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HomeMy WebLinkAboutMINUTES - 08052003 - C.137 TO: BOARD OF SUPERVISORS Contra ' Cyst FROM: William B. Walker, MD, Health Services Director 01 � DATE: July 18, 2003 �nty e SUBJECT: CERTIFICATION OF NON-SUPPLANTATION OF BIOTERRORISM PREPAREDNESS FUNDS SPECIFIC REQUEST(S)OR RECOMMENDATIONS)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: APPROVE AND AUTHORIZE the Chair of the Board of Supervisors to sign and certify that State of California funds received by Contra Costa County for bioterrorism preparedness are not being used to supplant existing county positions or activities for the period of the contract July 1, 2002, through June 30, 2003. FISCAL IMPACT: Certificationof this agreement of non-supplanting allows the County to utilize Federal funding through California State Department of Health Services for Bioterrorism Response Planning and Preparedness. No county funds are required. BACKGROUND: The County has accepted this funding for the contract year of July 1, 2002, through June 30, 2003. With these funds we have been able to initiate several new activities, including bioterrorism exercises, training, education of the medical community, and building of a Public Health infrastructure to respond to health emergencies, including bioterrorism. Persons in existing positions have had work assignments restructured and new activities assigned to be able to do this work, and new personnel have been hired where needed. These procedures are consistent with the supplantation provisions of funder. The designated areas of funding (1) Planning and Readiness, 2) Surveillance & Epidemiology, 3) Biologic Laboratory Capacity, 4) Health Alert Network, 5) Risk Communications, and 6) Education and Training) are all being addressed through this funding. CONTINUED ON ATTACHMENT: YES NO SIGNATURE --"'RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE ---APPROVE OTHER SIGNATURE(S): ACTION OF BO APPROVE AS RECOMMENDED X OTHER r" VOTE OF SUPERVISORS I HEREBY CERTIFY THATTHIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN X UNANIMOUS(ABSENT Nam ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. AYES NOES: ABSENT: ABSTAIN: ATTESTED Augmt 5, 2003 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CONTACT: Francle Wise,Director,Comm.Disease(6-6740) CC: William B.Walker,MD,HSD Director,20 Alien,Mtz Wendel Brunner,MD,Public Health Director,at - 597 Center Avenue,#200,Mtz BY �Iir f DEPUTY Plan and Guidance Page 39 of 48 CERTIFICATION FORM 111-1 PUBLIC HEALTH PREPAREDNESS AND RESPONSE TO BIOTERRORISM FISCAL YEAR 2002-03 Contra Costa Health Services - Public Health Division (County/City and Dame of Local Health Department) I hereby certify that the above-named local health department shall not use funds allocated by the California Department of Health Services to supplant funding for existing levels of service and that funds shall only be used for the purposes specified in the local health department's Bioterrorism Preparedness Plan and approved by the California Department of Health Services. I further certify that funds received shall be deposited in a Local Public Health Preparedness Trust Fund and expended only for the purposes stated in the local health department's Bioterrorism Preparedness Plan and Budget, and approved by the California Department of Health Services. Chairperson, Board of Supervisors or the Mayor of a City Signature: rinted Name: Mark DeSayiopr - Chair, Board of Supervisors Phone: (925) 646-5763 € Date: Please return the original certification with your Plan and Budget to: California Department Health Services Emergency Preparedness Office Attn: LHD Allocation Award Program 601 North 7" Street, M.S. 244 P.O. Box 942732 Sacramento, CA 94234.7320 County of Contra Costa BIOTERRt3RISM AGREEMENT Public Health Preparedness & Response to Bioterrorlsm County of Contra Costa 1. This Agreement is entered into between the California Department of Health Services, hereinafter referred to as "CDHS" and County of Centra Costa, hereinafter referred to as the "LHD." 2. This Is a multi-year Agreement. The term of this Agreement is: July 1, 2042 through August 30, 2004. 3. The Initial budget period under this Agreement is: July 1, 2002 through June 30, 2003, as appropriated by the 2002 California Budget Act. _---The rnaxitnumrnount- to urrel # rtfcsr- ._..:. tVa)ra St 0.3 shall not gxceeA $918 14 S. Use of Funding: A. Category 2 (FY 2002-03)funds may include carry over Category 1 funds and are hereby awarded in accordance with your application and plan in the amount of$833,093 to implement the core public health capacities and benchmarks required in CDHS`Application to the federal Centers for Disease Control and Prevention (CDC) and in accordance with the LHD Public Health Preparedness & Response to Bioterronsm Program Plan as submitted and approved. B. In addition, this Agreement should be considerer) as one source of funds to achieve critical capacities related to public health preparedness for terrorism, including increasing readiness for a smallpox attack through strategic pre-event smallpox vaccinations fallowing CDHS guidelines concerning redirection of Agreement funds. C. Costs of LHD and contract staff assigned on an ad hoc basis to implementing the various functions of smallpox vaccination clinics are allowable, presuming the appropriate time and attendance records are maintained. Page 'I of 5 County of Contra Costa D. Costs of medical screening (e.g., pregnancy, HIV testing and dermatological exams), medical care, administrative and/or medical leave for vaccinees are not allowable. E. Category 3 (FY 2002-03)funds: Your LHD maintains a Level A Public Health Laboratory. Funds in the amount of $35,721 are hereby awarded to plan and complete specialized biologic laboratory training activities and for specific approved laboratory enhancements that support the Laboratory Response Network as negotiated in your LHD Bioterrorism Preparedness Plan as submitted and approved. G. The parties agree to comply with the terms and conditions of the following exhibits, which are by this reference made a part of this Agreement. Exhibit A Terms and Conditions Exhibit B Budget Detail and Payment Provisions: Exhibit C Travel Reimbursement Information (Note: Exhibit C is not valid and does not apply if other rates have been approved in your public Health Preparedness &. 7. Expenditure and Program Requirements A. In accordance with the LHD signed Certification Form 111 -1 against supplanting, funds shall not be used to supplant funding for existing levels of services and will only be used for the purposes designated in Item 5 above and Attachment A. B. In executing this Agreement, the LHD assures that it will comply with the LHD Public Health Preparedness & Response to Bioterrorism Program Plan as submitted and approved by the CDHS. C. Funds made available are limited to activities as proposed in the LHD Plan and in accordance with the approved LHD budgets submitted for each focus area. Page 2 of 5 County of Contra Costa D. Focus Area Approved Budgets. FOCUS AREA AMOUNT APPROVED Focus Area A $164,730 Focus Area B $252,155 Focus Area C $35,721 Focus Area E $147,963 Focus Area F $223,542 Focus Area G $94,703 8. Reporting Requirements Written progress reports and expenditure reports must be submitted on a semiannual basis. An annual cost reconciliation report is due at the close of the federal budget period. The purpose of the progress reports and expenditure reports are to document activities and expenditure of funds. The due dates for the progress and expenditure reports are: 9. Progress and Expenditure Reports 02115102 --03/31103 05/15/03 04/01/03—08130/03 09/30/03 08/31/03 — 02-28.04 03/30/04 03101/04—08130/04 09130/04 Annual Cast Reconciliation Reports Period Covered nue 02/15102 — 08/30/03 10/15/03 09/01103_08/30104 10/15/04 A. Each progress report shall include, but not be limited to, data and information required by statute and information needed to satisfy federal reporting and CDHS monitoring requirements. Specific requirements will be established by CDHS, in consultation with LHDs. The reports shall be submitted in accordance with procedures and a format required by CDHS. Page 3 of 5 County of Contra Costa B. The LHD shall, as a part of its semiannual progress and expenditure reports to CDHS, display cost data and the activities funded by the moneys deposited in the Fund. These reports must be submitted for costs in each Focus Area and be in accordance with the reporting requirements developed by CDHS. The semiannual reports shall: C. Display transactions of the Local Public Health Preparedness Fund and be certified by the County/City Auditor Controller as to their accuracy and the availability of supporting documentation. O. Identify and describe the actual costs incurred by the LHD by Focus Area in accordance with the LHD's approved Plan and Budget. Costs for increasing readiness for a smallpox attack through strategic pre-event smallpox vaccinations must be identified and reported separately by the LHD by focus area. E. Be certified by the Chairperson of the County Board of Supervisors or the Mayor of the City that the expenditures claimed represent actual expenses for services performed under this Agreement, that su ntin �istg _ . eveis of public health activities has not occurred, and that funds were expended for the purposes identified in State statute as approved by ......,.CONS. _ F. The LHD must reconcile actual expenditures, allowable costs, and their budgeted items by Focus Area annually, with the FY 2002-03 Cost Reconciliation Report due by October 15, 2003. This report will allow CONS to determine final expenditures for FY 2002-03 and to identify unexpended funds in each of the Focus Areas. 10. Project Representatives during the term of this Application will be: Caiifomia Department of Health Services County of Contra Costa Emergency Preparedness Office Attention: Patricia G. Felten 601 North 7t' Street, MS 244 P.Q. Box 942732 Sacramento, CA 942347320 Email: felten dhs.ca, ov Telephone: (916)324-7807 Fax: (916)324-7846 Page 4 of 5 County of Centra Costa 11. Cancellation 1 Termination A. This Agreement may be cancelled or terminated without cause by either party by giving thirty (30) calendar days advance written notice to the other party. Such notification shall state the effective date of termination or cancellation and include any final performance and/or payment/invoicing instructions/requirements. B. Upon receipt of a notice of termination or cancellation from either CDHS, or LHD, the LHD shall take immediate steps to stop performance and to cancel or reduce subsequent contract costs. C. LHD shall be entitled to payment for all allowable costs authorized under this Agreement, including authorized non-cancelable obligations incurred up to the date of termination or cancellation, provided such expenses do not exceed the stated maximum amounts payable. D. Agreement termination or cancellation shall be effective as of the date indicated in CDHS' notification to LHD. The notice shall stipulate any final E. In the event of early termination.or can.cellation,.L HD.shall.be.entitled to t�ri+�+r► ^i#i�sn-fes _ _. . ..