10.02.03.tcip.v.0930aoconnor.clean

Video Presentation Transcript
>>Good morning from the Centers of Disease Control and Prevention where we are currently managing public health responses to not only the ongoing H1N1 outbreak but also Anthrax, Salmonella and the Haiti Earthquake response. I'm not sure where I'm supposed to point this. This is the first presentation, CDC Public Health Preparedness and Response. [background noise] My last name? Austin. [noise] That's it. There you see a few photos of CDC in action. The Institute of Medicine has a public health prepar-edness definition, you see there on the screen. From a CDC perspective our prepared-ness goal is that people in all communities will be protected from significant public health impacts of infectious occupational, environmental and terrorists threats. In the coordination of emergency response activities, like most agencies, CDC has a hierarchy that we respond under. The Department of Homeland Security has the overall authority for emergency response activities as laid out not only in the national response frame-work but the national preparedness guidelines and very Homeland Security Presidential directives. HHS, under the NRF, has responsibility for public health and medical serv-ices, which is emergency support function 8 under the NRF. And of course as an opera-tional division of the health and human services, CDC is primarily responsible for exe-cuting public health response activities. We do that under the public health, I'm sorry, the pandemic and all hazards preparedness act and HHS CONOPS for ESF8. We also have our own plan structure which includes our emergency operations plan and nested scenarios specific plans such as the Pandemic Influenza Operations Plan, which we are currently revising based upon lessons learned in the H1N1 response. Public health and medical services is an integrated set of missions. As you see before you, HHS is pre-dominantly responsible for the medical care set at the top and HHS is responsible for the public health or populations set at the bottom. We specialize in surveillance of af-fected populations, shelter surveillance and water sanitation and infectious diseases. And as all of you should be responsible, I mean should be familiar with, all hazards ap-proach maximizes available resources. And the all hazards approach in the CDC allows us to take our subject matter experts from across the scientific spectrum and train them and prepare them to be able to respond in the CDC emergency operation center for any type of event. As you're all aware, if you have enough people to do your day to day job, you don't have enough people and resources to respond in an emergency. If you have enough to respond in emergency, you have too many for day to day. So we take people who are normally doing their day job and bring them into the emergency operations cen-ter to help flush out their response. Our preparedness objectives, we have a robust plat-form for emergency response within our core public health functions, as you see there on the screen. Our work in preparedness builds upon decades of science developed to promote public health and our emergency preparedness activities focus on developing new and more rapid surge capabilities and capacities in our core public health functions. And our new name for our office, as was indicated earlier, it used to be the Coordinating Video Presentation Transcript
Office for Terrorism, Preparedness and Emergency Response. As with most new ad-
ministrations, there's a change in names and we are now the office of Public Health,
Preparedness and Response so our name change reflects that key focus. Our prepar-
edness and response priorities within the CDC, we strive to strengthen biosecurity and
safety, develop nationwide biosurveillance capability and enhance public health prepar-
edness in state and local levels. And we do that in a variety of ways. Within the office
that I work in we have the BSU or the biosurveillance unit. We also utilize simple surveil-
lance systems, the biological risk factors, sorry, behavioral risk factors surveillance sys-
tems, BioWatch and the laboratory response network. We are very fortunate that within
the past several years the CDC now has a state of the art emergency operation center.
When the 911 attacks and the anthrax attacks occurred back in 2001, we really didn't
have an EOC and what we had to do was take our subject matter experts from across
the agency, cobble them together into large conferences rooms, bring in televisions for
situational awareness, computers and telephones and it really didn't work very well.
Bernard Marcus [assumed spelling] working with the CDC foundation and other part-
ners, provided us with some money's to set up our first emergency operation center,
which has now been replaced with a new state of the art facility, which is about three to
four times the size of the original one. When we first set that one up, we thought we
would never run out of space. Well as I indicated earlier we have four concurrent re-
sponses ongoing at the moment and now we're utilizing all the space, not only in the
EOC but also every available piece of real estate within buildings 21 and 19 on the main
campus of CDC in Atlanta. Our EOC supports the HHS secretary's operation center. It is
staffed around the clock. There's never not anybody there. If we don't have an active
response going on, we do have a watch staff there that serves as the central point of
entry into the CDC from people concerned with public health activities around the world.
We are also striving very hard to establish what we're referring to as virtual EOC. Not
only will that help us to maximize our capabilities to support multiple functions and re-
sponses but it also enables us to be able to utilize our subject matter experts much
more efficiently. We have some IT intensive resources which enable us to maintain a
common operating picture and situational awareness and we also have a very robust
communications platform in our EOC. Here you see the national operational phases.
