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Preparedness and Response in Action: Stories from the States

September 18, 2017 - 11:48am

CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities.  Since 9/11, the PHEP program has saved lives by building and maintaining a nationwide public health emergency management system that enables communities to rapidly respond to public health threats.

The following stories are examples of how PHEP has equipped states for each of the four stages of preparedness: Ready. Steady. Show. Go!

READY: Planning for the inevitable

Often the emergency managers and public health professionals who respond to an emergency are personally impacted by the same event. The ability of emergency response staff to take action during a disaster is limited when they are stranded in their homes due to an ice storm, without power, or unable to make it into the office.

The Connecticut State Department of Health, led by Jonathan Best, took on the challenge to ensure that operations can run smoothly even when their own staff are directly impacted by an emergency. They developed the Red Sheet Program, which trains three people for every key position in the emergency management structure – a primary contact with two back-ups. This means the health department can be fully staffed and ready to respond to a crisis within 20 minutes.

STEADY: Solving two problems at once

As the saying goes, even the best laid plans often go awry. Planning is an essential part of any preparedness program, but it is often difficult to imagine every scenario and obstacle that may arise during an emergency. But we also know that practice is the best way to identify and address those gaps– and practice is exactly what the Oklahoma State Department of Health does to improve its preparedness programs.

In September 2016, the Oklahoma Strategic National Stockpile team prepared to conduct a full-scale exercise of its ability to distribute medical countermeasures – medications and other products used to prevent and treat health conditions that may arise during a public health emergency.  Before the exercise began, the state realized they had shipments of flu vaccines that they needed to distribute around the state and the team distributed the vaccines as part of their regularly scheduled exercise. The team transported 11,960 doses of vaccine to eight local health departments while simultaneously completing this practice exercise.

SHOW: Creating a culture of preparedness

Emergencies impact all sectors of health, and experts from across departments are often asked to weigh in, from epidemiologists, to laboratorians, to mental health experts. However, public health staff in these positions may not often consider their roles in an emergency situation.

To build a culture of preparedness across the entire Oregon Health Authority, the Emergency Operations Division provided all staff with a 72-hour emergency kit, worked to enroll staff in the Health Alert Network, and trained staff on the Incident Management System. Since this initiative, staff personally feel more prepared for an emergency, and more staff are now prepared to respond should the need arise. “The culture has shifted. People are now talking in the elevator about what they would do in the event of a large-scale disaster,” acting PHEP director Akiko Saito said. “If we can build this culture of preparedness here, then we’re better equipped to build community resiliency on a larger scale.”

GO! Putting plans into action

While we all hope that emergencies never occur, they are inevitable and the true test of any preparedness system. Washington experienced an outbreak of mumps that affected more than 800 people of all ages in late 2016 and early 2017.

During this outbreak, the state and local health departments in Washington investigated new cases, advised local school districts on prevention measures, and developed culturally appropriate risk communication materials. Due to a robust preparedness system and the efforts of the health department staff and partners, more than 5,000 more people were vaccinated for measles, mumps, and rubella compared to previous years.

For 15 years, PHEP has been there, from Katrina to SARS; Joplin to H1N1 influenza. To find out more about how the PHEP program has equipped jurisdictions to prepare for, respond to, and recover from public health emergencies, check out our Stories from Field.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

September 12, 2017 - 11:44am
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event. Setting the Stage Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.

  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Empowering Kids to Make Their Families Safer

September 5, 2017 - 10:29am

After graduating from college I moved to Anchorage, Alaska for a year of post-graduate service through the Jesuit Volunteer Corps NW and AmeriCorps. I served as the Preparedness and Casework Specialist for the American Red Cross of Alaska. Though often overlooked, Alaska is the largest state in the country (more than twice as big as Texas!) and has more coastline than the rest of the United States combined. While a large portion of the population lives in Anchorage, dozens of Native Alaskan villages are scattered all across the state, often hundreds of miles apart.

While in Alaska, I spent a good portion of my time managing The Pillowcase Project, a Red Cross youth preparedness program for students between the ages of 8 and 11. The program educates children about how to prepare for emergencies they might experience in their communities. Since the program started in Alaska, The Pillowcase Project has reached youth all over the state and has even crossed the Arctic Circle!