�:.� _. .. _ . and expenses incurred up to the date of cancellation and any non- cancelable obligations incurred in support of this Agreement. In executing, this Agreement, the LHD assures the CDHS that it will comply with all provisions set forth in this document, the LHD plan and budgets as approved by the CDHS. The signature must be an original signature by an authorized official, employee, or agent. State of California County of Conga Costa Au , rued gnature: Authorize J Signature: Printed fume and Title: Printed Dame and Title: Patricia Felten, Assistant DeLy Director {'}!t t'4et J.1 Agency Name: Applicant Agency: DHS/Emer enc Preparedness Office Date Signed: 04/21/03 Date Signed: Page 5 of 5 E s ATTACHMENT A: PROGRESS REPORT TEMPLATE Using the Progress Report Template (below), provide a brief status report that describes progress made toward achievement of each of the critical capacities and critical benchmarks outlined in the continuation guidance issued by the DHS/EPO in August 2002. Each narrative update should be concise. LHDs should describe their overall success in achieving each critical capacity. The progress report narratives should not exceed 1 page, single-spaced, for each critical capacity, with 2-3 paragraphs being preferable. LHDs are welcome to use bullet-point format in their answers, so long as the information is clearly conveyed in the response. FOCUS AREA A. LOCAL PREPAREDNESS PLANNING AND READINESS ASSESSMENT CRITICAL CAPACITY #1: Establish a process for strategic leadership, direction, coordination, and assessment of activities to ensure local readiness, interagency collaboration, and preparedness for bioterrorism, infectious disease outbreaks, and other public health threats and emergencies. This year in Contra Costa County we initiated measures to enhance and to improve our ability to respond to bioterrorism and other health emergencies requiring public health's involvement. Activities have included hiring staff dedicated to health emergency coordination, identifying the internal health department planning entities responsible for elements of the emergency response plan, and expanding our planning and coordination efforts to include essential partners, in the various government agencies, community agencies and with other members. Cour Health EmergencyfBioterrorism Coordinator, Erika Jenssen, MPH, was hired as of January 1, 2003. Erika has extensive experience in Contra Costa Public Health in many programs, recently coordinating, implementing and assisting in the development of the Immunization Registry computer system. In addition, Christye Green, was hired as an Administrative Intern and is now providing support to the planning efforts. Finally, Susan Earley, Public Health Nurse was relocated to the Bioterrorism/Health Emergency Coordination program. Susan has 13 years experience in Public Health Nursing. In order to understand the different entities with emergency planning responsibilities within Contra Costa Health Services, we developed a table listing each entity and its mission, staffing and role (attached). Through the process of developing this table, we were able to clarify roles and ensure that members of each group understood the goal of that particular group. This coordination has allowed staff funded with bioterrorism funds to focus their efforts on the areas that have been previously unattended to, 1 i t without duplication of effort. All of these planning entities are routinely updated about bioterrorism planning and other health emergencies. The Bioterrorism Advisory Croup (BTAC) led by Wendel Brunner, MD, Director of Public Health, is the main forum for bioterrorism planning and meets monthly. Minutes are available and are used in the planning process to inform partners of progress, next steps and assignments. This group includes representatives from Contra Costa Environmental Health, Contra Costa Emergency Medical Services, Contra Costa Health Plan, Office of the Sheriff Office of Emergency Services, Red Cross as well as our Public Information Officer and Emergency Preparedness Manager. Topics discussed have included planning for the Strategic National Stockpile, developing a mass immunization plan complete with identified facilities, coordinating with other Homeland Security grants and reviewing the Local Inventory. In addition, we are in the process of recruiting additional partners, including representatives from Police, Fire, pre-hospital transport and cities within the county. In addition, bioterrorism planning is also an ongoing topic at HEED, an internal committee consisting of representatives from Hazardous Materials, Environmental Health, Emergency Medical Services and Public Health. HEED meets with Dr. William Walker, Contra Costa Health Services Director, every other week and has been a forum for discussing upcoming exercises, EOC training for managers, the status of the smallpox vaccination program and health emergencies including SARS and West Nile Virus. Finally, the Board of Supervisors has been updated three times during this progress report period by senior staff, including Dr. Brunner. Dr. Brunner reported on SARS, West Nile Virus and the progress of the smallpox vaccination program in Contra Costa. Critical Benchmark#1: Identify your designated senior local public health official responsible for directing local bioterrorism preparedness and response planning efforts. Name: Phone: Wendel Brunner, MD, PhD, MPH (925 ) 313 - 6712 Title: Fax: Director of Public Health (925 ) 313 - 5721 Agency/Dept Affiliation: Email: Contra Costa Health Services wbrunne:riftscl.co.contra- costa.ca.us Critical Benchmark#2: Has your department established an advisory committee consisting of partner organizations to aid in your response efforts? YES NO 2 CRITICAL CAPACITY#2; To conduct integrated assessments of public health system capacities related to bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies to aid and improve planning, coordination, and implementation. -d 'achieving this CriticalPI-Ovide, an update On -o( -SS during Project Year/ 10mal thy- Lcapac The Local Inventory was reviewed extensively at STAG with the following questions applied-, • Is this capacity in place? • Is it adequate? • Who is responsible? • Which plan is it in? • Are the plans in place coordinated with one another? Through this discussion we were able to identify areas where further work is needed. At the same time, partners also brought their emergency plans so we could understand where the plans were coordinated and what actually existed in whose plan. The inventory will be a tool used continually to assess our needs and programs. Critical Benchmark#3. What is the status of your department's integrated assessment (an assessment of current capabilities across all focus areas at the local and regional level) of public health system's capacity to respond to potential bioterroristlemergency events? Choose only erre of the following: ] Assessment work has not begun (0% completed) Q Assessment work has just started (less than 25% completed) [] Assessment work is underway (25-50% completed) Q Assessment work is more than half way completed (51-75% completed) E] Assessment work is close to completion (greater than 75% completed) 4 Assessment work. completed (100% completed) Critical Benchmark#4: What is the status of your department's legal assessment to determine adequacy of local public health authority in responding to a bioterrorist event? Choose only one of the following: M Assessment work has not begun (0©/a completed) n Assessment work has just started (less than 25% completed) Assessment work is underway (25-50% completed) n Assessment work is more than half way completed (51-76% completed) El Assessment work is close to completion (greater than 76% completed) 3 E] Assessment work completed (140% completed) CRITICAL CAPACITY#3: Develop, exercise, and evaluate a comprehensive public health emergency preparedness and response plan for emergencies caused by bioterrorism, other infectious disease outbreaks, and public health threats and emergencies. Provide an irpdate on p, gress Capacity: =Eli i In Contra Costa County, we have a Contra Costa health Services Emergency Plan whichhas been in existence for 4 years. This plan is exercised at least yearly and reviewed every two years for needed updates at the Emergency Management Team, a committee consisting of managers from all Divisions of the Health Services Department. In the Health Services Emergency Plan, there is a Bioterrorism Annex to this plan which was developed using the FBI 1l MD Incident Contingency Planning Template. One of the tasks of STAG is to review this Annex and develop it more fully. We have participated in two recent exercises about dirty bombs, one on November 14, 2402 at our County UES and a table top exercise with our Health Services Emergency Management Team on November 4th, 2002.. As a result of these exercises, we identified areas of improvement including better coordination of PIU activities with OES as well as the need for additional training for staff at the DOC. Training is being planned in coordination with OES. Critical Benchmark#5. What is the status of your local response plan? Choose only one of the following: El Werk on plan has not begun (0% completed) R Werk on the plan has just started (less than 25% completed) El Werk on the plait is underway (25-50% completed) E Work on the plant is more than half way completed (51-75% completed) ❑ Werk on the plan is close to completion (greater than 75% completed) The plan is completed (100% completed) The plan is completed and has been adopted Critical Benchmark iii►: What is the status of your jurisdiction's regional response planning activities? Choose on- ly,on e of the following: [1 Work on plan has not begun (0% completed) El rk on the plan has just started Mess than 25% completed) € El Werk on the plan is underway (25-50% completed) El Werk on the plan is more than half way completed (51-75% completed) 4 Work on the plan is close to completion (greater than 75% completed) The plan is completed (100% completed) [� The plan is completed and has been adopted CRITICAL CAPACITY i4: Ensure that local preparedness resources for and response to bioterrorism, ether infectious outbreaks, and other public health threats and emergencies are effectively coordinated with State response assets. Provide ao update on progmess during Protect