Environmental Health Training in Emergency Response EHTER An Overview FDA Southeast Region Food Safety Seminar 2010 N

2. Systems Approach

5. Environmental Health Preparedness Training Lack of defined roles in emergency response Multiple skills needed Understanding the broader scope of EH response No national training program Generally, there is a lack of a clearly defined role for Environmental Health practitioners during emergency response. This has been demonstrated time and again through a number of assessments and surveys conducted by credible and reputable agencies, organizations, and institutions. When responding to an emergency or disaster, Environmental Health practitioners will need to possess multiple skills and not just one or two. They may be asked to perform a variety of Environmental Health functions and tasks during a single mission or event. Therefore, multiple skills may be needed during emergency response. In order to have multiple skills, a greater understanding and awareness is needed regarding the broader scope of Environmental Health in emergency response. This also goes back to understanding the �systems approach� to Environmental Health. Currently, there is no consolidated, comprehensive national training program that is able to provide this sorely needed training and education for Environmental Health practitioners. We are trying to fill some of this gap through the EHTER course. Generally, there is a lack of a clearly defined role for Environmental Health practitioners during emergency response. This has been demonstrated time and again through a number of assessments and surveys conducted by credible and reputable agencies, organizations, and institutions. When responding to an emergency or disaster, Environmental Health practitioners will need to possess multiple skills and not just one or two. They may be asked to perform a variety of Environmental Health functions and tasks during a single mission or event. Therefore, multiple skills may be needed during emergency response. In order to have multiple skills, a greater understanding and awareness is needed regarding the broader scope of Environmental Health in emergency response. This also goes back to understanding the �systems approach� to Environmental Health. Currently, there is no consolidated, comprehensive national training program that is able to provide this sorely needed training and education for Environmental Health practitioners. We are trying to fill some of this gap through the EHTER course.

6. Lack of Environmental Health Preparedness Training 2004 Michigan EH Training Needs Assessment 2005 Centers for PH Preparedness Report 2005 Kansas Local Health Dept. Workforce Needs Assessment 2006 Ohio PH Preparedness Training Needs Survey 2007 North Carolina PH Workforce Assessment NEHA Training Needs Assessments Numerous peer-reviewed journal articles USPHS Commission Corps Environmental Health Officers A number of reports, surveys, assessments, and articles in peer-reviewed journals have consistently shown that one of the top training in educational needs for Environmental Health practitioners is in the area of emergency preparedness and response. This is just a small sample of those reports, surveys, assessments, and articles. This demonstrates a real need for the EHTER course. The EHTER course, therefore, is not just a good idea, but is also sorely needed! A number of reports, surveys, assessments, and articles in peer-reviewed journals have consistently shown that one of the top training in educational needs for Environmental Health practitioners is in the area of emergency preparedness and response. This is just a small sample of those reports, surveys, assessments, and articles. This demonstrates a real need for the EHTER course. The EHTER course, therefore, is not just a good idea, but is also sorely needed!

7. EHTER Development Focus on key areas of EH Common tasks Various skill sets 360o scope All-hazards The EHTER course was developed using an all-hazards approach that focuses on key areas of Environmental Health. Again, the focus was also related back to the common tasks that Environmental Health practitioners may have to undertake during emergency response and the various skill sets they might need to undertake those tasks. The knowledge and skills that the course teaches are based on the �systems approach� already mentioned and are more broad-based instead of being narrowly-based. The EHTER course was developed using an all-hazards approach that focuses on key areas of Environmental Health. Again, the focus was also related back to the common tasks that Environmental Health practitioners may have to undertake during emergency response and the various skill sets they might need to undertake those tasks. The knowledge and skills that the course teaches are based on the �systems approach� already mentioned and are more broad-based instead of being narrowly-based.