Pillowcases are not just for pillows

During Hurricane Katrina, a Red Crosser noticed college students were carrying their belongings in pillowcases as they evacuated to emergency shelters. Their actions inspired The Pillowcase Project, which uses an everyday household item to hold the necessary items for an emergency kit. Putting all of these supplies in one place makes it easier to grab and go in the event of an emergency.

The Pillowcase Project has reached over 800,000 children both nationally and globally. Trained instructors, mostly volunteers like me, share the curriculum with children in schools, after-school programs, summer camps, scout groups, and various venues.

Beyond the standard preparedness education curriculum, students decorate a pillowcase with symbols that are personal reminders of things that make them feel safe and brave. They are instructed to fill it with emergency essentials such as a first aid kit, flashlight, batteries, spare clothes, and a toothbrush. We also encourage students to include a comfort item such as a favorite stuffed animal or photographs of their friends and family to provide additional support during a stressful time. We also teach coping skills such as breathing exercises and positive visualization techniques, so our students know how to stay calm in stressful situations.

Learn. Practice. Share.

Research from FEMA shows that one of the best ways to promote family preparedness is by educating children, who then feel empowered to share what they learned with their families. It is often difficult to convince adults of the negative impact a disaster could have on their family and how important it is to be prepared. This is why The Pillowcase Project seeks to educate students; 8-11 year-olds who are able to accurately relay information and comprehend the curriculum to share it with others. The curriculum centers around three pillars:

  • LEARN. Kids learn about the types of natural disasters that are most likely to happen in their community or neighborhood. In the case of Alaska, we focused on earthquakes and home fires.
  • PRACTICE. We talked through different scenarios that were tailored to the children in the group, because one child might live in a trailer, one on the 7th floor of an apartment building, and one in a two story house.
  • SHARE. We always encouraged the kids to go home and share the information and skills they have learned with their family and friends. The kids I worked with were always so enthusiastic and excited to tell people about what they had learned, which makes this a very proactive preparedness education program.
Sounding the Alarm

No matter where or what kind of home you live in, you are at risk of experiencing a home fire. That is why every child educated through The Pillowcase Project learns home fire safety and prevention, not limited to how to properly maintain a smoke alarm to how to safely get out of a burning home.

Red Cross volunteers and partners all across the country install free smoke alarms, replace batteries in existing alarms, and help families create escape plans. This year, this Sound the Alarm effort will install its one-millionth smoke alarm. An impossible feat without the dedication and passion of those who believe in the value of disaster preparedness education and prevention.

Learn More Read our other National Preparedness Month blogs:

Beat the Heat at DragonCon

August 29, 2017 - 10:39am
Photo Credit: Jeffrey Hall, Office of Minority Health & Health Equity

DragonCon is a convention that combines science fiction and fantasy, with gaming, comics, and entertainment for the largest multi-genre event in the world. In 2016, an estimated 77,000 people from around the world attended this annual event that is held every Labor Day weekend in downtown Atlanta.

“This is a bad idea,” she said.

Cosplay is a shortened form of 2 words – costume and play. It is the practice of dressing as characters from books, video games, movies, etc. Many view it as an art form and take great pride in their costumes, especially the ones made by hand.

“No, it’s cool. I have it all planned out,” I replied.

“Yeah, I’m not so sure about that but ok…”

The topic was my costume. The problem was the weather; namely that it was 90⁰ F degrees outside with 85% humidity, making it feel closer to 100 degrees. I was covered from head to toe in clothing that, while not heavy, did not promote airflow. My only exposed body parts were my face and one of my hands. Unfortunately, both were painted red and covered with two layers of barrier spray to prevent sweating and make the makeup water resistant. I’d worked hard on my Hellboy cosplay and DragonCon was the reward for my six weeks of work.

“It’ll be fine. What’s the worst that can happen?” I said.

Prioritize your health

Four hours later, I was back in my hotel room with a case of vertigo so bad that I couldn’t walk down the hall without hugging the wall. I made it back to my room, fighting the urge to vomit with every step. I was too disoriented to shower. All I could do was grab a cool, damp washcloth for my head, and a bottle of water to drink before lying down hoping that it would help make me feel better. Instead, I ended up in bed for the next 24 hours instead of enjoying DragonCon.

