Disasters and CDC Operations
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Disasters and CDC Operations

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Disasters and CDC Operations Disasters and CDC Operations Presentation Transcript

  • Disasters and CDC Operations Dahna Batts, MD, FACEP Acting Team Leader Disaster Epidemiology and Assessment Team Health Studies BranchDivision of Environmental Hazards and Health Effects National Center for Environmental Health
  • Session Objectives Review types of disasters and potential public health impacts Review procedures for Federal government response to disasters Describe CDC’s Emergency Operations System Describe the types of assistance CDC can provide to local & state health departments after a natural disaster or emergency
  • What is an Emergency?An Emergency is , “An unexpected, serious occurrence or situation urgently requiring prompt action.” - Webster’s II, New Riverside Dictionary
  • Is it a Disaster? Hazard: not a disaster in itself, but a factor causing the disaster Emergency: not a disaster in itself, but an event requiring immediate response Disaster: overwhelms the affected community and requires outside assistance All have the potential for negative human impact
  • Disaster TypesTechnological Natural “Complex” Disasters or Disasters Disasters Terrorism acts
  • Natural Events Climate related  Hurricanes  Severe Flooding  Tsunamis  Cyclones  Tornadoes  Ice Storms  Severe Heat
  • Natural Events Geologic  Volcanic Eruptions  Earthquakes  Landslides  Avalanche Other  Disease Outbreaks  Drought  Fires  Famine
  • Human-induced Events Technological/Industrial  Radiation  Hazardous Chemicals  Oil  Biological  Deforestation  Transportation  Material shortages
  • Human-induced Events Terrorism  Chemical  Biological  Radiological  Nuclear  Explosion Bioterrorism
  • Complex EmergenciesA humanitarian crisis in a country, region or society Caused by internal or external conflict Breakdown in effective authority Requires an internationalresponse exceeding thecapacity of any single agency
  • What is the Risk? Nuclear Natural Weapons BiologicalImpact Improvised Radiological Device Chemical Explosive Incendiary Probability/Likelihood
  • Public Health Response “All Hazards Approach” The techniques and strategies used today in public health emergency planning for the most part transcend terrorism and can be used in any public health emergency. Some differences can include:  Lead agency  Size and Scope of Response  Risk Communication Messages  Evidence Issues  Psychological Impact
  • Priority Public Health Issues Safe Food/Water Shelter Health/Medical Care Safe Environment Communication
  • All Disasters Begin Locally!  Initial Detection  Initial Response  Initial RecoveryLocal Preparedness Is Essential
  • When Outside Assistance Required
  • Government Response to a Disaster DHS CDC USAMRIID DHHS FEMA DoD DoT NIH PHHSUSDA C/B-RRT SBCCOM FBI EPA ATSDR ? AIT NRL NMRI DoE
  • How We Respond: National Response Plan (NRP)The NRP was developed to align Federal coordination structures, capabilities, and resources into a unified, all- discipline, and all-hazards approach to domestic incident management.NRP incorporates: Federal Response Plan Federal Radiological Emergency Response Plan Terrorism Response Plan
  • NRP• Signed by 29 Federal Agencies, American Red Cross, National Voluntary Organizations Active in Disasters and Corp for National and Community Service• All hazards approach adopted in April, 1992 and revised in 1999 (FRP); replaced by the NRP December 2004 as directed by HSPD-5 and the Robert T. Stafford Disaster Relief and Emergency Assistance Act• Response organized under the Incident Command System structure and National Incident Management System NIMS (interoperability and compatibility between Federal, State, and local capabilities)
  • NRP Cross-walk with State Emergency Response Plans- Local Plans Brings resources including people, supplies, equipment, and funding Organizes the response into 15 Emergency Support Functions or ESFs with a lead agency and support agencies Components: •Base plan describing the structure and process •Appendixes providing supporting information •Support Annexes providing describing the functional processes and administrative requirements •Incident Annexes address contingency or hazard situations requiring specialized application of the NRP
  • The 15 ESFs 8. Public Health and Medical Services1. Transportation Department of Health and Human ServicesDepartment of Transportation 9. Urban Search and Rescue2. Communications Federal Emergency Management AgencyNational Communications System 10. Oil and Hazardous Materials Response3. Public Works and Engineering Environmental Protection AgencyU.S. Army Corps of Engineers 11. Agriculture and Natural Resource4. Firefighting US Department of Agriculture/Department ofDepartment of Agriculture/Forest Service the Interior 12. Energy5. Emergency Management Federal Department of EnergyEmergency Management Agency 13. Public Safety and Security6. Mass Care, Housing, Human Services Department of Homeland Security/JusticeDepartment of Homeland SecurityAmerican Red Cross 14. Community Recovery, Mitigation, and Economic Stabilization7. Resource Support U.S. Small Business AdministrationGeneral Services Administration 15. External Communications Federal Emergency Management Agency
  • ESF #8 – Public Health & Medical Services Coordinated by Secretary HHS through Assistant Secretary for Public Health Emergency Preparedness (ASPHEP) Core Functions: 1. Assessment of Public Health and Medical Needs 2. Health Surveillance 3. Medical Care Personnel 4. Health/Medical Equipment and Supplies 5. Patient Evacuation 6. Patient Care 7. Safety and Security of Human Drugs, Biologics, Medical Devices, and Veterinary Drugs 8. Blood and Blood Products
  • ESF#8 Functional Areas10. Agriculture Safety and Security11. Worker Health/Safety12. All-Hazards Public Health and Medical Consultations, Technical Assistance, and Support13. Behavioral Health Care14. Public Health and Medical Information15. Vector Control16. Potable Water/Wastewater & Solid Waste Disposal17. Victim Identification/Mortuary Services18. Protection of Animal Health
  • Mission Assignment System Federally Declared Disaster Local Emergency Local Health Needs Management AgencySupplies, equipment, people Mutual Aid State Emergency Management Agency FEMA State Health ESF #8 Mutual Aid DHHS EMAC
  • US Federal Government Civil Department Commissioned Service of Health CorpsPersonnel and Human Officers ~54,000 Services ~6,000 PHS Non-PHS Agencies Agencies OS ACF BOP USCG AOA AHRQ EPA NOAA ATSDR CDC USMS NPS CMS FDA DOD HRSA IHS NIH PSC SAMHSA
  • CDC Emergency Preparedness and Response Strategic PositionVision Statement: People protected – public health prepared.Mission Statement:Prevent death, disability, disease and injury associated with urgenthealth threatsby improving preparedness of the public health system, the healthcaredelivery system and the publicthrough excellence in science and services.
