Clifton Salas Manager, Disaster Response and Recovery Louisville Chapter American Red Cross

1. Environmental Health Training in Emergency Response Food Safety Clifton SalasManager, Disaster Response and RecoveryLouisville ChapterAmerican Red Cross CAPT Charles S. Otto, III RSTeam Leader EHSBCDC / NCEH / EEHS

2. Basics - Preparation Mass Feeding Operations Reopening Establishments Overview

3. Plan Equipment Guidance Educational Materials Other Basics - Preparation

4. Plan Review and Update Potential Mass FeedingSites Pre-Inspect Contingencies Flexibility Basics - Preparation

5. Equipment Overview Temperature Measurement Sanitizer Measurement Flashlight Other • Calibration • Protection • Positioning • Interpreting Basics - Preparation

6. Guidance Food Code 2005 State / Local Food Rules State / Local Disaster Plan Other References CA Disaster Field Manual EHSB – ETP website*/CD-ROM Basics - Preparation * www.cdc.gov/nceh/ehs/ETP

7. Educational Materials Basic Food Safety Guides Posters Food Temperatures Handwashing Cleaning & Sanitizing Food Salvage / Disposal Guides Log Sheets Basics - Preparation www.fightbac.org/content/view/175/2

8. Other Agency / Staff Contact Information List of Establishments Addresses Current Contact Information Maps Schedules for Coverage Basics - Preparation

9. Evacuation Centers / Responders Mass Feeding Operations Similar Food SafetyConcerns Field Tips: Use professionalism, sensitivity, and flexibility in working in harsh conditions with stressed managers, workers, and clients.

10. 1. Safe Sources Mass Feeding Operations • Drinking / Culinary Water • Verify • Backup Plan • Holding • Food • Origin • Transportation • Holding Field Tips: Match Menu to Available Facilities; Complex Meals Not Required; and Cook-Serve is Best for Optimum Food Safety

11. 2. Food Workers - Health - Hand Hygiene - Training - Monitoring Mass Feeding Operations Active Managerial Control

12. 2. Food Workers - Health Mass Feeding Operations • Food Operation Managementshould monitor and exclude: • Food workers with symptoms of: • vomiting, • diarrhea, or • jaundice(with onset within the last 7 days) Stop Norovirus @ Kitchen Door!

13. 2. Food Workers Hand Hygiene Mass Feeding Operations • Handwashing Stations • Running Warm Water • Used Water Disposal System • Soap • Disposable Towels • Trash Can Hand Sanitizer is Adjunct – Not Substitute for Handwashing

14. 2. Food Workers Hand Hygiene Mass Feeding Operations • Food Preparation and Service • No Bare Hand Contact with Ready to Eat Foods • Use Gloves • Use Utensils / Wraps

15. 2. Food Workers - Training Mass Feeding Operations • Basics • Health • Handwashing Active Managerial Control • Job Related Stations • Food Handling – Cross Contamination • Food Temperatures Cooking / Cooling / Holding • Cleaning and Sanitizing

16. 2. Food Workers - Monitoring Mass Feeding Operations • Active Managerial Control / HACCP • Certified Food Protection Manager • Knowledgeable Food Workers • Standard Operating Procedures (SOPs) • cleaning & sanitizing, • employee health, • employee training, • food sources, • handwashing, • receiving & storage • On-going monitoring, correction and verification Learn Active Managerial Control / Create SOP’s – Interactive Program http://www.dec.state.ak.us/eh/fss/amc/amcbroch.htm

17. 3. Food Preparation - Cooking / Reheating Mass Feeding Operations

18. 3. Food Preparation - Holding Temperature / Time Mass Feeding Operations Hot – 140°F or above Cold – 41° or below Time – <4 hours with controls

19. 3. Food Preparation - Cooling Mass Feeding Operations • Times / Temperatures • 2 hours from 140°- 70°F • 4 hours from 70°- 41°F • 4 hours to 41°F for food preparedfrom ambient • 4 hours to 41°F for received food Field Tip: Avoid Leftovers unless excellent refrigeration is available and cooling is closely monitored.

20. 4. Cleaning and Sanitization - Warewashing Mass Feeding Operations • Use potable water • Pre-scrap to garbage cans • Pre-flush to remove food debris • Wash in clean, hot detergent solution • Rinse in clean water • Use automatic warewashing facilities where possible Field Tips: Use single service and single use items to minimize warewashing / presoak pots and pans unless they can be immediately washed.

