November 2012 Inside this issue:
Ole and Lena’s Thanksgiving ...................................... 1
Director’s Chair ............................................................ 2
Minnesota Department of Health Preparedness ........ 2
Fungal Meningitis Media Challenge a Success ....................2
Statewide Anthrax Exercise .................................................3
Climate Change and Human Health Training Tools ............3
Healthcare System Preparedness ................................ 4
Training Mobile Medical Teams for Duty ...........................4
Continuity of Operations (COOP)............................... 4
Is Your Agency Ready for a Suspicious Package? ..............4
Office of Emergency Preparedness tasks the Continuity
Challenge .............................................................................5
MDH Public Health Laboratory Wins National
Award ............................................................................. 5
2012 Excellence in Public Health Response Award ............5
Upcoming Events .......................................................... 6
Editorial Board.............................................................. 6
Ole and Lena’s Thanksgiving
Thanksgiving Dinner – Minnesota Style
Lena took the role of the Incident Commander. She wants the
family and friends to gather on Thanksgiving at noon at the
homestead for stuffed turkey and the trimmings, followed by
games for the kids and plenty of recliners in the garage for the
sport fans to watch the game. She set these goals the SMART
way: specific, measureable, action orientated, realistic and
time sensitive. Then she rallied the team.
First, she told Ole what was going to happen. He volunteered
to be the Finance Section Chief and pay for it if he was
allowed to watch the Vikings undisturbed. Lena agreed.
Lena’s daughter Inga is the most organized of the bunch and
will be the Planning Section Chief. She’ll make sure they have
the menu set, arrange the seating and decide the timeline for
the preparations and “game day.” She’s tracking the status of
the resources and anticipating future needs in her
notebook…just in case the power goes out and she can’t
recharge her smart phone.
Sven’s wife Holda is the best cook of the lot. She’ll serve as
the Operations Section Chief and dish out assignments,
appoint someone to entertain the kids and make sure the men
stay in the garage. She’ll handle all the tactical details of the
day to make sure the turkey is perfectly cooked. She’ll also
recruit some of the others to help her that day.
The supplies like ingredients, decorations and games are the
responsibility of Lars, Lena’s oldest son. Lars is the Logistics
Section Chief, meaning he’s in charge of all the stuff and
stuffing necessary for the day. Since he lives in the big city,
he can find everything and have it there by Wednesday. He
may need to have the grandkids help get things ready for the
big day at the homestead.
Now Sven has found himself a very comfortable chair to
watch all the goings-on. He’s monitoring the safety of the
situation as the Safety Officer, and making sure no one causes
any illness from cross-contamination.
Ole and Lena’s Thanksgiving plans usually start with great
ideas but end up with them looking at each other with “what
happened?” expressions. Since they have been working on
their MN Responds volunteer online trainings, Ole and Lena
decided to use Incident Command System to manage
Thanksgiving. This would ensure the day had obtainable
objectives, functional grouping of activities and avoid
duplication of efforts (and wouldn’t end with the dog stealing
the day’s turkey.)
The big day arrived and so did a few extras! The table was
easily expanded with those who didn’t RSVP like they were
supposed to but there’s always extra pie. Everyone knew what
was going on, who was in charge of what, and the jobs to be
done. Lena kept a watchful eye on her brood as they briefed
each other and her throughout the day.
October 2011
By the end of the day, bellies were full, left-overs divided and
the naps were taken. Lena and Ole thought it was a grand day.
They’ll use ICS to plan Christmas and other holidays…so they
don’t wind up with extra lutefisk.
Minnesota Department of Health
Preparedness
Fungal Meningitis Media Challenge a Success
Director’s Chair
The past several months have been incredibly hectic in MDH
readiness circles with grant reporting, responses to real
emergencies, and some unique planning and training activities
described in this newsletter.
