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Disaster Preparedness Response


Coordinated Activities between CDC, FDA, and States. ID Cases ... Experienced and trained to evaluate diverse public health events. ... – PowerPoint PPT presentation

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Title: Disaster Preparedness Response

Disaster Preparedness Response
  • Adolfo M. Valadez, M.D., M.P.H.
  • Assistant Commissioner
  • Prevention and Preparedness Services
  • Adolfo.Valadez_at_dshs.state.tx.us
  • Sandra Guerra-Cantu, M.D., M.P.H.
  • Region 8 Medical Director
  • Regional and Local Health Services
  • Sandra.Guerra-Cantu_at_dshs.state.tx.us

Possible Texas Disasters/Threats Impacting Public
  • Natural Events
  • Disease Outbreaks
  • HazMat or Chemical Spills
  • Radiological Accidents
  • Terrorist Acts

2008 Emergency Response
  • San Angelo Yearning for Zion Ranch
  • Epi Investigation ESRD facility in Lufkin
  • Epi Investigation Salmonella Outbreak
  • Hurricane Dolly
  • Tropical Storm Edouard
  • Hurricane Gustav
  • Hurricane Ike

Principal ActivitiesSan Angelo Yearning for
Zion Ranch
  • Health Medical Support to Shelters
  • - Clinical Services
  • - Medical Care
  • - Pharmacy Services
  • - Infection Control
  • Communicable Disease Outbreak
  • Medical Triage of State Employees
  • EMS Transportation
  • Mental Health Services

Principal ActivitiesNationwide Salmonella
  • Coordinated Activities between CDC, FDA, and
  • ID Cases
  • Trace back food sources and distribution
  • Product recalls
  • Consumer advisories

U.S. Cases infected with Outbreak Salmonella
Saintpaul Strain as of August 3, 2008, 9PM EDT
NH 5
WA 17
ME 1
MT 1
VT 2
MN 22
MA 29
NY 39
OR 11
WI 13
ID 6
MI 26
PA 13
IA 2
RI 3
OH 10
NV 13
IN 21
IL 116
UT 2
CT 5
WV 1
VA 31
CO 16
KS 21
CA 12
KY 2
MO 20
NJ 16
NC 28
TN 10
MD 38
OK 25
AZ 56
SC 2
AR 21
NM 106
NM 108
DC 1
GA 40
AL 3
MS 2
LA 3
TX 508
FL 4
Infections with Outbreak Salmonella Saintpaul
Strain By date of illness onset (For whom
information was reported as of Aug 5, 9pm EDT)
Total TX lab-confirmed cases 507 TX counties
with confirmed cases 78 TX hospitalizations
reported 117 TX associated deaths 2
Number of cases
Date of illness onset
Some onset dates were estimated from other
information provided
Hurricane Response and Recovery
Principal Activities2008 Hurricanes
  • Evacuating MSN individuals UTMB
  • Establishing MSN shelters
  • Coordinating ambulances other transportation
  • Providing medical care DMATs, Pharmaceutical
    Support, and O2
  • Assessing and addressing public health risks
  • Disaster behavioral health response
  • Supporting healthcare facilities local public
  • Mosquito vector control
  • Repatriation of MSN individuals

  • Task Force Ike
  • Public Health Assessment
  • - infrastructure
  • - CASPER Team
  • MSN Shelters
  • Immunizations
  • Vector Control
  • Mortuary Services
  • Mental Health Services
  • - Community MHMR clinics
  • - CISM
  • Governors Disaster Recovery and Renewal

Components of the Public Health Emergency
Assistance Model
  • Rapid Assessment Team
  • Command Assistance Team
  • Diversified Occupation Group

Rapid Assessment Team
  • A two or three person deployable team
  • Experienced and trained to evaluate diverse
    public health events.
  • Responds within 24 hours to any unusual event
    anywhere in Texas at the direction of the
    Commissioner for the duration of the event.
  • Can remain on site and respond in various roles
    as deemed necessary.
  • Assess the situation and the on-site capabilities
    of staff to fully respond to the event.
  • Works in conjunction with on-site staff
    (region/local or both) to quickly determine
  • Assesses quickly
  • ICS staffing needs
  • Epidemiological staff needs
  • Medical staffing needs
  • Inspection staff needs
  • Logistical support needs
  • Works with DSHS SOC/MACC to fulfill needs
  • Can customize need fulfillment based on site
  • Allows Region/Local HD to focus on acute response
    while RAT ensures full response for duration.
  • Can be on-site health care for responders to