Year 1 toward achieving this critical plans? Hav_- yoo par1ic/j)atr;,,4, in, anyt-egional exorcises condlucted by State ot-federal or-it ic lei All designated managers in Centra Costa Health Services have been trained in SEMS. Sioterrorism/Health Emergency staff will also be trained in SEMS and are working with the Emergency Preparedness Manager to provide refresher training to identified managers and staff that may be required to respond to a health emergency. In addition, designated Health Services managers and staff will be participating in scheduled OES trainings about SEMS functions and EOC operations during the summer of 2003. We are planning participation in at least 3 exercises this fall, one at the Operational Area level, and two State exercises. In addition, we will participate in an anthrax exercise at Sandia National Laboratory with Alameda County s well as a State tabletop exercise with water districts about contamination. Critical Benchmark#7: Please complete the table below by providing the names, titles and contact information for key LHD individual(s) who are designated to work with DHS/EPO staff on the CDC Strategic National Stockpile (formerly called the National Pharmaceutical Stockpile) receipt, management, and dispensing planning: KEY STAFF NAME PHONE NUMBER TITLE FAX NUMBER AGENCYIDEPT AFFILIATION EMAIL ADDRESS Local PN staff Name: Sue Guest Phone: designated to ( 925 } 313 - 6236 work on Stockpile Title: Nurse Program Manager planning Fax: Agency/Dept Affiliation: ( } Contra Costa Health Services Public Health Clinic Services Email: sguest at�7hsd.co.contra- costa.ca.us 5 CRITICAL CAPACITY#5: Plan for the receipt, management, and distribution of the CDC Strategic National Stockpile should deployment of the Stockpile be necessary in the local jurisdiction. Providle am update oil progressduring ProJect Year I toward actlieving this crificol capacity, Haw,, ai iv local I"Wasool lei been desi(Inated to be hraitoed tot el,,-Oiw,� at id Inallage distlibuti011 of Items fion) tile Stnitoakll Nall0laa/ Stockpile? Have any local C)CCUIROd") if so, please briefly describe: Staff responsible for SNS planning have been designated in both Public Health and Contra Costa OES. We have identified a privately-owned hangar at Buchanan Airfield in Concord as the receiving and unpacking site for the SIBS. The hangar owner has agreed verbally and we are now working on an MOU for this purpose. In addition, all Contra Costa OES managers will receive a briefing on SIMS activation at the EOC trainings scheduled for summer of 2003. CDC is requesting the following additional information: CROSS-CUTTING ISSUE #1: Does your jurisdiction have an incident management system for responding to all incidents (natural and unnatural)for which local government deploys emergency response efforts? 4 YES ❑ NO If yesprovide a brief doscription of the system and the LHD's role in, rosponse effod,13- For any emergency, Sheriff's Dispatch is notified and there are protocols in place to notify the on-call Health Officer, which consists of three physicians who share duties to be available 24 hours/7 days a week. Depending on the incident, the health officer alerts appropriate Health Department staff, such as Hazardous Materials, Environmental Health, Emergency Medical Services and Public Health including Communicable Disease. In addition, we also have in place a Community Warning System which is utilized by refineries to alert the Health Department and the Sheriff's Office of a release. This is discussed further in Focus Areas B and E. WRAP-UP: (1) Discuss any major barriers you have encountered in Focus Area A this year and steps you have taken to address them. 6 One of the major barriers that we have encountered this year is that we have spent an enormous amount of time sorting the barrage of paper, listening to teleconferences and processing the information coming from various sources. This was particularly seen in the smallpox vaccination effort but it has also characterized most of the bioterrorism communications with the State and the CDC. It would be helpful for us to have more selective communication with not so much repetition of information. Secondly, it has been difficult to find time to do the overall planning and emergency preparedness that we laid out in our bioterrorism plan while responding to existing and new health emergencies. In our jurisdiction these emergencies included hazardous materials releases from refineries, tuberculosis in a high school, SANS and preparation for West Nile Virus. The smallpox vaccination effort consumed many hours of staff time. While we did learn from the process and perhaps it contributed to our overall preparedness, it did tape the focus away from overall planning efforts as well as existing programs. (2) Describe any activation of the public health emergency response system your department has completed this year in response to a planned exercise or an actual disease outbreak. These health emergencies and mandates did provide us with the opportunity to exercise all components of our public health response system. During the smallpox pre- event vaccination program, we were able to utilize our connection to the Infection Control Nurses in all of the hospitals in our county and through regular meetings and emails with them, ensure a coordinated response. In addition, we also presented educational information to the medical staff and Infectious Disease doctors. These personal connections have been extremely useful in handling BARS and will benefit us whatever the future health emergency. The smallpox vaccination effort involved planning of clinics, training nurses to administer the vaccine, and training doctors and ICNs about adverse events. When SARS arrived, we were able to get out timely information to the Infection Control Nurses and keep them updated of the local situation. For SARS, we mounted an epidemiological response including surveillance and case investigation as we did in order to follow up on smallpox vaccinees. For SARS, tuberculosis in a high school and West Nile Virus, we have been able to put out press releases and alerts and educational information to the public through fax blast and our website. These efforts were primarily led by staff funded by this bioterrorism grant in coordination with other Health Department staff. (3) Do you have any specific technical assistance or training needs related to this Focus Area? We need to have additional training about the role of SEMS specific to health emergencies. We understand that SEMS is useful onsite in an incident as well as in the FOC in an event, and we would like to understand our responsibilities 7 vis a vis the field operations about who is in charge. In the past, law enforcement has been in charge and we have provided guidance and direction to them, but not necessarily been Incident Commander. Also, in a health emergency, it may not be a one time incident but perhaps an ongoing effort and since SEMS is focused on specific events, it is not clear to us what the applicability may be in a longer operation. It would be helpful for us to have some interpretation of SEMS specifically designed for health professionals and perhaps some training around this issue. 8 FOCUS AREA 8—SURVEILLANCE AND EPIDEMIOLOGY CAPACITY CRITICAL. CAPACITY#8: Rapidly detect a terrorist event through a highly functioning, mandatory reportable disease surveillance system, as evidenced by ongoing timely and complete reporting by providers and laboratories in a jurisdiction, especially of illnesses and conditions possibly resulting from bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies. Provide all updalte oil, progress dt"'fing Project Year I 110ward achioving this capacifyl Contra Costa has maintained a 24/7 on call system for the past 12 years. This system involves 3 physicians designated as `on call Health officer' as well as the on call Communicable Disease Program Chief(this is also 24/7). The on-call system is routinely utilized in all health and hazardous materials emergencies, this system also responds to emergency workers (fire, police and ambulance) who are potentially exposed to a communicable disease in the course of their work. The CD Program Chief (or designee) respond 24/7 to these emergencies The Health officers have received additional pagers that will alert them automatically in the event of the hazardous materials emergency or ether disaster as a text message The Health officer and CD program manager have responded to numerous events in the past two years with this system which have included chemical spills, SARS/West Nile alerts, anthrax reports, responder exposure and Others Critical Benchmark#8: What is the status of your department's development of a system to receive and evaluate urgent disease reports from all private and public providers, including laboratories, within your jurisdiction on a 24-hour per day, 7--day per week basis? Choose onty one of the following: �] Development work has not begun (0% completed) Development work has just started (less than 25% completed) E] Development work is underway (26-50% completed) [� Development work is more than half way completed (51-75% completed) Development work is close to completion (greater than 75% completed) El Development work completed (100% completed) 4 System is being tested or is now operational ENHANCED CAPACITY!j-_A Qptionarl}• Rapidly detect and monitor bioterrorist events, other infectious disease outbreaks, or other public health threats by accessing potentially relevant data sources outside the health department by developing new active or sentinel surveillance systems. 