CAPT Mehran S. Massoudi, PhD, MPH Associate Director for Science

1. Establishing a Public Health Branch of an Incident Response Coordination Team — Haiti Earthquake Response, 2010 CAPT Mehran S. Massoudi, PhD, MPH Associate Director for Science Scientific Education and Professional Development Program Office (proposed) Centers for Disease Control and Prevention US Department of Health and Human Services Presented by: CAPT Holly Ann Williams, PhD May 24, 2010

2. Co-authors • CDR Daphne Moffett • CDR Margaret Riggs • LCDR Roque Miramontes • CAPT Holly Williams • CAPT Peter Bloland • A special thank you to CAPT Holly Williams, as this talk was modified from a previous one developed by her for the upcoming 2010 ESF 8 Summit: IRCT Training

3. 12 janvier 2010 : Tremblement de terre35 secondes fatales... plus de 220.000 morts

4. Haiti Earthquake, January 2010 On January 12, a 7.0 magnitude earthquake hit Haiti at 1653 hrs, ~10 miles from Port-Au-Prince (near Leogane) • 220,000+ deaths • 330,000+ injuries • 1,000,000+ homeless On January 20, at 0600 hrs, a 6.1 magnitude earthquake occurred with epicenter approximately 35 miles WSW of Port-Au-Prince

8. Public Health Branch in Haiti: What Did We Do?

9. Who Were We? • Branch composed of all US Public Health Service (PHS) officers, all of whom were stationed at CDC: • Branch modeled on PHS’s ‘Preventive Medicine Branch’ within the Rapid Deployment Forces (RDF) and ‘Applied Public Health Teams’ (APHT) • Size of branch varied and, at most, consisted of six officers • Expertise within the group included: epidemiology, anthropology, toxicology, environmental health, food safety, veterinary medicine, nursing and vector-borne diseases • Part of the HHS Incident Response Coordination Team (IRCT) and reported to the Operations Section Chief

10. Functions of the PHB • Force Protection: • Conducted environmental health assessments at DMAT, DMORT sites, including Hotel Montana • Stressed use of Personal Protective Equipment • DEET • Sunscreen • Insecticide treated bednets • Appropriate clothing • Malaria chemoprophylaxis • Provided public health education briefings (for HHS assets and others, such as Urban Search & Rescue Teams) Arm bites on DMAT responder

11. Functions: II • Surveillance of Diseases & Injuries: • Assisted with re-initializing and modifying Haiti’s national surveillance system to better address trends post-earthquake: • Modeled national surveillance on forms developed after the 2008 Haiti hurricanes and subsequent floods • Collected electronic medical record data (EMR) from Disaster Medical Assistance Teams (DMATs) on a daily basis: • Collaborated closely with SOC Fusion Cell • Summarized data and produced daily charts of DMAT data for distribution across DMAT sites, to IRCT, and interested partners, including the Ministry of Health CDR Lipinentering DMAT EMR data CDR Riggs on nightly EMR data calls

12. Functions: III • Provided technical assistance to larger, global humanitarian efforts: • Collaborated with Dept of Defense (DoD) on environmental assessments • Participated in Inter-agency Vector Borne Disease meetings and provided feedback on funding proposals from donors and UN • Provided technical assistance to DoD on operational issues related to establishing and maintaining a ‘federal medical station’ • Stressed the context of endemic tropical diseases in affected area to responders: • Dengue fever, malaria, leptospirosis, typhoid, TB, HIB, H1N1, and Hepatitis A • Consulted with CDC entomology and vector borne disease specialists in Puerto Rico and Fort Collins RADM Deitchman at FMS site assessment

13. Public Health Assessments Collaborative mission with DoD to assess field reality in towns of Jacmel and Leogone

14. Assessment of Hazards

15. Austere Working Conditions MREs for 32 days! Toilet for DMAT team Difficult sleeping arrangements

16. Structural Damage

17. Standing Water After Rains: DMAT Work Space

18. DMAT Sites: Testing for Contamination and Quality of Water CDR Riggs doing coliform testing at DMAT site Testing for chlorine: CAPT Williams & LCDR Grant

