In the wake
of the September 11th attacks
and the subsequent anthrax
scare, a great deal of time
and resources
were rapidly invested
in the public health system
to respond to this crisis.
In the process of preparing
to respond to bioterrorism,
we discovered that the skills
we learned were useful
in many emergency
and disaster situations.
We also learned that being
prepared for terrorism
or other disasters,
is not a one-time thing.
It has evolved from being
an acute problem into more
of a chronic issue
that needs to be addressed
on a long-term basis.
The question is, how do we
incorporate planning
for emergencies
into a sustainable
public health framework?
We'll try to answer that
question on today's episode of
"A Public Health Journal".
(male narrator) Welcome to
"A Public Health Journal",
a program that explores
public health issues
facing our society
today and tomorrow.
The host of the show
is Dr. Ed Ehlinger,
Commissioner of Health
for the state of Minnesota.
"A Public Health Journal"
is sponsored by
the Minnesota
Department of Health,
and the
Hennepin County
Human Services
and
Public Health
Department;
all working together
towards the goal
of healthy people
living in healthy communities.
Welcome to
"A Public Health Journal".
Today we're going to look at the
issue of emergency preparedness,
that is, how do we develop
emergency response plans
at the federal, state,
and local levels,
and how do we train the people
to respond in an effective way
and maintain their level
of experience.
We'll be talking about that
with a couple of experts
in the field
of emergency preparedness,
but first we'll start
with a recent news report
provided to us
courtesy of KSTP Channel 5.
It was a field hospital,
set up at
the Minneapolis Convention
Center today.
Medical professionals
from across the state
were triaging patients.
It was all a training mission
so that crews can be ready
to roll when a disaster strikes.
5 Eye Witness News reporter
Jessica Miles has the story.
Is everybody ready
for Scenario Number Two?
(Jessica)
It's the first time
all of this equipment has been
in the same place
at the same time.
(woman) Is it getting better?
Seems to be getting better.
(Jessica)
This vehicle is basically
a hospital on wheels.
Medical teams are training
how to use it.
The goal is to have
this unit set up
at the site of a disaster
within 36 hours.
One thing we worry about
a lot is tornadoes.
We saw in Joplin, Missouri,
a tornado can hit a hospital
and a community can lose
their medical care.
(Jessica)
Over here,
the ambulance strike team
that can deploy multiple
ambulances and crews
anywhere in the state
to take over 911 systems,
help with evacuations
or shelter.
We have systems built in place
that can be deployed quickly,
efficiently, and timely.
(Jessica)
Lanenberg says this huge
coordinated effort
can be set up anywhere
in the state in a day.
This tent right here can be used
as shelter, as a hospital,
as an operations center.
It can sustain
75 mile-per-hour winds,
it has its own electrical,
heat and air,
and it can pop up
in less than two hours.
Large buses can become
human transporters.
One was used back in 2009 when
the Red River flooded in Fargo.
We moved roughly about 180
patients in just under
6 to 7 hours,
once we got onsite.
(Jessica)
This training will help
communities across the state.
Drills like this keep us
very proficient and ready
to go in a moment's notice.
(Jessica)
But it's not only Minnesota
that benefits.
We have been told several times
that we have probably helped
more states out than
any other state in the country,
as far as our
response capabilities.
In Minneapolis, Jessica Miles,
5 Eye Witness News.
The mobile medical teams
consist of two different groups.
One is based right here
in the Twin Cities area,
the other is in St. Cloud.
Each group has
more than 30 members.
These are volunteers
who all have day jobs.
Their employers work with them
to let them go
on a moment's notice
if they're needed at a disaster.
Joining us now to discuss
the emergency preparedness
are Jane Braun, the Director
of Emergency Preparedness
for the Minnesota Department
of Health, and Dr. Jim Harris,
an Emergency Physician, and
Director of Emergency Services
at Riverwood Healthcare Center
in Aitkin, Minnesota,
and Medical Advisor
for the Mobile Medical Unit
and the Mobile Medical Team
Project.
Jane, Jim, welcome
to our program.
Thanks Ed.
