Establishing a Public Health Branch of an Incident Response Coordination

Team — Haiti Earthquake Response, 2010

CAPT Mehran S. Massoudi, PhD, MPH

Associate Director for ScienceScientific Education and Professional Development Program Office (proposed)

Centers for Disease Control and Prevention

US Department of Health and Human Services

Presented by: CAPT Holly Ann Williams, PhD

May 24, 2010

Co-authors• CDR Daphne Moffett • CDR Margaret Riggs• LCDR Roque Miramontes• CAPT Holly Williams• CAPT Peter Bloland

• A special thank you to CAPT Holly Williams, as this talk was modified from a previous one developed by her for the upcoming 2010 ESF 8 Summit: IRCT Training

12 janvier 2010 : Tremblement de terre35 secondes fatales... plus de 220.000 morts

Haiti Earthquake, January 2010On January 12, a

7.0 magnitude

earthquake hit Haiti

at 1653 hrs,

~10 miles from

Port-Au-Prince (near

Leogane)

220,000+ deaths

330,000+ injuries

1,000,000+ homeless

On January 20, at

0600 hrs, a 6.1

magnitude

earthquake occurred

with epicenter

approximately

35 miles WSW of

Port-Au-Prince

Public Health Branch in Haiti: What Did We Do?

Who Were We?• Branch composed of all US Public Health Service (PHS)

officers, all of whom were stationed at CDC:– Branch modeled on PHS’s ‘Preventive Medicine Branch’ within

the Rapid Deployment Forces (RDF) and ‘Applied Public Health Teams’ (APHT)

• Size of branch varied and, at most, consisted of six officers

• Expertise within the group included: epidemiology, anthropology, toxicology, environmental health, food safety, veterinary medicine, nursing and vector-borne diseases

• Part of the HHS Incident Response Coordination Team (IRCT) and reported to the Operations Section Chief

Arm bites on DMAT responder

Force Protection:– Conducted environmental health

assessments at DMAT, DMORT sites, including Hotel Montana

– Stressed use of Personal Protective Equipment

DEET Sunscreen Insecticide treated bednets Appropriate clothing Malaria chemoprophylaxis

– Provided public health education briefings (for HHS assets and others, such as Urban Search & Rescue Teams)

Functions of the PHB

Surveillance of Diseases & Injuries:– Assisted with re-initializing and

modifying Haiti’s national surveillance system to better address trends post-earthquake:

Modeled national surveillance on forms developed after the 2008 Haiti hurricanes and subsequent floods

– Collected electronic medical record data (EMR) from Disaster Medical Assistance Teams (DMATs) on a daily basis:

Collaborated closely with SOC Fusion Cell

– Summarized data and produced daily charts of DMAT data for distribution across DMAT sites, to IRCT, and interested partners, including the Ministry of HealthCDR Riggs on nightly EMR data calls

CDR Lipin entering DMAT EMR data

Functions: II

• Provided technical assistance to larger, global humanitarian efforts:– Collaborated with Dept of Defense (DoD)

on environmental assessments– Participated in Inter-agency Vector Borne

Disease meetings and provided feedback on funding proposals from donors and UN

– Provided technical assistance to DoD on operational issues related to establishing and maintaining a ‘federal medical station’

• Stressed the context of endemic tropical diseases in affected area to responders:– Dengue fever, malaria, leptospirosis,

typhoid, TB, HIB, H1N1, and Hepatitis A– Consulted with CDC entomology and

vector borne disease specialists in Puerto Rico and Fort Collins

RADM Deitchman at FMS site assessment

Functions: III

Public Health Assessments

Collaborative mission with DoD to assess field

reality in towns of Jacmel and Leogone

Assessment of Hazards

Austere Working Conditions

Toilet for

DMAT team

MREs for 32

days!