9 Projert Year I tol-valot ;Ichievitlq this Critical capacdyfocusiog on hovl/ 1171s 001-V Not applicable. CRITICAL CAPACITY #7: Rapidly and effectively investigate and respond to a potential terrorist event as evidenced by a comprehensive and exercised epidemiologic response plan that addresses surge capacity, delivery of mass prophylaxis and immunizations, and pre-event development of specific epidemiologic investigation and response needs. e -ifical -ogrc achieving this ci • IY- The Epidemiologic response plan for Contra Costa has included the following items: • Hiring additional PHNs for epi work • Expand epi team meetings to include additional staff • Expand surveillance and investigation activities of the PHNs in epi • Develop regular communication with the hospitals and laboratories in the county • Inform all partners of BT/emergency roles of PH initially and on a routine basis • Train PH staff on emergency response and their role in this response • Expand joint activities of Public Health and Environmental Health in epidemiologic investigation and disease surveillance • Environmental Health reviewing all policies and questionnaires related to food- borne investigations • Environmental Health/Public Health attended West Nile Virus seminar provided by Mosquito and Vector Control Contra Costa has continued with .several activities that have been in place to address rapid response to emergent events, including: • Extensive publication and maintenance of the 24x'7 on call system for the use of medical providers on a routine basis and in brochures !utilized by the providers such as our CD/Lab program brochure (updated every 2 years) and the materials developed and distributed for BT/emergency response • Trained all Public Health Nurses in emergency/disaster response and preparedness (training updated yearly) • Visited all hospitals (CD Chief, EMS Director, PH Lab Director) to discuss emergency response, review the individual hospital plan for emergency response and inform of Health Services role in the event of an emergency 10 In addition to these activities the following items have been initiated: • Designated an existing PHN position as .5 BT and hired two additional PHNs who will be assigned to BT/epi on a full time basis • Trained all Public Health Nurses (72) in smallpox vaccine administration and disease recognition • Expanded the Epidemiology and Surveillance team to include all new/funded positions (6-Environmental health, 2 Public Health Laboratory, 6 Public Health and State Epidemiologist via phone). This team will meet 2 times a month to discuss disease issues that are occurring, discuss and implement expanded epi activities, discuss and implement joint activities such as joint visits in food facilities in the event of illness and develop policies and procedures that will address joint and individual activities. This team now includes the BT coordinator who has an active role in the policy/procedure development and in the planning of expansion of epi activities. • Installed and upgraded computer system in the PH laboratory that will link directly with the CD unit to obtain lab results quickly • Investigated various computer systems for field nurses to link epidemiologic findings directly to CD and have more active/real time surveillance. Have not decided on system at this time Critical Benchmark##9: Has the LHD completed its assessment of current epidemiologic capacity? � YES ❑ NO Does your LHD have at least one epidemiologist(1.0 FTE) or staff specifically trained in epidemiology dedicated to bioterroriist and emergency response? � YES ❑ NO Please complete the table below by providing the names, titles and contact information for keyLHD individual(s) who are designated as the LHD's epidemiologic response coordinator: KEY STAFF NAME PHONE NUMBER TITLE FAX NUMBER AGENCY/DEIN AFFILIATION EMAIL ADDRESS 11 LJH staff Name: Francie Wise, BSM, MPH Phone: designated as the ( 925 ) 313 -5740 Epidemiologic Title: Director of Communicable Response Disease Programs Fax: Coordinator: ( 925 ) 313 - 6465 Agency/dept Affiliation: Contra Costa Public Health Email: fwise@hsd.co.contra- Time Base: ?? costa.ca.us CDC is requesting the following information: CROSS-CUTTING ISSUE 42: During the past year, did the public health department conduct any joint or coordinated activities with the local hospital community, including smallpox vaccination planning and implementation efforts, disease surveillance projects, or response to actual disease outbreaks? Ni'YES [. NO 1 if yes, providec, brief description of thejoint public health-hospil"W Or he'--Iflh Gore, SYS/01P L activities and the local heallh (1epadment's role., • PH Director and CD director have made presentations at 3 community hospitals regarding smallpox. • CD Director, BT Coordinator and other CD staff attend Infection Control Nurse meeting bi-monthly to discuss emergency response and the role of PH and the Hospitals in disease investigation and emergency response • Held session with ICNs regarding smallpox vaccinations and PH clinics-- hospitals were invited to participate in smallpox vaccinations administered by the hospitals—a few staff members from 3 hospitals were vaccinated by PH • Vaccinated staff members from State Health department IZ Branch, FBI staff'and DMAT team members in PH smallpox vaccination clinics • Distributed smallpox educational materials to all hospitals in the county this included brochures, videos and information on satellite broadcasts and State of California weekly Smallpox update bulletin • Routinely communicated via email with ICNs as information on smallpox reaction and vaccine information as available—this communication will be ongoing for ether health information and we have utilized this system in informing them of Lyme disease, West Nile and BARS. 12 WRAP-UP (4) Discuss any major barriers you have encountered in Focus Area S this year and steps you have taken to address them. The recent health emergencies (SARS, coming of West Nile) have been very time consuming for all staff in epi and have slowed some of our progress, however this has also given us an opportunity to communicate with the ICNs, community providers and hospitals and to review our emergency communication systems. (5) Describe any plans to incorporate hospital-based surveillance systems into the public health surveillance systems that are being planned. In this next year we plan, with the additional PHN staff, visit all hospitals and laboratories on the routine basis to promote active surveillance and rapid reporting of disease. We will continue to participate in the bi-monthly ICM meeting and schedule hospital staff conferences when there is an emergent need. (6) Do you have any specific technical assistance or training needs related to this Focus Area? We plan to meet with the Center for Infectious Disease Preparedness and discuss future collaboration and opportunities for technical assistance. 13 FOCUS AREA C — BIOLOGIC LABORATORY CAPACITY ''Will 1111111111"M CRITICAL CAPACITY#9: Develop and implement a jurisdiction-wide program to provide rapid and effective laboratory services in support of the response to bioterrorism, ether infectious disease outbreaks, and other public health threats and emergencies. We have visited all of the hospitals and discussed laboratory PH capability, including how to contact the PH Lab in an emergency, what testing is available locally and at the State, and use of the PH Lab courier. We held a workshop for all laboratories in the county to: 1) discuss PH Lab capabilities, 2) provide useful information on what to do if a BT threattagent is suspected; and 3) discuss newly emerging pathogens. We have ongoing, regular communication with the Infection Control Nurses at all of the hospitals in our county to inform of how to submit specimens, and of the tests available and to be available soon for emerging pathogens. We have also developed and distributed smallpox specimen kits to all hospitals. CRITICAL. CAPACITY#10: As a member of the Laboratory Response Network (LRN), ensure adequate and secure laboratory facilities, reagents, and equipment to rapidly detect and correctly identify biological agents likely to be used in a bloterrorist incident. " ,Ct Year I toward achieving these crit, We did not receive approval of our plan submitted in October of 2002 until June of 2003. This did delay some of our activities. Activities We have continued to honor agreements stated in the Work Statement of October 2002. 14 Training • Enrolled three trainees who will be trained to qualify as PH microbiologists after passing required testing • Assisted in training of 3 State PH microbiologists trainees and one from San Francisco County Clinical Laboratory Outreach • See description of workshop in Critical Capacity#9. • Served as the primary contact for the clinical laboratories on emergent event and for emerging pathogens • Work with the Level B lab to distribute materials to the clinical labs, at workshop, through site visits and via email • Acquired and routinely update the list of clinical laboratories and the contact for each • Informed and arranged rooms/satellite link for clinical laboratory education First Responder Cross Training • Have held training for Hazardous Materials specialists on handling of hazardous/potential BT agents • Have not received protocols for cross training of all First Responders, have not proceeded in this task State Sponsored Readiness Assessment • PH Lab has done a thorough safety assessment of our own facility, modified areas of concern and established protocols for entry and surveillance of all high risk areas. Other activities have been delayed in waiting for protocols and direction from the State Laboratory which is the Level B lab to which we respond. Critical Benchmark#10: Has your LRN Level A or Level B Public Health Laboratory developed a plan to improve working relationships and communication between Level A (clinical) laboratories and Level BIC Laboratory Response network labs to ensure Level A corecapabilities (perform rule-out testing on critical BT agents, safely package and handle,specimens, refer to higher level (BIC) labs for further testing)? For LRN Level A laboratories, this plan includes developing communication, training and working relationships with Level A (clinical) laboratories in the jurisdiction, 15 Distributed information regarding B level tab contact to area clinical labs For LRN Level 8 laboratories, this includes a plant to improve communications and working relationships between Level A PHLs and Level A clinical laboratories and building compliance with reporting requirements, coordination of multi-jurisdictional training, and adherence to LRN-approved testing procedures. ❑ YES F] NO If"no"is checked, please describe major barriers; Please provide an update on your PHL's training programs. Please list all staff involved in training of certified public health microbiologists and for safe Dandling and transport of human samples for chemical threat agent analysis. Please indicate the portion of their time devoted to training activities: CDC is requesting the following information. CROSS-CUTTING ISSUE #3. Given the myriad forms that terrorism might take, emergency preparedness requires that different types of analytical laboratories be defined, but also that operational relationships be well defined. Describe any progress made during the Project Year in linking the public health laboratory and hospital-based clinical laboratories. See above. CROSS-CUTTING ISSUE#4. Describe any experiences of the local public health department laboratory in promoting electronic exchange of clinical laboratory results and associated clinical observations with area hospitals or clinics. We have not received direction from the State for collection of this data, i.e. CELDAR. 