CDC Region 3 Bio-Emergency Health Official/Elected Official In-Service

1. CDC Region 3 Bio-Emergency Health Official/Elected Official In-Service [Linda Drey, Health Planner] 2004

2. Objectives • Describe the role of local public health in Iowa. • Identify the role of the local board of health. • Identify relationships to the Iowa Department of Public Health, local board of supervisors, local county attorney, and other partners. • Understand the aspects of bio-terrorism and the role/responsibilities of local public health in the event of a bio-emergency. • Become familiar with CDC Bioterrorism grant requirements for FY 03-04..

3. Local Public Health’s Role Protecting the Health of the Public! Public health is responsible to safeguard the community’s health through assessment, policy development and assurance.

4. Public Health’s Impact • Public health is not a collection of programs for the poor. • Has public health affected your life today? • Public health affects everyone who drinks public drinking water, eats in a restaurant, buys milk, has an elderly relative who needs home care, needs emergency medical services, wants to avoid getting sick from an infectious disease, and is concerned about preparedness for natural or intentional disaster.

5. Local Public Health Is responsible for protecting and safeguarding the health of all people within its jurisdiction; Public health touches every person’s life every day; Promotes physical and mental health; Prevents disease and injury; Prevents epidemics and spread of disease; Promote healthy behaviors Respond to disasters; Assures the quality and accessibility of health services for all Public Health vs. Hospital

6. Hospital/Individual Provider Focus is on providing care to specific individuals seeking care for an illness/injury; Makes decisions that are best for the respective patient and not necessarily the general public; No emphasis/responsibility for the health and welfare of the general public; Not required to provide treatment to all individuals requesting care with a few exceptions (ER’s, etc.) Public Health vs. Hospital

7. Core Public Health Functions • Assessment • Policy Development • Assurance

8. Core Public Health Functions/Essential Services • Assessment • Monitor health status • Diagnose and investigate health problems and health hazards in the community • Evaluate the effectiveness, accessibility, and quality of personnel and population-based health services

9. Core Public Health Functions/Essential Services • Policy Development • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Research for new insights and innovative solutions to health problems.

10. Core Public Health Functions/Essential Services • Assurance • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure a competent public health and personal health care workforce. • Inform, educate and empower people about health issues. • Mobilize community partnerships to identify and solve health problems.

11. For Local Communities… • Public health is an economic issue, because healthy workers are productive and a good public health system attracts business. • Public health is an education issue because healthy children learn. • Public health is the front line defense for the public’s health promotion and protection.

12. Local Public Health SystemPublic Health Providers • Local Boards Of Health (County/City/District) • WIC agencies • Maternal Child Health (MCH) agencies • Visiting Nurse Service (VNS) agencies • And others…..perhaps MANY others...

13. Vaccinations Safer workplaces Safer and healthier food Vehicle safety Control of infectious diseases Family planning Advances in treatment and prevention of heart disease and stroke Decrease in tobacco use Better care for mothers and their babies Fluoridation of drinking water 10 Greatest Advances in PH

14. Local Boards of Health History • In 1866 the Local Health Law was adopted. • Designated mayor and town council or township trustee as LBOH. • LBOH had authority to establish regulations for public health and safety, control nuisances, and regulate sources of filth and causes of sickness in communities.

15. 1967 New Local Health Act • Chapter 137 of the Code of Iowa: • Each county required to establish a BOH - one member had to be a physician licensed by the State of Iowa. • BOS to appoint other members. • A city with a population of 25,000 + could establish a city board of health. • Counties and cities were also allowed to form district boards of health.

16. LBOH Power and Jurisdiction • Chapter 137of the Code of Iowa • 5 members, one must be an Iowa licensed physician • The BOH has autonomy over public health matters within the county. (IA Code137.5; 137.6; 137.7) • Can write rules and employ persons for the discharge of its duties.

17. LBOH Power & Jurisdiction Cont. • Boards of Supervisors have little authority over public health matters. • The Board of Supervisors role is three fold: • appoint board of health members; • determine county funding portion of the local health budget; and • approve regulations adopted by board of health

18. LBOH Roles & Responsibilities • IA Administrative Code 641-Ch.77 • Requires local BOH to carry out the three core functions and ten essential public health services. • Required to meet at least quarterly. • Required to comply with open meeting laws. • LBOH must report to the IDPH on certain activities defined in IAC 641-77.5.

19. Local Boards of Health • Powers of Local Boards of Health • Refer to LBOH Guidebook page 9… • Legal Responsibility of Local Board of Health • Refer to LBOH Guidebook page 10… • Working with the County Board of Supervisors • Refer to LBPH Guidebook page 12...

20. Local Boards of Health in Iowa • 99 county Boards of Health • 1 District Health Department • Siouxland District Health Department • 2 City Boards of Health • Council Bluffs • Ottumwa

21. Bioterrorism/Bio-emergencies are Different • Medical and public health systems are usually first to detect bioterrorism. • A delay is likely between the release of the agent and the knowledge that the occurrence is a bioterrorist act. • A short window of opportunity exists between the first cases and the second wave. • Public health officials must determine that an attack occurred, identify the organism, and prevent more casualties.

22. Local Public Health Bio-Emergency Planning • Need to build the infrastructure of local public health across Iowa and the nation. • In Iowa, the IDPH is the lead public health agency and coordinates the CDC Iowa Public Health Cooperative Agreement (public health BT grant) • Each local health department charged with developing a bio-emergency plan by Aug. 2004.