And it's nice having you on
after this event that you had,
this training program
that KSTP kinda filmed.
Jane, you've been in, you know,
emergency preparedness
for a while.
Could we have done that kind
of thing 12, 13 years ago,
the kind of get together that
you had of all of those people
and all of that equipment
and all of this planning?
Absolutely not; things have
really evolved over the last
10 to 12 years, where we have
built the partnerships,
we've built the teamwork, as
well as obtained the equipment
and the types of resources
we need and the training.
And a lot of it we've been
working on lately
is the coordination.
How do we know
who's role is what?
How do we bring in
the things we need?
And that exercise actually
was the first time that
we've ever had all of our mobile
assets in one place to practice
statewide with a lot
of different teams.
So, so how did this come about?
I know we had, the September
11th attacks, and we got
resources to do that.
And how did the planning
actually happen, to say what do
we need to do this, to make
this actually come together?
Yeah, shortly after September
11th, there was a realization
that there was a real lack
of coordination of efforts,
and incapacity to surge
the healthcare system
and the public health systems.
And so the federal government
did give large grants to states
at that time to start building
this capacity and capability.
And so we worked very hard to
determine what the needs were
and then to work on building
on systems and resources
and partnerships
to take care of those needs.
Now, and this all came about
because of September 11th,
but I have a slide here
that shows you know,
what happened just recently
up in Moose Lake,
where we have a, the Moose Lake
Elementary School underwater.
Uh, this is an example.
Jim, what are some of
the things, you know,
this is, we're not just talking
bioterrorism, you know, nuclear
disaster, we're talking what
happens in your local community.
(Jim Harris)
Absolutely, yeah, there's uh,
you know, obviously we see
flooding in our state,
we see tornadoes, there's plenty
of natural disasters that can
do this, and put communities
or healthcare at risk.
But there are other more uh,
more mundane things, you know.
One example would be if a,
a say part of a hospital
or a rural health clinic
had a sprinkler malfunction,
and they lost a lot of their
bioelectronics, lost part of
their facility, that could
put them at risk as well,
to be able to care for their
community's healthcare needs.
Yeah, so, so preparedness
is not just preparing
for this major disaster.
It's preparing for something
that happens probably every day
somewhere in Minnesota,
somewhere in the United States.
(Jim Harris)
Absolutely, yeah.
Now I've got another slide,
'cause Jane talked about
all of the resources
coming together.
So I've got a slide here
that says alright we've got
Public Health as their role,
and you got Emergency Management
and Healthcare; how do these
all come together?
Explain what's going on
with the thinking
behind this kind
of Venn diagram.
(Jane Braun)
What we're really looking at
is what we call an all-hazards
approach, that it's not about
a tornado specifically, or about
bioterrorism specifically,
it's what do we need to do
in the system working with
our different partners
to be able to deal with any type
of hazard that might occur?
And as the slide shows, we're
really trying to coordinate
the things between
Public Health, Healthcare
and Emergency Management.
We need to understand each
other's roles, we need to use
each other's assets, we need
to have common language,
we need to make sure that we
know, have compatible equipment.
All of those kinds of things.
And so the federal government,
has separate grants
to these different disciplines,
but they have things that are
called the capabilities, and
some of those themes are common
among the different programs.
And so we work very hard
to work on certain things,
like for example, communications
is one of them, things like
surveillance and epidemiology,
mass care, all kinds of
those things are parts of each
of our responsibilities.
So we work very hard not only
with different geographic areas,
but with different disciplines
of professional expertise
to bring one system together
where we understand
the big framework and we know
our roles and work together.
Now Jim, you know, those of us
in public health, we,
collaboration is part of our DNA
and we work with partners,
'cause that's sort of what
Public Health does.
But you come more from an
individual patient perspective
as an ER doc, you know,
you take care of individuals.
How, what kind of mind set
change do you have to have
to actually say, "Oh yeah, we've
got lots of partners in here,
"we need partners, we need
systems, we need collaboration?"
It must have been
sort of a culture change.
It's, yeah, a little different
way of looking at things.
