Evaluation of a CBRN Response Program at a Tier I Medical Treatment Facility [POSTER]

Introduction: As the nation’s disaster management capabilities evolve, civilian and military emergency management and medical interoperability is critical for development of a successful response and consequence management plan. The U.S. military has a history of training for and managing healthcare needs in complex and unpredictable environments, such as Chemical, Biological, Radiological or Nuclear (CBRN) incident response, while civilian medical response capabilities during these scenarios vary drastically from community to community. Integration of military and civilian medical resources and response capabilities is important, and has been achieved in some regions, but capabilities, resources, and programs vary. Purpose: The purpose of this poster is to provide an example of a comprehensive guidance for medical contingency response to CBRN threat at a Tier 1 Medical Treatment Facility (MTF), based on the military model.

Methods: A model is provided for an effective response, providing thorough guidance on the employment of the Decontamination Incident Response Team (DIRT) to secure the MTF and protect the hospital staff members and patients from exposure to potentially life-threatening chemical, biological, or radiological contaminants. Described is the DIRT team’s responsibilities in developing, conducting, and managing warm-zone operations to prevent the spread of contamination by victims/patients in need of medical attention prior to entering the MTF. The seven categories of the warm-zone operations plan are dissected, and each category, including but not limited to agent detection, decontamination, and triage, is detailed with regard to how it affects the response actions and decision-making process. Roles and responsibilities of response team members are also discussed.

Conclusion: Providing a thorough glimpse of an effective military hospital-based program, this poster may be used as a reference to guide environmental health professionals involved in CBRN emergency response development, planning, or program improvement in similar military or civilian healthcare institutions.

Using Community-Based Participatory Research to Build Capacity for Environmental Emergency Preparedness and Disaster Resilience

As natural and man-made emergencies or disasters have negative repercussions on the environmental health and safety of those affected, it is imperative that the Environmental Health and Emergency Preparedness/Response (EHEPR) programs of local public health departments coordinate their efforts to engage with communities in discovering solutions to disparities in emergency preparedness. In this mixed methods, quasi-experimental study, we are comparing the conventional expert-driven approach to public health emergency preparedness by the San Bernardino County EHEPR workforce to an environmental health emergency preparedness (EHEP) community-based participatory approach by the Riverside County EHEPR workforce. These adjacent counties have the greatest land mass in the nation, but are two of the most resource poor. Almost half of their population is Latino, many being low English proficient. A great proportion of the residents of these two counties live adjacent to the largest railyards east of the Los Angeles port cities. In addition to the chronic earthquake threats endemic to all of California, their health and safety is endangered by environmental hazards including high levels of air pollution due to train and truck exhaust and potential hazardous materials spills resulting from train derailments. Formative research was conducted with EHEPR and community residents of both counties using key informant interviews, validation focus groups, windshield surveys, and GIS demographic mapping. The qualitative data set was transcribed, coded, and analyzed for emerging themes. Next, the EHEPR workforces were surveyed to examine personal and collective efficacy, capacity, and readiness to engage community organizations and members in environmental health emergency preparedness. Community capacity to deal with emergencies was captured in a household survey administered in both counties. Baseline assessment findings lead to the creation of a culturally-appropriate EHEP community program for Riverside County. Such alliances are essential for public health to effectively move forward in these challenging times.

Riverwatch 2011: How a Local Environmental Public Health Agency Implemented Health Codes to Condemn Private Residences

In April 2011, Shelby County, TN and the City of Memphis were faced with potential for Mississippi River flooding due to increased seasonal rains combined with an elevated spring snow melt.  It was anticipated the River would crest at levels not seen in over 70 years.  On May 12, 2011, the river crested at 48 feet; effectively flooding 3 mobile home “parks” in the County.  Approximately 346 mobile units were completely flooded and were unsuitable for re-habitation.  Because these three mobile home communities are proximal to flood zones, it became evident during the emergency response recovery period a permanent solution was needed to prevent future flooding incidents.  This presentation will highlight the flood and briefly discuss the environmental response to the flood.  This introduction will assist in developing the thought process and work behind using local and state health codes to declare the properties hazardous and unfit for re-habitation.  This declaration prefaced County Code Enforcement to declare the 3 communities to be demolished.  This presentation hopes to elaborate on the processes necessary to condemn a flooded private residence while integrating the importance of inter-agency collaboration, all during an emergency response event. 

Riverwatch 2011: An Environmental Public Health Response to a Major Flood Event.

In April 2011, Shelby County, TN and the City of Memphis were faced with potential for Mississippi River flooding due to increased seasonal rains combined with an elevated spring snow melt.  It was anticipated the River would crest at levels not seen in over 70 years.  Pre-planning mitigation was enacted by the Shelby County Emergency Operations Center to prepare for myriad issues inherent in community flooding.  Among the public health concerns addressed were effective and extended sheltering of displaced residents, environmental sanitation, vector control, and pollution control issues.  Once the flooded Mississippi River crested on May 12, 2011, the environmental public health response was activated. The following presentation will highlight the environmental public health mitigation, response, and recovery to a flood event by discussing the medical sheltering issues, the emergency public information sharing, and responder safety issues implemented during the response. Additionally, this presentation will further discuss the environmental public health components of mitigation, response, and recovery from flood activities. Novel environmental sheltering practices will be highlighted along with processes identified and executed in the remediation of vectors, sanitation, and pollution post flood event.

A Day of Disaster: The Environmental Health Impact of the April 2011 Tornadoes in Alabama

The severe weather outbreak that occurred on Wednesday, April 27, 2011 moved across the state of Alabama in two devastating waves and tested the environmental health response capabilities of the Alabama Department of Public Health.  The first wave made its way across the northern portions of central Alabama in the early morning hours and produced widespread damage from straight line winds and a few isolated tornadoes.  The second wave involved numerous super-cell thunderstorms that spawned long lived, strong to violent tornadoes across the northern two-thirds of the state.  The damage brought about by this weather system and its estimated 62 tornadoes was widespread and catastrophic in a large portion of the state and caused the death of 247 Alabamians.

From the earliest power outages through the weeks of debris clean-up, environmental health specialists were on the front lines of response, mitigation, and recovery.  This monumental event had far reaching impact on environmental health from the issuing of boil water notices; devising alternative means of sewage disposal; water filtration for community use; rapid assessments of food establishments; and the removal and proper disposal of solid waste.

Environmental health staff from across the state responded to the affected areas and were put in situations very different from what they had experienced before.  Those who were members of strike teams” and completed the CDC’s Environmental Health Training for Emergency Response course were better equipped to react to the unusual environmental health circumstances caused by the devastating storms.  Preparedness training in environmental health is essential for local staff so that citizens can be protected from potential environmental health hazards and inspections can be made to prevent further disease outbreak by successful interventions from environmental health staff.