You may have heard about or seen the “Performance
Measures” put forth by HHS and CDC around the
preparedness grants. We are in the process of clarifying,
compiling, and distributing the requirements so local and tribal
health departments and healthcare partners can collect and
report the proper data for MDH to pass along to CDC and
ASPR. We’re told this is a baseline assessment year, so we are
hopeful the data reporting process will be streamlined for next
year.
Over the coming months, you will also be hearing much more
about the rollout and refinement of the Health Coalitions in
Minnesota. The Hospital Preparedness Program (ASPR) grant
is based primarily on the development of “Healthcare
Coalitions” to plan for surge capacity in healthcare systems.
Fortunately, our HSPP system that has been in place for nearly
10 years in the eight regions of the state is a very good start on
what the federal grant requires. Because the partners needed
for the coalitions mirror in many ways the sectors mentioned
in the PHEP grant, we are choosing to refer to “Health
Coalitions” to encompass the planning for all partners and to
ensure increased coordination and reduced duplication.
Congratulations to the Northeast region public health, tribal
health, and healthcare staff on their well-coordinated and very
effective response to the flash flooding in June. The region
worked well together, overcoming a number of logistical
obstacles around transportation difficulties, as well as damage
and loss of power and communications with their own homes
and offices. They ably showed the payoff from years of
planning, exercising, and building partnerships, and served
their communities well.
Best wishes for a happy and healthy holiday season!
Ready to Respond Newsletter
Sudden emerging, high-profile incidents like the current
fungal meningitis, present unique communication challenges
and test the ability of public health agencies to do effective
crisis and emergency risk communication.
After several days of growing concern at the federal level, the
meningitis outbreak entered the public consciousness in a big
way on October 4. On that day, the Center for Disease
Control and Prevention and the Federal Drug Administration
announced that three potentially contaminated lots of
injectable steroid products, produced by a compounding
pharmacy in Massachusetts, were distributed to health care
providers in 23 states. The products were linked to a highly
unusual outbreak of meningitis. Unlike more familiar forms
of the illness, this form of meningitis was caused by a type of
fungus rather than a bacteria or a virus.
Six clinics in Minnesota received the implicated steroid
products, and the first order of business was to contact patients
who might have been treated with them. MDH began working
with the providers to complete that task. MDH also issued a
news release describing the situation and what was being done
to address it, but not until late afternoon.
As a result, the major initial burst of media interest did not
occur until the next day. The MDH Communications Office
worked with program staff to triage the incoming media calls
and make sure media inquiries were promptly answered.
Providing on-camera interviews for television reporters can be
especially challenging in times of heightened media interest,
because interviews can’t simply be handled by phone. The
answer in this case was a specially scheduled Friday media
availability for television only.
Intense media interest continued through the weekend, as
MDH staff worked to assist the affected health care providers
in contacting patients. Minnesota recorded its first two cases
in the nationwide fungal meningitis outbreak on Saturday, and
a third case on Sunday, further heightening demand from the
media for fresh information. Insofar as possible,
Communications Office staff took over the task of responding
to multiple inquiries and interview requests, in order to take
pressure off of MDH officials and staff who were conducting
the outbreak investigation. It was also determined that MDH
would begin posting information about new cases to a Web
page to which media could subscribe to receive email
announcements when new cases were reported – and eliminate
redundant requests for that kind of routine information.
The “story” of the meningitis continued to unfold on Monday
and into the following weeks. However, MDH met the critical
test of providing effective risk communication during the first
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minutes and hours of a crisis. The agency responded quickly,
accurately and credibly to the demand for information about
the incident and what was being done about it.
Statewide Anthrax Exercise
In conjunction with the MDH Postal Plan Exercise, the MDH
Public Health Laboratory (MN-PHL) held a Statewide
Anthrax Laboratory Response Functional Exercise to test the
MLS sentinel laboratories testing and communications
capabilities. The two main objectives tested were,
communication and laboratory capabilities.