You know, fortunately
for me I do some,
I do disaster medicine
for the federal government
under DMAT, NDMS System.
And so I kinda learned the way
of working together there,
but yeah, partnerships
are very important,
I think for physicians one
of the hard things is when
you work in the Emergency
Department, you're generally
in charge at least of that area,
and getting used to the idea
of letting go of that
and working under
the instant command system,
letting other people deal with
um, the command and control
and really focusing on patient
care and what you need to do
for that particular mission
to take care of people.
Giving up control is always hard
isn't it?
[laughter]
I want to talk
about different roles,
but first we need to take
a little break,
so we'll be back
right after this message.
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Welcome back, we're talking
about emergency preparedness
with Jane Braun, Director
of Emergency Preparedness
at the Minnesota
Department of Health,
and Dr. Jim Harris, an Emergency
Physician who's also been
engaged in a lot of planning
for emergency preparedness.
Jane you talked a little bit
about roles, that came about,
you know the feds said
we need to do something.
I want to go through;
what is the federal role,
what is the state role,
what is the local community role
in all of this?
So let's start with the feds.
Where do they play, what role
do they play in overall
preparedness?
Well the federal government
really sets
the overall direction.
They provide the structure,
the scope, you know, what pieces
should we be working on,
what are outside of our scope.
And then they have secured
a lot of the funding,
actually 97% of our Public
Health emergency preparedness
in the state, at the state
level, is federal money.
So they do a lot of the big
picture, the vision of where
we are, how the structure
is run, what we're working on.
At the state level,
we work on kind of
more of an assurance role.
'Cause a lot of this work
needs to be done locally,
we make sure
that the local departments
are doing the assessments that
they need, that they understand
what the priorities of the state
are and how we want to be
moving forward over the next
several years, and monitoring
and also providing a lot
of guidance and coordination.
And then at the local level,
that's really where the work
is done.
There's the phrase,
all disasters are local.
And so they are doing
a local assessment.
Emergency Management,
Healthcare, and Public Health
have all done assessments
in the last couple years.
What are our risks here?
What are the places
where we're most vulnerable?
Where do we want to focus
our resources?
And then that's where they build
those local partnerships,
because these are not things
you can start up in an instant.
You have to have
the structures in place,
you have to think about,
what are fact sheets,
what is our recommendation
for if you're flooded?
You know, we know you can use
the paper products,
but what about the cans
and the bottles?
All those kinds of things are
very hard to do just in time.
And so we work on having
the pieces in place,
so that when something happens
and there's the expectation
of Minnesotans
that we're able to respond,
to provide them information,
provide them with help that
those systems are in place.
And Jim, how does
the local voice get elevated
into this conversation?
You know, the local providers,
the local ER doc,
the local ambulance crew,
the local community.
How do you say,
these are our needs
and we have to get
these addressed?
Well um, you know, it happens
again at the local level, and so
most of us, because we work
for healthcare organizations,
we get involved with
the emergency planning
or business continuity planning
for those organizations.
And then usually with that,
you're partnering with your,
your county government and uh,
county emergency managers.
And then you kinda partner
with them and,
and come up with a joint plan.
And then if there's anything
you need beyond that,
then you'll push that up
to the state.
So you had mentioned, you know,
giving up control of things.
And how do we determine
who actually is in control?
We have, you know, let's say
we had a nuclear spill
or we had a public health
emergency with, you know,
an outbreak of infectious
disease, or you've got a tornado
or you've got, uh, Jane how do
you determine who sort of
takes the command
in these situations?
Well there's a couple
of structures.
The first one is that you handle
it at the lowest level you can.
And so locally, generally
the first person of authority
on scene begins.
We have what's called
the Incident Command System,
which outlines roles for people,
makes it clear who reports
to whom, who communicates
in which direction,
who has which piece,
how often do you report in,
you have briefings,
those kinds of things.
And then at the state level
there's what's called
the Minnesota Emergency
Operations Plan, or the MEOP.
And that outlines the role
of every state agency.
Do have the lead role,
or are they a support role?
And so we have these structures
we've been building over
the years where we understand
who's got which piece,
who communicates,
how do we come together,
how are decisions made?
