CDC Region 3 Bio-Emergency
Health Official/Elected Official
In-Service
[Linda Drey, Health Planner]
2004

Objectives
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Describe the role of local public health in Iowa.
Identify the role of the local board of health.
Identify relationships to the Iowa Department of Public Health, local board of supervisors, local county attorney, and other partners.
Understand the aspects of bio-terrorism and the role/responsibilities of local public health in the event of a bio-emergency.
Become familiar with CDC Bioterrorism grant requirements for FY 03-04..

Local Public Health’s Role
Protecting the Health of the Public!
Public health is responsible to safeguard the community’s health through assessment, policy development and assurance.

Public Health’s Impact
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 Public health is not a collection of programs for the poor.
Has public health affected your life today?
Public health affects everyone who drinks public drinking water, eats in a restaurant, buys milk, has an elderly relative who needs home care, needs emergency medical services, wants to avoid getting sick from an infectious disease, and is concerned about preparedness for natural or intentional disaster.

Public Health vs. Hospital
 Local Public Health
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Is responsible for protecting and safeguarding the health of all people within its jurisdiction;
Public health touches every person’s life every day;
Promotes physical and mental health;
Prevents disease and injury;
Prevents epidemics and spread of disease;
Promote healthy behaviors
Respond to disasters;
Assures the quality and accessibility of health services for all

Public Health vs. Hospital
 Hospital/Individual Provider
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Focus is on providing care to specific individuals seeking care for an illness/injury;
Makes decisions that are best for the respective patient and not necessarily the general public;
No emphasis/responsibility for the health and welfare of the general public;
Not required to provide treatment to all individuals requesting care with a few exceptions
(ER’s, etc.)

Core Public Health Functions
 Assessment
 Policy Development
 Assurance

Core Public Health
Functions/Essential Services
 Assessment
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Monitor health status
Diagnose and investigate health problems and health hazards in the community
Evaluate the effectiveness, accessibility, and quality of personnel and populationbased health services

Core Public Health
Functions/Essential Services
 Policy Development
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Develop policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Research for new insights and innovative solutions to health problems.

Core Public Health
Functions/Essential Services
 Assurance
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Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
Assure a competent public health and personal health care workforce.
Inform, educate and empower people about health issues.
Mobilize community partnerships to identify and solve health problems.

For Local Communities…
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Public health is an economic issue, because healthy workers are productive and a good public health system attracts business.
Public health is an education issue because healthy children learn.
Public health is the front line defense for the public’s health promotion and protection.

Local Public Health System
Public Health Providers
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Local Boards Of Health (County/City/District)
WIC agencies
Maternal Child Health (MCH) agencies
Visiting Nurse Service (VNS) agencies
And others…..perhaps MANY others...

10 Greatest Advances in PH
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Vaccinations
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Safer workplaces
Safer and healthier food 
Vehicle safety
Control of infectious diseases
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Family planning 
Advances in treatment and prevention of heart disease and stroke
Decrease in tobacco use
Better care for mothers and their babies
Fluoridation of drinking water

Local Boards of Health History
 In 1866 the Local Health Law was adopted.
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Designated mayor and town council or township trustee as LBOH.
LBOH had authority to establish regulations for public health and safety, control nuisances, and regulate sources of filth and causes of sickness in communities.

1967 New Local Health Act
 Chapter 137 of the Code of Iowa:
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Each county required to establish a BOH one member had to be a physician licensed by the State of Iowa.
BOS to appoint other members.
A city with a population of 25,000 + could establish a city board of health.
Counties and cities were also allowed to form district boards of health.

LBOH Power and Jurisdiction
 Chapter 137of the Code of Iowa
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5 members, one must be an Iowa licensed physician
The BOH has autonomy over public health matters within the county. (IA Code137.5;
137.6; 137.7)
Can write rules and employ persons for the discharge of its duties.

LBOH Power & Jurisdiction Cont.
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Boards of Supervisors have little authority over public health matters.
The Board of Supervisors role is three fold:
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 appoint board of health members; determine county funding portion of the local health budget; and approve regulations adopted by board of health

LBOH Roles & Responsibilities
 IA Administrative Code 641-Ch.77
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Requires local BOH to carry out the three core functions and ten essential public health services.
Required to meet at least quarterly.
Required to comply with open meeting laws.
LBOH must report to the IDPH on certain activities defined in IAC 641-77.5.