19. Vector Control Old Tires:Vector Breeding Sites Insufficient length of bednets

20. Poor Air Quality Search & Rescue not wearing respirators Burning of garbage at Gheskio

21. Unrelenting Noise: Airport Lack of Ear Protection

22. Lack of Waste Removal: Biohazard and Other Look carefully: this has both biohazard and other trash

23. Future of IRCT Public Health Branch

24. Challenges Faced in Haiti • PHB – a new concept within IRCT and National Disaster Medical System (NDMS – DMAT, DMORT responders): • Different orientation and expectations for acute medical care versus public health • No identified cache • CDC focused on longer term perspective: • PHB was caught between need to focus on IRCT Public Health issues, while responding to requests from home agency

25. Recommendations • Develop training modules on role and functions of Public Health Branch for IRCT and NDMS staff, and other HHS deployed assets, including PHS Officers deployed through OFRD • Provide direct access to EMR data so that PHB can better assist SOC Fusion Cell in analyzing field data in a timely manner • Identify and obtain needed items for cache • Ensure that equipment is readily available and accessible • Examples: sampling equipment for water, soil and air quality; sufficient amounts of insecticide, appropriate computer software for data analysis

26. Thank You and Acknowledgements • The people of Haiti • All the members of the Public Health Branch in Haiti: • CAPTs Peter Bloland, Holly Williams, and Mehran Massoudi • CDRs Daphne Moffett, Margo Riggs • LCDRs Juliana Grant and Roque Miramontes • Photo Credits: • Members of the PHS Branch and CA 6 DMAT • Questions: Mehran.Massoudi@cdc.hhs.gov

27. Extra Slides

28. Roles and Functions of the Public Health Branch

29. Public Health Branch • Collaborates with IRCT Chief Medical Officer, IRCT Safety Officer, Veterinarian Care Group Supervisor, Field Teams’ Supervisors and others as appropriate • Assists IRCT Operations Section in selection of public health expertise and necessary assets/resources • Directs efforts of all CDC/ATSDR teams/assets deployed to area of operations with the IRCT Operations Section • Monitors all field operations for public health threats on a continuous basis: • Conducts daily visits, when possible, to field sites

30. Public Health Branch • Works with DMAT teams on collection of electronic medical record (EMR) data: • Gathers EMR data from all field sites on daily basis • Summarizes data on ‘patient encounters’ and ‘patients treated’ by site and across site • Produces summary document of EMR data that is disseminated to all sites, IRCT, partners, state/local health departments or Health Cluster/MoH in affected countries • Collaborates with SOC Fusion Cell to ensure that EMR data are transmitted in a timely and efficient manner: • Provide technical assistance for analysis and interpretation of surveillance data as requested by SOC Fusion Cell

31. Public Health Branch • Provides technical assistance on public health matters to other partners as requested and as appropriate • Provides input to the Hazard Risk Assessment (HERA) and Force Protection Plan • Conducts environmental, food safety and engineering assessments on an “as needed” basis • Provides public health education, formal and informal

32. Evolution of IRCT Public Health Branch (PHB) • Critical consideration: • “CDC will assume the lead for HHS for public health response operations in- country” • CDC Haiti Earthquake Relief Public Health Concepts of Operations (CONOPS), Jan 2010 (p. 4) • Haiti response: 1st time PHB integrated into IRCT: • Memorandum of Understanding (MoU) between ASPR and CDC, Jan 2009 • Per MoU, Public Health Branch (PHB) Chief: • “…responsible to coordinate public health missions and resources when an IRCT is activated” • “…will follow direction of IRCT Operations Section”

33. Why Do We Collect all those Numbers? • Public health surveillance uses data to assess public health status, define public health priorities, and evaluate programs: • Tells where problems are • Who is affected • Informs where programmatic and preventive activities should be directed • Data collected went through IRCT to SOC Fusion Cell and onwards to higher levels in HHS and the White House • Most importantly, the data helped inform programmatic planning for the longer, transition and reconstructive periods

34. Public Health Strategic Objectives • Assist in rapid assessment of emergency water, sanitation and shelter services • Provide emergency public health assistance • Provide epidemiological and surveillance assistance • Execute population-based surveys on conditions not covered in surveillance • Distribute safety, sanitation and infection control guidelines for healthcare workers based on epidemiological situation