16 WRAP-UP (7) Discuss any major barriers you have encountered in Focus Area C this year and steps you have taken to address them. (8) Do you have any specific technical assistance or training needs related to this Focus Area? We have not been able to obtain needed CDC reagents on emerging pathogens. We have requested becoming part of the LRN system (level B). 17 FOCUS AREA E — HEALTH ALERT NETWORKICOMM'UNICATIONS AND INFORMATION TECHNOLOGY CRITICAL. CAPACITY#11: Ensure effective communications connectivity among the LHD, the DHS, healthcare organizations, law enforcement organizations, pudic officials, and others as evidenced by: a) continuous, high speed connectivity to the Internet; b) routine use of e-mail for notification of alerts and other critical communication; and c) a directory of public health participants (including primary care clinical personnel), their roles, and contact information. Contra Costa Health Services employees have continuous Internet access on the computers as well as Lotus Notes email. In addition, we utilize Reddinet. Reddinet connects Emergency Medical Services, acute care hospitals via the emergency rooms, the Sheriff's Office Dispatch, American Medical Response and state officials. Communicable Disease also communicates regularly with the Infection Control Nurses via email and fax with information and health updates, and this information, if critical, is posted again to Reddinet to ensure the widest possible distribution. We are currently participating in the CAHAN system as well. Three staff members attendees CAHAN trainings and have trained the initial 12 users in its use. We are awaiting assessment instructions from the State in order to expand usage. Many staff in Contra Costa Health Services, particularly the managers, also get EDIS notifications, on either email or pagers. We have been encouraging people to sign up for EDIS as well as discussing a template for posting EDIS messages to ensure that there is a contact name and number for any message posted by Contra Costa Health Services staff. Here in Contra Costa we also have a Community Warning System (CWS). The Community Warning System was developed originally as a warning system to use particularly in refinery release incidents. However, it is now being expanded to an all- hazard system. Contra Costa Health Services staff has been participating in this expansion. The components of the Community Warning System include sirens, pagers and phones, email and fax, weather radios and the media. One of the main components is the ring down system which is in the process of being upgraded. This ring down system will allow users to make automatic phone calls to lists of pre-defined personnel. Contra Costa Health Services is considering utilizing this capability for health alerts within Contra Costa County, both for specific groups of providers (for instance, Public Health purses or Infectious Disease Practitioners) as well as for the public. 18 Finally, we are also evaluating the use of a software package for our public health directory. Internally developed, PMIS (Provider Management Information System) wouldallow staff to complete and update information on providers in Contra Costa County, including their specialties and contact information. Critical Benchmark#11: Estimate the percentage of your jurisdiction's population that lives in areas that are currently covered by the Health Alert Network. 90% of the public can be reached via the Community Warring System ring down component Critical Benchmark#12: Is your LHD's communication system capable of sending and receiving critical health information (including alerts of emergency event data) among hospital emergency departments, state and local officials and law enforcement officials, 24 hours a day, 7 days a week? 4 YES ❑ NO If"no," please list major barriers: CRITICAL. CAPACITY#12: Ensure a method of emergency communication for participants in the public health emergency response that is felly redundant with e-mail. Contra Costa Health Services employs a number of alternative communication methods. MEDARS is a T-band 4 channel repeated radio system (with hilltop repeaters). This system is used multiple times per day to connect ambulance units with hospitals and County Sheriff's Dispatch. In a disaster, MEDARS is available at the Health'Services DOC to communicate with hospitals and ambulance units. Contra Costa Health Services also has L3 radios, a low-band local government radio channel which, during a disaster, Health Services has priority use. This system is used to connect the DOC with Contra Costa Regional Medical Center (County Hospital) Command Center and additional major county clinics as well as Haz Mat, Environmental Health and Public Health operations centers. Other local government such as'hector Control also can use this system. This system is tested weekly. RACES, the Radio Amateur Civil Emergency Services, has a chapter in Contra Costa. RACES operators are assigned to the County EQC, city DOCS, the Health Services DOC as well as to particular hospitals, and have participated in all drills. The Health Services DCC has RACES communication equipment installed and an antenna, as do some of the hospitals. This equipment is tested periodically during drills. 19 We also have direct line telephone connection capabilities in our DOG and ether operation centers such as Haz Mat and Public Health to connect them to the EOC. In addition, there is an alternate phone system in the county that has no linkage to the public',phone system. This phone system connects the EOC, the County Administrator's Office and each of the cities, as well as the Health Services DOC. Finally, we also have a Nextel phone system which is cell phones with two way radios. These Nextel phones are carried by key county officials, including the health officers and all of the Haz Mat response team. The advantage of this Nextel system is that the healthofficers can conference with responders in the field and obtain information directly from the field. CRITICAL. CAPACITY#13: Ensure ongoing protection of critical data and information systems and capabilities for continuity of operations. Pfovi(Je an update on progress during Project assessilli,e,rits. security practices or other local'Ofoo'llation: A wheeled generator was purchased for Emergency Medical Services to provide power for the Health Department DOC and EMS in the event of a power outage. In addition, the alternate DOC, Public Health Operations, also has uninterruptible power. We have developed capabilities to keep Centra Costa Health Department's web site up and running should a disaster occur. The web site is currently hosted by Pair Networks, located in Pennsylvania. Pair Networks has a back up server as well as emergency power.' In addition, we purchased a Palm with Internet access and we are currently testing the possibility of updating the web site remotely with disaster information via the Palm, in case our web developers are unable to access their computers (due to power outage or impassable roads.) Within the Health Services Department, the Information Services Division operates critical patient care systems as well as communications systems, including email. As far as disaster recovery and continuity of operations goes, we are currently in the process of migrating our point-to-point data circuits to an CSC-3 ATM circuit and two DS- 3 Frame Relay circuits. All of our remote sites will be migrated to either Frame Relay or ATM, and will have redundant PVC's to our disaster recovery site. This should enable all of our sites to .access the systems at our disaster recovery site in the event that our data center is destroyed. We plan to have this project finished by December of this year. We have the architectural plans for our disaster recovery center, and the buildout should begins in the next two months. This site will also have emergency power. Meanwhile, we have purchased several servers to be housed at the disaster recovery site, and in fact, have some of them currently installed at that site. The plan is to be able to duplicate our functionality at that site over time. We already have duplicate 20 Primary Domain Controllers, Domain Name Servers, WINS Servers, Lotus Notes Servers, a duplicate server for our Appointment system, a duplicate server for our patient billing system, duplicate servers for our Lab and Pharmacy systems, and a duplicate server for our case management system for our Health Plan. Planning for additional systems, including the Public Health Laboratory system, Diaz Mat, EMS and Environmental Health, will begin shortly. In order to increase security, our IS Division will be installing biometric door locks in the data center in the next month. We are also implementing biometric logons for one to two thousand of the PC's In the department, primarily in the hospital and clinics. We are exploring iris scanners as well. CRITICAL CAPACITY#14:_ Ensure secure electronic exchange of clinical, laboratory, environmental, and other public health information in standard formats between the computer systems of public health partners. Achieve this capacity according to the relevant IT Functions and Specifications. Provide ao tjp(lafe on progress dinving P1,0ject Year,/ howat'd achieving this cl , Cal ies to We are in the process of evaluating software that will capture patient information, including case management and surveillance. This software will hopefully allow Contra Costa 'Health Services to exchange data within divisions including incorporating lab results. We have seen three demonstrations of software packages and are exploring additional vendors. Part of the evaluation will be inquiring about PHIN compliance. We also purchased and installed an upgraded lab computer system and are installing electronic transmission of lab results to Communicable Disease. WRAP-UP (9) Discuss any major barriers you have encountered in Focus Area E this year and steps you have taken to address them. One major barrier has been our connection with our Information Services Division. Due to other, competing priorities, it is only recently that we have been able to make contact with the person who is charge of disaster planning and recovery for computer systems in the Health Department. Now that we have Identified this person, we will be incorporating this person into our Sioterrorism Advisory Croup, assessing and developing joint protocols for systems, and asking advice and guidance on technical areas including data security and recovery (10) Do you have any specific technical assistance or training needs related to this Focus Area? 21 We are Waiting for the CAHAN assessment process with the hope that we can use it not only with CAHAN but for an overall assessment of notification of partners and public in our county, regardless of whether we use CAHAN or our internal Community Warning System ring down capability or both. FOCUS AREA F - RISK COMMUNICATION AND HEALTH INFORMATION DISSEMINATION (PUBLIC INFORMATION AND COMMUNICATION) CRITICAL. CAPACITY#16: Provide needed health/risk information to the public and key partners during a terrorism event by establishing critical baseline information about the current communication needs and barriers within individual communities, and identifying effective channels of communication for reaching the general public and special populations during public health threats and emergencies. Provi'de an update on P'rogress duning Project Yea!