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www.naccho.org
@NACCHOalerts
April 30, 2015
www.naccho.org
@NACCHOalerts
Moderator:
Chevelle Glymph, MPH
Director of Community Preparedness, Recovery, and Resilience,
National Association of County & City Health Officials
Speakers:
Michael Heumann, MPH, MA
Principal Epidemiologist, Heumann Health Consulting
Ashley Conley, MS, CPH, CHEP
Epidemiologist, City of Nashua, Division of Public Health and Community
Services
Jennifer Kiger, MPH
Senior Preparedness Specialist, Harris County Public Health and
Environmental Services
Kelly M K Johnson, MS
Epidemiologist – Data and Support Unit Supervisor, Harris County
Public Health and Environmental Services
Ashley Conley
Michael Heumann
Division of Public Health
& Community Services
Nashua, NH
HeumannHealth Consulting
Portland, OR
2015

Disaster Epidemiology Subcommittee
◦ Meets monthly via conference call
◦ Hosts webinars and workshops
◦ Speaking at national conferences on disaster
epidemiology
◦ Subject matter experts on disaster epidemiology
◦ Website: http://www.cste.org/group/DisasterEpi

The CSTE Disaster Epidemiology Subcommittee is
intended to bring together various disciplines of
epidemiology to enhance the public health response to
emergencies.

Convenes various wide range of partners to develop
unified and collaborative epidemiologic approaches
towards improving emergency preparedness and
disaster response capacities at local, state, regional,
and national levels following natural disasters and
other emergencies.

Disaster Epidemiology Toolkit Work Group

Disaster Mental Health Surveillance Work Group

Shelter Surveillance Work Group

Program Planning Work Group (meets Nov-May)
Stronger Together: Building Partnerships and
Moving Disaster Epidemiology Forward




May 14-15, 2015
Atlanta, GA
80+ attendees this year
Live webinar option! Come join us!
1.
Define disaster epidemiology and its role in predisaster, disaster, and recovery phases.
2.
Identify how a variety of standard epidemiologic
methods are applied in the public health response
to disasters
3.
Discuss the role of the epidemiologist during a
disaster and how epidemiologists can partner with
emergency management.

The application of DE provides reliable and
actionable information to incident commanders,
planners, and decision-makers to make decisions
and allocate resources

Origin in 1980s; term “Disaster Epidemiology” (DE)
became common in 2010

DE has become a core capability under
“Emergency Services Function – 8 public health
planning and response”

Public Health Emergency Preparedness
Capabilities and DE:
◦
◦
◦
◦
◦
◦
Capability 1: Community Preparedness
Capability 2: Community Recovery
Capability 5: Fatality Management
Capability 7: Mass Care
Capability 10: Medical Surge
Capability 13: PH Surveillance and Epidemiological
Investigations
◦ Capability 14: Responder Safety and Health

DE executed in large
scale emergencies
encompasses:
◦ Rapid needs assessment,
Surveillance, Tracking,
Research and Evaluation,
and Registries

Goal is prevention

ICS: Link DE to Medical
Unit

Public Health
◦ Federal, State, County, Local,
Tribal







Hospitals
Academic Partners
Industrial hygiene and safety
professionals
Emergency managers
Responders
Regulators
Business community
Goals:

◦
Strengthen capacity to respond by integrating DE into
the emergency management cycle
◦
Help public health and emergency management
leadership understand essential role of DE
◦
Identify common set of capabilities to support collection
of epidemiologic information during emergency response
situations

Framework created the applications of
epidemiology in disaster settings

Developed by:
◦ Centers for Disease Control & Prevention (CDC)/National
Center for Environmental Health (NCEH) and
◦ Council for State and Territorial Epidemiologists (CSTE)
Disaster Epidemiology Activities
The Disaster-Management Cycle
Humanitarian Action ◄▬▬▬► Sustainable development
Tracking
Registries
Epidemiologic studies
Rehabilitation
Prevention/
Recovery
Mitigation
Response
Preparedness
Evaluation studies
Surveillance
- Affected communities
- Responders
Rapid needs assessments
- Relief programs
- Other interventions
Disaster
Impact
Studies to compare
efficacy of control
strategies and
interventions

Community Assessment for
Public Health Emergency
Response (CASPER) – tool
developed by CDC

Two-staged cluster sampling

Door-to-door survey with 7
interview teams in 30 clusters
for 210 surveys
http://www.cdc.gov/nceh/hs
b/disaster/casper.htm




Assess potential mental health issues
2 CASPERs performed – 1 in 2010
following the incident and a second in
2011
In 2011, 8%-15% of individuals
reported depressive symptoms
compared to 15%-24% of individuals
in 2010
Respondents with decreased income
as a results of the spill were more
likely to report mental health
symptoms
http://www.adph.org/CEP/as
sets/CASPER_report.pdf