How could this happen? I work in public health and know about the dangers of heat stroke and heat exhaustion. Yet, there I was, confined to my bed because in all the excitement of the convention I had made a series of bad decisions that could be traced back to one thing: I prioritized my costume over my health. Each decision felt small, so small that I don’t think it would matter. And, even when I knew better, they all added up to dehydration and heat exhaustion.

Stay cool. Stay hydrated. Stay informed.
  • Wear appropriate clothing. If you are participating in DragonCon, it’s difficult to dress with the weather in mind. Most decisions about cosplay are made without considering the weather. That said, do your best.
  • Limit your time in the sun. Even though all the big photoshoots happen outdoors, do your best to stay in shaded areas and avoid going into the sun until it is necessary.
  • Stay Hydrated. While drinking water can equate to more bathroom breaks, it’s important to drink plenty of water and some sports drinks to replace your body’s salt and minerals.
  • Do not let yourself get thirsty. Once you’re thirsty, you already dehydrated and nothing wrecks a convention faster than passing out.
  • Be aware of the temperature and extreme heat alerts. You may be able to adjust your cosplay and activity roster based on weather reports.
  • Learn to recognize signs off heat exhaustion and address them immediately. It’s hard to listen to your body with all the excitement of DragonCon, but it’s important. If you start feeling queasy or lightheaded, it’s time to retreat to a cool area, sit down, and have something to drink. If you know what to look for, you can address it much more quickly.
Pay attention to your body

Upon reflection, there were four big things that led to my downfall:

  1. I ignored the weather. I decided to dress as a character who wore multiple layers of clothing. Because my clothing was hot, that meant that I needed to be able to sweat more.
  2. I sealed my face paint. My cosplay required face paint and I used a sealant to prevent sweating, which limited my body’s ability to cool off.
  3. I did not drink water. I needed help getting in and out of my cosplay, which added a level of difficulty when I needed to use the bathroom. To avoid frequent trips to the restroom, I didn’t drink enough water to stay hydrated.
  4. I did not listen to my body. I started feeling sick within minutes of standing in the sun. Instead of listening to my body, which was telling me to find a cool place to sit down and drink some water, I stayed outside in the sun. It wasn’t until the world started spinning, along with my stomach, that I realized I couldn’t stay.

I would say it was a rookie mistake but it wasn’t. I just didn’t prioritize my health and well-being and as a result, I experienced heat exhaustion, which could have easily escalated to heat stroke.

DragonCon is meant to be a fun event. Being aware of how things can go badly is the first step in preventing them. The most important lesson I learned from my encounter with heat exhaustion was that recovering from it takes a lot longer than preventing it in the first place.

Now I do my best to be prepared. I hope you do, too.

Happy DragonCon!

Don’t forget to stop by the official CDC table in the lobby of the Hilton Atlanta.

Preparing for College Life: A Healthy Guide

August 24, 2017 - 2:44pm

Zoey Brown joined the Office of Public Health Preparedness and Response during this past summer to help with a data analysis project. She saw a number of CDC programs and activities, and authored the following post to the Public Health Matters blog. The views expressed are her own, and do not necessarily represent those of CDC, HHS or other government entities. A number of the links included take those interested in these topics to both CDC and non-CDC sites for more information. The Office was pleased to have this talented young woman on staff for an internship experience.

As a rising high school senior, college looms large on my horizon. Everywhere I turn, there’s another form to fill out, essay to write, and decisions to make. And although I’ve had plenty of help during the application process, no one seems especially concerned with what happens after I choose a school. I’ve lived in the same town my whole life; how do I pick up my life and move it to a campus one thousand miles away?

For all the students out there like me, who aren’t quite sure how to prepare for college, I want to share some tips to help you prepare to start this school fall.

You are what you eat

Odds are, your parents have had some control over your food up until now. A lot of kids go to college without any sense of how to manage their diet; hence, the infamous Freshman 15. With that in mind, here’s some helpful tips on maintaining your nutrition on a meal plan.