8. Purpose and Objectives Increase knowledge of Roles & responsibilities of EH practitioners Adverse impacts caused by disasters Protective actions Roles, responsibilities & capacities of response partners Key initiatives taking place in other jurisdictions By the end of this course, you should be able to: Better understand the roles and responsibilities of Environmental Health during emergency response. Better understand the adverse impacts caused by emergencies and disasters, particularly those related to Environmental Health. Know what protective actions to take during certain emergency situations and what to recommend to the public and other emergency responders. Better understand the roles, responsibilities, and capacities of emergency response partners during an incident. This includes partners like law enforcement, fire, EMS, emergency management, public works, and others. It is important to understand what they do and how they fit into the overall emergency response system. Identify key emergency preparedness initiatives and activities taking place at the national level and within other state and local jurisdictions. It is also important to think about how these activities and initiatives can be used by your own jurisdiction to increase response capacity. By the end of this course, you should be able to: Better understand the roles and responsibilities of Environmental Health during emergency response. Better understand the adverse impacts caused by emergencies and disasters, particularly those related to Environmental Health. Know what protective actions to take during certain emergency situations and what to recommend to the public and other emergency responders. Better understand the roles, responsibilities, and capacities of emergency response partners during an incident. This includes partners like law enforcement, fire, EMS, emergency management, public works, and others. It is important to understand what they do and how they fit into the overall emergency response system. Identify key emergency preparedness initiatives and activities taking place at the national level and within other state and local jurisdictions. It is also important to think about how these activities and initiatives can be used by your own jurisdiction to increase response capacity.

9. You will also acquire a variety of resources that will hopefully improve your knowledge, skills, and abilities to respond to emergencies and disasters. We give you a LOT of resources to help with this. This course may also help to refresh or improve your ability to use certain types of equipment for emergency response. Some of this may be redundant or is a refresher for some students. Remember, not everyone in the class knows how to use all types of equipment. Please be patient and allow others to learn as well. Better yet, you might be able to assist in this area. For example, if you are very skilled in using various types of food thermometers for food safety inspections, you can assist those who might not have this knowledge base by explaining to them how this type of equipment is used. And finally, we will be sharing a lot of best practices and lessons learned throughout the course. We have many people in here from a lot of different jurisdictions. This is an excellent environment for learning from one another. Get to know one another and share your experiences with one another throughout the course. You will also acquire a variety of resources that will hopefully improve your knowledge, skills, and abilities to respond to emergencies and disasters. We give you a LOT of resources to help with this. This course may also help to refresh or improve your ability to use certain types of equipment for emergency response. Some of this may be redundant or is a refresher for some students. Remember, not everyone in the class knows how to use all types of equipment. Please be patient and allow others to learn as well. Better yet, you might be able to assist in this area. For example, if you are very skilled in using various types of food thermometers for food safety inspections, you can assist those who might not have this knowledge base by explaining to them how this type of equipment is used. And finally, we will be sharing a lot of best practices and lessons learned throughout the course. We have many people in here from a lot of different jurisdictions. This is an excellent environment for learning from one another. Get to know one another and share your experiences with one another throughout the course.

10. Target Audience EH Specialists/Sanitarians and Environmental Scientists Federal, state, local, tribal Other PH decision-makers and practitioners Applicable to multiple agencies, departments, and organizations The primary target audience for the EHTER course is Environmental Health practitioners from state, local, and tribal jurisdictions. Those from the Federal level will also greatly benefit from this course. Remember, different jurisdictions may refer to their Environmental Health practitioners with different titles. They may be called: Sanitarians Environmental Health Specialists Environmental Health Managers Environmentalists And other titles Just because the primary target audience for this course is Environmental Health practitioners doesn�t mean that other professionals can�t benefit from this course as well. Nurses, physicians, Emergency Managers, Fire Chiefs, Public Works, and a variety of other professionals from a multitude of disciplines can also benefit from the course. In fact, they will have the added benefit of learning what Environmental Health does on a daily basis and what these professionals do during an emergency or disaster. It will improve their overall understanding of Environmental Health. This is the first step at ensuring that Environmental Health is brought to the table as a key emergency response partner. The primary target audience for the EHTER course is Environmental Health practitioners from state, local, and tribal jurisdictions. Those from the Federal level will also greatly benefit from this course. Remember, different jurisdictions may refer to their Environmental Health practitioners with different titles. They may be called: Sanitarians Environmental Health Specialists Environmental Health Managers Environmentalists And other titles Just because the primary target audience for this course is Environmental Health practitioners doesn�t mean that other professionals can�t benefit from this course as well. Nurses, physicians, Emergency Managers, Fire Chiefs, Public Works, and a variety of other professionals from a multitude of disciplines can also benefit from the course. In fact, they will have the added benefit of learning what Environmental Health does on a daily basis and what these professionals do during an emergency or disaster. It will improve their overall understanding of Environmental Health. This is the first step at ensuring that Environmental Health is brought to the table as a key emergency response partner.

