State Community Health Services Advisory Committee
Strategic Plan for Public
Health Emergency
Preparedness in Minnesota
FINAL REPORT
December 14, 2007
Community and Family Health Division
Office of Public Health Practice
P.O. Box 64882
St. Paul, MN 55164-0882
Protecting, maintaining and improving the health of all Minnesotans
January 17, 2008
Marcia Ward, Chair
State Community Health Services Advisory Committee (SCHSAC)
30978 Four Farmer Road
Dakota, MN 55925
Dear Ms. Ward,
Thank you for sending me the final report of the State Community Health Services Advisory
Committee (SCHSAC) MDH-LPH Preparedness Committee: Strategic Plan for Public Health
Emergency Preparedness in Minnesota. We have been repeatedly reminded this past year of the
importance of public health preparedness for all types of hazards. The work of this committee
will help focus our preparedness efforts, strengthen our capabilities, and build our capacity to
respond effectively.
I approve the final report and believe these recommendations will support established statewide
public health emergency preparedness priorities.
I want to applaud the committee for their thoughtful and thorough approach to this important
topic. The committee members’ commitment to discussing issues frankly and striving to identify
strategies for public health that will assist state and local health departments to become better
prepared is impressive. The recommendations generated from this work group reflect that
thoughtfulness and creativity. The communications recommendations, while relatively simple,
will help us communicate better with each other. The roles and responsibilities recommendations
challenge all of us to look at our work, recognize our strengths and limits, and move forward
with realistic expectations.
I look forward to continuing to work with the SCHSAC in the coming months and years, as we
jointly continue to improve the partnership, better the public’s health, and increase our ability to
be ready to respond.
Sincerely,
Sanne Magnan, M.D., Ph.D.
Commissioner
P.O. Box 64975
St. Paul, MN 55164-0975
Community and Family Health • Office of Public Health Practice
Golden Rule Building, Suite 220 • PO Box 64882 • St. Paul, MN 55164-0882 • (651) 201-3880
http://www.health.state.mn.us
An equal opportunity employer
State Community Health Services Advisory Committee
Strategic Plan for Public
Health Emergency
Preparedness in Minnesota
For more information, contact:
Office of Public Health Practice
P.O. Box 64882
St. Paul, MN 55164-0882
Phone: 651/201-3880
Fax: 651/201-3881
TDD: 651-201-5797
This report is partially supported by the Public Health Preparedness and Response for Bioterrorism Grant and the Preventive
Health and Health Services Block Grant from the Centers for Disease Control and Prevention (CDC). Its contents are solely
the responsibility of the authors and do not necessarily represent the official views of CDC.
Strategic Plan for Public Health Emergency Preparedness in MN
3
Table of Contents
Page(s)
Work Group Charge and Membership
7
Executive Summary
9-14
Full Report
15-24
Background
15
The Strategic Planning Process
15
Public Health Roles and Responsibilities Subcommittee
16
Public Health Emergency Preparedness Communications Subcommittee
20
Recommendations
22-24
Appendices
25-63
Appendix A. Blue Print
27
Appendix B. MDH and Local Health Department Incident Lifecycle Maps
29-30
Appendix C. Crosswalk
31-38
Appendix D. Public Health Emergency Preparedness Responsibilities Tiers
39
Appendix E. Working Model of Emergency Preparedness Responsibilities Model
41
Appendix F. Public Health Emergency Preparedness Communication Scenarios
43-47
Appendix G. Public Health Emergency Preparedness Communication
Subcommittee Products
49-62
Appendix H. Priority Areas Not Addressed in 2007
63
Strategic Plan for Public Health Emergency Preparedness in MN
5
SCHSAC MDH-Local Public Health Preparedness Committee
Charge
•
•
Articulate the strategic direction and shared Local Public Health - MDH preparedness priorities for three to
five years; describe the roles that local health departments and MDH should play in achieving them;
establish measurable outcomes; and monitor performance over time.
Present a report of their activities, accomplishments and recommendations at the September 2007 SCHSAC
meeting, including a recommendation whether to continue the group and a proposed charge and work
products for the coming year if the recommendation is to continue.
Membership
Members
Alternates
Bev Wangerin (McLeod County)
Nancy Schouweiler (Dakota County)
Mary Wellik (Olmsted County Public Health)
Jane Norbin (St. Paul-Ramsey County Public Health)
Patricia Adams (Dakota County Public Health)
Sandy Tubbs (Douglas County Public Health)
Ann Bajari (Meeker-McLeod-Sibley CHS)
Lynn Theurer (Winona County Public Health)
Bruce Tolzmann (Redwood County)
Karen Nordstrom (Bloomington City Council)
Jim Gangl (St. Louis County Public Health & Human Services)
Susan Palchick (Hennepin Cty Human Services & Public Health)
Carolyn Schmidt (Carver County Public Health)
Bette Friederichs (Chisago County Public Health)
Carmen Reckard (Faribault-Martin CHS)
Kathleen Evers (Wabasha County Public Health)
MDH Staff
Members
Alternates
Aggie Leitheiser
John Stine
Norm Crouch
Pat Bloomgren
Debra Burns
Margaret Kelly
Buddy Ferguson
Ralph Morris
Jane Braun
David Wulff
Chris Everson
Craig Acomb
Maggie Diebel
Carol Woolverton
John Stieger
Laurel Briske
Office of Emergency Preparedness
Environmental Health
Public Health Laboratory
Infectious Disease, Epidemiology Prevention and Control
Community and Family Health
Executive Office
Public Information Office
District Offices
Staff to Committee
Mickey Scullard, Office of Public Health Practice, Community and Family Health
Strategic Plan for Public Health Emergency Preparedness in MN
7
SCHSAC MDH-LPH Preparedness Committee
Emergency Preparedness Strategic Plan
Executive Summary
The critical importance of public health emergency preparedness came to the forefront after 9/11 and the
anthrax events which followed shortly thereafter. Congress dedicated funding to help the public health
sector focus on developing its capacity to respond to all hazards. Shortly after the funding was received,
states were asked to begin smallpox vaccinations, followed by the emergence of a new disease, SARS.
Plans, training, and exercise topics followed the event of the moment, leaving many feeling that
preparedness activities were fragmented. The public health system was also struggling to assess the
extent of improvements in response capacity.
The State Community Health Services Advisory Committee (SCHSAC) was involved in public health
emergency preparedness from the start, with work groups charged to recommend how preparedness
funding for local health departments should be allocated and what duties needed to be performed.
Simultaneously, the Minnesota Department of Health (MDH) was working to increase its ability to
respond to public health emergencies. However, the state and local work was taking place in parallel
processes, with few opportunities to decide on overall goals and the strategies each would employ to
reach the goals. In the summer of 2006, the opportunity arrived to engage state and local public health
professionals in a dialogue about a shared vision and goals for public health preparedness.
Development of a Blue Print
On November 13, 2006 the SCHSAC MDH-LPH Preparedness Committee, consisting of local health
departments and MDH representatives, had their first meeting to identify shared priorities and roles
around public health preparedness and develop a strategic plan. Prior to the first meeting, key informant
interviews were conducted with state and local public health and key emergency response partners.
Interviewees shared their opinions about shared preparedness priorities and roles.
On December 8, 2006 the committee agreed on “Blue Print” comprised of six priorities (as described in
the list below) identified from the key informant interviews and the first strategic planning meeting
(Appendix A):
•
•
•
•
•
•
Define MDH and local health departments roles, responsibilities and functions
Strengthen mechanisms for communication
Identify statewide training priorities
Develop an integrated (state, regional, local) exercise plan
Conduct a public education and awareness campaign
Provide preparedness plan framework and templates
The committee voted to focus additional joint work on the first two of the six priorities. Two
subcommittees were formed to address the top two priorities: defining roles and responsibilities and
strengthening mechanisms for public health emergency preparedness communications. Both received
specific tasks and were asked to report back to the full committee with recommendations for further
discussion.
Strategic Plan for Public Health Emergency Preparedness in MN
9
Public Health Roles and Responsibilities Subcommittee
This subcommittee was charged with defining local health departments and MDH emergency
preparedness roles and responsibilities by exploring the concept of tiers, using the MDH Incident
Lifecycle Map to frame the discussion. A complementary incident lifecycle map was created for local
health departments, reflecting the roles and responsibilities they perform. In addition, resources created
and defined by previous SCHSAC work groups [Essential Local Activities and Disease Prevention &
Control (DP&C) Common Activities Framework] were used as a starting point and as a model for
creating tiered emergency preparedness responsibilities (See Appendix C).
Incident Lifecycle Maps
MDH created an Incident Lifecycle Map after struggling with different ways of identifying the state
health department’s functions, roles, and responsibilities prior to, during and after a public health
emergency event. The current iteration of the Incident Lifecycle Map focuses on the functions of
planning, detection, response, recovery, and long-term recovery. The MDH-LPH Preparedness
Committee agreed to use that map as the framework for the discussion of state and local public health
roles and responsibilities. A complementary Local Health Departments Incident Lifecycle Map was
created. While similar and easily compared to the MDH map, the local health department map identifies
the unique activities performed by local health departments.