Command Assistance Team
  • These are Command Teams pre-identified to
    respond to the event
  • After a Rapid Assessment Team has deemed
    necessary, the teams can be deployed in part or
    in full.
  • Teams will consistent of staff able to assume the
    roles of section chiefs for
  • Operations
  • Logistics
  • Planning/Intelligence
  • Safety Officer
  • Public Information Officer
  • Administration/Finance
  • Incident Commander
  • Additional Sections as deemed necessary for event

Diversified Occupation Group
  • May include ability to invite/consult external
    partners with areas of expertise such as
  • Academic partners
  • Medical Schools
  • Schools of Public Health
  • Bi-national partnerships
  • Texas Epi Deployable team
  • Federal Partners
  • Staffing compliments to include but not limited
  • Nursing/Medical
  • Sanitarians/Inspectors/Regulatory
  • Epidemiology/Disease Surveillance
  • Pharmacy
  • Administrative support

Rapid Assessment Team
  • DSHS Rapid Assessment Team determines public
    health needs immediately before and after a
  • Work with partners and local health departments
    to allocate resources, providing direct health
    care, and leadership to re-establish
  • Perform actions needed that are often not
    traditional public health services evacuations,
    health care responders, direct patient care,
    coordination of EMS, health care systems support
    or transfer

Sheltering of Displaced Persons
  • Responses tailored to population needs
  • Health assessments
  • Provision of direct care
  • Immunization history
  • Evaluation of responders
  • General sanitation
  • Epidemiology
  • Medical support during stressful events or

Medical Special Needs Sheltering and Management
  • Challenging all over Texas
  • Appropriate accommodations
  • Long term placements
  • Health care
  • Family needs
  • Transportation issues (repatriation)
  • Successful partnership with Baptist Family and
    Child Services

Front Line Challenges
  • Limited capacity/infrastructure quickly
    overwhelmed when disaster strikes
  • Public health not in direct patient care
    routinely, but are gap filling during a disaster
    pharmacy support, supplies, immunizations,
    in-shelter care, communicable disease control
  • Health providers homes/lives disrupted and
    cannot respond
  • Local systems for emergency operations vary
    greatly throughout the state
  • Disaster prone areas without sheltering plans
  • Jurisdictions worry about costs/expenses if ask
    for assistance, so they ask late

Future Directions
  • After Action Review Workgroup
  • Disaster and COOP Response Policy
  • Disaster Response Exceptional Item

Disaster Public Health Response What Went Well
  • Increased EMS Capacity for disaster response
  • Evacuated MSN individuals from different parts of
    Texas based on uncertainty of Hurricane Ikes
    ultimate landfall
  • Use of state-wide MSN evacuees tracking system
  • Use of DSHS electronic system to identify
    hospital bed availability by hospital regional
  • Use of state facilities for sheltering
    placement of MSN evacuees in nursing homes as
  • Faster deployment of health professional staff
    for MSN shelters evacuation
  • Quick execution of pharmaceutical contracts to
    supply medical special needs shelters with needed
  • Deployment of DSHS strike teams with various
    expertise to provide assistance or consultations
  • Conducting case management in MSN shelters
  • Having mosquito control contracts
    plans in place for
    aerial spraying
    soon after landfall

Major Challenges
  • Patient Evacuee Tracking
  • Medical Evacuation Plan Training
  • Local Planning for Shelters
  • Identification of home-bound MSN individuals who
    self-evacuated or stayed in place have chronic
    health needs
  • Acuity levels of MSN evacuees (much sicker
  • Larger than expected numbers of morbidly obese
    MSN evacuees
  • Scarcity of specialized MSN assets, especially to
    accommodate morbidly obese MSN evacuees
  • Federal rules on National Disaster Medical System
    air evacuation assets are restricted to
    hospitalized patient evacuations only
  • Repatriation of MSN evacuees within Texas to
    neighboring states
  • Protecting healthcare facilities
  • Recovery Planning
  • Internal Procedure Documentation

Employee Responsibilities in Disaster or COOP
Response PolicyOverview
  • Requires that employees complete necessary
    training to fulfill their role, including
    web-based IS-100, IS-200, and IS-700 courses
  • Provides consistent language for all position
    postings, employee job descriptions, and
    Performance Plans/Evaluations regarding
    employees participation during a disaster event
    or COOP activation
  • Supports the Agencys commitment to respond
    during disasters affecting Texas
  • Defines employees roles during a disaster event
    or COOP activation including
  • Active participation
  • Supportive participation
  • Continuity of operations

Disaster Response Exceptional Item81st
Legislative Session
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