performance of the
public health preparedness system. It uses videos and real
world examples about team dynamics in emergency situations.
It is essential for MDH staff working in the DOC to learn and
apply the tools and strategies that lead to successful team
performance while working during a public health emergency.
The training detailed behavioral markers and active failures
that will be identified during the in situ simulations, such as
situational awareness, closed-loop communication, SBAR-R
(Situation, Background, Assessment, Recommendation and
Respond), shared mental model and decision making.
Participants gave high evaluation remarks about this training.
Once all study participants receive the Team Dynamics
training, the in situ simulations will begin in late May.
The MDH DOC provides Command and General Staff a
place to work together during an emergency response.
Ready to Respond Newsletter
The project is funded by the CDC Preparedness and
Emergency Response Research Centers.
Page 4 of 6
MnWARN—Utilities Helping Utilities
Our Mission: To promote and support a statewide response to
utility emergencies and disasters through mutual assistance
for water, wastewater, and storm water utilities in Minnesota.
Leaders in the water/wastewater community and state agencies
have created the Minnesota Water/Wastewater Utilities
Agency Response Network. MnWARN is a formal emergency
response program in Minnesota. MnWARN is a mutual aid
agreement to provide a program whereby water, wastewater
and storm water utilities sustaining physical damage from
natural or man-made disasters in Minnesota can obtain
emergency assistance in the form of personnel, equipment and
materials, and other associated services necessary to protect
the health and welfare of the utilities' customers.
Law enforcement and fire departments have been organized
for many years. MnWARN is an initiative to organize the
water and wastewater professionals to be prepared to respond
to water, wastewater and storm water entities in a professional
and timely manner. A pre-established agreement among a
network of utilities can complement and enhance local
capabilities to prepare to respond to a broad range of threats,
both natural and man-made.
This initiative is not meant to compete with any existing
mutual agreements that your utility may already have in place
with neighboring communities or counties. It is meant to
enhance the abilities of utilities to help utilities. It is essential
that all partners in the water, wastewater and storm water
community work together to support this concept.
MnWARN assists member utilities with:
●
●
●
●
●
Emergency assessment, emergency response, and
recovery
Mutual Aid Agreement for sharing emergency resources
with members
Resources to help recover from a disaster
Emergency contact network
Voluntary participation
Public health lab newborn screening section
involved in multi-state collaboration
Newborn Screening is a critical laboratory function. In the
face of an emergency that incapacitates laboratory function, it
may be necessary to request aid and resources from another
state to ensure continuity of operations.
The Minnesota Department of Health-Public Health
Laboratory (MDH-PHL) Newborn Screening Section is
currently engaged in a multi-state collaboration to assess
Ready to Respond Newsletter
emergency response plans, policies, and procedures as they
pertain to a laboratory disaster. MDH-PHL has participated in
three separate exercises with the University of Iowa Hygienic
Laboratory Newborn Screening Unit, the Missouri Public
Health Laboratory Newborn Screening Unit, and Emergency
Management Agencies, as part of the Emergency Management
Assistance Compact (EMAC).
During these EMAC exercises, one state declares a mock
emergency that temporarily incapacitates their laboratory
equipment. The state experiencing the mock emergency sends
previously tested newborn screening specimens to one of the
other states for analysis. In November 2009, MDH-PHL sent
specimens to Iowa. In December 2009, specimens were sent to
Missouri for analysis. In February 2010, MDH-PHL received
specimens from Iowa. Another exercise is scheduled for May
2010 with Missouri.
These exercises allow each state to evaluate the capacity of the
Newborn Screening Lab to receive, accession, test, and report
one day’s worth of specimens from another state. A quality
control check is also completed on testing performed by the
same techniques between the two states.
More exercises are planned for the future to further improve
the process and ensure that critical laboratory function is not
disrupted in an emergency. These drills ensure that all babies
born in Minnesota can be screened without disruption during
an emergency. It also shows that the MDH-PHL has the
capacity to assist other states during an emergency.
MN.
Did You Know? …the Saved Search Criteria tool is an
excellent way to receive periodic updates of what's new on
MN.TRAIN?
