State Role in Public Health
Emergencies – Division of
Communicable Disease Control
Jessica M. Núñez de Ybarra, MD, MPH
Public Health Medical Officer III
CA Department of Public Health (CDPH)
Division of Communicable Disease Control (DCDC)
Office of Workforce Development
All 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 System
Police
EMS
Community
Centers
MCOs
Health
Department
Home Health
Churches Corrections
Parks
Schools
Elected
Hospitals
Officials Nursing Mass Transit
Doctors
Philanthropist
Homes
Environmental
Civic Groups
Health
CHCs
Fire
Tribal Health
Economic
Laboratory
Employers
Drug
Mental
Development
Facilities
Treatment
Health
Public Health in America
•
•
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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
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Workforce
Information Systems
Communication
Epidemiology/surveillance
Laboratory
Policy and Evaluation
Preparedness and Response
Columbia University Center for Public Health Preparedness
California
Definitions
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
Family Disaster Plan Materials
Source: FEMA: www.fema.gov
Example Personal Emergency Plans:
During Working Hours
After Working Hours
NEW YORK CITY DEPARTMENT OF HEALTH
SCHOOL HEALTH PROGRAM
NEW YORK CITY DEPARTMENT OF HEALTH
SCHOOL HEALTH PROGRAM
PERSONAL EMERGENCY PLAN
PERSONAL EMERGENCY PLAN
In the event that I am called upon to respond to an emergency as a Department of Health
In the event that I am called upon to respond to an emergency as a Department of Health
employee I, _____________________________________, have made the following
employee I, _____________________________________, have made the following
arrangements to ensure that my family and pets are cared for while I am on duty:
arrangements to ensure that my family and pets are cared for while I am on duty:
My child(ren) will be cared for by:
My child(ren) will be cared for by:
___________________________________(Name)
___________________________________(Name)
__________________________________(Phone
__________________________________(Phone
#)
#)
________________________________________________________________(Address
________________________________________________________________(Address
)
)
My pet(s) will be cared for by:
___________________________________(Name)
My pet(s) will be cared for by:
___________________________________(Name)
__________________________________(Phone
__________________________________(Phone
#)
#)
________________________________________________________________(Address
)
My parent(s) will be cared for by:
___________________________________(Name)
________________________________________________________________(Address
)
My parent(s) will be cared for by:
___________________________________(Name)
__________________________________(Phone
__________________________________(Phone
#)
#)
________________________________________________________________(Address
)
________________________________________________________________(Address
)
NYC-DOH School Health Program Draft, August 2001
Columbia University Center for Public Health Preparedness
Remember……
Make provisions for:
• Child(ren)
• Spouse/Partner
• Parents
• Pets
• Others
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COMPETENCY
A 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:
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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
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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)
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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
DHS
FEMA
PRESIDENT
HHS
CDC
GOVERNOR’S
OFFICE
STATE OES
STATE DOH
Office of Local
Elected Official
LOCAL OES
LOCAL DOH
Federal
State
Local
Fire
Police
Columbia University Center for Public Health Preparedness
Other
Federal, State and Local Coordination in
California DISASTERS for Public Health
PRESIDENT
GOVERNOR’S
OFFICE
DHS/FEMA
HHS/CDC/VA etc.
Governor’s OFFICE OF
EMERGENCY SERVICES (OES)
SOC
OES/REOC
Admin & Mutual Aid Regions
Local Official’s
OFFICE
OPERATIONAL Area EOC’s
Cities, Counties, Special Districts
Incident Command
Federal
FIRE-EMS
State
Local
Media
CDPH/EMSA
JEOC
RDMHC
MHOAC
LHJ
Voluntary
Health Sector
Police
Voluntary Agencies
(ARC, etc.)
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 Officers
http://www.cdph.ca.gov/programs/dcdc/Pages/default.aspx
Health Officer Practice Guide for Communicable Disease
Control in California
Examples
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LIMITS TO OWN SKILLS OR
AUTHORITY
KEY SYSTEM RESOURCES
Communication with media
Legal authority
Supervision of others
Allocation of resources
Clinical skills or decision making
Policy decision
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Columbia University Center for Public Health Preparedness
Agency chain of command
Web resources
Logistics Officer
Policy and procedure
manual
• Disaster plan / protocols
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
Columbia University Center for Public Health Preparedness
Resources
• Local Emergency Room
• DOH Public Relations
(or Public Affairs Dept.)
• Shelter manager
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
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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
Voters
State
Agencies
Health and Human
Services
Depts.
CDPH
Columbia University Center for Public Health Preparedness
California Dept. of Public Health
www.cdph.ca.gov
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
Center for
Chronic
Disease
•Chronic Disease
& Injury Control
•Environmental &
Occupational
Disease Control
Center for
Infectious
Disease
Director’s
Office
Center for
Family
Health
•OWH
•OMH
•OBBH
•EPO
Center for
Healthcare
Quality
Center for
Environmental
Health
•Food, Drug &
Radiation Safety
•Communicable
Disease Control
•Office of AIDS
•Licensing
•WIC
& Certification
•Maternal, Child
& Adolescent
•Laboratory Field
Health
Services
•Genetic Disease
Executive
Centers
Divisions
Columbia University Center for Public Health Preparedness
•Drinking Water
& Environmental
Mgmt.
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/Surveillance
Roles and Responsibilities in Emergency
Response
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Provide background info on emergency surveillance data
Conduct field epidemiological investigations (prn)
Monitor existing surveillance systems
Establish new surveillance system
- Assemble field teams
- Develop questionnaires/forms
- Liaison with hospital/field personnel
- Collect data
- Develop recommendations for policy
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- Establish databases
- Enter data
- Analyze data
Laboratories
Roles and Responsibilities in
Emergency Response
• 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
Columbia University Center for Public Health Preparedness
Operations
Roles and Responsibilities in
Emergency Response
• Provide resources to facilitate others’
activities
• Transportation
• Communication
• Facilities
• Security
• Personnel
• Printing
• Coordinate hotlines for public &
providers
Columbia University Center for Public Health Preparedness
Environmental
Roles and Responsibilities in
Emergency Response
• Research specific topic
• Provide background information
• Prepare recommendations re:
-Public health threat
-Sample collection
-Evacuation/reoccupation
• Collect samples
• Collaboration w/ Hazmat
Columbia University Center for Public Health Preparedness
Medical Information Systems (MIS)
Roles and Responsibilities in Emergency
Response
Facilitate computing issues during
emergencies
-Field to Headquarters data transmission
-Database management
-Mapping/GIS
Columbia University Center for Public Health Preparedness
Local Medical/Clinical
Roles and Responsibilities in
Emergency Response
• Prepare recommendations on clinical aspects of emergency
-Public safety issues
-Occupational safety issues
-Develop prevention & treatment message
-Training of community MDs
-Disinfection/decon issues
• 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
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?
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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
QUESTIONS?
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, MPH
jnunez2@cdph.ca.gov
Phone: 916 650-6875
Fax: 916 552-8973
California Department of Public Health
Division of Communicable Disease Control
1616 Capitol Avenue, MS 7300
PO Box 997377
Sacramento, CA 95899-7377
Thank You