State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M....
-
Upload
marilynn-walker -
Category
Documents
-
view
216 -
download
2
Transcript of State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M....
State Role in Public Health Emergencies – Division of
Communicable Disease Control
Jessica M. Núñez de Ybarra, MD, MPHPublic Health Medical Officer III
CA Department of Public Health (CDPH)Division of Communicable Disease Control (DCDC)
Office of Workforce DevelopmentAll Hazards Workshop – San Joaquin County
August 2008
Purpose
Provide a basic understanding of the State communicable disease control role as part of the overall State Public Health Emergency Preparedness and Response system in California.
PUBLIC HEALTH
While health care is vital to each of us some of the time, public health is vital to all of us all the time.
C. Everett Koop, M.D., former U.S. Surgeon General
• Mission: The fulfillment of society’s interest in assuring conditions in which people can be healthy. Institute of Medicine.
• Functions: Assessment, Policy development & Assurance.
The Public Health System Process
• a continuous cycle of gathering information, deciding, acting, evaluating
• Public health is always evaluating the health of the community
Columbia University Center for Public Health Preparedness
“System”
• More than just the public health agency
• “Public health system”– All public, private, and voluntary
entities that contribute to public health in a given area.
– A network of entities with differing roles, relationships, and interactions.
– All entities contribute to the health and well-being of the community.
The Public Health SystemThe Public Health System
MCOs
Home Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory Facilities
Hospitals
EMS Community Centers
Doctors
Health Department
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
Public Health in America
• Prevent epidemics and spread of disease
• Protect against environmental hazards
• Prevent injuries
• Promote and encourage health behaviors
• Assure the quality and accessibility of health services
• Respond to disasters and assist communities in recovery
Columbia University Center for Public Health Preparedness
Public Health Preparedness Threats and Emergencies
7 Core Capacities
• Workforce• Information Systems• Communication• Epidemiology/surveillance• Laboratory• Policy and Evaluation• Preparedness and Response
Columbia University Center for Public Health Preparedness
Workforce
The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operations
Columbia University Center for Public Health Preparedness
The Essential Public Health Services (1994)
1. Monitor health status
2. Diagnose and investigate health problems
3. Inform and educate
4. Mobilize communities to address health problems
5. Develop policies and plans
6. Enforce laws and regulations
7. Link people to needed health services
8. Assure a competent health services workforce
9. Evaluate health services
10.Conduct research for new innovations
Information Systems
Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information.
Columbia University Center for Public Health Preparedness
Communication
Public Health systems maintain communication mechanisms to:
– Routinely translate scientific and health information for communities and policy makers
– Provide timely, accurate public information and advice to policy makers during emergency events
– Coordinate logistical communication within the response community.
Columbia University Center for Public Health Preparedness
Epidemiology/Surveillance
Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors.
Columbia University Center for Public Health Preparedness
Laboratory
Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage.
Columbia University Center for Public Health Preparedness
Policy and Evaluation
Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions.
Columbia University Center for Public Health Preparedness
Preparedness and Response
Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies.
Columbia University Center for Public Health Preparedness
Communication with Your Family
Your family may be concerned, involved and/or have their routines changed.
Do you have a:• Family Disaster Plan?
• Personal Emergency Plan?
Columbia University Center for Public Health Preparedness
NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM
PERSONAL EMERGENCY PLAN
In the event that I am called upon to respond to an emergency as a Department of Health
employee I, _____________________________________, have made the following
arrangements to ensure that my family and pets are cared for while I am on duty:
My child(ren) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address
)
My pet(s) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address)
My parent(s) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address)
Example Personal Emergency Plans:
NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM
PERSONAL EMERGENCY PLAN
In the event that I am called upon to respond to an emergency as a Department of Health
employee I, _____________________________________, have made the following
arrangements to ensure that my family and pets are cared for while I am on duty:
My child(ren) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address
)
My pet(s) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address)
My parent(s) will be cared for by: ___________________________________(Name)
__________________________________(Phone
#)
________________________________________________________________(Address)
NYC-DOH School Health Program Draft, August 2001
During Working Hours After Working Hours
Columbia University Center for Public Health Preparedness
Remember……
Make provisions for:•Child(ren) •Spouse/Partner•Parents•Pets•Others
Columbia University Center for Public Health Preparedness
COMPETENCYA complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization
(Center for Public Health Practice, Emory University)
Columbia University Center for Public Health Preparedness
Core Public Health Worker Competencies for Emergency Preparedness and Response
Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.
Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team.
