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State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M. N úñ ez de Ybarra, MD, MPH Public Health Medical Officer III CA Department of Public Health (CDPH) Division of Communicable Disease Control (DCDC) Office of Workforce Development

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State Role in Public Health Emergencies – Division of Communicable Disease Control

Jessica M. Núñez de Ybarra, MD, MPH

Public Health Medical Officer III

CA Department of Public Health (CDPH)

Division of Communicable Disease Control (DCDC)

Office of Workforce Development

All Hazards Workshop – San Joaquin County

August 2008


Purpose

Provide a basic understanding of the State communicable disease control role as part of the overall State Public Health Emergency Preparedness and Response system in California.


PUBLIC HEALTH

While health care is vital to each of us some of the time, public health is vital to all of us all the time.

C. Everett Koop, M.D., former U.S. Surgeon General

  • Mission: The fulfillment of society’s interest in assuring conditions in which people can be healthy. Institute of Medicine.

  • Functions: Assessment, Policy development & Assurance.


Columbia University Center for Public Health Preparedness

The Public Health System Process

  • a continuous cycle of gathering information, deciding, acting, evaluating

  • Public health is always evaluating the health of the community


“System”

  • More than just the public health agency

  • “Public health system”

    • All public, private, and voluntary entities that contribute to public health in a given area.

    • A network of entities with differing roles, relationships, and interactions.

    • All entities contribute to the health and well-being of the community.


The Public Health System

Police

EMS

Corrections

MCOs

Health Department

Philanthropist

Churches

Community Centers

Nursing Homes

Home Health

Parks

Doctors

Schools

Elected Officials

Hospitals

Mass Transit

Environmental Health

Civic Groups

CHCs

Fire

Tribal Health

Employers

Laboratory Facilities

Economic Development

Drug Treatment

Mental Health


Columbia University Center for Public Health Preparedness

Public Health in America

  • Prevent epidemics and spread of disease

  • Protect against environmental hazards

  • Prevent injuries

  • Promote and encourage health behaviors

  • Assure the quality and accessibility of health services

  • Respond to disasters and assist communities in recovery


Workforce

Information Systems

Communication

Epidemiology/surveillance

Laboratory

Policy and Evaluation

Preparedness and Response

Columbia University Center for Public Health Preparedness

Public Health Preparedness Threats and Emergencies7 Core Capacities


California


Definitions


Columbia University Center for Public Health Preparedness

Workforce

The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operations


Monitor health status

Diagnose and investigate health problems

Inform and educate

Mobilize communities to address health problems

Develop policies and plans

Enforce laws and regulations

Link people to needed health services

Assure a competent health services workforce

Evaluate health services

Conduct research for new innovations

The Essential Public Health Services (1994)


Columbia University Center for Public Health Preparedness

Information Systems

Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information.


Columbia University Center for Public Health Preparedness

Communication

Public Health systems maintain communication mechanisms to:

  • Routinely translate scientific and health information for communities and policy makers

  • Provide timely, accurate public information and advice to policy makers during emergency events

  • Coordinate logistical communication within the response community.


Columbia University Center for Public Health Preparedness

Epidemiology/Surveillance

Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors.


Columbia University Center for Public Health Preparedness

Laboratory

Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage.


Columbia University Center for Public Health Preparedness

Policy and Evaluation

Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions.


Columbia University Center for Public Health Preparedness

Preparedness and Response

Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies.


Columbia University Center for Public Health Preparedness

Communication with Your Family

  • Your family may be concerned, involved and/or have their routines changed.

  • Do you have a:

    • Family Disaster Plan?

    • Personal Emergency Plan?


Family Disaster Plan Materials

Source: FEMA: www.fema.gov


Example Personal Emergency Plans:

Columbia University Center for Public Health Preparedness

During Working Hours

After Working Hours

NYC-DOH School Health Program Draft, August 2001


Columbia University Center for Public Health Preparedness

Remember……

  • Make provisions for:

    • Child(ren)

    • Spouse/Partner

    • Parents

    • Pets

    • Others


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COMPETENCY

A complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization

(Center for Public Health Practice, Emory University)


Columbia University Center for Public Health Preparedness

Core Public Health Worker Competencies for Emergency Preparedness and Response

Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.

Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team.


Columbia University Center for Public Health Preparedness

In order to respond to any emergency/disaster, ALLpublic health workers should be able to:

  • IDENTIFY & LOCATE the emergency plan

  • DESCRIBE the role of Public Health

  • DESCRIBE the Chain of Command

  • DESCRIBE & DEMONSTRATE one’s functional role

  • RECOGNIZE deviations from the norm

  • IDENTIFY limits to own authority

  • DESCRIBE communication roles

  • DEMONSTRATE use of communication equipment

  • APPLY creative problem solving skills


Columbia University Center for Public Health Preparedness

Role of the State Public Health Agency in Emergency Response

  • Collaborate with other agencies in policy decisions and actions (e.g., request to Feds for Strategic National Stockpile)

  • Surveillance

  • Investigation

  • Public information


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Role of the State Public Health Agency in Emergency Response (cont’d)

  • Medical provider information

  • Reference laboratory support

  • Public health interventions (e.g. mass vaccinations)


Columbia University Center for Public Health Preparedness

Role of the State or Local Office of Emergency Services (OES)

Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations.


