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DISASTER IN A RURAL COUNTY – A PUBLIC HEALTH SIMULATION

Using the following template, you will participate in a disaster scenario. Utilizing the ICS structure and research on weather-related incidents, complete sections of the template as directed. You will assume the role of a public health professional and make decisions/prepare documents as needed. All the basic information concerning the disaster is contained in the scenario. Upon completion, save your file in the following format SmithUnit9Project.doc; substitute your own last name for “Smith”.

Situation: Severe thunderstorms, tornado, flash flooding which occurred overnight.

DAY 1, 0700 hours – The public health goal is to ensure that residents are kept safe from the myriad public health concerns as the community rebuilds. You have no detailed information on the severity of the situation at this time.

DAY 1, 0800 hours - On your way to your office, a reporter stops you and asks the following questions. Write your replies in the spaces provided. Give substantive answers where possible or refer the reporter to a more appropriate agency. Remember, you could be quoted on the local news so think before you speak.

Question 1: Do you have time for a quick question?
REPLY 1 :

Question 2: We have heard unconfirmed reports of deaths from last night’s tornado. Can you tell us more?
REPLY 2:

Question 3: Can you give us an idea of how extensive the damage is?
REPLY 3:

DAY 1, 0810 hours - The first Incident Command Briefing is scheduled and the Public Health Director, Dr. Burke, is contacted by the Incident Commander and asked to attend due to the immediate and long-term public health impact of the storm. You accompany him.

The first speaker is XXXXX XXXXX, the Fire Chief. He reports the following items:
a. There was an F4 tornado at 0200 hours with 3 confirmed deaths. Fire and EMS provided medical response and transported the wounded to the local hospital.
b. A tanker truck carrying sodium hydroxide overturned off the highway. A hazardous materials team was contacted and is on the way to that location.
c. There is severe flooding and the southwest portion of the county is cut off.
d. The bridge over the major river in the county is impassible.
e. Public works is clearing roads, organizing sandbag crews, and closing off impassible roads.
f. The power is out over most of the county.
g. The county emergency manager announced that the EOC (Emergency Operations Center) is opening and the first briefing will be at 1000 hours. All agencies are to send a senior representative. Dr. Burke will attend as will you.

The Incident Commander asks if there are any public health concerns.

Dr. Burke, the public health director, asks you to make brief remarks identifying the four most important items for his department to address. Write your response below.

What four public health items would you mention at this point?
1.
2.
3.
4.
Why did you feel these were the most important?


Day 1, 0915 hours - You are now tasked to establish the public health department Incident Command System. When you arrive at the public health office, only eight employees were able to get to work. The others were delayed by the storm. The good news is that all of them are NIMS trained.

What individual planning principles should all public health staff have in effect to maximize their ability to come to work during an emergency? List the principles below (you may list more than four):
1.
2.
3.
4.

Looking at the employees who are present, select your Section Chiefs and Command Staff.
Place the name of your choice next to the Assignment in the table below and write a brief justification for your selection.

You can choose from the following employees.

1. Ben Linder – Director of Communications. 3 years experience; trained in reducing health disparities; facilitates focus groups.
2. Betsy Snyder – Receptionist. 6 years experience; project management training; excellent communications skills.
3. Brent Volstad – Health Planner. 6 years experience; trained in cultural responsive health planning; knows all the local community organizations; represents the department at outside meetings.
4. Seth Stattmiller – Environmental Health Supervisor. 15 years experience; trained in emergency preparedness and response; has been involved in emergency exercises; strong supervisory skills.
5. XXXXX XXXXX – Epidemiologist. 7 years experience; community based behavior intervention training; good problem solver.
6. Lane Harris – Health educator. 6 years experience; risk communication training; good contacts with local media.
7. Mary Schneider – Bookeeper. 3 years experience; county finance system training; spreadsheet and database expertise.
8. XXXXX XXXXX – Public health nurse supervisor. 2 years experience; mass dispensing site training; organized; detail oriented.

Place the name of your choice next to the Assignment in the table below and write a brief justification for your selection.