Do we have one person in charge
or in a larger incident
there's a thing called
Unified Command,
where a lot of people
have a big role.
And so they have to do
the command as a group.
So it's
systems we've been practicing
over the last many years,
that are used to quickly get a
handle on the situation,
and they're scalable up and down
as the situation changes.
So Jim, in your training
as a physician
and an emergency room doc,
do you get training
in disaster preparedness,
emergency preparedness,
and do you know when
to sort of call for help?
Um, you know, there's, I think,
you know, I've been in this
for a little while so my answer
for my training would be no.
But I know that the programs
now are including it,
it is part of the training that
newer physicians are getting.
The Instant Command System
is really the, the key.
Understanding that and knowing,
and again, that kind of
guides you on, on who to call,
and when to do it,
so if anything, we could kinda
bring out,
it's using Instant Command;
that really helps
keep you on track and on target.
And I know recent,
relatively recent, we had the
35W Bridge collapse, which was,
certainly Emergency Medicine
really needed to be involved
and Public Safety.
And how did that play out,
how did it come up that our,
let's mobilize the resources?
Could you kinda walk through
the, the framework,
the scenario of that?
And again, it, it starts out
with the first on scene
and they're doing an assessment,
and then they're reporting
up to their structures.
And then they quickly determine
what the scope is.
It's, you know we have
situational awareness,
we have a size-up
of the situation.
And so they start saying what
other assets are needed here,
be they for water rescue or for
all different kinds of things.
How many ambulances
might we need?
All the issues they had there
with um, problems of not
being able to get across
the river or access.
And how do we determine
who comes in from what side,
which jurisdiction, who,
how are we communicating,
all those kinds of things,
and what are the roles for
public health in there a little
bit farther down the road?
For example, they had a huge
component with that,
on what we call
behavioral health.
The traumatic effects to both
those affected, their families,
and the responders and,
who has these roles
on helping these families while
they're waiting to hear
about their loved ones,
getting information on status
of those who have been taken
to a hospital
or those who are still missing.
All of those kinds of pieces,
we bring the system together,
we know our roles ahead of time
because we've practiced,
we've trained, we know
what we're doing ahead of time,
so that the system can work
smoothly and efficiently.
And Jim, you know,
you have a practice,
you're a practicing physician,
so you're, and,
work for an organization
that you have a job to do,
that's part of your
daily routine.
How do you build this in and how
does, how does your organization
that you work for say, you know,
I'm going to give some time
available to do
some of this coordination
for things that, don't happen
every day, that are sort of
beyond the scope of what
our responsibility is.
It must take some commitment
and some recognition
that there is, needs to be
a community effort.
Yeah, there definitely is and
there's, there's time carved out
for myself as well as
a lot of other people
on our administrative team,
our emergency management side.
The, one of the organizations
that uh,
involved with credentialing
hospitals, JCAHO,
kind of mandates
some of this stuff,
so there is kind of a framework
there that's laid out
and, so to meet those guidelines
that they lay out
we budget time and, and work
towards those goals.
I'm going to talk about what you
called some of the assets,
some of the equipment that you
got in the last segment,
so that people know what's
available in the state
if they need some needs, but we
need to take another break.
We'll be back
right after this message.
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Did you make sure
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Did you go through the plan
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Welcome back; we're talking
about emergency preparedness
with Jane Braun from the
Minnesota Department of Health,
and uh, Jim Harris,
an emergency room physician
who is actively involved in
disaster and emergency planning.
When we started the program,
we had a little clip from KSTP
and it showed, the you know,
kind of getting together
of all of the assets and all
of the equipment and things.
And I think people may not
be aware of all of the things
that go into this
and I just want to go through
fairly quickly
what these things are.
I know that you have a casualty
bus, a multiple casualty bus,
why do you need that
and how does that play into
your disaster planning?
Well there's actually two of
them, and uh, the importance
of them is to be able
to transport larger amounts,
numbers of patients quickly and
possibly for greater distances.