Emergency Preparedness Tiers
The crosswalk of the resources described above served as the starting point for examining the concept of
tiers. The subcommittee members recognized and were able to distinguish differences in the
responsibilities that initially led to three tiers. The subcommittee concluded that the concept of tiers for
emergency preparedness responsibilities was feasible and sought agreement from the MDH-LPH
Preparedness Committee and from SCHSAC to work further on developing the details.
The members deliberated on the number of tiers, noting concern from local health departments and
county commissioners about the lowest and highest tiers. After reviewing research about several models
currently being explored through National Association of City and County Health Official’s (NACCHO)
Project Public Health Ready and Advanced Practice Centers, as well as work in the state of
Massachusetts, the decision was made to use as the foundation the Essential Local Activities already
agreed upon, create Standard and Comprehensive tiers, and explore the concept of Projects of Statewide
Significance (see below).
Feedback was obtained from Community Health Services (CHS) Administrators and Directors at
regional meetings as directed by SCHSAC at the September 2007 meeting. The concept of the tiers was
well-received and supported by the administrators and directors. Additional revisions to the tiers have
been made based on the feedback received.
Projects of Statewide Significance
Throughout their discussions, the subcommittee noted that there were responsibilities that did not have
to be completed by all local health departments. The subcommittee explored the concept of a lead
regional or a multi-county local health department lead, but struggled with the potential burden some
local health departments might experience with added regional or multi-county responsibilities. They
also discussed the possibility that not all regions would have a lead local health department.
The subcommittee proposed Projects of Statewide Significance (PoSS) which may be completed jointly
with MDH in some cases, and would involve a proposal or application process by interested local health
Strategic Plan for Public Health Emergency Preparedness in MN
10
departments. This concept was discussed during regional conversations in October and November and
received mixed reviews. The subcommittee will be revisiting this concept and additional work is needed
to define how projects are selected, funded, and implemented.
Public Health Emergency Preparedness Communications Subcommittee
The Public Health Emergency Preparedness Communications Subcommittee was charged with
exploring mechanisms for strengthening emergency preparedness communications. They first defined
this as communication between, among, and within local health departments and MDH. The
subcommittee members first acknowledged there is a history of communications issues and frustration
in identifying solutions. The members discussed issues, perceptions, challenges, and consequences of
communication problems between, among, and within local health departments and MDH. They also
identified communication strategies that are working well.
To further guide their discussions, five scenarios where selected that reflected the primary types of
communication issues (Appendix F). Following each scenario, perspectives of each partner were
described and used to help identify additional communication strategies.
Targets for Improvement
The discussions helped establish specific targets for improvement.
•
•
•
•
•
•
•
•
•
•
Better communication, not more communication, means: clear messages and clear expectations for
actions and response (e.g., define terms such as “alert”)
Better coordination among MDH divisions for external/partner communications
MDH providing timely information to local health departments so they have the tools and
information they need to communicate to public and the media
MDH needs to ensure consistent information is provided to local health departments
Local health departments and MDH need to learn to implement incident management structures
earlier and when events are much smaller
Assess existing tools for communication;
o Re-invent the workspace
o Hold joint debriefings (hot washes) and share after action reports
Use annual public health preparedness conference as an opportunity for dialogue between MDH and
local health departments
Establish communications expectations and standard operating procedures
Conduct Chapter 13 trainings to include information on data privacy and public vs. non-public data
Develop a mechanism for sharing tips, tools, techniques, exercises, annexes, etc. across the state
The subcommittee identified three sets of recommendations: immediate recommendations that include
strategies that could be easily implemented by MDH and local health departments, situational
communication recommendations, and ongoing communications recommendations.
Priority Focus Areas Not Addressed in 2007
Although the four remaining priorities were not a focus of the MDH-LPH Preparedness Committee
work in 2007, activities took place in each priority during the year. A short description of 2007 activities
in the remaining four Blue Print priorities (coordinated public education and awareness campaign;
training priorities, preparedness plans/templates, integrated exercise plans) is provided in Appendix H.
Strategic Plan for Public Health Emergency Preparedness in MN
11
Recommendations
The following recommendations are based on the work of the two subcommittees and discussions by the
full committee. SCHSAC recommends that:
Emergency Preparedness Tiers Recommendations
1. The Commissioner should adopt a tiered approach to public health emergency preparedness
responsibilities for Community Health Boards (See Appendix D).
2. MDH and selected local health departments should pilot test the tiers framework between
January and April 2008 and revise the responsibilities contained in the tiers as necessary, based
on the results of the pilot test.
3. The 2008 SCHSAC Work Plan should include continued work by a MDH-LPH Preparedness
Committee to achieve the following:
a. Monitor the pilot tests described in Recommendation #2.
b. Define the preparedness related roles and responsibilities of MDH and the MDH District Offices that
are in support of local health departments; as well as roles of other partners as appropriate.
c. Discuss funding and capacity issues and the related implications for fulfilling local and state roles and
responsibilities.
d. Continue to work jointly to address the remaining four priorities identified in the Public Health
Emergency Preparedness Blueprint (integrated exercise plan, training, plan templates, and public
communication). (See Appendix A).
e. Further develop the Project of Statewide Significance concept and/or explore additional models for
identifying and addressing areas of common need.
f. Recommend refinements to the Essential Local Public Health Activities (ELAs) related to public
health emergency preparedness to reflect the current knowledge, practices, and experience that have
evolved since the ELAs were first established.
g. Bring additional recommendations forward for SCHSAC approval based on the pilot test results and
discussions of the issues identified above.
Emergency Preparedness Communications Recommendations
4. The following templates and protocols for public health emergency preparedness
communications should be approved for immediate adoption and use by MDH and local health
departments as mechanisms to improve public health emergency preparedness communications
by providing the tools to achieve more uniformity, specificity, and efficiency.
The products are (see Appendix G):
• Conference call template and protocol
• Email template and protocol
• Situation Report templates for food-borne illnesses, vaccinepreventable diseases, and natural disaster events [Note: the
Situation Report is specifically intended for those directly
involved in the response and contains non-public information]
• Event Summary templates, which are slightly redacted versions
of the Situation Report containing information that can be shared
with all partners, the public, and the media
• Initial Checklist (aka “Pink Sheet”), with a similar version
already being used by MDH
• Internal Notification Chart, to provide consistent language
around notification and activation across the state.
Strategic Plan for Public Health Emergency Preparedness in MN
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The templates and protocols for emails, conference calls, and briefing summaries should be
shared statewide and adopted for use by MDH and local health departments. Suggested steps for
implementation include:
•
•
•
•
•
•
•
Post all documents to the Workspace
Notify local health departments and MDH staff about the new
tools, templates and protocols and outline how and when they
should be used
Publish an announcement about the new tools, templates and
protocols in publications, such as the Office of Emergency
Preparedness Ready to Respond Newsletter, the Commentary
Newsletter, the CHS/PHN Listserv, and the CHS Mailbag
Share the items listed above at advisory committee meetings and
in reports
Promote the items listed above at conferences, trainings, and
meetings (e.g., presentations, posters, displays)
Use the items listed above in emergency preparedness exercises
Implement the items listed above in actual responses, events, and
discuss utility and functionality of the items listed above during
event follow-up discussions
Situational Communications
5. MDH should notify affected local health departments of “suspect cases” when there is the
potential for a “big” event in order for local health departments to provide local information,
begin identifying resources, and staffing availability.
Note: Local health department staff have indicated to MDH that it is acceptable to not receive all
the details of all potential events, but it is important for MDH staff to notify local health
departments when local health department action might be needed (e.g., “How many public
health nurses could you have available on Saturday?”).
6. When a health-related situation occurs, for which some entity other than MDH is responsible,
(such as peanut butter recalls), MDH should post information indicating which state or federal
agency regulates that product.
7. Local health departments should be proactive in seeking information about health-related issues,
which may include signing up for federal agency alerts, calling the MDH Office of Emergency
Preparedness 24/7 toll-free number, and learning more about different regulating bodies.
Ongoing Communication Improvement
8. MDH should offer training for state and local public health department staff on the application of
Minnesota State Statute 2006 Chapter 13, Data Practices, (which addresses governmental data
privacy), to increase understanding and familiarity about the differences in information which
can be released to partners versus what can be released to the public.
9. MDH and local health departments should develop a mechanism for regular communication
check-ins, debriefings, and feedback (e.g., joint debriefing “hot washes”) to address issues in a
timely manner.
Strategic Plan for Public Health Emergency Preparedness in MN
13
10. MDH and local health departments should share the five issue scenarios and the corresponding
recommendations broadly with their staff and encourage discussion.
11. MDH, local health department and community health services administrators should clarify
expectations for staff who serve on work groups and task forces, including a description of who
they are representing and their responsibility to report back to their constituents.