Communication was tested by sending out a MLS Laboratory
Alert to all the Sentinel laboratories and then measuring the
response times. The response times for participating
laboratories is summarized in Table 1. Although there is
significant room for improvement, the response times were
impressive when considering that roughly one third of the
responders (i.e. LRN Basic Sentinel laboratories) had not
previously participated in this type of exercise and were
unsure if or how they should respond. Among LRN Advanced
Sentinel laboratories, response times were delayed in some
cases because the primary contact was not scheduled to work,
or because the existing MLS contact information was incorrect
or incomplete. Laboratories that did not respond within 24
hours were contacted by phone to insure that all messages had
been received and understood.
Table 1: Aggregate response times among participating
laboratories (n = 155)
Start time (StartEx):
5/1/2012 09:37
Time to 50% of lab
5/1/2012 10:31 (54 minutes)
responses
Time to 90% of lab
5/2/2012 14:16 (28 hours, 39
responses
minutes)
Time to 100% of lab
5/3/2012 07:54 (46 hours, 43
responses
minutes)
One sample was sent to each of the advanced sentinel
laboratories. They were expected to use their protocols to
either “rule out” or refer the isolate back to MN-PHL.
Overall, a total of 115 LRN Advanced Sentinel Laboratories
received culture isolates for this exercise; 105 laboratories
(91%) performed some level of testing and reported their
results. Among those laboratories, 88 (86%) correctly either
ruled out or referred the isolate to MN-PHL for additional
testing.
MDH-PHL was successfully able to assess the laboratory
testing and communications capabilities of the Minnesota
Laboratory System and the LRN Advanced and Basic Sentinel
laboratories that participated. The data generated from this
exercise will enable MDH-PHL to target specific training and
education efforts to individual facilities with a demonstrated
need for additional resources. The results will also guide
Ready to Respond Newsletter
efforts to more accurately classify LRN Sentinel laboratories
based on changes in laboratory practice and testing capability.
Finally, communications practices will be modified in
response to specifically identified gaps in existing policies,
procedures, and systems. Overall, this exercise was a
tremendous success and provided MN-PHL with great
information.
Climate Change and Human Health Training
Tools
Climate Change and Human Health Training Tools
Climate Change and Public Health 101; Water Quality
and Quantity, Climate Change and Public Health; and
Air Quality, Climate Change and Public Health are the
latest training tools from the Minnesota Climate and Health
Program in MDH’s Environmental Health Division. Recently
released, they join another training module, Extreme Heat
Events, Climate Change and Public Health. The
modules are free and can be used as an educational tool for
interested individuals or as a “train the trainer” for presenters.
Each training is approximately one hour long and is available
to download as a fully scripted PowerPoint document. Module
descriptions follow with their links.
Current climate change training modules:
Climate Change and Public
Health 101. This module provides
an overview of the observed
climate changes in Minnesota and
discusses the potential human
health impacts of climate change.
The module provides
communication, mitigation, and adaptation strategies that
public health and local government can employ to prevent
climate-related illness, injury, or death. View this module
here:
http://www.health.state.mn.us/divs/climatechange/climate101.
html
Water Quality and Quantity,
Climate Change and Public
Health. This training module
provides an overview of the
importance of water in Minnesota,
the public health issues related to
climate change and water, and
public health strategies to prevent injury and illness due to
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changing water conditions. View this module here:
http://www.health.state.mn.us/divs/climatechange/water.html
Air Quality, Climate Change and
Public Health. This training
module provides an overview of the
observed climate changes in
Minnesota, the public health issues
related to climate change and air
quality, and public health strategies
to mitigate and adapt to climate
change to reduce the health impacts. View this module here:
http://www.health.state.mn.us/divs/climatechange/air.html
Extreme Heat Events, Climate
Change and Public Health. This
module provides an overview of
extreme heat events and the public
health impacts of heat. The module
also discusses strategies for
individuals to stay cool and for
local health departments to protect
their communities during heat events. View this module here:
http://www.health.state.mn.us/divs/climatechange/extremeheat
.html
This information regarding the most likely climate changes in
Minnesota and their potential impacts on public health,
compiled from many local and state partners, is possible
through funding from the Centers for Disease Control and
Prevention (CDC).
