Applied Public Health Teams (APHTs) of the US Public Health Service (USPHS) Captain Joe Maloney, REHS, MPH Background Response to the White House publication, The Federal Response to Hurricane Katrina: Lessons Learned Key recommendation: HHS to develop preconfigured deployable teams of public health professionals Tiered response teams Tier I 24 hour response time Tier II 36 hour response time 1 Tier II Teams Rapid Deployment Force (approx. 100 officers) Applied Public Health Team (approx 50) Mental Health Team (approx 20) Site Access Team (approx 10) 2 1
In the aftermath of a disaster Post disaster needs out strip local public health department capabilities Staff of local Public Health Departments may not be available: Evacuated with family Supporting relocated populations 3 USPHS APHTs 5 Teams formed in 2006 Approximately 50 Officers per team (not regional teams) Multi disciplinary staffing including Command Staff One team on-call each month Pre-event, response and/or recovery missions Mirror and support local health department programs Scalable response Deploy only what is needed based on Mission Assignment Team structure grows/shrinks to address need Augmentable Subject matter experts 4 USPHS APHTs Public Health Department in a Box Non-Clinical Missions 5 2
USPHS APHT Functional Structure APHT Command Staff Epidemiology Surveillance Group Environmental Public Health Group Preventive Services Delivery Group 6 USPHS APHT Role or Contribution Epidemiology and Surveillance Group Data collection and data analysis Community health status profile Contact tracing Preventive (medical) Services Group Health statistics information dissemination Vaccinations Public health or medical education & recommendations Alert or advise local providers, officials, & public Environmental Health Group Adequate and safe water supply Availability of safe, nutritious food Access to adequate shelter Environmental & occupational hazard assessment 7 Typical APHT Staffing Roster Commander Deputy Commander Liaison Officer IT Personnel Safety Officer Epidemiology/Surveillance Group Epidemiologist (2) Preventive Services Delivery Group Physician (preventive or occupational medicine) (2) Public Health Nurse or Practitioner (2) Health Educator (2) Environmental Health Group Industrial Hygienist (2) Disaster Response Engineer (2) Environmental Health (3) Food Safety Inspector (2) Hazardous and Solid Waste Consultant (2) Veterinarian 8 3
APHT Deployments June 2006 Louisiana Nursing Home Survey Evaluation of emergency plans, review of evacuation and transportation plan, and integrity of infrastructure to withstand storm 13 Officers of mixed technical expertise August 2006 Louisiana Hospital Shelter in place assessments of the 56 hospitals in the 12 coastal LA parishes that are most at risk from a hurricane 13 Officers of mixed technical expertise 9 Hurricane Ike - 2008 APHT Deployments (cont.) Kelly Air Force Base FMS Air Quality/Industrial Hygiene Assessment College Station FMS Infection Control Evaluation Epidemiological Support to TDSHS, Austin Food Establishment Inspections TDSHS Region VI/V South Office Galveston Island Medical Facility Industrial Hygiene Assessment Liberty and Manville Rapid Community Public Health Needs Assessment 10 APHT Deployments (cont.) August/September 2008 Wisconsin Flood Recovery 5 environmental specialists and engineers, to conduct house to house assessments of flood and water damage to homes 2 separate teams deployed for 2-weeks each Conducted: 696 home visits 114 water sample collections Disinfected 36 wells 450 homes provided water sampling kits with instruction on correct water sampling procedures 11 4