  • CDC/ATSDR Emergency Response Resources Specialized Strategic Technical Specialized National Consultation Laboratory Stockpile and Support (SNS) Expertise
  • The Initiation Point: The Director’s Emergency Operation Center (DEOC) Serves as CDC’s incident management center Monitors CDC/ATSDR’s involvement in major public health events IS YOUR LIFELINE TO CDC during an emergency 770-488-7100 – 24 hour emergency contact number
  • CDC’s Emergency Response System 24 hour EOC (770 488-7100) Emergency Response Coordinators  Experienced in local, state, and federal public health programs  Coordinates CDC response  Support state/local responders from Atlanta or on scene Preliminary Assessment Team  Multi-disciplinary
  • CDC/ATSDR Response Assist state and local health departments and other agencies with public health functions Collecting data  Lab samples  Review clinical cases  Surveys Analyzing and Interpreting results  Identify agent  Assess extent of damage or contamination Developing recommendations based on those results  Medical management guidelines  Worker protection methods Evaluating processes
  • General Public Health Effects of a Natural Disaster Unexpected Numbers of Deaths, Injuries, Illnesses exceeding local capacity Destruction of local health infrastructure Spontaneous population movements Interruption of communication Power outages Food/Water Shortage or Safety Inadequate Sanitation Environmental Effects Psycho-Social
  • NCEH HSB Disaster Epidemiology Activities: Rapid community health and needs assessment Surveillance  disaster-related morbidity and mortality  evaluation of existing morbidity related to the disaster event Descriptive and analytic investigations - environmental exposure assessments - special surveys, e.g., health care needs, identification and evaluation of program interventions - analyses of risk factors for adverse health outcomes Training and consultation
  • Disaster Epidemiology Activities Rapid Community Health and Needs Assessments  Determine critical needs and health status  Systematic sampling  Strengthen response  Improve prevention and mitigation strategies for future disasters
  • Disaster Epidemiology Activities MS Community Health and Needs Assessment following Hurricane Katrina  36% of the homes were destroyed in Hancock County  23% of homes did not have anyone home (could have been uninhabitable)  Lack of household services  Telephone service 53%, Electricity 41%, Indoor toilet 37%, Trash removal 33%  Health care needs  34% needed medical care  29% would run out of prescription medications MMWR 2006:55(9):234-236
  • Disaster Epidemiology Activities 3 Assessments conducted in Florida after Hurricane Wilma  ~400 interviews  2 days  377,000 households Household Needs  Need food: 46,000  Need tarps: 26,000
  • Disaster Epidemiology Activities Surveillance  Specific illnesses and injuries?  Clusters and outbreaks?  Geographic differences?  Differences between residents and relief workers?  Dispel rumors  Systematic and factual information
  • Disaster Epidemiology Activities Surveillance in New Orleans after Hurricane Katrina—Sept 9 through Oct 22  4 Parish area  >22,000 case 20% reports  29 acute care facilities 10%MMWR 2005: 54(40):1018-1021
  • Disaster Epidemiology Activities Analytic investigations  Environmental exposure assessments  Special surveys  Risk factors for adverse health outcomes Hurricane Isabel, Sept 18, 2003 Training
  • Disaster Epidemiology ActivitiesHurricane Isabel Pesticide Exposure studyObjectives and Methods: Quantify human exposure from aerial ultra-low volume (ULV) spraying with naled (Dibrom®) Compare urine pesticide metabolite levels before and after spraying to determine if spraying caused an overall increase in exposure for this population Systematic random sample of households in the targeted community was recruited Pre-spray and post-spray urine samples obtained and exposure questionnaires administered
  • Disaster Epidemiology Activities Hurricane Isabel Pesticide Exposure study Conclusion: Virginia  North Carolina  84 (88%) of 95  74 (82%) out of 90 provided postspray provided postspray urine and exposure urine and exposure questionnaires questionnaires Aerial spraying with ULV naled at a concentration < 0.7 ounces per acre was not associated with an increase in the dimethylphosphate urine levels of participants
  • Other Assistance Provided by CDC to Local & State Health Departments Laboratory Testing and Confirmation Vector Control Assessment Worker Health and Safety Population Based Registries Public Health Information (e.g., Fact Sheets, Public Safety Announcements and Recommendations, Travel Advisories) Technical Assistance  Environmental Health Issues  Biological, Chemical, Radiological Issues  Recommendations for Quarantine/Shelter in Place  Public Health Grants for Planning and Preparedness  Public Health Response Guide
  • Linking Response SystemsFirst Responders Medical & MentalFire/EMS Health ServicesPublic LawHealth Enforcement Emergency Management
  • Resources http://www.cdc.gov/nceh/hsb/disaster http://www.bt.cdc.gov http://www.dhs.gov/dhspublic/interapp/editorial/e ditorial_0566.xml
  • Thank you for your attention!Dahna Batts, MD, FACEPPlease send your inquires toCOCA@CDC.GOV