Columbia University Center for Public Health Preparedness
In order to respond to any emergency/disaster, ALL public health
workers should be able to:
• IDENTIFY & LOCATE the emergency plan
• DESCRIBE the role of Public Health
• DESCRIBE the Chain of Command
• DESCRIBE & DEMONSTRATE one’s functional role
• RECOGNIZE deviations from the norm
• IDENTIFY limits to own authority
• DESCRIBE communication roles
• DEMONSTRATE use of communication equipment
• APPLY creative problem solving skills
Columbia University Center for Public Health Preparedness
Role of the State Public Health Agency in Emergency Response
• Collaborate with other agencies in policy decisions and actions (e.g., request to Feds for Strategic National Stockpile)
• Surveillance
• Investigation
• Public information
Columbia University Center for Public Health Preparedness
Role of the State Public Health Agency in Emergency Response (cont’d)
• Medical provider information
• Reference laboratory support
• Public health interventions (e.g. mass vaccinations)
Columbia University Center for Public Health Preparedness
Role of the State or Local Office of Emergency Services
(OES)
Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations.
Columbia University Center for Public Health Preparedness
Example of a Common Multi-level Scheme for Disaster Communication and Coordination
PRESIDENTDHS FEMA
GOVERNOR’S OFFICE
Police
STATE OES STATE DOH
HHSCDC
Office of LocalElected Official
LOCAL OES LOCAL DOH
Fire OtherState
Federal
Local
Columbia University Center for Public Health Preparedness
Federal, State and Local Coordination in California DISASTERS for Public Health
Media Voluntary Agencies(ARC, etc.)
Police
DHS/FEMA
Governor’s OFFICE OF EMERGENCY SERVICES (OES)
SOC
State
Federal
Local
FIRE-EMS
Voluntary Health Sector
Local Official’sOFFICE
PRESIDENT HHS/CDC/VA etc.
MHOACLHJ
CDPH/EMSA JEOC
GOVERNOR’SOFFICE
OPERATIONAL Area EOC’sCities, Counties, Special Districts
RDMHCOES/REOCAdmin & Mutual Aid Regions
Incident Command
EMERGENCY PREPAREDNESS COMPETENCY
• IDENTIFY limits to own knowledge/skills/authority and..
• IDENTIFY key system resources for referring matters that exceed these limits
Columbia University Center for Public Health Preparedness
Role of Local Health Officershttp://www.cdph.ca.gov/programs/dcdc/Pages/default.aspx
Health Officer Practice Guide for Communicable Disease Control in California
Examples
LIMITS TO OWN SKILLS OR AUTHORITY
• Communication with media
• Legal authority
• Supervision of others
• Allocation of resources
• Clinical skills or decision making
• Policy decision
KEY SYSTEM RESOURCES
• Agency chain of command
• Web resources
• Logistics Officer
• Policy and procedure manual
• Disaster plan / protocols
Columbia University Center for Public Health Preparedness
Examples
Public Health Nurse in the Shelter Setting:
Limits• Treatment of the
seriously ill
• Providing information to the media
• Re-assigning roles of other shelter staff
Resources• Local Emergency Room
• DOH Public Relations (or Public Affairs Dept.)
• Shelter manager
Columbia University Center for Public Health Preparedness
Cultural and Linguistic COMPETENCE
“A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.”
Terri Cross, 1989
[From March 2005 Presentation by Dr. Melanie Tervalon, MD, MPH, Education Director, COE Nutritional Genomics]
Rationale for Cultural Competence
• Responding to demographic changes• Eliminating disparities in the health status of
people of diverse, ethnic & cultural backgrounds• Improving quality of services and outcomes
Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural
Competence. Washington DC, 1999. [From March 2005 Presentation by Dr. Tervalon]
Rationale for Cultural Competence (cont.)
• Meeting legislative, regulatory, and accreditation mandates
• Gaining a competitive edge in the marketplace• Decreasing the likelihood of liability/malpractice
claims
Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural
Competence. Washington DC, 1999.
Cultural Humility
• Self-reflection and life long learner
• Patient-focused interviewing and care
• Community-based care and advocacy
• Institutional consistency
[From March 2005 Presentation by Dr. Tervalon]
Public Health for Emergency Preparedness and Response
Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.
Columbia University Center for Public Health Preparedness
State of California – Executive Branch
Voters
GOVERNOR’S OFFICE
CDPH
Health and Human Services
State
Voters
Agencies
Columbia University Center for Public Health Preparedness
Depts.
CDPH
• VISION: Healthy individuals and families in healthful communities
• MISSION: Dedicated to optimizing the health and well-being of the people in California.
CDPH
•CCLHO•Advisory Cmte
Director’s Office
Center for Chronic Disease
Center for Infectious Disease
Center for Environmental
Health
•OWH•OMH•OBBH•EPO
•Chronic Disease & Injury Control
•Environmental & Occupational
Disease Control
•Communicable Disease Control
•Office of AIDS
•Food, Drug & Radiation Safety
•Drinking Water & Environmental
Mgmt.