Describes the health burden of an affected
community
◦ Quantifying mortality and morbidity in affected
communities and first responders and residents

Characterize pressures on health care service
system

Health surveillance in
shelters

Syndromic surveillance

Health monitoring and
surveillance among
responders to assure the
health and safety during
response and recovery

Descriptive analysis of
injuries and fatalities

A health monitoring and surveillance framework
for protecting responders through all phases of a
response
◦ http://www.cdc.gov/niosh/topics/erhms/

Pre—deployment
◦ Assessment for fitness and ability to safely deploy
◦ Train for anticipated hazards and protective measures

Deployment
◦ Approaches for centralized tracking and
rostering
◦ Surveillance and monitoring for exposures
and health effects

Post-deployment
◦ Out-processing assessments
◦ Follow-up or long-term surveillance for
delayed adverse effects

Track affected people for medium to long-term
health consequences

Informs needs for continuing medical/behavioral
care or establishing public health measures

Follow exposed population for conditions that may
have delayed symptom onsets

Provides a basis for health education and disease
prevention

Identify determinants of
disaster-related death,
illness, injury, disability

Identifies appropriate
intervention and prevention
strategies

Provides information to
understand the short-,
medium-, and long-term
sequelae from a disaster
event

Chemical Release Response
ATSDR/CDC training &
response
◦ Epidemiologic assessment after
a chemical release
◦ Toolkit materials:
 Surveys, consent forms,
medical chart abstraction form,
Interviewer training manual,
databases

May be applied at different
phases of disaster
management cycle to
assess response actions or
interventions