12. The MDH Office of Emergency Preparedness and representatives from local health departments
should design a statewide public health emergency preparedness communications-specific
exercise to analyze the process and tools.
13. The MDH Office of Emergency Preparedness should facilitate a training and discussion on the
appropriate uses of the “General Message” feature on the Workspace for MDH staff involved in
emergency preparedness.
14. The Director of the MDH Office of Emergency Preparedness and a local health department
representative should make a report to SCHSAC in one year to discuss progress in strengthening
public health emergency preparedness communications, how the improvements are working,
adjustments that have been made, and future initiatives to continue strengthening public health
emergency preparedness communications.
Strategic Plan for Public Health Emergency Preparedness in MN
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SCHSAC MDH-LPH Preparedness Committee
Emergency Preparedness Strategic Plan
Full Report
Background
The critical importance of public health emergency preparedness came to the forefront after 9/11 and the
anthrax events which followed shortly thereafter. Congress dedicated funding to help the public health
sector focus on developing its capacity to respond to all hazards. Shortly after the funding was received,
states were asked to begin smallpox vaccinations, followed by the emergence of a new disease, SARS.
Plans, training, and exercise topics followed the event of the moment, leaving many feeling that
preparedness activities were fragmented. The public health system was also struggling to assess the
extent of improvements in response capacity.
The State Community Health Services Advisory Committee (SCHSAC) was involved in public health
emergency preparedness from the start, with work groups charged to recommend how preparedness
funding for local health departments should be allocated and what duties needed to be performed.
Simultaneously, the Minnesota Department of Health (MDH) was working to increase its ability to
respond to public health emergencies. However, the state and local work was taking place in parallel
processes, with few opportunities to decide on overall goals and the strategies each would employ to
reach the goals.
In the summer of 2006, the opportunity arrived to engage state and local public health professionals in a
dialogue about a shared vision and goals for public health preparedness.
The Strategic Planning Process
SCHSAC and the Commissioner of Health approved the formation of a committee comprised of local
health department representatives and MDH key decision makers, with staffing provided by the MDH
Office of Public Health Practice. A management consultant from Management Analysis and
Development (MAD) was hired to facilitate the initial development of a strategic plan. Prior to the first
meeting, a list of key public health and emergency response partners were interviewed by the consultant
and asked to identify priorities for public health emergency preparedness. The same questions were
posed to the committee members at their first meeting.
Review of the key informant summary report was followed by a discussion of participants’ priorities for
public health emergency preparedness, a discussion about the shared values that underlie the priorities
listed, and identification of the barriers to achieving the priorities. Strategies or suggestions to eliminate
the barriers and make progress toward the priority goals were then identified.
The second meeting was again facilitated by a management consultant from MAD, with assistance from
MDH staff. The committee was presented with six priorities pulled from the key informant interviews
and the first strategic planning meeting. The committee agreed that these were the most important
priorities and voted on the two priorities they wanted to begin working on immediately.
The top two priorities were:
• Define state and local public health roles, responsibilities and functions
• Strengthen mechanisms for communication between MDH and local public health departments
Strategic Plan for Public Health Emergency Preparedness in MN
15
In addition to the two top priorities, the committee also brainstormed various actions for the remaining
four priorities:
•
•
•
•
Training – identify statewide training priorities
Integrated (state, regional, local) exercise plan
Public education and awareness
Preparedness plans and template
The committee worked in five teams and brainstormed actions for each of the priorities. At the end of
the meeting, interested committee members volunteered to serve on one of two subcommittees: 1) Roles
and Responsibilities, or 2) Public Health Emergency Preparedness Communications.
Public Health Roles and Responsibilities Subcommittee
The Roles and Responsibilities Subcommittee was tasked with the following instructions by the
committee:
•
•
•
Jointly develop a system of “tiers” or levels of public health emergency preparedness capacity within
local health departments. Each level would be clearly defined with roles spelled out. Each agency
would self assess to determine their level.
Jointly develop a guidance document that describes responsibilities between MDH and local health
departments. This would be based on the work above and would clearly define responsibilities for
events that range from a small local outbreak to a multi-jurisdictional public health emergency. This
could be done in a format similar to the Disease Prevention and Control (DP&C) Common Activities
Framework or could be in an algorithm format.
“LifeCycle of an Incident” could be used as a framework for describing work and roles.
Incident Lifecycle Maps
MDH created an Incident Lifecycle Map (Appendix B) after struggling with different ways of
identifying the state health department’s functions, roles, and responsibilities prior to, during and after a
public health emergency. The current iteration is the MDH Incident Lifecycle Map, which focuses on
the functions of planning, detection, response, recovery, and long-term recovery. The MDH-LPH
Preparedness Committee agreed to use this map as the framework for the discussion of state and local
public health roles and responsibilities. A complementary local public health department Incident
Lifecycle Map was created (Appendix B). While similar and easily compared to the MDH map, the map
identifies the unique activities performed by local health departments.
Areas of Public Health Responsibility and the Essential Local Activities
In 2004, SCHSAC appointed a work group to identify and define a set of local public health activities
that Minnesotans can expect no matter where in the state they live (i.e., “essential”). The intent was to
provide a consistent framework for describing local public health and to provide a basis for ongoing
measurement, accountability, and quality improvement related to the implementation or assurance of
essential local activities.
One of the areas of public health responsibility is “Prepare for and Respond to Disasters and Assist
Communities in Recovery” which is comprised of seven essential local activities. In 2004, the SCHSAC
Emergency Preparedness Local Grant Duties Work Group helped define the emergency preparedness
essential local activities, with the premise that these are the activities that need to occur even if federal
emergency preparedness grant funds were not available. Additional activities related to public health
Strategic Plan for Public Health Emergency Preparedness in MN
16
emergency preparedness are found in three other Areas of Public Health Responsibility; Assure an
Adequate Local Public Health Infrastructure, Protect Against Environmental Hazards, and Prevent the
Spread of Infectious Disease. The work group agreed that with federal funding there is an expectation
that local health departments perform an additional set of activities. However, a long-standing concern
among local health departments has been the expectation that all local health departments complete the
same set of emergency preparedness grant duties, despite significant variations in capacities and
capabilities. (SCHSAC Assuring Essential Local Public Health Activities Throughout the State Work Group
Report, 2005)
Disease Prevention and Control (DP&C) Common Activities Framework
The other resource that was used to help frame this subcommittee’s discussion was the Disease
Prevention & Control Common Activities Framework. The Framework (created in 1989 and revised
several times since, most recently 2001) sets standards for DP&C activities at the state and local levels
and lays out a minimum set of DP&C activities that MDH and local health departments are expected to
perform. Those local health departments who are unable to carry out those activities are expected to
strive to reach this level. MDH activities listed in the Framework are to be implemented by MDH
Infectious Disease Epidemiology, Prevention and Control (IDEPC) Division staff in support of local
health departments’ DP&C activities. The Framework also lists DP&C activities that are conducted
jointly by MDH and local health departments. MDH and local health departments have worked together
to carry out the DP&C activities contained in the Framework, initially through pilot projects. (State and
Local Public Health Communicable Disease Prevention and Control Common Activities Framework, February
2003)
Development of Public Health Emergency Preparedness Roles and Responsibilities Tiers
Using the Local Health Department Incident Lifecycle as a guide, and the crosswalk developed from the
emergency preparedness, infrastructure, infectious disease, and environmental health essential local
activities and the DP&C Common Activities Framework, the subcommittee members began examining
the roles within each functional area: planning and preparedness, detection, response, recovery and longterm recovery. Each role could be broken down into several tasks, or responsibilities. As the
subcommittee worked through the roles, it became apparent that it was possible to create tiers of
responsibilities that better reflected individual local health departments’ capacities (i.e., size of staff) and
capabilities (i.e., skills of staff). Two major questions emerged: how many tiers? and, is there a role for a
lead local health department? As a starting point, the subcommittee members had divided the
responsibilities into three tiers, but had discussions about whether there should be two or three tiers.
There was hesitancy and discomfort about the top tier because it was not clear that any local health
department would want to assume the top tier responsibilities. A number of issues surfaced when
discussing the concept of a lead local health department. Those issues included; reticence to assume a
significant number of regional responsibilities, criteria for determining lead local health departments,
and concern that some regions may not have a lead local health department.
Review of the work with the committee, SCHSAC, and CHS/local health department administrators and
directors at regional meetings, provided support for continuing to work through the process of creating
public health emergency preparedness responsibility tiers. SCHSAC members expressed concerns about
changes to funding that might result in a loss of dollars, the potential stigma of being a lower tier, and
concern about the expectations for the top tier. The issue of the regional or multi-county lead also
continued to be problematic.