Federal

State

Columbia University Center for Public Health Preparedness

Local

Example of a Common Multi-level Scheme for Disaster Communication and Coordination

PRESIDENT

DHS

FEMA

HHS

CDC

GOVERNOR’S

OFFICE

STATE OES

STATE DOH

Office of Local

Elected Official

LOCAL OES

LOCAL DOH

Fire

Police

Other


Federal

State

Local

Federal, State and Local Coordination in California DISASTERS for Public Health

PRESIDENT

DHS/FEMA

HHS/CDC/VA etc.

GOVERNOR’S

OFFICE

Governor’s OFFICE OF

EMERGENCY SERVICES (OES)

SOC

CDPH/EMSA

JEOC

OES/REOC

Admin & Mutual Aid Regions

RDMHC

Local Official’s

OFFICE

OPERATIONAL Area EOC’s

Cities, Counties, Special Districts

MHOAC

LHJ

Incident Command

Voluntary

Health Sector

FIRE-EMS

Police

Media

Voluntary Agencies

(ARC, etc.)


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EMERGENCY PREPAREDNESS COMPETENCY

  • IDENTIFY limits to own knowledge/skills/authority and..

  • IDENTIFY key system resources for referring matters that exceed these limits


Role of Local Health Officershttp://www.cdph.ca.gov/programs/dcdc/Pages/default.aspxHealth Officer Practice Guide for Communicable Disease Control in California


Columbia University Center for Public Health Preparedness

Examples

  • LIMITS TO OWN SKILLS OR AUTHORITY

  • Communication with media

  • Legal authority

  • Supervision of others

  • Allocation of resources

  • Clinical skills or decision making

  • Policy decision

  • KEY SYSTEM RESOURCES

  • Agency chain of command

  • Web resources

  • Logistics Officer

  • Policy and procedure manual

  • Disaster plan / protocols


Columbia University Center for Public Health Preparedness

ExamplesPublic Health Nurse in the Shelter Setting:

  • Limits

  • Treatment of the seriously ill

  • Providing information to the media

  • Re-assigning roles of other shelter staff

  • Resources

  • Local Emergency Room

  • DOH Public Relations (or Public Affairs Dept.)

  • Shelter manager


Cultural and Linguistic COMPETENCE

“A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.”

Terri Cross, 1989

[From March 2005 Presentation by Dr. Melanie Tervalon, MD, MPH, Education Director, COE Nutritional Genomics]


Rationale for Cultural Competence

  • Responding to demographic changes

  • Eliminating disparities in the health status of people of diverse, ethnic & cultural backgrounds

  • Improving quality of services and outcomes

    Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural Competence. Washington DC, 1999. [From March 2005 Presentation by Dr. Tervalon]


Rationale for Cultural Competence (cont.)

  • Meeting legislative, regulatory, and accreditation mandates

  • Gaining a competitive edge in the marketplace

  • Decreasing the likelihood of liability/malpractice claims

    Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural Competence. Washington DC, 1999.


Cultural Humility

  • Self-reflection and life long learner

  • Patient-focused interviewing and care

  • Community-based care and advocacy

  • Institutional consistency

    [From March 2005 Presentation by Dr. Tervalon]


Columbia University Center for Public Health Preparedness

Public Health for

Emergency Preparedness and Response

Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.


Voters

State

Columbia University Center for Public Health Preparedness

Agencies

State of California – Executive Branch

Voters

GOVERNOR’S

OFFICE

Health and Human Services

Depts.

CDPH


California Dept. of Public Health www.cdph.ca.gov


CDPH

  • VISION: Healthy individuals and families in healthful communities

  • MISSION: Dedicated to optimizing the health and well-being of the people in California.


Executive

Centers

Columbia University Center for Public Health Preparedness

Divisions

CDPH

Director’s

Office

  • OWH

  • OMH

  • OBBH

  • EPO

  • CCLHO

  • Advisory Cmte

Center for Chronic Disease

Center for

Environmental

Health

Center for

Infectious

Disease

Center for

Family

Health

Center for

Healthcare

Quality

  • Chronic Disease

  • & Injury Control

  • Environmental &

  • Occupational

  • Disease Control

  • Food, Drug &

  • Radiation Safety

  • Drinking Water

  • & Environmental

  • Mgmt.