23. Public Health Infrastructure Laboratory Practice Epidemic Investigations Surveillance Information Systems Organizational Capacity Workforce PublicHealthResponse • Bioterrorism • Emerging Infections • Other Public Hlth Programs Essential Scientific Capabilities Basic Infrastructure Reference: Public Health Practice Program Office (PHPPO), CDC, 1999.

24. BT Core Capacities – 10/15/01 • Mission • To protect the publics health and safety by developing the capacity of state and local public health systems to prepare for and respond to a bioterrorist act.

25. BT Core Capacities Framework • Surveillance and Epidemiologic Investigation • Identification • Communication • Mobilization • Public Health Interventions

26. BT Core Capacities Framework • Goals • Pre-Event Objectives • Event Objectives • Indicators (pre-event and event) • Planning/Policy Indicators • Workforce/Training Indicators • Evaluation/Quality Indicators

27. BT Core Capacities Example • Mobilization • Pre-Event Objective: Identify organizations that comprise the public health response system and integrate preparedness activities with partners • P/P: plans that define roles and responsibilities • W/T: train staff in response role within larger emergency response system • E/Q: review plans periodically and adjust

28. Activation of Federal Assistance Major disaster Internal local and State resources State resources exhausted Governor requests President to declare disaster Federal Assistance- based on severity and need FEMA may request DOD or National Guard

29. Federal Response Plan • FBI leads on information release I crisis management • FEMA leads on information release in consequence management • Transfer from the FBI to FEMA by Attorney General • Core Federal Responses: DOJ/FBI DOE FEMA DOD EPA HHS

30. Technical support, personnel and equipment Disease detectives Agent identification; collection and testing of samples Medical management Medical supplies, drugs and vaccinations (SNS) Regulatory follow up (e.g. FDA) Outbreak/disease threat assessment Onsite safety Mass fatality management Health and Human Services (HHS) Provides

31. CDC Bioterrorism Grant 03-04 • Focus Area A: Planning & Assessment • Focus Area B: Surveillance & Epidemiology • Focus Area C: Laboratory Biological Agents • Focus Area D: Laboratory Chemical Agents • Focus Area E: Health Alert Network/IT • Focus Area F: Risk Communication • Focus Area G: Education & Training • Strategic National Stockpile (SNS) • Smallpox

32. Funding Formula – for LPHA • Base aware per LPHA: 30% • Population: 40% • Critical Assets: 15% • Agricultural Value: 15%

33. Funding

34. LPHA Grant Responsibilities • By July 15, 2004 complete county bio-emergency plan and submit template checklist to IDPH. • By July 15, 2004 complete mass dispensing plan, policies and procedures for smallpox/oral prophylaxis and submit checklist to IDPH. • By July 15, 2004 submit improvement plan for reportable disease surveillance system for your county to IDPH.

35. LPHA Progress Report • Two progress reports are due to IDPH from each local public health agency as a part of the CDC grant. • Due April 10, 2004 • September 10, 2004

36. LPHA Regional Responsibilities • Submit county information for Regional Resource Directory for reports due Jan. 5, April 1, and July 1. • Submit the # of trained staff in advanced epidemiology/surveillance for Aug. 1 report. • Submit the # of trained staff in EPI-INFO for Aug. 1 report.

37. Regional Grant Reports • As a member of Region 3 (16-county area of northwest Iowa) each county must submit requested information in addition to what is asked for in the regional resource directory for a regional report compiled by the regional planner. • The report is due: • April 10, 2004 • September 10, 2004

38. WELCOME TO BIOTERRORISM BASICS

39. Objectives • Upon completion of the course, learners should be able to: • Define terrorism using the B-NICE model • Define the role of public health in dealing with a terrorism attack • List three or more messages that should be sent to the general public regarding terrorism

40. Terrorism Terrorism is the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives. FBI Definition from 28 CFR Section 0.85.

41. PSYCHOLOGICAL IMPACT of terror…intrusive thoughts, nightmares and sleeping difficulties, anxiety or fear, alienation from people, ‘jumpiness’, emotional numbness and problems with social relationships

42. Objectives of Terrorism • Bring down a government or regime • Attack those who attack their religion • Cause a Change!!!

43. Countermeasures to Terror • Awareness of terrorism objectives • Deny the objective of the attack • President Bush: • Keep shopping, keep traveling • Subsidies for airlines, insurance industry to keep working

44. Public Health’s Role in a Bio-Emergency • PREPARE • RESPOND • MITIGATE • RECOVER

45. Why Iowa? • Nearly 1000 interstate bridges • More than 100 dams • Greatest concentration of hog lots in the nation • Critical rail links • Over 3000 miles of pipelines (natural gas, gasoline, etc.) • Iowa is a symbol of stability • Not In My Back Yard Syndrome

46. Types of Terrorism B-NICE • Biologic • Nuclear • Incendiary • Chemical • Explosive

47. Bioterrorism • Since 1985, the number of terrorist incidents involving the threatened or actual use of chemical, biological, radiologic, or nuclear materials has risen sharply; (Tucker, 1999) • The threat to the nation from biologic weapons is no longer a debate issue. (Russell, 1997)

48. Why Bioterrorism? • Poor man’s nuclear bomb • Cheap • Easily available • Compact • Deadly • Psychological Impact • Stealthy

49. Ease of Dissemination

50. Mortality Rates