Strategic Plan for Public Health Emergency Preparedness in MN
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Regional or Multi-county Leads
An Examination of Emergency Preparedness Regional Models
The question of a regional or multi-county lead was difficult to answer and the subcommittee members
spent a considerable amount of time considering how this might look. Although there is not a lot of
literature on this topic, there are some NACCHO funded projects (Project Public Health Ready and
Advanced Practice Centers) focused on exploring regionalization of public health preparedness
activities. Additionally, the state of Massachusetts is exploring regionalization of all public health work,
using the Ten Essential Services as their framework (Draft Recommendations of the Public Health
Regionalization Working Group, January 18, 2006). The Massachusetts Model was not exclusively
focused on emergency preparedness, but their approach was useful to the subcommittee members
because it approached regionalization in a slightly different manner than the NACCHO projects,
focusing more on what services are provided and how they are delivered. (Draft Recommendations of
the Public Health Regionalization Working Group, January 18, 2006)
While regions and regional work has long been part of regular public health practice in Minnesota, both
projects provided concepts and structures which helped guide and focus the discussions around
preparedness work and how it might be done differently.
Reasons given for regionalization included some common themes across all the projects:
•
•
•
•
•
Increase sharing and understanding of responsibilities in regional response;
Develop formal agreements;
Increase sharing of and access to resources;
Identify strengths, weaknesses and gaps in planning and regional capacity; and
Increase opportunities for training.
NACCHO Regionalization Models
(Project Public Health Ready and Advanced Practice Centers)
Four types of regionalization, although regionalization probably occurs on a continuum;
Networking
• Share exercises, forms
• Share some results
• Share planning process
Coordination
• Work with other counties to develop, implement and evaluate
• All counties work on the exercise, assuming responsibility for different components of exercise
Standardization
• Exercises are written that are used across the region to test regional plans
• Exercises are written that are used in each county to test county plans
• Forms, observer and evaluator materials created to be used by each county
Centralization
• Tight integration of resources and staff, controlled by a centralized source
• Suggests notifications, plan activation, communications and response occur linearly
• Clear chain of command
• Simplest model
Strategic Plan for Public Health Emergency Preparedness in MN
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Massachusetts Model
Comprehensive Services Model
A large number of municipalities join together to create a centralized agency that is responsible for
providing a full complement of public health services. Such a model would be especially helpful in rural
locations where no single town has the infrastructure to provide the proper array of public health services.
• The regional public health agency provides services to multiple small communities.
• This model is inherently complex as it will require collaborative decision-making among multiple
independent jurisdictions. Governance structure to ensure that no town is disempowered is needed.
• Financial assessments will be required of each community. A system will be needed that is fair to each
municipality.
Stand-Alone Model
While smaller towns will need to form alliances to meet the challenges of providing the ten essential
services of public health, there are a few larger communities (e.g., Boston, Worcester, and Springfield)
that may find it advantageous to operate as a single-municipality district.
• This model is most suitable for larger communities.
• It is inherently simple because only one community is involved.
Limited Services Model
Some regions will determine that a comprehensive model is not necessary and will elect to develop a
model in which a limited number of core services are provided regionally. This was the case with the
establishment of the emergency preparedness regions, which were created for the sole purpose of
responding to the challenges of emergency preparedness. Such an arrangement would be most beneficial
to larger suburban towns.
• Regions can tailor their common initiatives around their particular needs.
• There is a danger that some services would fall through the cracks.
• This model leaves open the possibility that some communities will continue to have disparities of
public health protection by not requiring all towns to provide the same services through their regional
entities.
Cafeteria Services Model
In many regions, there is a diversity of competencies such that not all towns would require the same level
of support. It may become necessary for a central agency to provide a wide range of services that each
participating municipality would contract for, dependent on individual need.
• Provides a great degree of flexibility for participating communities.
• Is expensive in that the central agency is responsible for providing services that may or may not be
used by a large number of participants.
• Uneven usage makes coherent governance by participating communities difficult.
• Difficult to ascertain how to direct state funds when each town is doing something slightly different.
(Draft Recommendations of the Public Health Regionalization Working Group, January 18, 2006)
Strategic Plan for Public Health Emergency Preparedness in MN
19
Local Public Health Department Emergency Preparedness Responsibilities Working Model
The subcommittee members discussed the pros and cons of the different models, the public health
system in Minnesota and the emergency preparedness work to date. The result of the discussion is the
working model of the Minnesota Local Public Health Emergency Preparedness Responsibilities Model
(see Appendix E), comprised of a foundation, two tiers and projects of statewide significance. The
foundation of the Minnesota Emergency Preparedness Working Model is the Emergency Preparedness
Essential Local Activities. As discussed above, these activities have been adopted statewide. The next
two pieces of the Working Model are the tiers, Standard and Comprehensive. These tiers address many
of the issues that were part of the charge to this subcommittee, including the varying capacities and
capabilities of local health departments across the state. The tiers encompass those responsibilities that
need to be completed at the local level. At the top are the Projects of Statewide Significance (PoSS).
These responsibilities are bigger than MDH or any one local health jurisdiction and they do need to be
done in order to have an effective response. However, it doesn’t make sense for all local health
departments to develop the same items when the work could be centralized and the products could be
shared statewide. This work was brought back to SCHSAC and once again, the SCHSAC indicated
comfort with the concepts and directed the committee to obtain feedback from CHS Administrators and
Directors across the state.
Regional Meetings
During the months of October and November, all regions were solicited for feedback on the tiers and
PoSS. Overall, the concept of the tiers was well-received and the concept of the PoSS received mixed
support. The responsibilities included in the essential local activities column generated the most
discussion. Concerns were raised about if and how funding would change if the tier system is adopted.
There was mixed interest in using MDH and local health department funding for PoSS. Some people felt
it would be an efficient use of money that would result in savings, while others felt that a loss of any
amount of money would make it difficult to do their work. Based on the feedback, revisions were made
to the tiers. The Projects of Statewide Significance concept continues to be discussed and different
models are being explored.
Public Health Emergency Preparedness Communications Subcommittee
The Public Health Emergency Preparedness Communications Subcommittee was charged with focusing
on the other immediate priority, exploring mechanisms for strengthening public health emergency
preparedness communications. The MDH-LPH Preparedness Committee asked the subcommittee to
focus on MDH and communications in public health emergency preparedness events. The subcommittee
members acknowledged there is a history of communications issues and frustration in identifying and
implementing solutions. The members frankly and respectfully discussed issues, perceptions, challenges,
and consequences of public health emergency preparedness communication problems between, among,
and within local health departments and MDH. However, the members wanted to acknowledge that
there have been significant improvements and identified communication strategies that are working
well, both in the emergency communications area and across MDH.
The subcommittee defined the scope of public health emergency preparedness communications issues
the subcommittee would address and the members agreed on the following guiding principles to help
steer their work:
•
The focus is on MDH to local health department communication, local health department to MDH
communication, and inter-agency and intra-agency communications (within MDH and within local
health departments);
Strategic Plan for Public Health Emergency Preparedness in MN
20
•
•
•
The work needs to help people feel connected and have the information they need;
The work needs to interface with the Incident Management Structure (IMS); and
There needs to be clarity about public health emergency preparedness communications policies.
In discussing the communication issues that have occurred and identifying strategies for improvement,
the members clearly stated that the issues are not about the quantity of information; they are about the
quality of the information. However, there were situations when more information would have been
appreciated but was not conveyed. In other cases, e.g., conference calls, the purpose of the call was not
clear so the correct people were not on the call. Another common issue discussed was situations when
staff received different information from different staff at MDH. Some issues concerned delayed
activation of the incident management system at the state and local health departments. Finally, the
subcommittee discussed some of the public health emergency preparedness communications tools,
including Health Alert Network (HAN) and the Workspace. The HAN system works well, but the
Workspace continues to need major revisions and is missing some key components that would address
several public health emergency preparedness communication issues.
Emergency Preparedness Scenarios
During the discussion, the subcommittee members found there were several instances when it became
clear that the perspectives of the partners had not previously been understood or considered. To facilitate
further dialogue about perspectives, the members worked through five emergency preparedness
scenarios (Appendix F). The generic scenarios, which are based on real occurrences, included examples
of problematic communications that the subcommittee members had described.
Targets for Improvement
The discussions helped establish specific targets for improvement, for example:
•
•
•
•
•
•
•
•
•
•
Better communication, not more communication, means: clear messages and clear expectations for
actions and response
Better coordination among MDH divisions for external/partner communications
MDH needs to provide timely information to local health departments so they have the tools and
information they need to communicate to public and media
MDH needs to ensure consistent information is provided to local health departments
Local health departments and MDH need to learn to implement incident management structures
sooner and when events are smaller
Assess existing tools for communication-what works;
o Re-invent the workspace
o Hold joint hot washes and share after action reports
Use the annual public health preparedness conferences for continued discussion
Establish communications expectations and standard operating procedures
Conduct Chapter 13 training to include data privacy, public vs. non-public data
Develop a mechanism for sharing tips, tools, techniques, exercises, annexes, etc. across the state
Priorities Focus Areas Not Addressed in 2007
Although the four remaining priorities were not a focus of the MDH-LPH Preparedness Committee
work in 2007, activities took place in each priority during the year. A short description of 2007 activities
in the remaining four Blue Print priorities (coordinated public education and awareness campaign;
training priorities, preparedness plans/templates, integrated exercise plans) is provided in Appendix H.