1. Begin by clicking on the “Course Search” tab, located on
the horizontal gray navigation bar.
2. On the resulting page, select the appropriate criteria for
your search from the menu list that appears on the left
hand side of the screen.
3. You can save your search criteria by clicking the “Save
Criteria” button and TRAIN will send you an email every
Monday with a list of courses that meet your search
criteria.
New Training: Protecting Our Food System from
Intentional Attack
A compilation of resources about farm to table vulnerabilities
and control strategies, incident command system basics, and
public information risk communication for food system
emergencies. This training is suitable for cooperative
extension, environmental health, food production or
processing, media or government personnel. The program was
developed several years ago by the University of Minnesota
Center for Public Health Preparedness, as well as Robert Berg,
Dr. Will Hueston and Dr. John Shutske.
(http://www.sph.umn.edu/ce/trainings/coursepage.asp?activity
Id=7002)
Page 5 of 6
Upcoming Events
Communications Quick Tips
Disaster Madness: Staying Calm in Chaos
It happens every spring, and we don’t mean
baseball
April 28-29, 2010
Shooting Star Casino
Mahnomen, MN
The 2010 Northwestern Minnesota Partners in Preparedness
conference will focus on community based response to
disaster situations. Topics include Caring for the Caregiver, a
Pandemic Response Hotwash, Interoperable Communications,
and an update on disaster response in Haiti. See conference
webpage for a full list of topics and speakers
(http://www.sph.umn.edu/ce/trainings/disastermadness.asp).
New this year is a Regional Fair highlighting emergency
preparedness equipment available in the region. Co-sponsored
by the Northwest Healthcare Systems Preparedness
Committees, Minnesota Department of Health, Greater
Northwest EMS, and the University of Minnesota Center for
Public Health Preparedness.
Contributors to this issue
Aggie Leitheiser, Office of Emergency Preparedness
Amy Scheller, Centers for Public Health Education &
Outreach University of Minnesota School of Public
Health
Beau Amadeus Crabb, MDH Newborn Screening Program
Christine Austin-Roehler, Wright County Public Health
Deb Radi, 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
Lynne Markus, Environmental Health
Marcia Robért, Office of Emergency Preparedness
Mark Doerr, Office of Emergency Preparedness
Mark Sloan, Environmental Health
Nancy Torner, Communications Office
Patti Constant, Public Health Laboratory
Samantha Herrington, Office of Emergency Preparedness
Toby McAdams, Office of Emergency Preparedness
If snow is melting in Minnesota, sooner or later floods will
probably follow. Far less predictable is when, where and to
what extent the excess water will raise over river banks and
out into communities. Yet annual flooding is an example of
how frequent experience with an emergency sharpens public
communication and makes vast amounts of health-related
information widely available.
Because flooding is almost a given, the communications
department at the Minnesota Department of Health (MDH)
keeps flood news releases and talking points on file from one
year to the next. This helps to get health-related flood news
out to media fast and eliminates delays compiling and vetting
the same information each year. It also leaves more time to
spend on any updated or expanded guidance.
The standard flood news release, issued this year in mid
March, urges private owners of water wells in areas prone to
flooding to take precautions to protect their water both before
and after a flood. The news release offers basic steps well
owners can take and directs them – to get detailed instructions
for disinfecting and testing private wells – to the MDH Web
site and district offices with well management units in
Bemidji, Duluth, Fergus Falls, Marshall, Rochester, St. Cloud
and the metro area.
MDH also keeps a wide range of flood-related fact sheets
online year round for the public and emergency responders.
Fact sheet topics range from basic health safety, food safety
and biting insects and ticks to carbon monoxide, mold and
using bleach. More detailed fact sheets deal with health and
safety tips for volunteers, immunization guidance during
floods, cleaning up homes and personal care. Fact sheets
targeted to responders include self care during difficult work,
evacuation tips and guidelines for facilities impacted by
disasters. These fact sheets are at
http://www.health.state.mn.us/divs/eh/emergency/natural/floo
ds/factsheets.html.
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 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
Ready to Respond Newsletter
Page 6 of 6