-I toward achieving this Critical "Y' focusing In order to understand the current situation and uses of emergency communications systems here in Contra Costa, we conducted an analysis of systems in use for both the public and providers. This analysis is attached and was presented to senior management in the Health Department. The analysis demonstrated that there are many systems in place, although they are not coordinated and gaps still exist. In addition, with so many systems, it has been easy for messages and information to be confusing and not reach the appropriate people in all cases. Based on this analysis, a Risk Communications Committee was formed with these main goals: • Recommend how to collect accurate information internally • Recommend how it should get out to the public • Provide input on content of emergency website • Standardized EUIS template • How to organize the DOC PICS function in coordination with the EOC • Updating incident maps including Shelter-in-Place areas so that they can be given to the media and public • Review and recommend communications systems This Communications Committee has been meeting monthly since January 2003 and is led by our Communications Officer. Participants are drawn from Hazardous Materials, Environmental Health, Information Systems, Public Health, EMS, Community Warning System and the Crisis Center (a non-profit that has a call center). Topics that have been discussed include: the information flow that the Haz Mat staff currently use, the 211 system, establishing a call center for the public in a health emergency, the Community Warning System and how it may be used in a health emergency and the establishment and use of a Employee Emergency Hotline. 22 In the Community Education and Information Program here in the Health Department, we have been focusing on implementing different communication strategies, both to ensure we reach as many people as possible in a health emergency and that messages are consistent and coordinated amongst different agencies. Some of the strategies we have employed include: • Establishing and continuously adding to a fax blast system which reaches 192 community-based organizations throughout the county • Contacting and connecting with the PIOs in all the hospitals and cities • Improving, maintaining and updating our websites (www.cchealth.or , www.goublichealth.org ) with current information on potential and existing health emergencies • Meeting with PIOs in other departments in the County such as OES to develop county-wide strategies and tools • Expanding the language capacities that are available by identifying two Environmental Health Inspectors that would assist in an emergency and hiring a full-time Spanish-spearing health educator(within this program, we also have staff who speak Farsi, Tagalog and Japanese) • Creating and producing six television shows in Spanish on disaster preparedness and specific health topics such as smallpox and West Nile Virus that were aired on our local cable channel • Creating and producing a television show about the County's Community Warning System • Created go-kit of critical phone numbers and fact sheets such as Frequently Asked Questions of bioterrorism agents • Convened a committee of Contra Costa Health Services key managers to prepare consistent media messages • Scheduled CDCs Barbara Reynolds to train managers and other key staffl • Assessed the functionality of the county Health Services Department and also Public Health website and identified areas for improving the usability • Conducted a survey of community groups to determine how they would like to receive bioterrorism information and created a newsletter • Began participating in the County's Emergency Public Information team to create a PIO infrastructure Critical Benchmark#13: What is the status of your risk communication purr? Choose on one of the following [ Work on plan has not begun (0% completed) Work on the plan has just started (less than 25% completed) Work on the plan is underway (25-50% completed) [ Work on the plan is more than half way completed (51-75% completed) Work on the plan is close to completion (greater than 75% completed) El The plan is completed (100% completed) ❑ The plan is completed and has been adopted 23 WRAP-UP (11') Discuss any major barriers you have encountered in Focus Area F this year and steps you have taken to address them. A major barrier has been our lack of ability to communicate with communities who do not speak English primarily or at all, especially in a situation that requires timely, constantly updated information. Also, in working out an MOU with the call center in another department, we are faced with the problem of staffing in other languages. Here in Centra Costa Health Services, we have a program called Limited English Access Program (LEAP) which has staff that speak 11 different languages, including Mandarin Chinese, Cantonese Chinese, Vietnamese, Farsi, Dari, Russian, Lao, Thai, Mien, Khmu and Spanish. We are exploring the possibilities of utilizing this staff in a health emergency, for instance, to staff a call center to respond to calls from the public or to record informational messages. A second barrier has been developing contacts with Spanish-speaking media and informational messages in Spanish. This has been somewhat remedied by hiring a full-time Health Educator who has been invaluable in putting together timely information for distribution to Spanish-speaking media and to post on the public website. She has also been working on identifying more Spanish-speaking media outlets and developing Spanish-speaking educational programs about disaster preparedness and particular health emergency topics. For the first time in the history of Contra Costa Health Services, we were able to hold a press conference in both English and Spanish simultaneously. (12) Do you have any specific technical assistance or training needs related to this Focus Area? It would be helpful to have the State define and develop a system of mutual aid for P10s, in the same way other mutual aid agreements and systems work throughout the State and nationally. FOCUS AREA G— EDUCATION AND TRAINING CRITICAL. CAPACITY#16: Ensure the delivery of appropriate education and training to key public health professionals, infectious disease specialists, emergency department personnel, and other healthcare providers in preparedness for and response to bioterrorism, other Infectious disease outbreaks, and ether public health threats and emergencies. ing Pi -d achievilly this Critical 24 We have done training assessments in particular areas, including bioterrorist agents, disaster preparedness, smallpox and SARS. When we determined that more training was necessary, we provided it. For instance, during the fall of 2001, the medical diretor of EMS developed a training program on bioterrorism agents and we trained more than 400 people. This training was developed into a 70-minute television show called "The Health Department Talks About Bioterrorism." We broadcast this show to the public on our local cable station and it subsequently won a "Telly" award. This award was founded in 1980 to recognize non-major network.TV commercials, film and video. Additionally, after the anthrax event on the East Coast, our EMS Director, Public Health Lab Director and Communicable Disease Control Director visited every hospital in the county to train them about anthrax. In the case of smallpox, we trained 72 Public Health Nurses in Contra Costa health Services. We also offered training via satellite link, video tapes and CDs to the Infection Control purses in the hospitals in both Alameda and Contra Costa counties and visited 3 hospitals to provide training to medical staff about the disease, vaccination and adverse events. We recently hired two Public Health Nurses for bioterrorism who will provide guidance to the Bioterrorism/Health Emergency Coordinator about training curriculum for providers. In addition, BT staff attended the open house of the UC Berkeley Center for Infectious Disease Preparedness and look forward to working with them on this issue. We also have attended many trainings put on by the CDC, State, FBI and other entities about smallpox and bioterrorism issues. We are identifying which of these trainings would be useful to staff throughout Contra Costa Health Services and making arrangements for them to attend. For instance, bioterrorism staff attended the Risk Communication training by Barbara Reynolds of the CDC. We decided that all senior managers in Contra Costa Health Services could benefit from this training, and have arranged for Barbara Reynolds to come to our county in August 2003. We have also identified that Contra Costa Health Services staff are in need of additional training to be able to staff the DOC appropriately. For this reason, we are working with County QES to provide training and will follow up with specific training directed at staff who would be mobilized in a health emergency, to ensure that staff understands their roles and responsibilities. Critical Benchmark#14:What is the status of your department's assessment of the training needs in preparedness for and response to bioterrorism/emergency events for public health and private health professionals? Choose only-one of the following. ( Assessment work has not begun (fl% completed) Assessment work has just started (less than 25% completed) 25 �1 Assessment work is underway (25-50% completed) (] Assessment work is more than half way completed (51-75% completed) F] Assessment work is close to completion (greater than 75% completed) Assessment work completed (100% completed) CDC has requested the following information: CROSS-CUTTTING ISSUE#5. Describe any training plans being put in place that will ensure that LHD staff and those in hospitals, community care centers, emergency response agencies, and public safety agencies are aware of public health resources and know what their duties are and with whom they will interact during a bioterrorist attackor other public health emergency. During our visits to every hospital in the fall of 2001, we discussed the public health response to a bioterrorist attack and instructed them in who to contact in the case of an emergency. By having the EMS Director, the Public Health Lab Director