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21
Recommendations
The following recommendations are based on the work of the two subcommittees and discussions by the
full committee. SCHSAC recommends that:
Emergency Preparedness Tiers Recommendations
1. The Commissioner should adopt a tiered approach to public health emergency preparedness
responsibilities for Community Health Boards (See Appendix D).
2. MDH and selected local health departments should pilot test the tiers framework between
January and April 2008 and revise the responsibilities contained in the tiers as necessary, based
on the results of the pilot test.
3. The 2008 SCHSAC Work Plan should include continued work by a MDH-LPH Preparedness
Committee to achieve the following:
a. Monitor the pilot tests described in Recommendation #2.
b. Define the preparedness related roles and responsibilities of MDH and the MDH District Offices that
are in support of local health departments; as well as roles of other partners as appropriate.
c. Discuss funding and capacity issues and the related implications for fulfilling local and state roles and
responsibilities.
d. Continue to work jointly to address the remaining four priorities identified in the Public Health
Emergency Preparedness Blueprint (integrated exercise plan, training, plan templates, and public
communication). (See Appendix A).
e. Further develop the Project of Statewide Significance concept and/or explore additional models for
identifying and addressing areas of common need.
f. Recommend refinements to the Essential Local Public Health Activities (ELAs) related to public
health emergency preparedness to reflect the current knowledge, practices, and experience that have
evolved since the ELAs were first established.
g. Bring additional recommendations forward for SCHSAC approval based on the pilot test results and
discussions of the issues identified above.
Emergency Preparedness Communications Recommendations
4. The following templates and protocols should be approved for immediate adoption and use by
MDH and local health departments as mechanisms to improve emergency preparedness
communications by providing the tools to achieve more uniformity, specificity, and efficiency.
The products are (See Appendix G):
• Conference call template and protocol
• Email template and protocol
• Situation Report templates for food-borne illnesses, vaccinepreventable diseases, and natural disaster events [Note: the
Situation Report is specifically intended for those directly
involved in the response and contains non-public information]
• Event Summary templates, which are slightly redacted versions
of the Situation Report containing information that can be shared
with all partners, the public, and the media
• Initial Checklist (aka “Pink Sheet”), with a similar version
already being used by MDH
• Internal Notification Chart, to provide consistent language
around notification and activation across the state
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22
The templates and protocols for emails, conference calls, and briefing summaries should be
shared statewide and adopted for use by MDH and local health departments. Suggested steps for
implementation include:
•
•
•
•
•
•
•
Post all documents to the Workspace
Notify local health departments and MDH staff about the new
tools, templates and protocols and outline how and when they
should be used
Publish an announcement about the new tools, templates and
protocols in publications, such as the Office of Emergency
Preparedness Ready to Respond Newsletter, the Commentary
Newsletter, the CHS/PHN Listserv, and the CHS Mailbag
Share the items listed above at advisory committee meetings and
in reports
Promote the items listed above at conferences, trainings, and
meetings (e.g., presentations, posters, displays)
Use the items listed above in emergency preparedness exercises
Implement the items listed above in actual responses, events, and
discuss utility and functionality of the items listed above during
event follow-up discussions
Situational Communications
5. MDH should notify affected local health departments of “suspect cases” when there is the
potential for a “big” event in order for local health departments to provide local information,
begin identifying resources, and staffing availability.
Note: Local health department staff have indicated to MDH that it is acceptable to not receive all
the details of all potential events, but it is important for MDH staff to notify local health
departments when LDH action might be needed (e.g., “How many public health nurses could
you have available on Saturday?”).
6. When a health-related situation occurs, for which some entity other than MDH is responsible,
(such as peanut butter recalls), MDH should post information indicating which state or federal
agency regulates that product.
7. Local health departments should be proactive in seeking information about health-related issues,
which may include signing up for federal agency alerts, calling the MDH Office of Emergency
Preparedness 24/7 toll-free number, and learning more about different regulating bodies.
Ongoing Communication Improvement
8. MDH should offer training for state and local health department staff on the application of
Minnesota State Statute 2006 Chapter 13, Data Practices, (which addresses governmental data
privacy), to increase understanding and familiarity about the differences in information which
can be released to partners versus what can be released to the public.
9. MDH and local health departments should develop a mechanism for regular communication
check-ins, debriefings, and feedback (e.g., joint debriefings “hot washes”) to address issues in a
timely manner.
10. MDH and local health departments should share the five issue scenarios and the corresponding
recommendations broadly with their staff and encourage discussion.
Strategic Plan for Public Health Emergency Preparedness in MN
23
11. MDH, local health departments, and community health services administrators should clarify
expectations for staff who serve on work groups and task forces, including a description of who
they are representing and their responsibility to report back to their constituents.
12. The MDH Office of Emergency Preparedness and representatives from local health departments
should design a statewide communications-specific exercise to analyze the process and tools.
13. The MDH Office of Emergency Preparedness should facilitate a training and discussion on the
appropriate uses of the “General Message” feature on the Workspace for MDH staff involved in
emergency preparedness.
14. The Director of the MDH Office of Emergency Preparedness and a local health department
representative should make a report to SCHSAC in one year to discuss progress in strengthening
public health emergency preparedness communications, how the improvements are working,
adjustments that have been made, and future initiatives to continue strengthening public health
emergency preparedness communications.
Strategic Plan for Public Health Emergency Preparedness in MN
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Appendices
Appendix A. Blue Print
Appendix B. MDH and Local Health Department Incident Lifecycle Maps
Appendix C. Crosswalk
Appendix D. Public Health Emergency Preparedness Responsibilities Tiers
Appendix E. Working Model of the Emergency Preparedness Responsibilities Model
Appendix F. Public Health Emergency Preparedness Communication Scenarios
Appendix G. Public Health Emergency Preparedness Communication Subcommittee Products
Appendix H. Priority Areas Not Addressed in 2007
Strategic Plan for Public Health Emergency Preparedness in MN
25
Appendix A: Blue Print
Blueprint1: Working List of 3 – 5 Year Priorities
4/23/2007
One of the tasks identified in the charge to the work group was to identify shared MDH and local public
health priorities for the next three to five years.
The following list of priorities represents themes taken from the key informant interviews and the
strategic planning meetings. It is proposed as a “working document”, with the underlying assumption
that the priorities will evolve, as public health preparedness and response activities in Minnesota and
nationally continue to evolve and mature; and as new issues are identified.
1. Define state and local public health roles, responsibilities and functions
Methods:
• Jointly develop a system of “tiers” or “levels” of capacity within local public health departments.
Each level would be clearly defined with LPH roles spelled out. Each LPH agency would self
assess which level they are in.
• Jointly develop a guidance document, based on the tiers, that describes responsibilities between
MDH/LPH in reportable/communicable disease prevention and control. This would clearly
define responsibilities for events that range from a small local outbreak to a multi-jurisdictional
public health emergency.
• “Life-Cycle of an Incident” will serve as the framework for describing work and roles.
2. Training – Identify statewide training priorities; assure that appropriate staff are trained.
3. Preparedness plans/templates – Provide a consistent framework for state and local public health
response that is flexible enough to reflect the varying capacities and unique hazards and
vulnerabilities that exist across the state.
4. Exercise plan – Develop an integrated state, regional, and local public health exercise plan.
5. Public education and awareness campaign – Conduct coordinated public education and awareness
activities.
6.
Communications – Strengthen mechanisms for communication around public health emergencies
within MDH, and between MDH and local health departments.
Methods that have been proposed:
• Review mechanisms for communication between state and local public health in an emergency
response situation and identify gaps.
• Develop systems to improve communication between all MDH divisions working on
preparedness as well as consistent coordinated communication with local public health partners.
1
A carefully designed plan.
Strategic Plan for Public Health Emergency Preparedness in MN
27
Appendix B: MDH Incident Lifecycle Map
Strategic Plan for Public Health Emergency Preparedness in MN
29
Appendix B: Local Health Department Incident Lifecycle Map
Strategic Plan for Public Health Emergency Preparedness in MN
30
Appendix D: Emergency Preparedness Responsibilities Tiers
Pending
The tiers will be pilot tested January – May
The final version will be added to the report after the May SCHSAC meeting
Anyone interested in a draft copy of the tiers can contact:
Mickey Scullard, MPH
Community Health Planner
Office of Public Health Practice
Community and Family Health
Minnesota Department of Health
Golden Rule Building, Suite 220
PO Box 64882
St. Paul, MN 55164-0882
Ph: 651-201-3882
Fax: 651-201-3881
Strategic Plan for Public Health Emergency Preparedness in MN
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Appendix E: Working Model – Emergency Preparedness Responsibilities Model
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Responsibilities requiring
greater capacity or capability
STTAANNDDAARRDD TIIEERR
Responsibilities reflecting new expectations of local
health departments’ roles in emergency response.