Name Assignment Justification
Liaison Officer
Finance/Admin Chief
Planning Chief
Logistics Chief
Public Information Officer
Operations Chief

Complete the organization chart below by inserting the name of your selected ICS members in front of their job title. Dr. Burke is already on the chart.
Day 1, 1000 hours – The first EOC briefing is convened. The EOC command structure is noted on the following organizational chart.



Mr. Newhouse, the EOC commander, gives the following briefing:
1. The updated EOC ICS chart is now published with the names of the command staff and section chiefs.
2. The rain is tapering off.

Ms. Brower, Operations Chief, speaks next.
1. Search and rescue is taking place in the most damaged areas.
2. Six confirmed dead with 14 injured.
3. No power at the water treatment facility; sewage is backing up and most of the county is without water. Houses with water wells have contamination from flooding.
4. Roads are blocked by debris.
5. 125 people have been evacuated from their homes and need temporary housing.
6. The sodium hydroxide spill has been contained.

Mr. Dubay, Logistics Chief, reports:
1. A temporary shelter is being set up by a local volunteer agency.
2. Landline telephones and cell phones are inoperable. Radios are being used for communications.

Dr. Burke, Health Director, asks you to give a briefing on any public health announcements needed or actions in progress.
Write your briefing points here (select issues that correspond to the information given by Operations and Logistics). You should have at least one announcement and two action items.
1. Public Health announcements needed:
2. Action 1:
3. Action 2:

Mr. Newhouse schedules a press conference for 1600 hours. You will need to prepare a public health press release.

You now have a To Do List:
1. Conduct an inspection of the temporary shelter.
2. Evaluate food safety at the shelter.
3. Assist the Public Information Officer in preparing the press release.

Day 1, 1300 hours – Shelter inspection. Public health provides support to ensure a safe/healthy environment. You are accompanying the environmental health specialist who was tasked by the operations chief to inspect the shelter. You will look at three areas and make appropriate decisions.

1. Food Preparation – There is hot food at the shelter which was professionally prepared by a volunteer group. The food temperature is acceptable. There is a limited amount of bottled water. However, there are many food items which have been brought in by community members and were prepared in private homes.
2. Living Conditions – There are several people in the shelter who brought pets with them.
3. Sanitation- The rest rooms are overcrowded, unsanitary, and there is no soap.

What decisions will you and the environmental specialist make concerning these three issues? What outside agencies can you call on for support? What supplies/equipment will you order? Write your decisions/actions below.

Issue Action
Food Preparation
Living Conditions
Sanitation

Day 1, 1600 hours – Press Conference

You have assisted the PIO in preparing the public health portion of the press conference. What will you report? What handouts or public service announcements will you provide? Think about the health issues that have surfaced so far and consider the people who are still in their homes without power or supplies. Complete the following table.

Handout topics
Public service announcement topics
Public health issue reports
Other topics (optional)


Day 2, 0900 hours – Second EOC briefing.

Mr. Newhouse reports that 1500 homes are without power and it will not be restored for four days. The water levels are now stable. Cell phone use has been restored.

Dr. Burke reports:
1. Tetanus vaccine is available. He is using Health Alert Network to provide clinics with information on who is at highest risk and information on the CDC recommendations.
2. Restaurants are requesting inspections for re-opening.
3. A mutual aid pact with a neighboring county has provided three additional public health staff.

Ms. Bower reports that the residents in the southwest portion of the county are isolated by flooding. There are no immediate life or safety issues but the residents need to be checked.

Mr. Newhouse replied that multi-disciplinary teams will be sent to that area with representatives from fire, public health, and public works. These teams will have some emergency supplies.

Your To Do List:
1. Conduct an inspection of local restaurants.
2. Assist the Public Health Nurse on the multidisciplinary team visits.

Day 2, 1000 hours – Because of the power outage, many residents need to purchase food. You must ensure that local restaurants meet standards. Your job is to inspect and determine if the restaurant can re-open.

Restaurant 1 – Don’s Café
License is valid; has a generator for power; boiling water to wash pots and pans; using paper plates for customers; fresh food arrived today; food temperature is acceptable; restroom and hand washing facilities are acceptable; refrigeration is operative.