Healthcare System Preparedness
Training Mobile Medical Teams for Duty
Beginning March 2009, the Minnesota Department of Health
(MDH) received Homeland Security and Emergency
Management (HSEM) grants to begin developing and training
Mobile Medical Teams. The teams could respond during a
disaster that impacts a community’s ability to provide primary
or emergency healthcare services. Missions could include
providing support staffing for a hospital, alternate care site, or
for the Minnesota Mobile Medical Unit.
The primary goal of the project is to organize volunteer
healthcare professionals and others into a team structure and
to offer training that will better prepare them to provide
medical care in a disaster environment. The healthcare
professionals selected to join the mobile medical teams will
already have had training to provide emergency patient care.
The project focus is to familiarize team members with the
specific equipment they will encounter, and provide leadership
training to make them more effective in providing the medical
care in austere field environments. The teams will respond,
establish the medical care sites, and then transition to a
leadership structure as additional healthcare volunteers are
activated from the Minnesota Responds MRC system, or from
the impacted healthcare provider in the community.
Some specific accomplishments related to this grant include:
 Developing online training to help familiarize clinical
personnel with the equipment and procedures on the
Mobile Medical Unit. To view the training go to:
http://www.mmuorientation.umn.edu/
 Formation of two regional Mobile Medical teams that
are able to respond anywhere within Minnesota
 Finalizing qualifications for membership, team
structure, training standards, and activation and
deployment procedures
The grant ends March 2013, culminating with a fourth planned
functional exercise meant to test the capabilities of the Mobile
Medical Teams and other response partners. For more
information regarding Mobile Medical Teams, or the
Minnesota Mobile Medical Unit, go to http://wwwdev.health.state.mn.us/oep/healthcare/mmu/index.html
Continuity of Operations (COOP)
Is Your Agency Ready for a Suspicious Package?
Volunteers participating in a field exercise within the Mobile
Medical Unit
Ready to Respond Newsletter
MDH employees encountered police officers and roadblocks
as they left work at the department’s Freeman and Public
Health Laboratories Buildings at the end of the day on
October 1. Soon after the end of business hours, a suspicious
package was brought to the Freeman Building Capitol
Security officer, who called 911 and evacuated the facility.
The St. Paul Emergency Ordinance Disposal Team responded
and determined that the unmarked, beeping package contained
thermometers used for vaccine storage.
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The good news was employees followed the “See Something,
Say Something” mantra, the evacuation was safe and orderly,
facilities remained secure throughout the incident, and MDH
essential services were not interrupted. However, not all plans
and procedures were followed.
Here are MDH lessons learned that may benefit LHD planning
for suspicious package and other incidents requiring
evacuation:





If you see something – say something!
Do not move a suspicious letter or package. Isolate
it, restrict access to the area, call 911 and then notify
others.
Talk to your vendors. Ask them to ensure packages
are appropriately labeled and include a return
address.
Fine tune your evacuation procedures, especially for
after-business hours incidents.
Determine what you would do if you had to evacuate
after hours for an extended period of time without
your coat, keys, and purse/briefcase.
MDH employees discussed lessons learned and created an
After Action Report and Improvement Plan (AAR/IP). MDH
made immediate changes to procedures and asked employees
to review them. Over the coming months, plans will be
changed, new trainings provided, and exercises held. Just like
after a public health emergency, the AAR/IP will be used to
guide department improvement activities to increase MDH’s
ability to respond safely and effectively in the future.
When was the last time your agency reviewed its suspicious
package procedures? If you can’t remember, it may be time.
Have you planned for, and practiced, evacuation procedures
for after business hours? This is something we may all need
to do.