and the Director of Communicable Disease there, we were able to answer many questions about who fills which rale. We also participated in a training for individuals involved in grief counseling, including hospices, called Caping with Grief. Our PIO discussed the public health response to a disaster and educated participants about our ongoing efforts. With the hiring of the Bioterrorism Coordinator, and the ongoing meetings of the Bioterrvrism Advisory Group, we have increased the visibility of Centra Costa Health Services in regard to a bioterrorism incident as well as other health emergencies. Training has also happened as the Coordinator and ether bioterrorism staff in Communicable Disease, Environmental Health and the Public Health Laboratory become more knowledgable and are able to communicate this knowledge to staff of other agencies in formal and informal ways. CROSS-CUTTING ISSUE #6: If applicable, describe any activities underway or planned that will directly involve nearby academic health centers in your education and training activities. We plan to meet with the UC Berkeley Center for Infectious Disease Preparedness to get some assistance with the assessment process as well as implementation of trainings Dere in Contra Costa. WRAP-UP (13) Discuss any major barriers you have encountered in Focus Area G this year and steps you have taken to address them. 26 There have been so many important health emergencies that have required our attention in the last year that it has been difficult to find time to do the ongoing work or do a broad, more formal assessment of training needs. However, these different health emergencies have also provided us with the opportunity to establish ourselves as a resource for future health emergencies and to provide education about the role of Contra Costa Health Services in responding to such emergencies. (14) Do you have any specific technical assistance or training needs related to this Focus Area? Yes, we need assistance with the training assessment process as well as creating a training plan for health care providers. 27 Smallpox Preparedness or zirt;i # 0Update 0 H Ith Services ubwmoreoMsfsmaNpupreparsft"socMos GONUMadonfrOMMS Cdftnft Doeartaeentt et Ife le Serdess wins i t preerams fired pa € eat maY a er- atlat. 7W$eommme "is I Nem lot ft eras t & ,Pt d 2W I0 Date: July 11, 2003, Issue 23 Number of Volunteers Vaccinated with Smallpox Vaccine (as of COB 7/4/2003) emumulative ublic Health Healthcare Other Hospitals where esponse Response (FBI, DIVIAT, vaccination has Total earns Teams HAZMAT) started DHS ,611 786 661 164 48 2 updated) 2 updated)' (0 new) (0 new) (0 new) Los Angeles 238 70 127 41 19 National 37,875 11,789 24,204 1,882 2,129 *2 PHRT vaccinations that took place in May were reported late to DDHS PVS update The most recent crass-match of PVS records with reported vaccinations indicate that only 60% of vaccinations given are currently recorded in PVS. Twenty-nine local jurisdictions apparently have records not recorded. The PVS consultants will contact and work with these programs to achieve full entry. It is important to have full documentation of those personnel who were vaccinated. Number of Number entered Variance (Not vaccinations into PVS recorded in PVS)_ 1611 961 -648 60% -40% Planning Ucdate The planning update section will provide summary information on past, current, and future planning activities at the state and local levels. Training information and other support activities will also be highlighted. If you are interested in having information featured in the Smallpox Planning Update, please contact Dr. Relda Robertson-Beckley, Smallpox Planner, at 510-540-3324 or rrobert1 c.dhs. .,go S'mallpo'x Preparedness eatif ;aUpdate Ik�pu�trt�nrnt Health Serai+.°rs YWwmftt*W olftapa pmMdain W W IN MUM0144#naffs 0011nis 6epsttme O Neff MMus tooWn WOUNIN 81016afts SPA ttiaitmobs$o ntoofGoadeatiotthisso�taoaishEioablatosdoAoxsi�reisiOrthsusoeliosdhostih mato.shouNibocoas d�»Mi�tYod,ffw�i b t1Y 28�lf PwI ds Current Smallpox-Planning Activities.at the CI3HS # mun#zat on Brat— Smailpox planning activities have focused on developing the smallpox guidance for the local health jurisdictions. Smallpox critical capacities are required activities and are smallpox funding specific. The theoretical and applied framework for the smallpox guidance focuses on smallpox preparedness. The on-going preparedness elements that should be addressed are. 1. Preparing key responders before an event occurs. 2. Rapid detection, identification, investigation and response to suspect or confirmed cases',of smallpox. 3. Protection of the public including provision of mass vaccination clinics. A a -Needles for,fflily of BaedTraining CDHS is trying to obtain as many bifurcated needles as possible for training by local health departments. CCC does not currently have sufficient supply and has indicated that the manufacturer of the new individually packaged needles has only enough manufacturing capacity to produce any needles for their existing contracts with CDC and Acambis to provide enough needles for new vaccine production. They do have a limited supply of shaker tube needles that are being replaced by the individually packaged new needles. However, they are aware that states will require additional needles for mass vaccination training. We will try to secure as many as possible for California. Casts of Smallpox Vacc#nation Pmram A I�ildi.iW ®IIA �lYYM01 PiY iYI�Y? NACCHO Research Brief The National Association of County and City Health Officials (NACCHO)worked with nine regional public health agencies during January-March of 2003 to define the costs incurred in planning and implementing the smallpox vaccination program Analyses of actual and estimatedcosts were reported for implementing three program components: community mobilization and preparation; vaccination clinics and follow-up care and surveillance. Costs incurred included labor cost, products(educational material), data entry, data analysis, communications, information technology and reporting and materials used such as alcohol swipes, bandages, and computers. NACCHO estimates the cost of all three components per person vaccinated ranges from $154 to$284, with the mean cost of$204 per person. The research conclusions noted that the data demonstrates that the per capita costs of smallpox vaccination is substantial and that expanding the program will consume far greater resources than had been estimated thus far. The study concluded that sustaining a defined number of vaccinated individuals to serve every community will require additional expenditures dedicated to smallpox vaccination for an indefinite period of time. For more information on Research Brief 10 contact:www.naccho.oro. Smallpox Preperede Update TpliMt#i�flDiM�tl$Ip�11t�pNi�iii3 iClNl�i�t ilif i110�1tiik CdHit'ili Dii�ltbt Hiil�liilfl�Cit Ciptilii TIp�Itfi1ti�NtiiCiBli illd i�i� iii Iii 3i�ti 6i Lii1i�l .T�Giiii�iCitEii tE Mdi�lir tpi tBi i1 iigi hititll dipYtttiiiti.liOldd ii 09Niid#ICid i�iifA L 3�fttt,t4�8 ViYi�td� Devartment of Defense {D!2D)Training Web-caste CE Credit now available for on-line smallpox training: Complete one of the on-line smallpox training modules& receive Uniformed Services University of the Health Sciences (USUHS) sponsored Continuing Education Credits (CME, CNE &ACME). More information available here: hft:l/www.smalIL)ox.mil/digiscrigLc2.aso Smallpox. Individual's Briefing. A multimedia version of this updated presentation is now directly available on-line according to DOD. This presentation given by COL Randy Randolph, Director, MILVAX Agency, is suitable for all audiences prior to vaccination. hftp://smailpQxdiaiscrit)t.com Smallpox. Healthcare Provider's Briefing: A multimedia version of this updated presentation, which is directed towards medical health care professionals, is now available in the "Briefings" section of the DOD on-line training library. This presentation is given by COL John Grabenstein, Deputy Director Clinical Operations, MILVAX Agency. You must complete the full registration to view this presentation. httalldod.diniscriiot.com Smallpox Resources The CDC has provided extensive information on smallpox and smallpox vaccination on their Public Health Pre tiredness and Emer enc Res onse Web site. Links to key selected items/documents follow: • Smallpox Vaccination Overview for Clinicians • Clinical-Evaluation Tools for Small ox Vaccine Adverse Reactions • Small cox Vaccination and Adverse Reactions: Guidance for Clinicians(MMWR 2003;52:1-19) • Smallpox Pre-vaccination Information Packet(for prospective vaccinees to help them in decision making; includes the vaccine information statement) • Smallpox Vaccination Method • Smallp-oxImenes • Weis-casts and nide sets • Specimen Colles for Vaccinia Virus • Guidelines for Smallpox Vaccine Packing and Shiooino Smallpox Preparedness cf; ix Update f fish S r ices lfrfsyyYeifdytiierfif#eI INi9fdfipetirpli�eiWFtlifiidfrrlerrasden ffeerffriOffe"Wasi iefefNeaukSelSimsermnfefermeffeeeeiremmsad Pon"maim iocetser6 Tfds eetlesfsdoetdfiiciMUMOrmfe"and eerOMINretedfrlriir. jon2eu fft"iefo Software for Mass Vaccination Planning Two software programs have became available to aid in mass vaccination planning. 1. Maxi-Vac is a program that can be used by state and local public health officials to plan optimal large-scale smallpox vaccination clinics. The program can be downloaded (for free) and the user can then enter the number of human resources available to operate a clinic (e.g., physicians, nurses, cleric staff). Maxi-Vac will then allocate those staff among the pre- designated required activities that will result in the maximum patient flow-through. The software may be downloaded and the manual accessed at hfto:l/www.bt-cdc.,-Qovia-gents/smallpox/vaccination/maxi-vact A second version of the software will be available later this year. For more information contact Michael Washington at mwashin-qtoa@cdc.gov or(444) 639-8800. 