Local Emergency Management

Roles in Communicable Disease

Outbreaks: A Dialogue with Public Health

North Carolina Emergency Management AssociationMarch 24, 2015

Harrah’s Cherokee Casino Resort

ObjectivesDefine communicable disease outbreak

Compare and contrast local EM incident response and local PH communicable disease (CD) response

List potential local EM roles in CD response using scenarios

Quick quiz...What is an outbreak?

Quick quiz...What is an outbreak?

What is communicable disease?

Quick quiz...What is an outbreak?

What is communicable disease?

What is epidemiology?

What are some characteristics of an

outbreak?Usually, there is no “scene”

Happens over time—sometimes weeks or months

Different/same diseases behave differently/ the same

Ill persons may not be obvious, may not seek care

Often self-limiting and not detected/ reported

Symptoms by definition are subjective

Steps of CD investigation

First… situational awareness/ size-upHow do you do your size-up?

Steps of CD investigation

First… situational awareness/ size-upHow do you do your size-up?

“Everyday operations” vs. “incident”

Steps of CD investigation

1. Identify investigation team and resources

2. Establish existence of an outbreak

3. Verify diagnosis

4. Construct case definition

5. Find cases and list them

6. Perform descriptive epidemiology/ develop hypotheses

7. Evaluate hypotheses/ perform additional studies

8. Implement control measures

9. Communicate findings

10. Maintain surveillance

What are some similarities between PH CD investigation and EM’s approach to incidents?

Some differences?

How can EM participate and support?

ICS

EOC

ICS-EOC interface

MACS

Resource management

Pre-scripted IAPs

Communication: tactical and public

ScenarioAugust, 2015: There is a new water park in your

jurisdiction that opened Memorial Day, with large and small all-ages pools, kiddie pools, and a large whirlpool/jacuzzi. It’s August, with temperatures in the 90s, and the park is jammed with locals and tourists.

At 4 pm Friday afternoon:Dispatch starts getting calls from people with vomiting

and bloody diarrheaDitto the health departmentThe hospital ED is starting to see multiple people of all

ages with these symptoms

We know what the health department is doing.

What could EM be doing?

Scenario Part 2It is the following Tuesday morning. Now we

have:45 people 1 year-65 years reporting symptomsLab results positive for ShigellaKiddie pool, jacuzzi and locker room positive for

Shigella

By Wednesday, there are over 60 cases from your jurisdiction, 3 surrounding counties and the Tribe; the hospital is full and there are reports of cases at the nursing home

Would your local resources be overwhelmed?

How could EM help with incident response organization and resource management?

Another scenarioIt’s April 2016, and the local Health Department

gets a call that a strain of influenza, recently identified in Canada and highly virulent, is spreading from Canada to the US. Cases have been identified in 12 states, including NC, with several deaths in young, previously healthy adults.

The virus responds to available antiviral oral medications, and, remarkably, last season’s flu vaccine seems to have a moderating effect on symptoms.

When will EM know about it?

What would you do in your jurisdiction to help stand up, scale, and maintain

a response?

How can EM participate and support? (Take 2)

ICS

EOC

ICS-EOC interface

MACS

Resource management

Pre-scripted IAPs

Communication: tactical and public

Questions? Comments?

Thanks for joining us!WNC Public Health Staff

Martha Salyers martsaly@nc-cherokee.com -- EBCIPhilip Anderson -- Cherokee County

Alison Cochran -- Swain County Health DirectorMisty Lewis -- Swain County

Ashley McGugan – Swain CountyShelia Metcalf -- Madison CountyRobin Wallin -- Madison County