Office of Emergency Preparedness takes the
Continuity Challenge
The current state, national and international environment has
seen increasing risks to the Minnesota Department of Health
(MDH) and the services it provides from man-made and
natural disasters. This has been accompanied by expectations
of the public for uninterrupted availability of government
services, especially the important public health and healthcare
services MDH provides. In response, the department places
an emphasis on business continuity planning that covers its
essential functions and critical activities. The MDH’s Office
of Emergency Preparedness (OEP) coordinates these
preparedness and planning activities and assists MDH
employees and programs in their efforts to plan for, respond
to, and recover from continuity emergencies.
Ready to Respond Newsletter
To improve its abilities to assist the department–while
simultaneously continuing its own services–during a
continuity emergency, the OEP developed a four day series of
seminars, workshops and exercises, called the Continuity
Challenge in August. The business continuity coordinator and
planning team created a series of challenging and realistic
experiences for OEP staff to raise their awareness of
continuity plans and procedures, review and update response
resources, and practice their roles both virtually and in person.
Day 1
Day 2 Day 3
- Breakfast
Plan Seminar
Go-Kit
Workshop
- Prizes
- Hotwash
- Next Steps
Functional
Annex
Seminar and
Workshop
Virtual
Department
Operations
Center
Exercise
- Alternate
Laptops
Workshop
- Gap Filling
Activities
Day 4
- Notification
Drill
Department
Operations
Center at
Alternate
Site Exercise
- Service
Provision at
Alternate
Site Exercise
The Continuity Challenge events were designed to draw out
participants in a positive manner to encourage employees and
programs to strengthen their continuity plans and to practice
their incident management and other roles and responsibilities
during a continuity emergency. OEP is committed to MDH
readiness for a continuity emergency–and employee education
and exercise events such as the Continuity Challenge are a
great way to learn and practice.
MDH Public Health Laboratory Wins
National Award
2012 Excellence in Public Health Response Award
The Association of Public Health Laboratories (APHL) has
presented MDH's Public Health Laboratory Division with
their 2012 Excellence in Public Health Response Award for
"the depth and effectiveness of...public health preparedness
efforts over the last decade."
In addition to PHL's work during the 2009 H1N1 pandemic,
the testing of threat letters sent to Home Depot, and the testing
of water samples following break-ins at water treatment
facilities, APHL specifically cites the August 2011 response to
what turned out to be a very rare case of inhalational anthrax.
The award cites PHL's all-hazards approach to preparedness,
and the cooperative relationship between our Infection Disease
Laboratory and the Environmental Laboratory, and notes the
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exceptional collaboration among the partners, such as sentinel
labs, CDC, and our IDEPC Division, and Homeland Security
and Emergency Management (HSEM). The labs also work
closely the Civil Support Team (CST) and the FBI, who were
very involved in the anthrax investigation.
Upcoming Events
February 4-5, 2013
Convention Center
MMU Exercise at the Minneapolis
March 19 – 21, 2013 Operation Super Bug – Camp Ripley
May 15, 2013 Operation Loon Call, second annual statewide
communication and coordination exercise
Editorial Board
Editorial Board members include representatives from MDH
divisions that receive preparedness funds.
Jane Braun, Director of Emergency Preparedness
Chris Everson, Infectious Disease Epidemiology, Prevention
& Control
Kirsti Taipale, Office of Emergency Preparedness
Lynne Markus, Environmental Health
Nancy Torner, Communications Office
Maureen Sullivan, Public Health Laboratory
Steven Dwine, Office of Emergency Preparedness
Tina Firkus, Editor, Office of Emergency Preparedness
Contributors to this issue
Jane Braun, MDH Office of Emergency Preparedness
Buddy Ferguson, MDH Communications Office
Maureen Sullivan, MDH-Public Health Laboratory
Ann Gibbs, Otter Tail County Public Health Department
David Wulff, Office of Emergency Preparedness
Rob Carlson, Office of Emergency Preparedness
Lynne Markus, Environmental Health
Ready to Respond Newsletter
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