Local Boards of Health
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Powers of Local Boards of Health
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Refer to LBOH Guidebook page 9…
Legal Responsibility of Local Board of
Health
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Refer to LBOH Guidebook page 10…
Working with the County Board of
Supervisors
 Refer to LBPH Guidebook page 12...

Local Boards of Health in Iowa
 99 county Boards of Health
 1 District Health Department
 Siouxland District Health Department
 2 City Boards of Health
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Council Bluffs
Ottumwa

Bioterrorism/Bio-emergencies are Different
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Medical and public health systems are usually first to detect bioterrorism.
A delay is likely between the release of the agent and the knowledge that the occurrence is a bioterrorist act.
A short window of opportunity exists between the first cases and the second wave.
Public health officials must determine that an attack occurred, identify the organism, and prevent more casualties.

Local Public Health Bio-
Emergency Planning
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Need to build the infrastructure of local public health across Iowa and the nation.
In Iowa, the IDPH is the lead public health agency and coordinates the CDC Iowa Public
Health Cooperative Agreement (public health
BT grant)
Each local health department charged with developing a bio-emergency plan by Aug.
2004.

Public Health Infrastructure
Public
Health
Response
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Bioterrorism
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Emerging Infections
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Other Public Hlth Programs
Essential
Scientific
Capabilities
Basic
Infrastructure
Surveillance
Laboratory
Practice
Epidemic
Investigations
Information
Systems Workforce
Organizational
Capacity
Reference: Public Health Practice Program Office (PHPPO), CDC, 1999.

BT Core Capacities – 10/15/01
 Mission
 To protect the publics health and safety by developing the capacity of state and local public health systems to prepare for and respond to a bioterrorist act.

BT Core Capacities
Framework
 Surveillance and Epidemiologic
Investigation
 Identification
 Communication
 Mobilization
 Public Health Interventions

BT Core Capacities
Framework
 Goals
 Pre-Event Objectives
 Event Objectives
 Indicators (pre-event and event)
 Planning/Policy Indicators
 Workforce/Training Indicators
 Evaluation/Quality Indicators

BT Core Capacities Example
 Mobilization
 Pre-Event Objective: Identify organizations that comprise the public health response system and integrate preparedness activities with partners
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P/P: plans that define roles and responsibilities
W/T: train staff in response role within larger emergency response system
E/Q: review plans periodically and adjust

Activation of Federal Assistance
Major disaster
Internal local and State resources
State resources exhausted
Governor requests President to declare disaster
Federal Assistance- based on severity and need
FEMA may request DOD or National Guard

Federal Response Plan
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FBI leads on information release I crisis management
FEMA leads on information release in consequence management
Transfer from the FBI to FEMA by
Attorney General
Core Federal Responses:
DOJ/FBI DOE
DOD EPA
FEMA
HHS

Health and Human Services
(HHS) Provides
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Technical support, personnel and equipment
Disease detectives
Agent identification; collection and testing of samples
Medical management
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Medical supplies, drugs and vaccinations (SNS)
Regulatory follow up
(e.g. FDA)
Outbreak/disease threat assessment
Onsite safety
Mass fatality management

CDC Bioterrorism Grant 03-04
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Focus Area A: Planning & Assessment
Focus Area B: Surveillance & Epidemiology
Focus Area C: Laboratory Biological Agents
Focus Area D: Laboratory Chemical Agents
Focus Area E: Health Alert Network/IT
Focus Area F: Risk Communication
Focus Area G: Education & Training
Strategic National Stockpile (SNS)
Smallpox

Funding Formula – for LPHA
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Base aware per LPHA: 30%
Population: 40%
Critical Assets: 15%
Agricultural Value: 15%

Funding
Local public health agencies
CDC Regions (6)
IDPH
Shared Capacity
UHL
TOTAL
% of Total
Funding
Total Funding
21% $2,644,609
20% $2,504,515
21% $2,669,579
21% $2,594,892
17% $2,188,378
100% $12,601,973

LPHA Grant Responsibilities
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By July 15, 2004 complete county bioemergency plan and submit template checklist to IDPH.
By July 15, 2004 complete mass dispensing plan, policies and procedures for smallpox/oral prophylaxis and submit checklist to IDPH.
By July 15, 2004 submit improvement plan for reportable disease surveillance system for your county to IDPH.

