Download Strategic National Stockpile (SNS)

Public Health 101 for
First Responders
Tarrant County Public Health
Public Health Preparedness Division
&
Southwest Center for
Advanced Public Health Practice
2011
Target Audience
• Law enforcement
• EMS
• Fire
• Emergency Management
Course Outline
I.
II.
III.
IV.
Introduction to Public Health
Public Health Preparedness
Incident Command System (ICS)
Public Health Response to
Emergencies
V. Strategic National Stockpile (SNS)
VI. Introduction to Epidemiology
VII. Isolation and Quarantine
Course Objectives
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Identify the basic roles and responsibilities of a local
public health agency
Discuss the importance of collaboration between
public health and first responders in the event of an
emergency
Provide examples of events that are within the scope
of public health preparedness
Explain and demonstrate how public health utilizes
ICS during emergencies
Describe functions of public health surveillance and
alerting system for law enforcement/first responders
Describe several of the main steps in an outbreak
investigation
What is Health?
• Health is a state of complete
physical, mental and social wellbeing and not merely the
absence of disease or infirmity.
Public Health vs.
Medicine
Public Health
Medicine
Patient
Entire Populations
Individuals
Intervention
Assess, Policy
Development &
Assurance
Medical
Treatment
Process
System Management
Patient
Management
Outcome
Healthy Community
Healing
Public Health Objectives
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Prevent epidemics and the spread of
disease
Protect against environmental hazards
Prevent injuries
Promote and encourage healthy
behaviors
Respond to disasters and assist
communities in recovery
Assure the quality and accessibility of
health services
The American Public Health Association http://www.apha.org/ppp/science/10ES.htm
Public Health Services
• Personal Health Services (clinical services)
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Immunizations
STD/HIV testing and counseling
Chronic disease counseling
Tuberculosis services
Family planning and maternal & child health
services
– Travel health services
Providing direct clinical services is only one part
of the mission of a local health department
Population Based
Public Health Services
• Environmental Health
• Infectious Disease Control and
Investigation
• Laboratory Services
• Health Education Services
The Public Health System
Federal Agencies
State Agencies
Local Agencies
Public Health’s Many Partners
Police
EMS
Home Health
MCOs Churches
Corrections
Health
Department
Community
Centers
Parks
Schools
Doctors
Hospitals
Philanthropist
Civic Groups
CHCs
Elected
Mass Transit
Officials Nursing
Homes
Environmental
Health
Fire
Laboratory
Facilities
Drug
Treatment
Tribal Health
Economic
Mental
Employers
Development
Health
Which level of government is
responsible for protecting public
health?
• 10th Amendment to the U.S.
Constitution:
– All powers not delegated to the
Federal government shall be reserved
for the state governments
• States are responsible for
protecting public health
What is Public Health
Preparedness?
“Plans,
procedures,
policies,
training,
and equipment
necessary to
maximize the
ability to prevent,
respond and
recover from
major events.”
(HSPD-21)
Public Health Preparedness
Builds Infrastructure for:
Public Health Emergencies
Bioterrorism, pandemics
Everyday health threats
Infectious & foodborne
diseases
Preparedness and Bioterrorism
What is
bioterrorism???
-- The use of...
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Bacteria
Viruses
Parasites
Their by-products
…in a terrorist act.
Preparedness and Bioterrorism
• Possible agents of
bioterrorism
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Anthrax
Smallpox
Plague
Botulism
Preparedness and Bioterrorism
• What might an attack of bioterrorism
look like?
– Not necessarily explosions or plumes of
smoke
– May not be readily apparent and detectable
– Sick people arrive at hospitals or doctors’
offices
– Delayed recognition and diagnosis
– Population panic
Why is Public Health a
Responder?
• Public health has been
involved with
preparedness issues
long before 9/11/2001
• Public health
preparedness involves
more than just
bioterrorism
Roles in Preparedness
Examples:
– Outbreaks from
contaminated food
or water, infectious
diseases, etc.
– Natural disasters:
hurricanes, floods,
fires
Roles in Preparedness
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Planning
Coordination/Collaboration
Training and Exercise
Response
Evaluation and Corrective
Action
Collaboration is critical to success!
Roles in Preparedness
• Examples of public
health roles:
– Health threats
investigator
– Public
service/media
– Post-event tracking
– Environmental
investigators
Early Detection of Health
Threats
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PRIMARY SURVEILLANCE TARGET:
Covert Health Threats
KEY GOAL: protecting community
assets and reducing illness and death
HSPD-21 defines key directive for state
and local biosurveillance
Collaboration on detection response
critical to achieving key goal
Initial detection and response is LOCAL
Public Health
Biosurveillance Systems
• Automated collection from 56
hospitals in NC Texas, 16 ISDs and
pharmacies 24/7/365
• Automated alerting
• Local initial response
• Special secure web-based
communication system
Incident Command System
• Allows a more
effective, efficient
response to
emergencies
• Examples:
– HazMat incidents
– Terrorist incidents
– Natural disasters
– Incidents
involving multiple
casualties
Incident Command
LHD’s use ICS
Command & Control
PH Resources &
Personnel
Communicate to
partner agencies
Incident Command & Public Health
• In the event of a public
health emergency the
public health director will
interact with the local EOC
or incident command post.