Difficult sleeping arrangements

Structural

Damage

Standing Water After Rains:

DMAT Work Space

CDR Riggs doing

coliform testing at

DMAT site

DMAT Sites: Testing for Contamination and Quality

of Water

Testing for chlorine:

CAPT Williams & LCDR

Grant

Vector Control

Insufficient length of bednets

Old Tires: Vector Breeding Sites

Poor Air Quality

Search & Rescue not wearing respirators

Burning of garbage at Gheskio

Unrelenting Noise: Airport

Lack of Ear Protection

Lack of Waste Removal:

Biohazard and Other

Look carefully: this has both

biohazard and other trash

Future of IRCT Public Health Branch

Challenges Faced in Haiti• PHB – a new concept within IRCT and National

Disaster Medical System (NDMS – DMAT, DMORT responders):– Different orientation and expectations for acute

medical care versus public health

• No identified cache

• CDC focused on longer term perspective:– PHB was caught between need to focus on IRCT

Public Health issues, while responding to requests from home agency

• Develop training modules on role and functions of Public Health Branch for IRCT and NDMS staff, and other HHS deployed assets, including PHS Officers deployed through OFRD

• Provide direct access to EMR data so that PHB can better assist SOC Fusion Cell in analyzing field data in a timely manner

• Identify and obtain needed items for cache– Ensure that equipment is readily available and accessible– Examples: sampling equipment for water, soil and air quality;

sufficient amounts of insecticide, appropriate computer software for data analysis

Recommendations

Thank You and Acknowledgements

• The people of Haiti• All the members of the Public Health

Branch in Haiti:– CAPTs Peter Bloland, Holly

Williams, and Mehran Massoudi– CDRs Daphne Moffett, Margo

Riggs– LCDRs Juliana Grant and Roque

Miramontes• Photo Credits:

– Members of the PHS Branch and CA 6 DMAT

• Questions: Mehran.Massoudi@cdc.hhs.gov

Extra Slides

Roles and Functions of the Public Health Branch

Public Health Branch• Collaborates with IRCT Chief Medical Officer, IRCT Safety

Officer, Veterinarian Care Group Supervisor, Field Teams’ Supervisors and others as appropriate

• Assists IRCT Operations Section in selection of public health expertise and necessary assets/resources

• Directs efforts of all CDC/ATSDR teams/assets deployed to area of operations with the IRCT Operations Section

• Monitors all field operations for public health threats on a continuous basis:

– Conducts daily visits, when possible, to field sites

Public Health Branch

• Works with DMAT teams on collection of electronic medical record (EMR) data:– Gathers EMR data from all field sites on daily basis

– Summarizes data on ‘patient encounters’ and ‘patients treated’ by site and across site

– Produces summary document of EMR data that is disseminated to all sites, IRCT, partners, state/local health departments or Health Cluster/MoH in affected countries

– Collaborates with SOC Fusion Cell to ensure that EMR data are transmitted in a timely and efficient manner:• Provide technical assistance for analysis and interpretation

of surveillance data as requested by SOC Fusion Cell

Public Health Branch

• Provides technical assistance on public health matters to other partners as requested and as appropriate

• Provides input to the Hazard Risk Assessment (HERA) and Force Protection Plan

• Conducts environmental, food safety and engineering assessments on an “as needed” basis

• Provides public health education, formal and informal

Evolution of IRCT Public Health Branch (PHB)

• Critical consideration:– “CDC will assume the lead for HHS for public health

response operations in- country”• CDC Haiti Earthquake Relief Public Health Concepts of

Operations (CONOPS), Jan 2010 (p. 4)

• Haiti response: 1st time PHB integrated into IRCT:– Memorandum of Understanding (MoU) between ASPR

and CDC, Jan 2009

– Per MoU, Public Health Branch (PHB) Chief:• “…responsible to coordinate public health missions and

resources when an IRCT is activated”• “…will follow direction of IRCT Operations Section”

Why Do We Collect all those Numbers?

• Public health surveillance uses data to assess public health status, define public health priorities, and evaluate programs:

– Tells where problems are

– Who is affected

– Informs where programmatic and preventive activities should be directed

• Data collected went through IRCT to SOC Fusion Cell and onwards to higher levels in HHS and the White House

• Most importantly, the data helped inform programmatic planning for the longer, transition and reconstructive periods

Public Health Strategic Objectives

• Assist in rapid assessment of emergency water, sanitation and shelter services

• Provide emergency public health assistance

• Provide epidemiological and surveillance assistance

• Execute population-based surveys on conditions not covered in surveillance

• Distribute safety, sanitation and infection control guidelines for healthcare workers based on epidemiological situation