21. 4. Cleaning and Sanitization - Manual Sanitizing Mass Feeding Operations Chlorine Solutions≥10 seconds • Warm, clean sanitizing solution • Proper Strength verified with appropriate test strips • Immersion for specified time and temperatures Quaternary ammonium chloride Solutions- see manufacturers label directions forconcentration / ≥75°/ 500 mg hardness / ≥30 seconds Iodine SolutionspH <5 – 12.5 – 25 mg/L / ≥75°F / ≥30 seconds Hot Water171°F / ≥30 seconds

22. 5. Facilities Mass Feeding Operations • Issues: • Liquid and Solid Waste Disposal • Vector Control, as needed • Protection from Elements • Toxic Item Control • Physical Facility Security / Control Field Tip: Use fixed preplanned facilities where possible.

23. Reopening Establishments Plan the Work and Work the Planwith Flexibility Field Tips: Be professional and courteous; owners, managers, and workers will be under maximum stress; and be flexible and creative.

24. Reopening Establishments • The Environmental Public Health Agency will: • Promptly respond to imminent health hazards. • Provide guidance to help food establishments resume operation as quickly as possible • Assist food establishments to assess and pre- plan for food safety during a widespread emergency in developing their Emergency Action Plan. • Communicate with the industry during emergencies. • Conduct enforcement activity as appropriate to protect public health.

25. Reopening Establishments • Each disaster will bring its own unique problems • Promptly respond to imminent health hazards. • Provide guidance to help food establishments resume operation as quickly as possible. • Assist food establishments to assess and pre- plan for food safety during a widespread emergency in developing their own Emergency Action Plan. • Communicate with the industry during emergencies. • Conduct enforcement activity as appropriate to protect public health.

26. Reopening Establishments • Administrative Details: • Develop an assessment plan, reopening, criteria, reporting and work tracking procedures. • Quickly do an overall survey of facilities resume operation as quickly as possible. • Determine which can be reopened soonest • Limited menu service is an option. • Communicate with decision-makers • Communicate with the industry • Communicate with the public • Communicate with your staff Field Tip:Harvest Low Hanging FruitIt will reduce the pressure to make bad choices.

27. Reopening Establishments • Food Establishment Assessment • Building / Electrical Safety • Water Supply • Waste Disposal • Food Waste Disposal • Food Salvage • Vermin Control • Clean Up • Refrigeration • Beverage Systems • Ice Machines • Food / Provision Resupply

28. Reopening Establishments • Food Establishment Assessment: - Water Supply Issues • Clear Consistent Guidance • No Water Supply • Potentially Contaminated Water Supply /“Boil Water Notice” • Tap Water • Ice, Ice-making, Beverage & Water Vending • Handwashing • Cooking & Cleaning • Dishwashing/Warewashing • Rescinding The Boil Water Notice Field Tip:Coordinate – Make sure that you are on the same page

29. Reopening Establishments • Food Establishment Assessment: - Water Supply Issues • Food Establishment Response: • Suspend Food and Beverage Service until Approved Alternative Water Supply is initiated • Recognize limitations required to protect food safety • Provide alternative handwashing facilities • Provide alternative restroom facilities • Use approved alternative water supply for cooking and cleaning • Disconnect ice and beverage systems from water supply • Discontinue service when alternative supply fails or proves insufficient • Food Establishment Recovery: • Flush water lines, hot water heaters, and other reservoirs for at least 5 minutes • Clean ice machine, bins, and other equipment connected to water system and discard first hour of production of replacement ice and at least first 5 minutes of the beverage.

30. Reopening Establishments • Food Establishment Assessment: - Sewage Backup / Flood Issues • Limited to small area or throughout establishment • Involves food, food equipment, and food contact surfaces as well as facilities • Food Establishment Response: • Suspend Food and Beverage Service until Reopened by Regulatory Authority • Protect workers and patrons • Remove standing flood water / sewage • Remove and discard affected food, single service, and uncleanable surfaces • Clean affected remaining hard surfaces with hot detergent solution and rinse • Use approved disinfectant / sanitizer at proper strength to cleaned surfaces • Thoroughly air dry area to remove residual moisture • Use qualified service person to inspect affected equipment before reconnecting utilities • Food Establishment Recovery: • Replace affected food, single service and other supplies • Replace physical facilities to approved standards

31. Resources for Food Safety and Storage in Emergency Situations http://www.nal.usda.gov/fnic/emerg.html Emergency Action Plan for Retail Food Establishments http://www.michigan.gov/documents/MDA_EmergencyActionPlan_109428_7.pdf Imminent Health Hazard Emergency Response Reference for Regulators http://www.michigan.gov/documents/MDA_FSSS_regulatorreference3_111443_7.pdf Emergency Handbook for Food Managers http://www.naccho.org/topics/demonstration/APC/MN.cfm Flip Chart of Emergency Procedures http://www.michigan.gov/documents/MDA_FSPR_EmergencyFlipChart_Jan06_148793_7.pdf Resources

32. Environmental Health Training in Emergency Response Food Safety Clifton SalasManager, Disaster Response and Recovery Louisville ChapterAmerican Red Cross CAPT Charles S. Otto, III RSTeam Leader EHSBCDC / NCEH / EEHS