LPHA Progress Report
 Two progress reports are due to IDPH from each local public health agency as a part of the CDC grant.
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Due April 10, 2004
September 10, 2004

LPHA Regional Responsibilities
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Submit county information for Regional
Resource Directory for reports due Jan.
5, April 1, and July 1.
Submit the # of trained staff in advanced epidemiology/surveillance for Aug. 1 report.
Submit the # of trained staff in EPI-INFO for Aug. 1 report.

Regional Grant Reports
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As a member of Region 3 (16-county area of northwest Iowa) each county must submit requested information in addition to what is asked for in the regional resource directory for a regional report compiled by the regional planner.
The report is due:
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April 10, 2004
September 10, 2004

WELCOME TO
BIOTERRORISM
BASICS

Objectives
 Upon completion of the course, learners should be able to:
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Define terrorism using the B-NICE model
Define the role of public health in dealing with a terrorism attack
List three or more messages that should be sent to the general public regarding terrorism

Terrorism is the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social
objectives.
FBI Definition from
28 CFR Section 0.85
.

PSYCHOLOGICAL IMPACT of terror…intrusive thoughts, nightmares and sleeping difficulties, anxiety or fear, alienation from people, ‘jumpiness’, emotional numbness and problems with social relationships

Objectives of Terrorism
 Bring down a government or regime
 Attack those who attack their religion
 Cause a Change!!!

Countermeasures to Terror
 Awareness of terrorism objectives
 Deny the objective of the attack
 President Bush:
 Keep shopping, keep traveling
 Subsidies for airlines, insurance industry to keep working

Public Health’s Role in a
Bio-Emergency
1.
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4.
PREPARE
RESPOND
MITIGATE
RECOVER

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Nearly 1000 interstate bridges
More than 100 dams
Greatest concentration of hog lots in the nation
Critical rail links
Over 3000 miles of pipelines (natural gas, gasoline, etc.)
Iowa is a symbol of stability
Not In My Back Yard Syndrome

Types of Terrorism B-NICE
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Bioterrorism
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Since 1985, the number of terrorist incidents involving the threatened or actual use of chemical, biological, radiologic, or nuclear materials has risen sharply; (Tucker, 1999)
The threat to the nation from biologic weapons is no longer a debate issue.
(Russell, 1997)

Why Bioterrorism?
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Poor man’s nuclear bomb
 Cheap
 Easily available
 Compact
 Deadly
 Psychological Impact
 Stealthy

Ease of Dissemination
100
80
60
40
20
0
Category A
Category B
Category C

Mortality Rates
80
70
60
50
40
30
20
10
0
Mortality Rates
Category A
Category B
Category C

CDC Assistance
Local level needs CDC help to identify Category
B and Category C diseases/agents.

Public Health Staff Roles
• Describe the public health role in emergency response in a range of emergencies that might arise.
• Describe the chain of command in emergency response
•Identify and locate the agency emergency response plan

Public Health Staff Roles Cont.
• Describe your functional role in an emergency situation
• Demonstrate correct use of all communication equipment used in an emergency
• Describe communication role(s) in emergency response
• Recognize unusual events that might indicate an emergency and describe appropriate action

Preparation
 Communities prepare for a number of disasters including:
 Ice Storms
 Tornadoes
 Chemical spills
 And now …terrorism

Be Alert and Stay Calm!
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Report suspicious activity
Use common sense
Don’t approach
Write down a description
First responders are trained to protect lives and property.
Stay tuned to local radio stations for emergency messages.

Are You Prepared Personally?
 Have a family emergency plan that includes:
 Phone tree or notification plan for all family members.
 Identify a family meeting place
 Know school and workplace procedures
 Battery powered radio, flashlights and batteries
 First aid kit and other special needs
 Basic supplies for 72 hours

Actions You Can Take
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You as a member of the public health community may play a critical role.
Be prepared to identify possible incidents.
Be prepared to respond appropriately and rapidly.
If a bioemergency happens, it won’t be business as usual for any member of the public health team.

Contact Information
 Linda Drey – Health Planning & Development Coordinator
Siouxland District Health Department
Phone 712-279-6119
Cell 712-490-5937
Fax 712-255-02604
 Kevin Grieme – Health Planner
Siouxland District Health Department
Phone 712-279-6119
Cell 712-898-5176
Fax 712-255-02604