Expected of all Local Health Departments
EMMEERRGGEENNCCYY PRREEPPAARREEDDNNEESSSS
ESSSSEENNTTIIAALL LOOCCAALL ACCTTIIVVIITTIIEESS
Sustaining Responsibilities
Essential Local Activities: These are already agreed upon and in place statewide (state statute).
Standard Tier: These responsibilities reflect the new expectations of local health departments’ roles in emergency response.
All local health departments in Minnesota are expected to address these responsibilities in order to build infrastructure and capacity.
Comprehensive Tier: There are a set of responsibilities that require specific skills and/or specific staff time. These responsibilities
might be addressed several ways: local health departments with larger numbers of staff or who have staff with specific expertise could
address these responsibilities; a set of counties could work together to complete these responsibilities; or a region could work together to
address the responsibilities in this tier.
Projects of Statewide Significance: These are responsibilities that require significant staff time or specific expertise. Specific tools,
templates, procedures, policies, etc. would be produced, which every local health department in the state would use.
Strategic Plan for Public Health Emergency Preparedness in MN
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Appendix F. Emergency Preparedness Communication Scenarios
DISCUSSION PRINCIPLES
This document illustrates common emergency preparedness communication problems and issues that
local health departments and MDH encounter by:
• Stating issues in a neutral manner without assigning blame to either local health departments or MDH;
• Identifying misunderstood or unknown expectations; and
• Identifying misconceptions.
EVENT: in this document, the word “event” will be used to refer to potential or confirmed infectious
disease situations, food- or water-borne event, bioterrorism, or other incidents, which impact health.
EMERGENCY PREPAREDNESS (EP) COMMUNICATION ISSUE #1:
At what point in an investigation should MDH notify a potentially affected local health department(s)?
Example: A suspect or confirmed case of (an infectious disease/food- or water-borne
illness/terrorism) is being tested in the MDH laboratories. There is the potential for significant
media attention. The Commissioner of Health has been notified. The potentially affected local
health department learns about the situation many weeks later, possibly through non-MDH
sources.
LHD Perspective
•
•
•
•
•
•
The state-local partnership is important.
If the event had been confirmed, action might have been required by the local health department.
It takes time to activate staff.
Advance notice of the possibility can assist directors and administrators in thinking through all the
steps they would need to take.
Local health departments do not necessarily want to know specifics and they may or may not need to
share the information with other local health department staff.
The knows important characteristics about their communities: how the community may respond,
literacy levels, communication channels frequently used, and other unique issues of the community.
MDH Perspective
•
•
•
•
•
•
•
The state-local partnership is important.
MDH gets many “rule-outs” during a year. It is not a rare event.
May potentially violate data privacy laws;
May cause unnecessary action and concern on the part of local health departments;
May inadvertently signal a story to the media; and
Could result in incorrect information being disseminated because some staff may not have the
background/training to adequately answer questions or provide information.
They may have forgotten to inform local health departments.
Discussion Questions:
What are the factors that influence the decision to alert/notify or not to alert/notify local health
departments?
Does the specific situation make a difference – e.g. what the disease/agent/event is, how soon a result will
be available (4 hours vs. 4 days), or what the local health departments role may be?
What questions and factors should MDH consider in making that determination?
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43
EP Communications Issue #2:
What concerns do local health departments have when they learn about an event from a non-MDH source
such as the media, community partners, or community questions?
Example: During a recent peanut butter salmonella contamination event, local public health
departments were getting questions from the community and their partners. They expected information
from MDH. MDH provide information as it was an FDA and Department of Agriculture issue. MDH did
send out information, but it was later than local health departments expected. On the other hand, no local
health departments requested information from MDH.
LHD Perspective
• The state-local partnership is important.
• The local health departments may be inundated with telephone calls from the public
• Local health departments have spent a lot of time working with their local media and community
partners to be seen as the “go to” department with information and questions about health issues.
• Their partners don’t make a distinction between local and state health department – they just know it
is a health-related issue, “public health”, and assume that their local health department has
information;
• Local health department staff feel the delay in getting information made them look incompetent and
that it reflects poorly on their professionalism
• Local health departments (and the public) don’t necessarily know who has the regulatory authority for
different events
• Some staff feel uncomfortable saying “they don’t know” and getting back to people with information.
MDH Perspective
• They did not understand why local health departments would view this as a public health issue.
• MDH may not be aware of the questions local health departments are getting from local media,
community members and partners.
• They did not understand the role the local health departments could play in helping alert community
groups, institutions, organizations, etc.
• They may have forgotten to notify local health departments.
• They expect local health departments to ask for information when they need it.
Discussion Questions:
What are realistic and acceptable turnaround times for getting information out to local health
departments?
What actions might MDH take?
What actions might a local health department take?
What is MDH’s role, if any, in communicating about health-related issues that are not within the scope of
MDH’s authority?
What are local health departments’ responsibilities in knowing which state or federal agencies have
authority over different matters?
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EP COMMUNICATIONS ISSUE #3:
What is the appropriate level of participation and guidance from MDH?
Examples:
1. The first time heat advisories were sent out, some local health departments were concerned because
they were not aware of a role with heat emergencies, and therefore did not know what to do with the
information. MDH meant it as an informational document only for those that did not have plans and
did indicate this on the advisory.
2. An event occurs and local health department staff feel that MDH came in and took over the response.
LHD Perspective
• Local health departments are very conscientious and want to do the right thing.
• If it is new action/issue/event, some local health departments would like specific directions.
• On the other hand, other local health departments may not want or need direction.
• Expects the state-local partnership in action – discuss the event, options and approaches and division
of labor, based on capacity, skills, expertise, etc.
• The local health department knows their community and important characteristics such as
how the community responds, literacy levels, communication channels frequently used, etc.
• They may be concerned about the local media as the local health department will be the local
resource they will call.
MDH Perspective
• MDH staff is very conscientious and wants to do the right thing as local health department’s partner.
• MDH is able to provide general directions, suggestions, advice, but due to the great variety in local
health departments across the state, they do not provide specific directions.
• In addition, they often do not give specific directions because they have received complaints when
they have done that in the past.
• They do not want to offend local health departments by giving the impression that they think they
don’t know what to do.
• They are providing information to local health departments, as is often requested.
• Knows the particulars of the event.
• May not be familiar with the local health departments and what they can do.
• During a major or quickly evolving event, it is more difficult to develop joint responses.
• Concerned about media attention at the local and state level.
• Concerned about maintaining data privacy
Discussion Questions:
Are there criteria to determine when to provide specific guidance or be more general?
Can local health departments build something into their department emergency operations plan
procedures or protocols for times when they encounter a new type of event?
What process might be useful when “who’s in charge” issues arise?
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EP COMMUNICATION ISSUE #4:
At what point in an event should the local health department notify MDH?
Example: At an industrial site, a tank containing 50,000 pounds of hydrofluoric (HF) acid was
punctured, releasing 50,000 pounds. A gas cloud formed that was heavier than air and floated downwind
over a community of several thousand people. Approximately 4,000 people had some degree of exposure,
with approximately 100 people hospitalized. There were no deaths. The local health departments
responded with other local responders. They were initially involved environmental health effects issues,
mass evacuation, health effects questions, both acute and long term, and PIO activities. In all the
excitement, the local health department did not notify the Department of Health who heard about the
incident on the news. They also failed to notify Poison Control Center, which was receiving numerous
calls about the toxic effects of hydrofluoric (HF) acid.
LHD Perspective
• They may not have seen a role for MDH, so did not feel it was necessary to contact anyone.
• They forgot to notify MDH.
MDH Perspective
• The state-local partnership is important.
• MDH may be receiving calls and inquiries from the public or from state partners.
• While MDH assistance may not be required, state partners may not understand the distinction between
local health departments and MDH.
Questions for Discussion
What are the factors that influence the decision to alert/notify or not to alert/notify MDH?
Does the specific situation make a difference – e.g., what the disease/agent/event is, or what MDH’s role
may be?
What questions and factors should local health departments consider in making that determination?
What are realistic and acceptable turn around times for getting information to MDH?
What actions might MDH need to take?
Does MDH have a role in local health-related issues?
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EP COMMUNICATION ISSUE #5:
What are barriers to information flow issues within local health departments?
Example: A local health department staff person who is serving on a work group or committee
does not provide information to the director/administrator. The local health department
director/administrator tells MDH s/he is not aware of the information/project/process – no one
informed them. (Variations include administrator/director does not share information with staff
or an administrator/director or staff person who is representing a region does not share
information with others in the region).
LDH Perspective
• Administrators/directors and staff want to keep on top of current issues and any changes that may
affect their departments/programs.
• Administrator may think it's MDH's responsibility to provide information about all activities,
regardless of staff participation
MDH Perspective
• MDH did provide the information/process to the local health department (through a work group
member or sent to the director) and expected it would be shared internally.
• Assume that staff working on a project should follow their agencies' policies on informing supervisors
about activities, and supervisors are responsible for informing administrators
Discussion questions
What are the barriers to information flow within local health departments?