11. Recommended Pre-course Education & Training ICS 100.a � Introduction to the Incident Command System ICS 200.a � Incident Command System for Single Resources and Initial Action Incidents IS 700.a � National Incident Management System (NIMS), An Introduction IS 800.b � National Response Framework (NRF), An Introduction IS 808 � Emergency Support Function (ESF) #8 � Public Health and Medical Services Although not a requirement, it is recommended that these courses be taken prior to taking the EHTER course. They can be taken online through FEMA�s Emergency Management Institute (EMI) Independent Study Web site at http://training.fema.gov/IS. Keep in mind that in order to be NIMS compliant, one must take at a minimum the ICS 100 and 200, and the IS 700.a and 800.b courses. Although not a requirement, it is recommended that these courses be taken prior to taking the EHTER course. They can be taken online through FEMA�s Emergency Management Institute (EMI) Independent Study Web site at http://training.fema.gov/IS. Keep in mind that in order to be NIMS compliant, one must take at a minimum the ICS 100 and 200, and the IS 700.a and 800.b courses.

12. EHTER Content 10 modules: Disaster Management Responder Safety Potable Water Food Safety Wastewater Shelters The EHTER course includes 9 modules (NOTE: There is no need to go over each one. The students will be experiencing them soon enough!) There are also a number of group activities and exercises that have been built into the course. Finally, there are also some demonstration components. For example, students will get the opportunity to see the American Red Cross (ARC) Emergency Response Vehicle (ERV) and find out how the Red Cross prepares food for up to 5,000 individuals at a time during an emergency or disaster. The EHTER course includes 9 modules (NOTE: There is no need to go over each one. The students will be experiencing them soon enough!) There are also a number of group activities and exercises that have been built into the course. Finally, there are also some demonstration components. For example, students will get the opportunity to see the American Red Cross (ARC) Emergency Response Vehicle (ERV) and find out how the Red Cross prepares food for up to 5,000 individuals at a time during an emergency or disaster.

13. EHTER Encompasses All Phases of a Disaster

14. Other Benefits Enhances understanding of how EH fits within emergency response Introduces a broad spectrum of EH issues Creates an understanding of EH systems and how they interconnect Provides foundation for basic knowledge/skills Combined audience � local, state, federal Facilitates partnerships Some additional benefits of the EHTER course include: It enhances your understanding of how Environmental Health fits into the overall system of emergency response. It introduces a broad spectrum of Environmental Health topics, areas, and issues. It tries to provide some awareness and understanding of various areas of Environmental Health across the board. Remember, during an emergency, you may be asked to engage in areas of Environmental Health with which you have limited or no experience. Again� back to the �systems approach�� the course will increase your understanding of how various areas of Environmental Health are all interconnected and reliant upon one another. It provides a very strong foundation for basic Environmental Health knowledge and skills during emergency response. The combined audience of federal, state, local, and tribal jurisdictions will naturally facilitate new professional relationships and partnerships. Also, you can exchange best practices and lessons learned with one another all throughout the course. Some additional benefits of the EHTER course include: It enhances your understanding of how Environmental Health fits into the overall system of emergency response. It introduces a broad spectrum of Environmental Health topics, areas, and issues. It tries to provide some awareness and understanding of various areas of Environmental Health across the board. Remember, during an emergency, you may be asked to engage in areas of Environmental Health with which you have limited or no experience. Again� back to the �systems approach�� the course will increase your understanding of how various areas of Environmental Health are all interconnected and reliant upon one another. It provides a very strong foundation for basic Environmental Health knowledge and skills during emergency response. The combined audience of federal, state, local, and tribal jurisdictions will naturally facilitate new professional relationships and partnerships. Also, you can exchange best practices and lessons learned with one another all throughout the course.

