Public Health 101 An Introduction for Stakeholders A Trainer’s Guide

2. Public Health 101An Introduction for StakeholdersA Trainer’s Guide Tarrant County Public Health Public Health Preparedness Division & Southwest Center for Advanced Public Health Practice 2009

3. Course Outline • Introduction to Public Health • Public Health Preparedness • Incident Command System (ICS) • Public Health Response to Emergencies • Strategic National Stockpile (SNS) • Introduction to Epidemiology • Isolation and Quarantine • Case Study 1: Hepatitis A outbreak • Case Study 2: Avian Influenza outbreak • Case Study 3: White Powder Incident

4. Course Objectives • 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 • List scenarios where public health and first responders are most likely to interface

5. What is Health? • Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.

6. Public Health vs. Medicine

7. Tarrant County Public Health’s Vision & Mission Vision: The Tarrant County Public Health Department assures, protects and promotes the overall health and well-being of our residents Mission: Safeguarding Our Community’s Health

8. Public Health Objectives • 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

9. Tarrant CountyPublic Health Services • Personal Health Services (clinical services) • 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

10. Population BasedPublic Health Services • Environmental Health • Infectious Disease Control and Investigation • Laboratory Services • Health Education Services

11. The Public Health System Federal Agencies State Agencies Local Agencies

12. Public Health’s Many Partners Police HomeHealth EMS Churches Community Centers MCOs Corrections Health Department Parks Schools Elected Officials Hospitals Mass Transit Doctors Nursing Homes Philanthropist Environmental Health Civic Groups CHCs Fire Tribal Health Laboratory Facilities Drug Treatment Economic Development Mental Health Employers

13. 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

14. 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)

15. Public Health PreparednessBuilds Infrastructure for: Everyday health threats Infectious & foodborne diseases Public Health Emergencies Bioterrorism, pandemics

16. Preparedness and Bioterrorism What is bioterrorism??? -- The use of... • Bacteria • Viruses • Parasites • Their by-products …in a terrorist act.

17. Preparedness and Bioterrorism • Possible agents of bioterrorism • Anthrax • Smallpox • Plague • Botulism

18. 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

19. 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

20. Roles in Preparedness Examples: • Outbreaks from contaminated food or water, infectious diseases, etc. • Natural disasters: hurricanes, floods, fires

21. Roles in Preparedness • Planning • Coordination/Collaboration • Training and Exercise • Response • Evaluation and Corrective Action Collaboration is critical to success!

22. Roles in Preparedness • Examples of public health roles: • Health threats investigator • Public service/media • Post-event tracking • Environmental investigators

23. Early Detection of Health Threats 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

24. 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

25. LE/FR Advisory and Alerting Portal

26. Incident Command System • Allows a more effective, efficient response to emergencies • Examples: • HazMat incidents • Terrorist incidents • Natural disasters • Incidents involving multiple casualties

27. Incident Command LHD’s use ICS Command & Control PH Resources & Personnel Communicate to partner agencies

28. 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.

29. Notifying Public Health • Public health is a valuable & relevant partner • Public health is available 24/7 • System in place to triage calls during business & non-business hours

30. Notifying Public Health(24 Hour Hotline) • If you need their help in an emergency call, 817-994-3708 • Public health can’t respond if you don’t call them • Public health will always respond in a timely manner

31. Public Health Responding to Emergencies • In what type events would you expect Public Health to assume lead role for providing health and medical services ?

32. Public Health Preparedness Summary • Build public health infrastructure to respond to threats from: • Bioterrorism • Natural disasters & disease outbreaks • Requires collaboration between agencies: • Planning • Training & exercises • Response • Communication • Management of resources

33. Group Exercise:Crypto Outbreak Cryptosporidium (crypto) is a microscopic parasite caused by fecal contamination in water. It most often manifests in public swimming areas.

34. Group Exercise:Crypto Outbreak Lake Sharon a popular public swimming lake is source of a large crypto outbreak.

35. Group Exercise:Crypto Outbreak Based on the ICS 201… • Complete an ICS 202 • Write objectives • Write safety message • Secure perimeter • Take into account environmental hazards

36. Preparedness Exercise

37. 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

38. 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:

39. Strategic National Stockpile • Delivered within 12 hours of federal decision to deploy SNS assets • 12-hour “Push Package” • Push packages are warehoused in strategically- positioned locations around the US

40. 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

41. Local Response to Strategic National Stockpile • Essential that First Responders and others in contact with exposed civilians are the first to be medicated

42. Local Response to Strategic National Stockpile • Must prepare to dispense medicine to a huge number of people in a relatively short time span

43. 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

44. Local Response to Strategic National Stockpile • Remember the 5 P’s . . . Prior Planning Prevents Poor Performance

45. And What Type Of A Planner Are You Going To Be?

49. What is Epidemiology? Study of the spread and causes of diseases or events in specified populations, and the control of health problems.

50. 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