  • Talk to your doctor. Before you go back to school make sure you understand what your body needs. Everyone has different nutritional needs based on a variety of factors, like age, sex, size, and level of activity.
  • Stay well stocked. Keep your dorm room stocked with healthy snack alternatives. My personal favorites are carrots, cashews, apples, granola bars, and popcorn.
  • Make the swap. Consider switching out some fried foods for grilled versions and soda for juice or water
  • Consistency matters. Develop a consistent meal schedule that complements your schedule. Don’t skip a meal to study or party.
Stay active

If you’re anything like me, finding the motivation to exercise can be tough. Sleeping in a few extra minutes or catching up on Netflix are more tempting than getting in that cardio workout. Without the high school sport or fitness-loving parent to which you’re accustomed, you’ll have to take your health into your own hands. So, what are the best ways to stay in shape on campus?

  • Hit the gym. College is a great place to take advantage of free access to gyms and fitness classes. This is probably one of the last times in your life that you’ll have a free gym membership, so you might as well use it!
  • Get in your steps. Just walking on campus can also be a great source of exercise. Or think about a bike for transportation around your new town.
  • Try out a new sport. If you enjoy playing sports but don’t want to commit to varsity athletics, consider joining an intramural team. There’s no pressure to be an intense athlete, and it’s a great way to let off a little steam.
  • Join the club. Most colleges also offer clubs that go hiking, biking, climbing, and more. These are great way to expand your social circle.
Be mindful

As someone who has struggled with mental health issues over the past few years, I must admit that I’m a little concerned about my transition to college. Luckily, there are a ton of tips out there for maintaining and improving mental health in a new environment.

  • Battle feeling homesick. One of the most common mental health issues new college students experience is homesickness. This can be especially tough if you’ll be attending a college far away from home, like me. There’s no perfect solution, but one of the best things you can do is immerse yourself in college life – join clubs and activities, try to make friends with the people living near you, and make your dorm room feel a little more like home.
  • Avoid anxiety. College is a completely new environment, so it’s understandable that over 40% of college students suffer from anxiety. To help keep anxiety to a minimum make sure you exercise regularly, try to get at least 7 hours of sleep a night, drink less caffeine, and do something you enjoy every day. Of course, if feelings of intense anxiety persist, you should seek help through your school’s health services.
  • Watch your mood. It’s normal to feel down occasionally, but if these feelings persist, you may be suffering from depression. You should visit a counselor at your college’s health service if you experience any of the following for more than two weeks:
    • sleeping problems
    • lack of energy or inability to concentrate
    • eating issues
    • headaches or body aches that persist after appropriate treatment
    • You should also seek help if you are experiencing suicidal thoughts
Know about safe sex

I am fortunate to attend a school with a decent sex education program. However, many teenagers haven’t, so there are a few things that the average college student should know about safe sex.

  • Know it’s a choice. The choice to have sex is yours to make, and abstinence is a completely viable option.
  • Avoid sexually transmitted diseases and pregnancy. If you do choose to have sex, you should take steps to protect yourself. Use condoms, male or female. Be sure to check that the condom is intact and has not expired before use.
  • Talk to your partner. Ask your partner about their sexual health first. If they refuse to answer, they probably don’t deserve to have sex with you.
  • Get tested. If you are already sexually active, you should consider going into your college’s health clinic to get tested.
Drink responsibly

Drinking under the age of 21 is illegal in the US, but that isn’t always the reality on college campuses. With this in mind, I wanted to lay out some of the dangers of drinking on college campuses so everyone can be informed.

  • Beware of binge drinking. One of the biggest concerns regarding drinking on college campuses is the high rate of binge drinking – 90% of underage drinking is binge drinking. Frequent binge drinking in young adults can lead to alcohol dependence, liver problems, brain damage, and heart troubles. Binge drinking can also lead to poor decision making, including driving under the influences.
  • Don’t get hurt. Underage drinking is also linked to unintentional injuries, violence, school performance problems, and other risky behaviors.

Best of luck to those of you heading off to college and thank you to the Office of Public Health Preparedness and Response for the chance to experience public health in action at CDC!