Restaurant 2 – Sir G’s
License is valid; no power; serving food prepared by an outside vendor; no refrigeration; will throw away any food not served; drinks in sealed containers; battery operated lighting; fire extinguisher present; hand washing facilities acceptable.

Restaurant 3 – Opportunity Knocks
Unlicensed; serving homemade food from a cooler.

Restaurant 4 – Moveable feast
License is valid; food/ice purchased from local store; food temperature is acceptable; trash disposal is acceptable; this is a mobile food van.

You now must decide which restaurants may re-open and serve food; briefly justify your decision. Complete the following chart.

Restaurant Re-open Yes or No – Reason for decision
1
2
3
4

Day 2, 1300 hours – Visit to southwest portion of county
You accompany the public health nurse on a series of home visits. What questions would you need answered when you visit with residents of this area? Write at least six questions below. Note that this area houses both young families and elderly people. Some of the residents are using water wells and some are on city water. Several have generators for power. Write your questions below.

Question 1:

Question 2:

Question 3:

Question 4:

Question 5:

Question 6:

HOME VISIT INFORMATION

Home 1: basement flooded; spilling of several gallons of chemical solvents.
Home 2: Out of infant supplies; elderly grandparent in residence; very stressed environment; mother almost at the breaking point.
Home 3: The person who answered the door did not speak English.
Home 4: The resident has run out of blood pressure medicine. The nurse took his pressure and it was very high.
Home 5: A child sustained burns on her palms when playing near the site of the chemical spill.

Based on the above information, what actions will you and the nurse take? What other agencies might help? What advice can you give? Based on the above home visits, what handouts/materials can you give out that would help the residents?
Complete the following chart.

Home Actions/Advice/Materials/Handouts
1
2
3
4
5

Day 5, 1400 hours – Final EOC briefing

Mr. Brower reports that there are 20 individuals left at the shelter; the power is restored in the entire county and phone service is restored also; the water has receded. He wants to know if the last residents can return to their homes.

Dr. Burke discussed the safety of the food and water supply. He announced that the public health nurse was available to residents and the environmental health specialist could help with mold and hazardous material cleanup.

Mr. Brower asks for an operations plan so people are not returning home unsupported. He scheduled a town hall meeting in two days for an after actions report and a Q&A session. He scheduled an Information Fair prior to the meeting.

You are tasked to work with the PIO in determining what materials to hand out at the Information Fair.
List the topics of at least four brochures that you will bring to the Fair; you may list up to eight topics. Complete the following table.

Brochure Topic
1. 5.
2. 6.
3. 7.
4. 8.

Day 7, 1000 hours – Town Hall Meeting

Dr. Burke reports the following public health successes and shortfalls during the After Actions Report.

Things that went well included:
1. REMS training was evident as the department quickly established ICS.
2. Execution of Mutual Aid Pact to bring in additional public health staff from neighboring county.
3. Public health involvement early on at the EOC gave a good head start in responding to public health concerns.
4. Public health nurse involvement in home visits was essential to recovery efforts.
5. Inclusion of public health materials at the Information Fair was effective in providing information to the community.

Areas needing improvement included:
1. Dissemination of public health information needs improvement and consistency.
2. Lack of efficient emergency communications among public health staff when phone/cell lines are disrupted.
3. Food wasted due to preparation or temperature issues.
4. No plan for disposal of dead animals, fish, vectors (rodents).
5. No adequate plan to handle mental health needs.
6. Effective response sometimes delayed due to language barriers.

You are tasked with making recommendations for process improvements and emergency plan revisions. Write a brief recommendation for each issue noted above (areas needing improvement) taking into account public health resources (personnel, brochures/information, equipment/materials) and the use of outside agencies.

Complete the following table.

Issue Recommendation
1 dissemination
2 communications
3 food
4 disposal
5 mental health
6 language

Final Assessment- Answer the following questions:
a. Evaluate the effectiveness of this exercise in helping you to understand the role of public health in an emergency incident.
b. Briefly discuss the role of public health before, during, and after a public health emergency.
c. Give examples of the major threats to public health: natural, accidental and intentional
d. Describe the most important thing that you learned in this simulation and why you feel it was the most important.
e. Identify the most challenging assignment in the simulation. How did you approach the completion of this portion of the simulation?
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