Often provides information
about efficient, efficacious,
and cost-effective actions
during response and
recovery
Ashley Conley
Michael Heumann
City of Nashua
Division of Public Health &
Community Services
Nashua, NH 03060
[email protected]
HeumannHealth Consulting
LLC, Portland, OR 97212
[email protected]
For the Council of State and Territorial Epidemiologists (CSTE)
Non-Emergency CASPER: Cypress, Texas
Jennifer Kiger, MPH
Kelly M K Johnson, MS
April 30, 2015
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
HCPHES & Harris County
• HCPHES serves as the county health
department for unincorporated Harris
County (TX) with over 700 public health
professionals
• Third most populous county in the nation
with estimated population of 4.34 million
(approx. 2.2 million in HCPHES jurisdiction)
• Spread over 1,778 square miles (size of
Rhode Island)
• Geographically, politically, &
demographically diverse
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
CASPER Overview
• Community Assessment for Public Health Emergency Response
(CASPER)
• Dates: March 6-7th
• Area: Cypress, TX
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Partnerships
• Harris County Commissioners and Constables
(Precincts 4 & 5)
• Harris County Sherriff’s Office (HCSO)
• Harris County Office of Homeland Security and
Emergency Management (HCOHSEM)
• Texas Department of State Health Services
(DSHS)
• Volunteers:
•
•
•
•
•
Medical Reserve Corps (MRC)
Community Emergency Response Team (CERT)
EpiAssist (Texas A&M)
University of Texas School of Public Health
ARES (Amateur Radio Emergency Service)
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
PHEP Capabilities
• Capability 1: Community Preparedness
• Objective: Identify the potential hazards, vulnerabilities, and risks in the community that relate to the jurisdiction’s public health and medical
systems, the relationship of those risks to human impact, interruption & impact of health services & infrastructure to support a public health
emergency planning
• Capability 2: Community Recovery
• Objective: Assess the impact of a potential incident on the public health system in order to determine and prioritize the public health, medical,
or mental/behavioral health system recovery needs.
• Capability 3: Emergency Operations Coordination
• Objective: Direct ongoing public health emergency operations to sustain public health and medical response for the duration of the response.
• Objective: Test and utilize redundant communication equipment to ensure the safety of staff and volunteer during deployment.
• Capability 8: Medical Countermeasure Dispensing
• Objective: Determine what medical countermeasures are best suited for the incidents most likely to occur in the jurisdiction
• Capability 12: Public Health Surveillance and Epidemiological Investigation
• Objective: Acquire information from the community in order to provide statistical data and reports to public health leadership and applicable
partners in order to identify potential populations at-risk for adverse health outcomes during an incident
• Capability 15: Volunteer Management
• Objective: Demonstrate the ability to notify, organize, train, and dispatch HCPHES staff and volunteers of the MRC and CERT to serve as predisaster interview teams for a CASPER event.
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Methodology
• Cluster Selection
• 30 clusters
• Census Block level
• CDC sampling program
• Sub-Clusters
• 50+ housing units between sampled households
• Survey instrument and tracking form
• 21-question survey (17 questions for “completion”)
• Pilot tested survey instrument
• Ground Truthing
• Visited selected clusters to look for potential obstacles
• Allowed for problem solving prior to the event
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Methodology (Continued)
• Data Cleaning
•
•
•
•
•
Initial database in Epi Info 7 – experienced problems, had to abandon
Data entry conducted in MS Access 2013
Skip patterns
More than desired number of responses
Conflicted responses
• Data Analysis
• Data analysis conducted in STATA 13
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Public Information
• Press Release – given to
media and community
contacts a week before and
the week of the event
• Letter from Director –
provided to all teams and
used as needed
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Schedule of Events: Training
• Friday March 6, 2015 –
• 2 Orientations/Trainings held (9am & 6:30pm)
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Schedule of Events: CASPER Exercise
• Saturday March 7, 2015
•
•
•
•
•
•
•
•
•
5:30 am: Incident Command Post (ICP) Set up (CyFair ISD)
7:30 am: Team arrivals
8:00 am: Debriefing and meeting with group supervisors
8:45 am: Depart for assigned clusters and conduct surveys
11:30 – 1:00pm: Lunch/check back with supervisors
12:00/1:30pm: Return to field and continue with surveys
4:30pm: Return to ICP
5:00 pm: Hotwash/Evaluations
5:30 pm: ICP Demobilization
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
March 7, 2015
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Incident Commander
Mac McClendon
HCPHES
CASPER Organizational Chart
Liaison Officer
Mac McClendon
Safety Officer
HCSO
Technical
Specialist
David Zane
Operations
Section Chief
Jennifer Kiger
PIO
Martha Marquez
Planning Section
Chief
Samantha Harvey
Social Media
Hallie Frazier
Henry Bradford
Logistics Section
Chief
Nathan Vessey
Finance/Administration
Section Chief
TBD
Staging Area
Manager
Joe Hernandez
Epi Lead
Kelly Johnson
CASPER Group 1
Mary Ann Depoe
Interview Team 1
CASPER Group 2
Victoria Cummings
Interview Team 5
CASPER Group 3
Ashley Minkeu
Interview Team 9
Personnel Branch
CASPER Group 4
Denise Bishop
Interview Team 13
GIS Specialist
Tracy Haywood
Robert Gorena
Communications
Branch
ARES
IT Branch
Jeff Keeler
Interview Team 2
Interview Team 6
Interview Team 10
Interview Team 14
Interview Team 3
Interview Team 7
Interview Team 11
Interview Team 15
Interview Team 4
Interview Team 8
Interview Team 12
Interview Team 16
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Command Post
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Cluster Reporting/Tracking
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Results
• Total Housing Units Approached = 565
• Total Number of Surveys Completed = 169
• Response metrics
169 𝑐𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑠𝑢𝑟𝑣𝑒𝑦𝑠
• Contact Rate = 565 ℎ𝑜𝑢𝑠𝑖𝑛𝑔 𝑢𝑛𝑖𝑡𝑠 𝑎𝑝𝑝𝑟𝑜𝑎𝑐ℎ𝑒𝑑 = 𝟐𝟗. 𝟗%
169 𝑐𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑠𝑢𝑟𝑣𝑒𝑦𝑠
• Cooperation Rate = 329 𝑎𝑡𝑡𝑒𝑚𝑝𝑡𝑠 𝑤𝑖𝑡ℎ 𝑠𝑢𝑐𝑐𝑒𝑠𝑠𝑓𝑢𝑙 𝑐𝑜𝑛𝑡𝑎𝑐𝑡 = 51.4%
• Completion Rate =
The HCPHES Priority Public Health Issues for 2013-2018
169 𝑐𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑠𝑢𝑟𝑣𝑒𝑦𝑠
𝐶𝐴𝑆𝑃𝐸𝑅 𝑔𝑜𝑎𝑙 𝑜𝑓 210
Chronic
Disease
Food
Safety
Emergency
Preparedness
= 80.5%
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Results (Continued)
• 18.8% of households with at least one resident with a chronic
medical condition
• 92.9% of households felt at least somewhat prepared to handle an
emergency
• HCPHES Website
• 17.1% Yes
• Very few known allergies to common antibiotics
• Ciprofloxacin (4.4%)
• Doxycycline (3.2%)
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Social Media
• Utilized Facebook, Instagram and Twitter
• Hashtag created: #HCTXCasper
• YouTube: Forthcoming (June 2015)
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Lessons Learned
• Just in Time Training is essential
• More training time needed for completion of tracking
form/survey
•
•
•
•
•
•
•
•
•
3 person teams needed
16+ teams
Maps are very useful and need all street names labeled
Ground-truthing is essential
Working with media and law enforcement prior to event
ICP location near survey area is essential
IT wireless equipment needed for offsite ICP operations
ARES provided real time status updates
Social Media is a useful way to communicate to public and
get volunteers engaged
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing
Questions?
Thank you!
[email protected]
[email protected]
The HCPHES Priority Public Health Issues for 2013-2018
Chronic
Disease
Food
Safety
Emergency
Preparedness
Environmental
Health
Infectious
Disease
Injury
Social, Mental,
and Emotional
Wellbeing