What is the responsibility for sharing information of individuals serving on a committee or workgroup?
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Appendix G: Emergency Preparedness Communication Subcommittee Products
•
•
•
•
•
•
•
•
Email Protocol
Email Template
Conference Call Protocol
Nuts and Bolts of Conference Calls
Conference Call Template
Situation Reports
LHD Initial Notification Chart
Common Alerting Protocol
Strategic Plan for Public Health Emergency Preparedness in MN
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Email Protocol
Draft
Subject Line
Always be sure to use a relevant subject line that clearly states the topic, the level of importance of the topic and/or
the conference call and at what level of response the situation is at.
1. State Topic
2. State Level of importance
3. State Situation’s Level of response
Message Format
Place Action items at the top. Use Bullet points to make the content easier to read.
1. State topic
2. Indicate Level of Importance
3. Indicate what is needed from the participants (decisions, information, actions…)
4. Indicate who needs to see the message (administrators, directors, DP&C staff…)
5. State any follow-up that may be required/requested
Messaging Tips
•
•
•
•
•
•
•
•
Keep messages short and simple whenever possible.
Start with a summary of what you need people to know right away.
Use bullet points
If additional detail or information is needed, list it further down. (inverted pyramid format)
Use short sentences and paragraphs.
Avoid colored fonts, pictures, logos, diagrams, etc.
Do not write in CAPITALS.
Review email content before sending them.
A guide to constructing messages
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E-mail Template
Draft
SUBJECT LINE:
(Subject, Level of Importance, Level of Response)
(Be as specific as possible and indicate level of importance and level of response needed from MDH/)
Status:
Action:
‰No Action
‰Informational
‰Beware
‰Be Ready
‰Take Action
‰Collecting information
‰Decisions needed
MESSAGE FORMAT:
6. State Topic/Issue
7. Indicate Level of Importance
8. Indicate what is needed from LPH (decisions, information, actions…)
9. Indicate who needs to see the message (administrators, directors, DP&C staff…)
10. State any follow-up that may be required/requested
A guide to constructing messages
Strategic Plan for Public Health Emergency Preparedness in MN
51
Conference Call Protocol
Draft
When deciding to hold a conference call between MDH and local health departments, it is important to
answer these questions to assure you and your conference call participants have a satisfactory conference
call experience.
1.
Decide the purpose of the call
• Is it to obtain information?
• Is it to provide information?
• Is it to ask for help making decisions?
• Is it to communicate decisions that have already been made?
• Is it to have a discussion to help form procedures, protocols, decisions?
2.
Think about who needs to be involved
For MDH staff: Keep in mind that each local health department assigns duties differently, so a public health
nurse may be the program coordinator in one agency and in another, a health educator may be the program
coordinator. In some local health departments, supervisors or program coordinators may be able to make
decisions, in others, only the CHS administrators or directors can make decisions.
3.
Length of call
• Do you want feedback from all participants?
• Do you want to take a few questions?
• If there is not time for questions, or only for a few questions, be ready to let participants know how
questions can be asked and how they will be answered.
4.
Participants
• Indicate if all local health departments are expected/required to participate on a single phone call.
• Indicate if there will be multiple opportunities to participate.
• Indicate if call(s) will be done by region.
• Indicate if the call is only for those interested in the issue/topic.
5.
Follow-up
• Indicate the follow-up that will be done after the conference call (i.e., an email summarizing the call or
indicating decisions made, or providing information in written form…)
• Indicate if local health departments need to do anything (send in information and to whom, provide a
contact, make phone calls, etc.)
• Indicate whether there will there be additional conference calls?
6.
Provide information on other aspects (when appropriate)
• Contacts for additional information and questions
• Future plans for communications information, decisions, etc.
Strategic Plan for Public Health Emergency Preparedness in MN
52
Nuts and Bolts of Conference Calls
Draft
Prior to Call
Moderator
• Prepare a timed agenda
• State whether call is information with questions or decision with discussion
• Clearly state dial-in instructions
• List participants
Participants
• Review any materials prepared prior to call
• Have appropriate personnel on the call
During the Call
Moderator
• Be early to host the call
• Introduce self and purpose of call with stated time of call
• Remind people about general conference call etiquette (see below)
• Assign a note taker
• Take a roll call of participants
• Do ask for input by using a person’s name (everyone stay alert)
• Do check-ins
• Do close the call formally and thank people for their time
• Keep conversation moving, try to gauge when there is consensus, and check if there is any
disagreement
Participants
• Be on time for the call
• Introduce yourself when speaking
• Respect the time limits of the call
After the Call
Moderator
• Distribute notes of the call to all participants
Participants
• Follow up on requested actions or decisions
General Etiquette
• Do use the right equipment. If possible, avoid speaker phones unless they are “full digital duplex” which
allows all parties to speak at the same time. Use the mute button unless speaking. Avoid cordless phones as
they tend to pick up static. Cell phones should only be used if stationary with a strong signal.
• Do not put your phone on hold. Putting your phone on hold may introduce music into the conference call
and effectively end the call.
• Do deactivate call waiting. If your line starts beeping with call waiting, other participates may think a new
person is entering the call.
• Do speak directly into the phone or remote microphone. Speaking halfway across a conference table
into a remote microphone greatly diminishes the quality of sound.
• Do not shuffle papers, make extraneous noise, answer other phones, or have side conversations if
using a speaker phone or remote microphones as everything said can be heard by the other conference call
attendees.
Strategic Plan for Public Health Emergency Preparedness in MN
53
Conference Call Template
Draft
(To be used when sending out conference call announcement)
Topic:
Issue:
Lead:
Date(s):
Time(s):
Length of Call:
Approximate number of participants who will be on the call:
Level of Importance: ‰Notification
‰Advisory
‰Alert
Activation level:
‰Be Aware
‰Standby
‰Respond
Purpose of Call:
‰Need information
‰Need decisions
‰Need feedback
‰Provide information
‰Other
Type of staff needed (check all that apply):
‰Decision-makers
‰Supervisors
‰Program Coordinators
‰Program Staff
‰DP&C Staff
‰Health Educators
‰Environmental Health Staff ‰Other: __________________________________
Required Participants:
‰All local health departments in MN
‰Interested local health departments
‰Call will occur by Region, all counties in region need to participate
Potential follow-up:
‰Additional conference calls
‰Individual department conversations
‰Email messages
‰Other: ____________________________________________
Other information that should be provided:
Contact(s) for communications issues:
Contact(s) for questions:
CONFERENCE CALL PHONE-IN INFORMATION
Strategic Plan for Public Health Emergency Preparedness in MN
54
N
NO
OTT FFO
OR
RP
PU
UB
BLLIIC
CD
DIIS
STTR
RIIB
BU
UTTIIO
ON
N
Food-borne Illness Situation Report
Minnesota Department of Health
Department Operations Center
Situation Report #:
Date and Time of Report:
Incident Name:
State Incident Number:
Incident Manager:
Notification Level:
‰Notification
‰Advisory
‰Alert
Activation Level:
‰Be Aware
‰Standby
‰Respond
Situation
Overview:
Cases:
____Suspect
____Probable
_____Confirmed
Deaths:
____Suspect
____Probable
_____Confirmed
Geographic Scope: (link to map)
Verbal description:
Major Activities
Epidemiology:
Environmental Health:
Lab:
Agriculture:
Response:
Next Scheduled Briefing:
Strategic Plan for Public Health Emergency Preparedness in MN
55
N
BLLIIC
NO
OTT FFO
OR
RP
PU
UB
CD
DIIS
STTR
RIIB
BU
UTTIIO
ON
N
Natural Event Situation Report
Minnesota Department of Health
Department Operations Center
Situation Report #:
Date and Time of Report:
Incident Name:
State Incident Number:
Incident Manager:
Situation
Overview:
Injuries:
____Probable
_____Confirmed
Deaths:
____Probable
_____Confirmed
Executive Action
DOC Activation Level:
‰Standby
‰Partial
‰Full
MDH Plan Activation Level:
‰Be Aware
‰Standby
‰Respond
SEOC Activation Level:
‰Standby
‰Partial
‰Full
State of Emergency:
Disaster Declaration:
Major Activities
Local:
‰None
State:
‰None
Federal:
‰None
Volunteer:
‰None
Strategic Plan for Public Health Emergency Preparedness in MN
56
Resources Used
Local:
‰None
‰List:
State:
‰None
‰List:
Federal:
‰None
‰List:
Volunteer:
‰None
‰List:
Damages
Below is a county-by-county summary of damages reported, as of the time of this report:
County/City
Injuries
Deaths
Infrastructure
Individuals
Businesses
Agriculture
Comments
Other Notes
Next Briefing:
Strategic Plan for Public Health Emergency Preparedness in MN
57
N
NO
OTT FFO
OR
RP
PU
UB
BLLIIC
CD
DIIS
STTR
RIIB
BU
UTTIIO
ON
N
Vaccine-Preventable Disease Situation Report
Minnesota Department of Health
Department Operations Center
Situation Report #:
Date and Time of Report:
Incident Name:
State Incident Number:
Incident Manager:
Notification Level:
‰Notification
‰Advisory
‰Alert
Activation Level:
‰Be Aware
‰Standby
‰Respond
Situation
Overview:
Cases:
____Suspect
____Probable
_____Confirmed
Deaths:
____Suspect
____Probable
_____Confirmed
Geographic Scope: (link to map)
Verbal description:
Major Activities
Epidemiology:
Lab:
Clinics:
Response:
Supply Status:
Recommendations:
Next Scheduled Briefing:
Strategic Plan for Public Health Emergency Preparedness in MN
58
INITIAL RESPONSE CHECKLIST (AKA “PINK SHEET”)
Name of event:
Date and time:
Person completing form:
Source of information:
Description/assessment of the event (location, problem, number of people involved, initial actions
taken, requests for assistance from MDH, etc):
Lead contact person and number:
Scribe appointed:
Director or CHB Administrator notified: date/time
County Commissioners and County Administrator notified: date/time
Emergency Manager notified: date/time
Region notified: date/time
Notification level:
Autocall used:
___white ___yellow ___orange ___red
___no
____yes date/time:
Other notification method used:
Approval of All-Hazards Plan at activation level: ___0 ___1 ___ 2 ___ 3 ___ 4
Incident manager appointed:
Date/time:
Determination that local public health department of operations center (DOC) is needed:
____Full ____Partial date/time:
DOC set up staff person name:
Contacted date/time:
DOC up and running: date/time
Time and place for initial briefing:
Strategic Plan for Public Health Emergency Preparedness in MN
59
Person responsible to contact MDH:
MDH staff to contact:
District office to contact:
Date/time completed:
Office of Emergency Preparedness notified: 651-201-5735 (24/7 on-call) or 651-238-0351
date/time:
HAN sent to
___All
____Partial (who):
Date/time:
HSEM notified: date/time
Duty officer notified: (1-800-422-0798 or 651-649-5451) date/time:
Federal notifications:
Poison control notified: (1-800-222-1222)
Notification Levels: Notification to senior staff and response staff of potential health threats following initial or
ongoing assessments of the situation.