CDR Mark Methner,, Ph.D., CIH U.S. Public Health Service Applied Public Health Team 2 Strike Team #1 Wisconsin Flood Recovery (August/September 2008) Background June 5, 2008 - Southern Wisconsin was inundated by a series of severe storms that resulted in severe flooding. More than 30 Counties were w affected. Additional storms followed and resulted in flood events that continued for several weeks. Presidential Disaster Declaration signed on June 14. Governor of Wisconsin contacted FEMA who contacted ASPR who requested ested OFRD deploy 2 Strike Teams to address the situation under ESF #14 4 (Long Term Community Recovery Emergency Support). On August 17, 2008, Strike Team #1 was deployed for 2 weeks to a base of operations in Madison, Wisconsin. Strike Team #2 arrived on September ember 5 and departed September 19. Total deployment duration = 34 days. Mission Description Assess drinking water safety for flood affected families Provide environmental health technical assistance to identified families (collect samples/disinfect wells) Gather information to focus on areas of most significant need (Administer EPI questionnaire) Assess repair progress on homes that were damaged >50% & perform environmental health assessments 5
5 member Strike Team #1 Lead, CAPT James Ludington, Indian Health Service (IHS), Engineer CDR Kit Grosch,, IHS, Environmental Health Officer (EHO) CDR Mark Methner,, National Institute Occupational Safety & Health (NIOSH), Scientist (SCI-Industrial Industrial Hygiene) LCDR Gary Carter, IHS, EHO LCDR Gordon Tsatoke,, IHS, EHO 5 member Strike Team #2 Lead, CAPT Stephanie Harris - EPA CDR Chris Allen - IHS CDR David Hogner IHS LT Joel Hustedt FDA LT Chad Dowell NIOSH Equipment OFRD arranged for 5 rental cars and hotel rooms WI State DOH supplied bleach, sample bottles, hoses, buckets, funnels, & maps JFO supplied GPS & printer Team provided PPE, CL Strips, flashlights, tools, manuals, Laptops, phones, etc. 6
Tools Personal Protective Equipment What we did.. Arrived at JFO in Madison and held opening meeting with FEMA officials. Reviewed GIS flood maps that were overlayed onto neighborhood maps to identify impacted areas Made contact with Local health dept s s who supplied a list of homes with well contamination Split up into Teams of One - visited different areas within a County simultaneously to collect water samples, administer questionnaires, es, assess damage, disinfect wells, etc. Created daily Sitreps sent back to APHT Team Leaders and OFRD Worked long hours (12-14) 14) and drove a lot (200-250 250 miles per day)! 7
Activities. 2 Page Environmental Health Assessment gathered information on.. Wells Water sample Wastewater Flood damage Illness 20 Page EPI Questionnaire* * Somewhat onerous task, not field friendly. Somewhat confusing to the public Disinfecting Wells & Reducing Deficiencies, when possible 8
Teams disinfected 75 wells Performed 1043 home visits Collected 250 water samples, provided sampling kits w/ instructions to an additional 679 homes 9
Overtopping of wells and groundwater infiltration caused most contamination Door-to-door canvassing to collect samples, administer questionnaires, disinfect wells, educate public on water safety/illness prevention As Expected after a Flood MOLD! Lessons Learned.. Need to be resourceful, flexible, and be able to figure things out o on the fly (e.g. get tools you need at local K-mart)! K Must be tactful/empathetic in dealing with people affected by such a disaster (People wondered why the Military was out here doing sampling especially officers! ). It s s difficult, if not impossible, to identify homes of families with people serving in a war zone. For these families, having an officer knock on their door can only mean bad news! Be prepared to quickly explain the purpose of your visit! Be prepared to be challenged by Local/State Law enforcement. They y (or the residents you are attempting to help) may be skeptical especially given the rise in Scam artists following disasters! Know the limitations of what we can do in the field.(e.g. we can t t drill a new well or replace damaged pumps/plumbing)! Be prepared to answer many questions by residents! Be prepared to work long hours and drive long distances every day! Be prepared for lots of paperwork (especially 20 page questionnaires)! ires)! Adopt a Can Do attitude! Regional Health Administrator, Local Health Department officials and Residents appreciated our efforts and professionalism 10
Video Segment from a Local TV station. Questions??? 32 11
APHT Haiti Mission 33 12
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Training Camp Bullis, TX Fort AP Hill, VA County Health Departments and Remote Area Medical 46 Acknowledgements RADM Sven Rodenbeck CAPT Bob Newsad CDR Mark Methner LCDR Trent LeCoultre 47 16
USPHS APHT 5 48 17