• The public health
Department of Operations
Center (DOC) may be
activated to facilitate
tactical communications.
Notifying Public Health
• Public health is a
valuable & relevant
partner
• Public health is
available 24/7
• System in place to
triage calls during
business & nonbusiness hours
Public Health Preparedness
Summary
• Build public health infrastructure to
respond to threats from:
– Bioterrorism
– Natural disasters & disease outbreaks
• Requires collaboration between agencies:
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Planning
Training & exercises
Response
Communication
Management of resources
Strategic National Stockpile
(SNS)
• A national stockpile available in the event
of a major terrorist attack against the
civilian US population
• National repository consisting of:
– Pharmaceuticals (i.e., antibiotics and vaccines)
– Antidotes and antitoxins
– Medical and surgical supplies
Strategic National Stockpile
• SNS is a federal asset deployed
locally after a major disaster
– The governor of the affected state
requests deployment of SNS from:
Strategic National Stockpile
• Delivered within 12
hours of federal
decision to deploy
SNS assets
– 12-hour “Push
Package”
– Push packages are
warehoused in
strategicallypositioned locations
around the US
Local Response to
Strategic National Stockpile
SNS deployment is a large-scale event
requiring adequate:
•Security
Pre–determined Points of Distribution
•Crowd control
•Traffic control
Local Response to
Strategic National Stockpile
• Essential that First Responders and
others in contact with exposed civilians
are the first to be medicated
Local Response to
Strategic National Stockpile
• Must prepare to dispense medicine to a
huge number of people in a relatively
short time span
Local Response to
Strategic National Stockpile
• Expect to work with Public Health:
•Work collaboratively
•Implement emergency response
according to prior planning
•Have conducted prior training and
exercises
•Interagency Cross-Training
Local Response to
Strategic National Stockpile
• Remember the 5 P’s . . .
Prior Planning Prevents
Poor Performance
And What Type Of A
Planner Are You Going To
Be?
What is Epidemiology?
Study of the spread and causes of
diseases or events in specified
populations, and the control of health
problems.
Epidemiology concerned with
OUTBREAKS
• An adverse health event involving
an unusual increase in cases among
a certain population of individuals,
within a certain period of time, in a
certain location
Areas of Epidemiology
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Infectious diseases
Environmental
Behavioral
Forensic
Disaster
Key Elements in Epidemiology
• Person
• Place
• Time
Epidemiology Study Examples
(risk or exposure
outcome)
• Smoking (exposure) increases
the risk of developing Lung
Cancer (outcome)
Epidemiology Study Examples
(risk or exposure
outcome)
• Eating undercooked hamburger
(exposure) increases the risk of
infection with the bacteria E. coli
(outcome).
Epidemiology Study Examples
(risk or exposure
outcome)
• Getting a flu shot (exposure)
decreases the risk of
becoming ill with the flu
(outcome).
Simplified Steps in an
Outbreak Investigation
1. Confirm outbreak and verify
diagnosis
2. Perform field work and complete
study
3. Implement control and prevention
measures
4. Communicate findings
Disease Reporting: Notifiable Diseases
• Texas healthcare providers are required
by law to report patients with certain
diseases and conditions:
– Report immediately
• Potential BT agents (anthrax, smallpox,
plague)
• Botulism (foodborne)
• Viral hemorrhagic fever, including Ebola
• Other selected contagious serious diseases
that may affect children and immune
compromised or un-protected victims
Isolation and Quarantine
Protocol
Tarrant County Public Health
History of
Quarantine
• In the fourteenth century, to protect
cities from plague epidemics, ships
arriving in Venice from infected ports had
to sit at anchor for forty days before
landing.
• “Quarantine” is derived from the Latin
word quaresma, meaning forty.
Definitions:
Isolation:
• The separation of someone who’s
infected or contaminated from
others so that the infection or
contamination is not spread
Quarantine
• Limitation of freedom of movement
of a well person who’s been
exposed to an infectious agent
What Does it Mean to be
Isolated or Quarantined?
• No contact with any new people
• Can not leave home or place of
containment
• For evaluation and verification
purposes patient needs to check in
with Public Health every day
What is Voluntary
Compliance?
•Voluntary compliance with isolation,
quarantine or other control measures
means a patient cooperates and
complies with Public Health’s
instructions to comply with the
recommended control measures in
order to prevent the spread of
disease.
What is Involuntary
Detention?
• This is what Public Health will pursue if
an individual does not voluntarily
comply with an ordered control
measure.
What is the Health and Safety
Code?
• This is the law of the State of Texas
regarding various “control measures.”
• This is codified as Chapter 81
To What or Who Can
“Control Measures” be Imposed?
• Person (s)
• Groups (5 or more individuals)
• Area (city block, ZIP code, county)
– Buildings (hospital, hotel, business)*
– Common Carrier (plane, bus, train)*
Who Can Enforce these
Rules?
• Local law enforcement must
enforce an order issued by local
health authority.
Questions?
Contact Information
Kay Sanyal-Mukherji – APC Workforce
Development Specialist
[email protected]
Teresa Bates – SNS Coordinator
[email protected]