The one bus can do 12 patients,
lying down,
10 patients sitting;
the other I believe can do
16 or 20 laying down,
16 sitting up roughly.
They can take critical care
patients so they can take
patients that are
on ventilators, so they're
really key if you ever had
a mass casualty incident,
where you needed to transport
a lot of patients,
if you had to evacuate
a hospital, nursing home,
they can move large amounts
of patients relatively easily.
And as we go through these
things, are they available
statewide?
I mean I know they have to be
located someplace, but can they
be mobilized and moved
to various places
throughout the state?
All these assets that we'll be
talking about are state assets.
They are managed and coordinated
by various jurisdictions, but
through the State Duty Officer,
it's kind of a one call,
that if somebody needs these,
we'll talk to them quickly,
see what assets are the correct
fit, and they are available
for anywhere in the state
that they're needed.
Right, what about
the Mobile Medical Unit?
I know this is like a, kind of
a mobile hospital, right?
It is; the Mobile Medical Unit
is basically a 53-foot semi
that is an 8 bed hospital
inside the semi.
Kind of equate it to
an emergency department
or an urgent care, in general,
that type of thing,
but we have a lot
of capacity there,
being close to being
a regular emergency department.
And that's something that would
be real useful, for example,
the instance that Jim gave
earlier about if a sprinkler
ruined part of a
we could temporarily serve
hospital,
that purpose in that area, or if
a tornado hit a small hospital
or an emergency department,
serve as that function.
We occasionally, for training
purposes, we'll do
a large event, really to help
practice with the staff,
but it's an asset that provides
a level of care that's beyond
what one would expect
normally in a mobile area.
Yeah, I would expect that would
actually be very cool
at one of these large
outdoor concert things
where you have hundreds
of thousands of people
and in heat and it would be a
good thing to have available.
And then I know that,
we have to also worry about
alternate care sites, and what
are the assets that we have,
when something closes down,
you've got
the Mobile Medical Unit,
but you also need
alternate care kind of sites.
What do you use to do that?
Well there's um, there's two
mobile medical teams
in the state right now,
one in the Central Region,
one in the Metro Region,
and they both are capable
of setting up
alternate care sites.
Generally the alternate care
sites are 25-bed increments,
and they can provide
critical care if needed,
they can do ventilators, just
like the MMU would be able to.
But they can set those up
in gymnasiums, school.
One of the advantages
of the Mobile Medical Team's
alternate care site
is really timing.
If you look
at the Mobile Medical Unit,
it takes a little time to set
up, it's granted it's very cool,
it brings its own lab,
its own pharmacy.
Again, pretty much
an emergency department with a,
short of the CAT scanner.
But the Mobile Medical Teams
are a little bit more nimble.
They can get out
a little bit quicker,
get ahead of things
a little bit.
We talked about the MCI buses.
One of the advantage to them,
is they can usually go out
really quick and so again, it's
kind of the what do you need
and when you need
it kind of uh....
And I assume all of the planning
takes into account
Minnesota weather, particularly
our winters and cold?
You can operate all of these
things in 20 below zero?
Yeah, we do have,
fortunately for example,
on the Mobile Medical Unit,
we have an enormous generator
on there that can provide power
to some of the other assets.
But you know, the Minnesota
Ambulance Strike Team,
also has their tents
with generator capacity
and heating
and air conditioning.
And we did actually deploy
the Mobile Medical Unit,
in 2009, and we were in Moorhead
and it was down to 16 degrees.
We had a snowstorm; we deployed
in a blizzard, and learned that
Dr. Harris actually designed
a drill where we practiced
opening and closing the doors
and seeing if we could
keep the temperature comfortable
in there, and we could.
And so all of these various
assets, are big parts
of the whole, and they all can
operate in a wide variety
of temperature ranges
and other conditions.
And then lastly among the things
is the, the portable mortuary.
I don't think people actually
think through,
I mean the general population,
that you need to, in fact,
if some people die,
you need to have a plan
for how to deal with,
with the bodies.
Yeah, for a mass fatality
situation, again,
that's one you don't like
to think about,
but there's really no excuse
for not having a plan.
