Disaster Preparedness Response

1
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

2
Possible Texas Disasters/Threats Impacting Public
Health

• Natural Events
• Disease Outbreaks
• HazMat or Chemical Spills
• Radiological Accidents
• Terrorist Acts

3
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

4
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

5
Principal ActivitiesNationwide Salmonella
Outbreak

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

6
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
7
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
8
Hurricane Response and Recovery
9
Principal Activities2008 Hurricanes

• Evacuating MSN individuals UTMB
• Establishing MSN shelters
• Coordinating ambulances other transportation
  assets
• Providing medical care DMATs, Pharmaceutical
  Support, and O2
• Assessing and addressing public health risks
• Disaster behavioral health response
• Supporting healthcare facilities local public
  health
• Mosquito vector control
• Repatriation of MSN individuals

10
Recovery

• 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
  Commission

11
Components of the Public Health Emergency
Assistance Model

• Rapid Assessment Team
• Command Assistance Team
• Diversified Occupation Group

11
12
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
  needs.
• 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
  evaluation
• 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
  event.

12
13
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

13
14
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
  to
• Nursing/Medical
• Sanitarians/Inspectors/Regulatory
• Epidemiology/Disease Surveillance
• Pharmacy
• Administrative support

14
15
Rapid Assessment Team

• DSHS Rapid Assessment Team determines public
  health needs immediately before and after a
  disaster
• Work with partners and local health departments
  to allocate resources, providing direct health
  care, and leadership to re-establish
  infrastructure
• 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

15
16
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
  transport

16
17
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

17
18
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

18
19
Future Directions

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

19
20
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
  area
• Use of state facilities for sheltering
  placement of MSN evacuees in nursing homes as
  needed

• Faster deployment of health professional staff
  for MSN shelters evacuation
• Quick execution of pharmaceutical contracts to
  supply medical special needs shelters with needed
  medications
• 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

21
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
  population)
• 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

22
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

22
23
Disaster Response Exceptional Item81st
Legislative Session
23