Centers
Executive
Divisions
Columbia University Center for Public Health Preparedness
Center for Family Health
Center for Healthcare
Quality
•WIC•Maternal, Child
& Adolescent Health
•Genetic Disease
•Licensing & Certification
•Laboratory Field Services
CDPH through DCDC is responsible for investigating and controlling all
communicable disease and conditions in the State of California.
DCDC
DCDC, through its Branches, works in partnership with local, national and international health officials, health care providers, and the public to:
– monitor health, – identify and investigate existing and potential health
problems, – develop and implement prevention strategies, – conduct research, – provide education and training, – and formulate and advise on public health policy
DCDC Branches
• Infant Botulism Treatment and Prevention Program
• Infectious Diseases Branch• Immunization Branch• Sexually Transmitted Disease Control Branch• Tuberculosis Control Branch• Microbial Diseases Laboratory Branch• Viral & Rickettsial Disease Laboratory Branch
Epidemiology/SurveillanceRoles and Responsibilities in Emergency
Response
• Provide background info on emergency surveillance data • Conduct field epidemiological investigations (prn)• Monitor existing surveillance systems• Establish new surveillance system
- Assemble field teams - Establish databases
- Develop questionnaires/forms - Enter data
- Liaison with hospital/field personnel - Analyze data
- Collect data
- Develop recommendations for policy
Columbia University Center for Public Health Preparedness
• Provide recommendations for specimen types and
handling
• Accept specimens for testing
• Ensure rapid transports to reference labs
• Perform testing
• Coordinate with epi/surveillance re: data entry
• Liaison with Laboratory Response Network (LRN) i.e.,
outside labs re: testing and data reporting
LaboratoriesRoles and Responsibilities in
Emergency Response
Columbia University Center for Public Health Preparedness
• Provide resources to facilitate others’ activities
OperationsRoles and Responsibilities in
Emergency Response
• Transportation
• Communication
• Facilities
• Security
• Personnel
• Printing
• Coordinate hotlines for public & providers
Columbia University Center for Public Health Preparedness
• Research specific topic• Provide background information• Prepare recommendations re:
-Public health threat
-Sample collection
-Evacuation/reoccupation
• Collect samples• Collaboration w/ Hazmat
EnvironmentalRoles and Responsibilities in
Emergency Response
Columbia University Center for Public Health Preparedness
Facilitate computing issues during emergencies
-Field to Headquarters data transmission
-Database management
-Mapping/GIS
Medical Information Systems (MIS)Roles and Responsibilities in Emergency
Response
Columbia University Center for Public Health Preparedness
• Prepare recommendations on clinical aspects of emergency-Public safety issues -Training of community MDs
-Occupational safety issues -Disinfection/decon issues
-Develop prevention & treatment message
• Establish and staff prophylaxis/treatment distribution centers
• Staff DOH clinics involved in emergency
• Liaison with Coroner regarding mortuary issues
• Supplement clinical backup to school health program sheltering
activities
Local Medical/ClinicalRoles and Responsibilities in
Emergency Response
Columbia University Center for Public Health Preparedness
EMERGENCY PREPAREDNESS COMPETENCY
APPLY creative problem solving and flexible thinking to unusual challenges within functional roles and responsibilities and
EVALUATE the effectiveness of all actions taken.
Columbia University Center for Public Health Preparedness
CREATIVE PROBLEM SOLVING
What situations requiring creative problem solving and flexible thinking can you imagine occurring?
• Telephone system fails?
• Expected supplies are not delivered?
• Agency facility is inaccessible?
• Other types of problems???
Columbia University Center for Public Health Preparedness
CREATIVE PROBLEM SOLVING
What situations requiring creative problem solving and flexible thinking can you imagine occurring?
Columbia University Center for Public Health Preparedness
Evaluation
How would you evaluate the effectiveness of all actions you took?
• Were the issues you referred to others acted upon?
• Was the issue that you addressed resolved?
• After the situation, evaluate the effectiveness of the plan.
Columbia University Center for Public Health Preparedness
Acknowledgement Special thanks to the Columbia University Center
for Public Health Preparedness upon whose Public Health Emergency Preparedness and Training
Program this Presentation has been based.
Website: http://cpmcnet.columbia.edu/dept/sph/CPHP/index.html
Resources
• American Public Health Association www.apha.org
• Association of State and Territorial Health Officials www.astho.org
• Centers for Disease Control and Prevention
http://www.cdc.gov/
Resources
• National Association of County and City Health Officials www.naccho.org
• National Association of Local Boards of Health www.nalboh.org
• National Network of Public Health Institutes www.nnphi.org
• Public Health Foundation www.phf.org
Contact Information
Jessica M. Núñez de Ybarra, MD, [email protected]: 916 650-6875
Fax: 916 552-8973California Department of Public Health
Division of Communicable Disease Control1616 Capitol Avenue, MS 7300
PO Box 997377Sacramento, CA 95899-7377