White: Initial assessment does not warrant further notification. BUSINESS AS USUAL
Yellow: Credible but unsubstantiated threat, developing situation, or significant concern that does not
immediately impact Minnesota. BE AWARE
Orange: Potential health threat somewhere in Minnesota. BE READY
Red: Confirmed health threat somewhere in Minnesota. TAKE ACTION
Activation Levels: Implementation of the All-Hazards Response Plan. Initial activation may begin at any level
depending upon the needs at the time the event is recognized or the decision to stand up resources is made. The
Levels may increase or decrease as the situation unfolds.
Level 0: Response is managed using normal business procedures and processes. (Plan not activated.)
Level 1: Response requires activation of resources outside a single division, program area, or usual working
relationship.
Level 2: Response requires activation of department resources from several program areas. Some department
staff and resources may be redirected at this level of activation, but most routine services will be maintained.
Level 3: Response requires extraordinary activation of department resources and/or requests for significant
resources from outside of local health departments. Some normal activities of may be suspended until the
situation stabilizes and the need for additional resources diminishes.
Level 4: Need for resources and support from neighboring states and/or federal resources. Some non-essential
public health services will be suspended for a period of time.
Strategic Plan for Public Health Emergency Preparedness in MN
60
Internal Notification Chart
Notification
Level
White
Yellow -
Indication
Who to
Notify
Status
Actions
MDH Status
Initial assessment does not
warrant further notification
N/A
If increased community
concern may provide
information.
Credible but unsubstantiated
threat, developing situation or
significant concern that does
not immediately impact
community/jurisdiction.
Local:
No action
needed.
Business as
usual
Be Aware
No action
needed.
Business as
usual
Be Aware
State:
PHPC &
MDH OEP
If increased community
concern: announcement to
staff, may shift some staff
duties.
May be lead or may support
other agencies.
Urgency:
Severity:
Certainty:
Orange -
Status:
Potential health threat that may
affect community/jurisdiction.
Urgency:
Severity:
Local:
Be Ready
State:
PHPC &
MDH OEP
Disruption of duties, staff
expected to help. Prioritize
services.
Status:
Confirmed health threat in ’s
community/jurisdiction
Local:
Urgency:
State:
PHPC &
MDH OEP
Severity:
Certainty
Status:
Strategic Plan for Public Health Emergency Preparedness in MN
Be Ready
Staff expected to help.
Certainty:
Red -
Announce to staff and hold
briefing meeting.
Take Action
May be lead or may support
other agencies.
Immediate meeting of PH
emergency team and
announce to staff and hold
briefing meeting.
Take Action
Major service disruptions.
Staff expected to assume
assigned responsibilities.
May be lead or may support
other agencies.
61
Common Alerting Protocol from PHIN
Urgency
•
•
•
Alert: An alert requires public health activities to respond to a threat or public health event
Advisory: An advisory provides information that requires awareness and/or preparatory activities by
public health officials due to events that have or are suspected to occur.
Notification: Communications that reference an originating notification, advisory or alert based upon
changes to the originating specified set of criteria such as event severity, subject area, urgency, target
population, location, communication method, area affected.
Severity
•
•
•
•
•
Extreme: extraordinary threat to life or property
Severe: significant threat to life or property
Moderate: possible threat to life or property
Minor: minimal threat to life or property
Unknown: severity unknown
Certainty
•
•
•
•
•
Very likely: greater than 85% or certain
Likely: greater than 50%
Possible: less than 50%
Unlikely: not expected to occur 0%
Unknown: certainty unknown
Status
•
•
•
•
Actual: actionable by all targeted recipients
Exercise: actionable only by designated exercise participants
System: for messages that support alert network internal functions
Test: technical testing only, all recipients disregard
Cascading and Direct Alerting
Direct Alerting: An alerting system that sends alerts directly to a recipient using a variety of
communication devices (e.g. email, PDA, fax, cell phones, etc)
Cascade Alerting: An alerting system that delegates responsibility to intermediaries for sending on alert
messages to reach recipients.
Strategic Plan for Public Health Emergency Preparedness in MN
62
Appendix H. Priority Areas Not Addressed in 2007
Public Education and Awareness Campaign
An all hazards public education campaign, codeReady, was developed in partnership with the Department
of Safety. An advisory group was convened and included members from local public health, the local
public health association (LPHA), MDH, Minnesota Department of Education, businesses, and other state
and local partners from across the state. Consisting of education and media ready materials, the
codeReady campaign was widely distributed; publicized and local health departments and tribes were
provided with tool kits. Trainings were offered across the state. A website, http://www.codeready.org/
contains numerous resources for professionals and the public. A codeReady module was integrated into
the online personal preparedness training module through Minnesota Emergency Readiness Education
and Training (MERET). MERET is a program housed at the University of Minnesota which is designed to
educate and train Minnesota's health care workers in emergency preparedness.
MDH continues to partner with the Emergency and Community Health Outreach project (ECHO) and
MDH staff serve on the ECHO advisory group. MDH promotes and supports ECHO’s activities and
includes ECHO on our web-sites.
Training
A training plan was developed in 2003 and remains current, including Federal Emergency Management
Agency (FEMA) Incident Management System (IMS) coursework. Training efforts included a statewide
preparedness conference in May and the roll-out of MNTrain (Minnesota Department of Health’s
Trainingfinder Real-time Affiliate Integrated Network). MN.TRAIN facilitates training coordination
among multiple disciplines to improve knowledge and skills for public health preparedness. Minnesota
course providers, local public health, hospitals, EMS, and other users will be able to track their training
easily. Over 3000 training opportunities from 800 course providers from 26 affiliates are listed. Many of
the course offerings are available online.
The MDH public health preparedness consultants (PHPCs) continue to work with local health
departments to identify education and training needs. In addition, all efforts are made to maximize the
benefits of the MERET, promote the use of online modular training, and activities at the other Centers at
the University of Minnesota. Annual scholarships are available for the Summer Public Health Institute.
Preparedness Plans/Templates
The MDH PHPCs conduct an annual review of each local health departments planning process and
sharing between counties within regions occurs regularly. The MDH All Hazards Response and Recovery
Plan, with Annexes, is now available and can also be accessed through the MDH website. A regional
response and recovery plan template is currently in development.
Exercise Plan
Exercise templates have been shared and are posted on both the workspace and the public site. All the
MDH PHPCs will be trained in the Homeland Security Exercise and Evaluation Program (HSEEP)
format, required for all exercises.
Strategic Plan for Public Health Emergency Preparedness in MN
63
Office of Public Health Practice
P.O. Box 64882
St. Paul, MN 55164-0882
Phone 651.201.3880; Fax 651.201.3881; TDD 651.201.5797
Upon request, this publication can be made available in alternative formats such as large print,
Braille or cassette tape. Printed on recycled paper with a minimum of 10% post-consumer
materials.
Please recycle
December 14, 2007