Indian Health Service Federal Emergency Preparedness and Response

1. Indian Health Service Federal Emergency Preparedness and Response Robert Newsad, MPH IHS/ California Area Office Robert.newsad@ihs.gov 916-930-3981, ext. 337

2. Overview • 2008 Northern California Smoke Incident • IHS Response Capacity and Activation • H1N1 Influenza Preparation • Quarantine Authority in Indian Country

5. Tribal Site directly hooked into Internet

7. Willow Creek Air QualityParticulate Levels, Hourly Average 7-31 to 8-6, 2008 PM 2.5 Time

8. In a disaster things are going badly… probably very badly

11. Who Made it happen ? • Robert Holden – National Congress of American Indians – rholden@ncai.org • Steven Golubic – National FEMA Tribal Liaison- steven.golubic@dhs.gov

12. National IHSOffice of Emergency Services • Created after the hurricanes of 2004 • Office of Emergency Services include following Divisions: Emergency Management, EMS, Children’s EMS, Security Protective Services and Trauma Services Darrell LaRoche, National IHS Emergency Manager darrell.laroche@ihs.gov

15. IHS National Task Force 2007 Southern California Fires • Provided a Physician, Nurses and some pharmaceuticals to supplement clinic coverage • Arranged for FEMA and ACE teams to restore power at LaJolla and Mesa Grande reservations • Generated and processed Action Request Forms (ARFs) • Provided a Health Information Officer

16. Tribal Disaster Response Options According to the National Response Plan, Tribes have the options of working with the Federal government and local and state governments http://www.fema.gov/pdf/emergency/nrf/nrf-support-tribal.pdf

17. H1N1 Influenza Preparation The Swine Flu Virus

18. New Influenza-Like-Illness Tracking Software • Assist Service Units with their clinical responses. • Guide disease mitigation measures, such as school closures and other mitigation techniques • Plan deployment of assets, such as personal protective equipment and antiviral medicines, from the Strategic National Stockpile. • Ensure that diagnostic resources, such as influenza test kits, can be sent to where there is influenza activity.

19. OSHA-RequiredRespirator Program OSHA Standard 1910.134 (www.osha.gov) • Medical Evaluation Form • Training • Fit Testing • Written Program

20. Anti-Virals for High Risk Workers

21. SNS Phone Contact:

22. Surge Samples for H1N1 Phone Contact:

23. Suspected Influenza Testing County of San Diego Public Health Services Heather LaBelle PHN June 2009

24. Rapid Test Samples • “Quick Vue” is one example • Gives a 10 minute result • Positive or negative for A or B flu • Helps determine treatment course • Does not discern what type of A or B • Kits can be expensive $300/25 tests • False Negatives

25. Culture Samples • Swab sample is transported to lab • Lab performs organism specific tests • Results may take days • H1N1: Positive A sent for typing of human Hemaglutinin antigen and/or tested with seasonal flu reagents to determine if sample was a novel strain

26. Sampling Uses Rapid test for flu • Helps determine if further patient testing needed • Knowing flu results helps direct treatment • Can be done in house Collecting Culture Samples • Used to determine community trends • Takes days to process • Tracks specific strains

27. How Swab Tests are Paid For • MDs and clinics use private or commercial labs to process for patient care • Public Health response swab samples may be processed at public health lab CDC/State/County

28. Current H1N1 Swab Status: Done on hospitalized patients (in facility 24 hours or more) with influenza like illness Limited Surveillance activities: ie: military venues & surveillance clinics Once H1N1 is in the community, sampling is generally considered cost prohibitive unless clinically indicated or illness patterns change

29. Quarantine Authority - 2 Federal Laws TITLE 25 - INDIANS CHAPTER 5 - PROTECTION OF INDIANS Sec. 198. Contagious and infectious diseases; quarantine STATUTE- Whenever the Secretary of the Interior shall find any Indian afflicted with tuberculosis, trachoma, or other contagious or infectious diseases, he may, if in his judgment the health of the afflicted Indian or that of other persons require it, isolate or quarantine such afflicted Indian in a hospital or other place for treatment. The Secretary of the Interior may employ such means as may be necessary in the isolation, or quarantine, of such Indian, and it shall be the duty of such Indian so afflicted to obey any order or regulation made by the Secretary of the Interior in carrying out this provision. Year of Law: 1929

30. Quarantine authority (cont’d) 25 USC Sec. 231                                             01/02/2006 TITLE 25 – INDIANS, CHAPTER 6 - GOVERNMENT OF INDIAN COUNTRY AND RESERVATIONS  -   SUBCHAPTER I Sec. 231. Enforcement of State laws affecting health and education; entry of State employees on Indian lands -STATUTE-      The Secretary of the Interior, under such rules and regulations  as he may prescribe, shall permit the agents and employees of any State to enter upon Indian tribal lands, reservations, or allotments therein (1) for the purpose of making inspection of health and educational conditions and enforcing sanitation and quarantine regulations • Under separate authority (42USC Sec. 2001 ) the Secretary of the Interior’s authority is delegated to the Secretary DHHS, who in turn, directs the Director of the IHS

31. Interpretation • IHS can work with State agencies to declare quarantine on Indian land • IHS can work with the State to isolate non-Indians on Indian land (isolation authority over Indians on Indian land definite for IHS, uncertain for State)

32. Proposed Quarantine Regulation • CDC is seeking regulations to acquire quarantine authority on Indian land • Part of regulation would be to require consultation with IHS and Tribal leaders

33. Indian Health Service Federal Emergency Preparedness and Response Robert Newsad, MPH IHS/ California Area Office Robert.newsad@ihs.gov 916-930-3981, ext. 337