15. EHTER is NOT... An intermediate or advanced level training Designed to produce subject-matter-experts A substitute for planning, training, educational, or exercise activities and requirements A replacement for existing emergency operations plans, procedures, guidelines, resources, assets, and incident management systems We�ve talked a lot about what EHTER is. Now, let�s talk about what EHTER is not� First and foremost� this course is NOT an intermediate or advanced level training! I want to reiterate this again� It is NOT an intermediate or advanced level training! It is an Introductory level training! It is a beginner�s course! This course is NOT designed to produce �subject-matter-experts!� After taking this course� you will NOT suddenly be a �subject-matter-expert� in food safety, or water quality, or vector control, or pest management! So, don�t expect that! EHTER is NOT a substitute for all the preparedness activities in which you engage in your jurisdiction! You still have to plan, train, attend other courses, participate in exercises and other preparedness activities in your jurisdiction. EHTER can, however, serve as a supplement for all the other preparedness activities in which you engage. It can enhance or improve your level of preparedness, but it is not a substitute for other preparedness activities. And finally, EHTER does NOT replace your jurisdiction's plans, procedures, guidelines, resources, assets, and incident management systems that are currently in place to respond to emergencies and disasters. We�ve talked a lot about what EHTER is. Now, let�s talk about what EHTER is not� First and foremost� this course is NOT an intermediate or advanced level training! I want to reiterate this again� It is NOT an intermediate or advanced level training! It is an Introductory level training! It is a beginner�s course! This course is NOT designed to produce �subject-matter-experts!� After taking this course� you will NOT suddenly be a �subject-matter-expert� in food safety, or water quality, or vector control, or pest management! So, don�t expect that! EHTER is NOT a substitute for all the preparedness activities in which you engage in your jurisdiction! You still have to plan, train, attend other courses, participate in exercises and other preparedness activities in your jurisdiction. EHTER can, however, serve as a supplement for all the other preparedness activities in which you engage. It can enhance or improve your level of preparedness, but it is not a substitute for other preparedness activities. And finally, EHTER does NOT replace your jurisdiction's plans, procedures, guidelines, resources, assets, and incident management systems that are currently in place to respond to emergencies and disasters.

16. Responders Trained Hundreds trained from all 50 states, U.S. territories, DC, and Canada Since it�s inception in July 2006, hundreds of responders have been trained through the EHTER course. Students have come from all 50 states, a number of U.S. Territories, the District of Columbia, and from Canada! Since it�s inception in July 2006, hundreds of responders have been trained through the EHTER course. Students have come from all 50 states, a number of U.S. Territories, the District of Columbia, and from Canada!

17. Some of the challenges we face with the EHTER course include: Continuing to identify the common Environmental Health topics and issues that apply to all geographic locations and jurisdictions throughout the country. Also, trying to apply them in an all-hazards context in different geographic locations that face different hazards throughout the country. Addressing the lack of cross-training in the various areas of Environmental Health continues to be a challenge. We are trying to bridge this gap with the EHTER course, but there still continues to be a need for this that we just cannot address fast enough. Also, as many of you already know, Environmental Health services are fragmented throughout different agencies and departments in various jurisdictions. For example, the responsibility for food safety inspections can lie with the department of agriculture or the health department in one state, but can lie in the department of business and consumer affairs in another state. This presents a special challenge to ensuring that all Environmental Health practitioners are cross-trained in the various skills and areas related to environmental health. This fragmentation can also pose special challenges during emergency response. Time� there is and never will be enough time to train all the people that need to be trained. There is also never enough time in your schedule for education and training in emergency response! And finally, funding is the never-ending challenge. The Department of Homeland Security/Federal Emergency Management Agency (DHS/FEMA) here at the Center for Domestic Preparedness has help overcome some of the challenges associated with this through their support of the EHTER course. This is truly a great thing for Environmental Health emergency preparedness and response. Some of the challenges we face with the EHTER course include: Continuing to identify the common Environmental Health topics and issues that apply to all geographic locations and jurisdictions throughout the country. Also, trying to apply them in an all-hazards context in different geographic locations that face different hazards throughout the country. Addressing the lack of cross-training in the various areas of Environmental Health continues to be a challenge. We are trying to bridge this gap with the EHTER course, but there still continues to be a need for this that we just cannot address fast enough. Also, as many of you already know, Environmental Health services are fragmented throughout different agencies and departments in various jurisdictions. For example, the responsibility for food safety inspections can lie with the department of agriculture or the health department in one state, but can lie in the department of business and consumer affairs in another state. This presents a special challenge to ensuring that all Environmental Health practitioners are cross-trained in the various skills and areas related to environmental health. This fragmentation can also pose special challenges during emergency response. Time� there is and never will be enough time to train all the people that need to be trained. There is also never enough time in your schedule for education and training in emergency response! And finally, funding is the never-ending challenge. The Department of Homeland Security/Federal Emergency Management Agency (DHS/FEMA) here at the Center for Domestic Preparedness has help overcome some of the challenges associated with this through their support of the EHTER course. This is truly a great thing for Environmental Health emergency preparedness and response.