  • Communicable

  • Disease Control

  • Office of AIDS

  • Licensing

  • & Certification

  • Laboratory Field

  • Services

  • WIC

  • Maternal, Child

  • & Adolescent

  • Health

  • Genetic Disease


CDPH through DCDC is responsible for investigating and controlling all communicable disease and conditions in the State of California.


DCDC

DCDC, through its Branches, works in partnership with local, national and international health officials, health care providers, and the public to:

  • monitor health,

  • identify and investigate existing and potential health problems,

  • develop and implement prevention strategies,

  • conduct research,

  • provide education and training,

  • and formulate and advise on public health policy


DCDC Branches

  • Infant Botulism Treatment and Prevention Program

  • Infectious Diseases Branch

  • Immunization Branch

  • Sexually Transmitted Disease Control Branch

  • Tuberculosis Control Branch

  • Microbial Diseases Laboratory Branch

  • Viral & Rickettsial Disease Laboratory Branch


Columbia University Center for Public Health Preparedness

Epidemiology/SurveillanceRoles and Responsibilities in Emergency Response

  • Provide background info on emergency surveillance data

  • Conduct field epidemiological investigations (prn)

  • Monitor existing surveillance systems

  • Establish new surveillance system

    - Assemble field teams - Establish databases

    - Develop questionnaires/forms - Enter data

    - Liaison with hospital/field personnel - Analyze data

    - Collect data

    - Develop recommendations for policy


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LaboratoriesRoles and Responsibilities in Emergency Response

  • Provide recommendations for specimen types and handling

  • Accept specimens for testing

  • Ensure rapid transports to reference labs

  • Perform testing

  • Coordinate with epi/surveillance re: data entry

  • Liaison with Laboratory Response Network (LRN) i.e., outside labs re: testing and data reporting


Columbia University Center for Public Health Preparedness

OperationsRoles and Responsibilities in Emergency Response

  • Provide resources to facilitate others’ activities

  • Transportation

  • Communication

  • Facilities

  • Security

  • Personnel

  • Printing

  • Coordinate hotlines for public &

  • providers


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EnvironmentalRoles and Responsibilities in Emergency Response

  • Research specific topic

  • Provide background information

  • Prepare recommendations re:

    -Public health threat

    -Sample collection

    -Evacuation/reoccupation

  • Collect samples

  • Collaboration w/ Hazmat


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Medical Information Systems (MIS)Roles and Responsibilities in Emergency Response

Facilitate computing issues during emergencies

-Field to Headquarters data transmission

-Database management

-Mapping/GIS


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Local Medical/ClinicalRoles and Responsibilities in Emergency Response

  • Prepare recommendations on clinical aspects of emergency

    -Public safety issues -Training of community MDs

    -Occupational safety issues -Disinfection/decon issues

    -Develop prevention & treatment message

  • Establish and staff prophylaxis/treatment distribution centers

  • Staff DOH clinics involved in emergency

  • Liaison with Coroner regarding mortuary issues

  • Supplement clinical backup to school health program sheltering activities


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EMERGENCY PREPAREDNESS COMPETENCY

APPLY creative problem solving and flexible thinking to unusual challenges within functional roles and responsibilities and

EVALUATE the effectiveness of all actions taken.


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CREATIVE PROBLEM SOLVING

  • What situations requiring creative problem solving and flexible thinking can you imagine occurring?

    • Telephone system fails?

    • Expected supplies are not delivered?

    • Agency facility is inaccessible?

    • Other types of problems???


Columbia University Center for Public Health Preparedness

CREATIVE PROBLEM SOLVING

What situations requiring creative problem solving and flexible thinking can you imagine occurring?


Columbia University Center for Public Health Preparedness

Evaluation

  • How would you evaluate the effectiveness of all actions you took?

  • Were the issues you referred to others acted upon?

  • Was the issue that you addressed resolved?

  • After the situation, evaluate the effectiveness of the plan.


Columbia University Center for Public Health Preparedness

QUESTIONS?


Acknowledgement

Special thanks to the Columbia University Center for Public Health Preparedness upon whose Public Health Emergency Preparedness and Training Program this Presentation has been based.

Website: http://cpmcnet.columbia.edu/dept/sph/CPHP/index.html


Resources

  • American Public Health Association www.apha.org

  • Association of State and Territorial Health Officials www.astho.org

  • Centers for Disease Control and Prevention

    http://www.cdc.gov/


Resources

  • National Association of County and City Health Officials www.naccho.org

  • National Association of Local Boards of Health www.nalboh.org

  • National Network of Public Health Institutes www.nnphi.org

  • Public Health Foundation www.phf.org


Contact Information

Jessica M. Núñez de Ybarra, MD, MPH

jnunez2@cdph.ca.gov

Phone: 916 650-6875

Fax: 916 552-8973

California Department of Public Health

Division of Communicable Disease Control

1616 Capitol Avenue, MS 7300

PO Box 997377

Sacramento, CA 95899-7377


Thank You


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