And so there, it's a system
of 6 trailers that we have,
that are stored
in St. Paul currently,
but can be deployed anywhere
in the state and,
with the right facilities, say
an armory or some type of thing,
we can set up
a very large mortuary there
to deal with all the kinds
of things that need to be done
around identification
of remains,
all kinds of things like that.
And then we're working
on some software systems too,
on family reunification,
notification,
all those kinds of things.
And so, it's, it's not something
people like to think about,
but we do have that capacity
and capability in Minnesota too,
for if we were to have some sort
of a mass fatality situation.
And where do you get
the people to do this?
I mean we only have a limited
number of emergency room docs,
and who are the people that come
and volunteer their time
or work on these disasters
in the emergency preparedness?
Well, we kinda draw from a,
a large pool and again,
it's kind of based
a little bit around timing.
One of the things
is the Mobile Medical Teams,
and these are teams
that are preformed,
they're dedicated to doing this,
and they're able
to deploy relatively quickly.
Um, our goal with them
is to probably use them
in that first 24 to 72 hours as
an event is kind of unfolding.
Then we can pull from
the Minnesota Response
Medical Reserve Corps
and use volunteers from across
the state to kind of fill in
and our goal is to eventually
work towards using local staff
to staff some
of these resources.
But you need to give communities
time to, to take care
of their own, their own houses,
their own families, before you
can allow them to come back
and start, start working.
And we've only got
about a minute left,
but I know with tight budgets,
is there concern
that this training
that really has been ongoing
over the last 10 to 12 years,
which has brought us up
to a really good level,
can this be sustained?
And how much resources
do we need to make sure
that it's always there?
We are struggling with that
quite a bit right now.
These Mobile Medical Teams
that we've been talking about,
we have developed under
a Homeland Security grant
that is running out this year,
so our ability to keep
training and recruiting more
is going to be compromised.
With the, with the Medical
Reserve Corps again,
a lot of that is done locally,
but the grants that we pass
along to the locals, as we get
cut, we're cutting what's there.
So it is a difficult thing
to sustain this, which is
really a shame, because we've
built a system that I think
people expect to be there,
and it's jeopardized right now.
Yeah, and we know that disasters
will occur, events will occur,
weather, traumatic things occur,
so we have to be prepared.
Well, thanks, this has been
very helpful,
so thanks for being with us.
Thank you.
And I'll be back
with a closing comment,
right after this message.
[lively flute, strings
and piano play]
♪
♪
The difference between
medical care and public health
has been characterized over the
years in many dichotomous ways
like treatment or prevention,
individual or population,
short term or long term.
But as a society we tend
to lean more towards
the treatment, the needs of the
individual, and the short term.
But as we learn more about
protecting, promoting,
and improving health,
we begin to understand the need
to think more about prevention,
the needs of the community,
and our long-term health,
if we are to achieve
our personal
and societal health goals.
We need to think about
the structure
on which our health system
stands.
It's sort of like building
a house.
You need both a strong and firm
foundation on which to build
an attractive
and functional structure.
If you put all your resources
into decorating your house
and skimp on the foundation,
you will not have a house
that'll meet your needs
for the long term.
Conversely, if you spend
all your resources
on the foundation, you will
not have enough to put up
a structure that is comfortable
and enjoyable.
A balance is needed, but that
balance needs to start
with making sure
the foundation is adequate.
So it is with planning
for emergencies.
We need a preparedness
foundation
to protect our health.
We need the capacity
and the ability to respond
to the needs that arise
in the community from situations
that are out of our control.
We need a strong public health
infrastructure
on which to build
that response capability.
Too often, we've delayed
investing resources
in our public health
infrastructure
with the mistaken notion or hope
that nothing bad will happen.
The reality is that disasters
and emergencies
are going to be with us
for a long time.
So we need to rethink
and rebuild a balance
between treatment
and prevention,
between individual needs
and the community needs,
in between the short term
and the long term.
Only when we have
an appropriate balance
will we have a long-term
security and better health.
That's all for today,
thanks for watching.
I hope you can join us
again next time on
"A Public Health Journal."