18. And they have helped with this through the Memorandum of Agreement that has been established between the Centers for Disease Control and Prevention�s (CDC) National Center for Environmental Health (NCEH) and the Center for Domestic Preparedness (CDP). Through the Memorandum of Agreement, CDP is planning to offer the EHTER course at its facilities until 2011 at a minimum. CDP also hopes to expand its offering of courses in the areas of Public Health and Environmental Health. And they have helped with this through the Memorandum of Agreement that has been established between the Centers for Disease Control and Prevention�s (CDC) National Center for Environmental Health (NCEH) and the Center for Domestic Preparedness (CDP). Through the Memorandum of Agreement, CDP is planning to offer the EHTER course at its facilities until 2011 at a minimum. CDP also hopes to expand its offering of courses in the areas of Public Health and Environmental Health.

19. What we hope to eventually do is to work with our partners to create a comprehensive, national training program for Environmental Health in emergency response. We plan to offer an EHTER Train-the-Trainer course in the very near future. This one-day course will be offered as an added day to the EHTER Introductory Level course for those who might be interested in staying to take it. The EHTER �Train-the-Trainer� title is, in some ways, a misnomer. Instead of teaching the entire course with all the modules by yourself, what we teach you to do is how to coordinate with the appropriate agencies, department, and individuals within your jurisdiction and how to coordinate the planning and delivery of an EHTER course in your jurisdiction. So� in some ways� it is better to call it a �Train-the-Coordinator� course. Just remember that one must take the EHTER Introductory Level course before he/she can take the �Train-the-Trainer� course. CDC/NCEH is currently working on developing additional modules for the Introductory Level course. A Radiation module will be added to the course in the next few months. They will also be working on chemical/HAZMAT and biological modules to include in the course. They are also working on specific components for Intermediate and Advanced level courses. These are still in the works and will take some time to develop, however. CDC/NCEH is also currently working on some specialized EHTER courses. For example, they may develop a one-day condensed EHTER awareness course specifically for leadership personnel (state health officers, etc.) so that they can have a better general understanding of what Environmental Health does during an emergency or disaster. Also, they may develop some short courses on environmental sampling (soil, air, water, etc) and data analysis (e.g., how do you collect, package, and analyze samples� and what do you do with the results and data once you receive them� and how do you make emergency response decisions based on the data?) This is also a work in progress and may take some time to develop. What we hope to eventually do is to work with our partners to create a comprehensive, national training program for Environmental Health in emergency response. We plan to offer an EHTER Train-the-Trainer course in the very near future. This one-day course will be offered as an added day to the EHTER Introductory Level course for those who might be interested in staying to take it. The EHTER �Train-the-Trainer� title is, in some ways, a misnomer. Instead of teaching the entire course with all the modules by yourself, what we teach you to do is how to coordinate with the appropriate agencies, department, and individuals within your jurisdiction and how to coordinate the planning and delivery of an EHTER course in your jurisdiction. So� in some ways� it is better to call it a �Train-the-Coordinator� course. Just remember that one must take the EHTER Introductory Level course before he/she can take the �Train-the-Trainer� course. CDC/NCEH is currently working on developing additional modules for the Introductory Level course. A Radiation module will be added to the course in the next few months. They will also be working on chemical/HAZMAT and biological modules to include in the course. They are also working on specific components for Intermediate and Advanced level courses. These are still in the works and will take some time to develop, however. CDC/NCEH is also currently working on some specialized EHTER courses. For example, they may develop a one-day condensed EHTER awareness course specifically for leadership personnel (state health officers, etc.) so that they can have a better general understanding of what Environmental Health does during an emergency or disaster. Also, they may develop some short courses on environmental sampling (soil, air, water, etc) and data analysis (e.g., how do you collect, package, and analyze samples� and what do you do with the results and data once you receive them� and how do you make emergency response decisions based on the data?) This is also a work in progress and may take some time to develop.

20. For More Information...CDC EHTER Web Sitehttp://www.cdc.gov/nceh/ehs/Workforce_Development/EHTER.htm DHS/FEMA CDP Web Sitehttps://cdp.dhs.gov/schedules/program/s.html

21. Questions?Martin A. Kalis, MAPublic Health AdvisorEmergency Preparedness & ResponseCDC/NCEH/EEHS/EHSB(770) 488-4568mkalis@cdc.gov www.cdc.gov/nceh/ehs Any questions? Any questions?