2. A new computer model is available to help hospitals and health systems plan antibiotic dispensing and vaccination campaigns to respond to bioterrorism or large-scale natural disease outbreaks. The model was funded by the Agency for Healthcare Research and Quality(AHRQ)and developed by researchers at Weill Medical College of Cornell University after testing a variety of patient triage and drug dispensing plans in New fork, Washington D.C. and Arizona. Thousands of volunteers were given fake drugs during disaster drills in response to a hypothetical anthrax attack. dements were taken from these planning models to develop two best practice dispensing clinic designs that could be used in the event of a bioterrorism attack, including anthrax and smallpox. This project is part of a larger initiative of the U.S. Department of Health and Human Services to develop public health programs to address bioterrorism concerns. This new resource is the Nation's first computerized staffing model that is downloadable as a spreadsheet or accessible as a Web-based version. It can be used to calculate the specific needs of local health care systems based on the number of staff they have and the number of patients they would need to treat quickly in a bioterrorism event. The new computer model allows health care systems planners to estimate the number and type of staff required to operate these clinics in order to provide an entire community with critical medical supplies in an efficient and timely fashion. The model can be downloaded to run on common spreadsheet software and customized for use by health officials at all levels of government, hospital administration, and emergency medical planning. htto:/Iwww.ahro.gov/research/biomodel.htm. Smallpox Preparedness mpaat►atUpdate [�rerr fkalth gfvka am Wo"Is"11013 +l"lrriM+n"Unsomm"awhomft Ino the Odom" "4111"M$o an umrr abralfts a 0"11M end t> I ri a c"ftwWj rosommultaft It ftsW Sr NOWtar#hemt WMI hadthUMMIKshobs Wol isod o it "K ad Vd*MNW n2003 ft"5d# OTHER N08LS Strengthening Our Ability to Respond to Public Health Emergencies: Information Technology (May, 29133): The General Accounting Office (GAO) recently completed a report on the role of information technology and public health emergency response. The GAC}was asked to identify federal agencies~ information technology initiatives to Support the nations' readiness to respond to bioterrodsm. The GAO inventoried a wide range of activities and identified the use of health care standards in the initiatives identified. Six key federal agencies involved in bioterrorism preparedness and response were assessed. There were 70 planned and operational information systems in a variety of IT categories linked with supporting public health emergency. Based upon a comprehensive analysis of the data, the GAO recommends that HHS and other stakeholders develop a strategy that includes setting priorities for IT initiatives and coordinating the development of IT standards for health care. To view the full report contact 11MW.Qa�o.9oK/ i-binlaetrot. Influenza'as a Sloterrorist Agent: Sequencing of the influenza strain that caused the 1918 flu pandemic, which was responsible for the deaths of up to 40 million people, is nearly complete. Researchers warn that terrorists could use the information to create a virulent strain of influenza and unleash the virus as a bioterrorism weapon even more deadly than anthrax or smallpox. Influenza virus is readily available and the genetic manipulation is not technically difficult. The virus can be disseminated as an aerosol and has a short incubation period, allowing for widespread dissemination and impact before a vaccine could be developed. Contra Costa County: Crisis Communications Session: We are delighted that Barbara Reynolds, Senior Risk Communications Coordinator with the Centers for Disease Control and Prevention will be in Contra Costa in August doing several presentations on Risk Communications that could help all of us during a crisis. There will be a special session on August 6 from 2-4 p.m. in Martinez (more specific information will be available when we know how many people are planning to attend). The session will focus especially on the Psychology of a Crisis and the role of the spokesperson, using real-ife examples. If you are interested in attending, please RSVP to: Julie Freestone Communications Officer Smallpox Preparedness tllfs wooi�ff tof f offi f1fe91i�9alS a lAfff�f�fi ttu Or�€anN� IMMU880114mosewas Y9Nslfif[sffgl�iitoCit�Bio6Mf9bHHit1lds000l oUenfofIIABSdpIl90CI�E1Yi1!Nrtfli�fiof["mu sft"MW# atdtoLolWdendittfldfeQalcad MM2003 has 6 of a Contra Costa Health Services 925-313-6268; fax 925-313-6219 597 Center Avenue Suite 255 Martinez, CA 94553 Alameda County Department of Public Health #Conv of Alameda County Press Release LIVERMORE, Calif. - Locked in a "war room"for a day, representatives from Sandia National Laboratories and 24 other officials, mostly from the Alameda County Public Health Department (ACPHD), teamed up recently in a simulated bioterrorism event to evaluate Alameda County's ability to respond quickly and effectively to a weapons of mass destruction incident such as anthrax, and to test a disaster response and planning tool designed by Sandia. ACPHD got a chance to test drive Sandia's tool before it is presented at the Centers for Disease Control and Prevention (CDC) in Atlanta in July. Other participants in this"table-top exercise" included Contra Costa Health Services, City of Berkeley Public Health Department, Highland Hospital, Kaiser Oakland Hospital, California Department of Health Services (DHS), Alameda County {office of Emergency Services, and the Federal Bureau of Investigation. "The scenario, while vast in scale, was quite realistic," said'Tony Iton, MD, JD, MPH, who participated in the exercise. "The exercise re-emphasized that the core components of bioterrorism response are surveillance, disease control, communication, and coordination. The Sandia folks have developed an excellent tool to help local public health agencies test drive their response plans." Dr. Iton is the Alameda County Health Officer at ACPHD. Dr. Iton was also pleased to work with such a large collection of bioterrorism experts. "The benefits of the planning process are in establishing relationships and understanding what our various roles are," he said. It was far more helpful than handing out business cards to collaborative agencies, agreed Jim Morrissey, EMT-P. "It was much better to actually meet the related disaster staff in-person and to work with them side by side to provide a more efficient, interagency effort with the hopes of then having this become standard in the real events," he said. "I feel this was a tremendous opportunity to not only test out the Sandia system with them but also to try our combined skills and expertise in a particular type of simulated event." Morrissey is a disaster coordinator with the Emergency Medical Services division of ACPHD. Sandia is a Lockheed Martin company that does research and development for the U.S. Department of Energy in national security, energy and environmental technologies, and economic competitiveness. In a disaster situation, ACPHD coordinates the county-wide medical response, shifting around county staff and resources to stabilize the situation. The two organizations got together to test ACPHD's readiness to respond to a disaster, since smallpox Pro pare dil a SS Vv= Mt Update �u►rtm� t citith Scrvkvs 40 1Hs�tr�of'tit t�9uedt�t� 3� 1e�s�1l9�I�n11i9�rrr�totle#�CnNblN�ki O�ir�r �lurd Oolk that wy to Ctlil us sib"11"t 1 deptlu u*oom 116 CONSWI*i 11#004"d AMMON" 1ftn"N ft"1814 Sandia had developed a decision analysis computer program that helps assess bioterrorism preparedness. For this 6-hour drill, participants gathered in Sandia's Visualization Design Center, where information was displayed and updated via maps, charts, and text on three large screens lining the walls. representatives from Sandia`s Weapons of Mass Destruction-Decision Analysis Center{WMD-DAC} described an increasingly severe, simulated scenario involving highly infectious, weapon-grade anthrax released in the marina area near Berkeley, California. Participants were asked to imagine that it was January, the weather was cloudy, the country had recently gone from"code orange"to"code red,"and there was a spike in the number of respiratory illnesses in Alameda County. What to do? Participants, in groups of 4-6 people, had eight minutes to decide how to handle the situation and discuss it in their groups. Groups made numerous decisions, including asking hospitals to be on the alert for unusual symptoms and to reschedule elective surgeries, increasing security in Alameda County, and getting an inventory of prophylactic drugs. But then, the Sandia representative described, the situation got worse. The "spike"turned into 35 cases of similar respiratory illness that were "suspected"to be anthrax. Groups made more serious decisions, including treating the affected individuals with antibiotics, investigating the cases, conducting press briefings, and communicating with the CDC and the state DHS. During the next 24 hours modeled in the scenario -requiring just a few minutes of computer simulation time -the situation got even worse. The 35 cases were confirmed as anthrax and 613 more "suspect" cases were reported. In talking again, groups made many decisions that included holding more press briefings, issuing news advisories, and closing all schools in Alameda County to set up clinics and administer prophylactic drugs. Participants spent the morning in the simulation exercise. They spent the remainder of the day evaluating and reviewing the exercise. ACPHD was not the only group to benefit from the experience. "I feel like we definitely learned a lot," said Howard Hirano, a Sandia manager who arranged the visit. "And thatts the point of 1l MD-DAC -to provide a teaming triol for decision-makers who are tasked with protecting us and responding to potentially catastrophic events." Launched in early 2001, the MD-DAC bioterrorism simulation engages the perspectives of many decision-makers as they seek to deal with a complex event that unfolds over days, having to make decisions along the way with incomplete information. Sandia researchers began with the premise that it was only a matter of time until the U.S. suffered a terrorist attack, and it would be wise to be prepared for one. __ .................................................. Smallpox Preparedness Heihh imkcs T#IdwceRhrrepartais arl ae�p "Mm am irent"eam"WeDoWN OU"Se scext+ftwOr ON0"UsAW 6eilcY t9ctBi 9e cecerc er ccnfEd�►Bat ThF3 centcgcfictce 1s tuncdal sldttvtkr# e uct tt leCi• It dtYitt 36e�1d E�ceutd�itdNNd twd Ild�dNid�rl�!f�i: There are several ongoing projects to test enhancements to the models, according to Hirano. Epidemiological worts by Los Alamos National Laboratory and a model for atmospheric releases created by scientists at Lawrence Livermore National Laboratory are being incorporated. A nuclear terror scenario has also been developed. Another feature in the works is to allow health officials to track the spread of diseases, such as smallpox, that spread person-to-person. Recent news coverage of the rapid worldwide spread of SARS underscores the importance of this capability. In addition to two Bay Area models -this Alameda/Contra Costa County model as well as a San Francisco model -a third model involving a simulated bioterrorism attack on the 1.5 million residents of New Mexico - is nearing completion. Sandia's main facilities are in Albuquerque, N.M., and Livermore, Calif. ACPHD is based in Oakland, Calif.