Public Health Emergencies

1. Public Health Emergencies Processes, Expectations, Responsibilities, and Relations to Risk Management Uei Lei, MPH, EMT-P Emergency Preparedness and Response Manager Multnomah County Health Department uei.lei@multco.us

2. What are Public Health Emergencies? • Disease outbreaks • Novel, to the jurisdiction, diseases (e.g. Zika, Ebola) • Endemic diseases (e.g. STD, norovirus, influenza • Intentional incidents • Bioterrorism (e.g. anthrax, plague, tularemia) • Secondary to other emergencies • Wild fire, exacerbation of chronic asthma • Flooding, tetanus / diptheria

3. A Few Givens • Regardless of how much we plan and prepare, incidents will still happen; people will still get sick • How “fewer” are sick and “less” sick become the reason for preparing. • For risk management, how much “less” workers lost, time lost, productivity reduced, public trust lost, etc. • In a nutshell, “reducing the severity of impact”

4. A Few Givens • Regardless of how much we plan and prepare, incidents will still happen; people will still get sick • How “fewer” are sick and “less” sick become the reason for preparing. • For risk management, how much “less” workers lost, time lost, productivity reduced, public trust lost, etc. • In a nutshell, “reducing the severity of impact”

5. Introduction to a few Processes Disease State Occurs Ill Person Seeks Medical Attention Disease Diagnosed, Reported Public Health Receives Report Return to Routine Monitoring Information and / or Intervention Public Health Initiates Investigation For the novel / endemic disease, the process is generally as follows:

6. Processes Continued Disease State Known Public Health initiates ACTIVE Surveillance Disease Diagnosed, Detected Public Health Initiates Investigation Information and / or Intervention For disease outbreaks “elsewhere”:

7. Processes Continued • For intentional (bioterrorism) incidents: • Unclaimed (covert) incidents will follow the previous methods of detection and response • Overt incidents will involve simultaneous law enforcement and public health investigation ** Strategic National Stockpile, Medical Countermeasures

8. Strategic National Stockpile Centers for Disease Control and Prevention (CDC) SNS is a large quantity of medicines and medical supplies designed to be a “first response” to public health emergencies to augment local supplies Request for SNS starts from Local  State  Federal Receipt of SNS is in reverse – Federal  State  Local ** Subject to change – e.g. 2009 H1N1

9. Strategic National Stockpile Continued • A few “buzzwords” • RSS Warehouse – Receiving, Staging, and Storing Warehouse • EOC / ECC / AOC / DOC – Emergency Operations Center / Emergency Coordination Center / Agency Operations Center / Department Operations Center • POD / CPOD – Point of Dispensing / Closed Point of Dispensing • Cipro / Doxy – Ciprofloxacin / Doxycycline • Federal responsibilities – timely action on request, and delivery of SNS to State authorities • State responsibilities – timely action on local request, receipt, inventory, prioritization, and redistribution to Locals • Local responsibilities – initiate request, receipt, inventory, delivery to community

10. Strategic National Stockpile Continued

11. Some Resources https://public.health.oregon.gov/Preparedness/Partners/Documents/MCM%20Docs%202014/Oregon_POD_FOG.pdf http://www.cdc.gov/phpr/stockpile/stockpile.htm https://commons.multco.us/ https://commons.multco.us/incident-management-team

12. Risk Management and Emergency Management • Hazard Identification and Vulnerability Analysis • Mitigation / Preparedness Planning • Response / Recovery Planning • Exercise / Reevaluate • Identifying / Analyzing loss exposures; • Examining the feasibility of risk management techniques / select appropriate technique; • Implementing, monitor, adjust as needed

13. Confounders • Authority, responsibilities, abilities, capabilities • Often, public health has authority and responsibilities but not the resources and personnel to execute • Culture / “Other duties as assigned” • Unlike traditional responders, public health does not exist to respond to emergencies alone. Programmatic deliverables still have to be met • Grant-based • Grant deliverables and administrative tasks may not directly lead to a “prepared” agency / personnel. How do we reconcile?

14. Questions,Concerns,Requests? Uei Lei uei.lei@multco.us