We're normally in a steady state, which you see there in the green and whenever some-
thing starts showing up, whether it's on BioWatch or our Central Surveillance Systems
or communications come in through our EOC, then we start raising our level of aware-
ness. As you'll see in one of our later slides, in early to mid April we had a lot of informa-
tion start coming in that raised our awareness level about H1N1. Once we get past the
awareness level, certain triggers are met. Then we go into a concerned phase which will
then lead us eventually into the activation of the EOC and full level staffing. As any good
EOC should be, the EOC serves as a central hub for coordination, not only with our
state and local partners but also our international partners, such as with the H1N1 re-
sponse and the Haiti earthquake response but also serves as a central coordinating hub
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within the CDC centers institutes and offices which you see on the right. And of course
we coordinate with higher level operation centers such as the HHS [inaudible] and the
Department of Homeland Security National Operational Center. In supporting the H1N1
response our EOC has been at either a level 1 or level 2 activation continuously since
April the 23rd of last year, providing space, logistics, operations and IT support to all of
the personnel that have been responding to the H1N1. And what our EOC allows our
subject matter experts to do is to focus on the science of the response. We in the divi-
sion of emergency operations provide the core IMS staffing for our IMS leadership. We
refer to what you might be familiar with as ICS as IMS because of course in the CDC we
don't command but we manage. And so those of us like myself, who work in the division
of emergency operations, are well trained in emergency management and response
and the ICS structure that FEMA promulgates and our subject matter experts are usu-
ally working scientific duties on a day to day basis. When they come into the EOC they
need some assistance in doing this new job that might be a little bit strange for them.
On the bottom line you see that we're supporting a current response profile of over 1700
CDC staff. That seems like a lot of people and it is but keep in mind that that includes
our laboratory personnel, our personnel that are deployed on [inaudible] or that are as-
sisting some of the state and locals with some of their response capabilities. They re-
quest CDC, epidemiological and surveillance assistance. It also includes a tremendous
amount of people that have to clear scientific documents and guidance for public re-
lease. We support our federal emergency response personnel in a number of ways. We
provide training and education. A lot of this is available online through the CDC univer-
sity school of preparedness and emergency response. We provide foreign travel secu-
rity briefings also online. And all of our FEMA ICS courses or the majority of them are
also available online. Certain courses such as ICS300 and 400 are done with mobile
training teams that usually last about three or four days. We provide travel and logistics
support for both domestic and international deployments, providing medical clearance
and vaccination for deployers as necessary. PPE also is necessary and communica-
tions equipment. We have come a long way since 2001 when some of the senior scien-
tific SME's, when they were contacted by the Division of Emergency Operations to re-
port to the EOC, they said what is ESFA and what is IMS? We now require IMS training
for all of our tier 1, tier 2 and tier 3 responders and so that coupled with all the re-
sponses we have had in the EOC of late, means that we have a very robust training
scientific staff that's familiar with EOC operations and IMS. This is a screen shot from
our CDC.gov flu website. It is constantly reviewed by subject matter experts and up-
dated and it will always have the posting dates so that you know how fresh the informa-
tion is. I'm also very impressed with the work that's done by Dr. Marsha Vanderford [as-
sumed spelling] in our JIC, Joint Information Centre in the clearance of all the docu-
ments that are done but also she's staying up with the times and trying to make sure
that she promulgates information through all the new media including Twitter, Facebook
and trying to modify content for use on mobile devices. For our first responders, CDC
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provides guidance on patient assessment, inner facility transport and the cleaning of
vehicles. That includes recommendations for 911 public safety answering points. The
information is constantly reviewed. It goes through a clearance process and then is
posted on the CDC website. Flu experts and [inaudible] experts make recommendations
as the situation warrants and provide updates and posting. Another screen shot you see
that we strive very hard to try to tailor the guidance that's provided. During the H1N1 re-
sponse there was a constant series of questions that were provided to our subject mat-
ter experts based upon query's that were received from our public health partners
across the nation if they felt that the guidance they had been provided so far properly
addressed the needs of their special populations then they would ask is there anything
that you can provide for this population subset? In working with the states, this is one of
the favorite things that they like, which is basically money. And in FY09 we provided
guidance and funds to the tune of about $689 million dollars to 62 state, local and terri-
torial public health departments. Now when you read local don't read the thousands of
city and county public health departments but there are 62 legally defined project areas
so that includes the 50 states, territories and then certain other project areas such as
Washington, D.C., New York City and LA County. We provide technical assistance
through project officers and CDC subject matter experts and of course we have to ac-
count for how the money is spent so we develop performance symmetrics and report
back on how much bang we got for our buck. During the H1N1 response we had to pro-
vide supplemental funding because the PEP grants were not sufficient and so the public
health emergency response grants were provided and our division of state and local
readiness, which is already fully engaged doing the PEP cooperative agreements, ad-
ministered $1.35 billion dollars over two months to upgrade local capabilities to prepare
for and respond to a pandemic influenza outbreak. Hopefully most of you are familiar
with the strategic national stockpile. It is a federal national repository that is strategically
located at numerous locations around the United States and within 12 hours of a formal
request for SNS and approval of deployment of those assets, a pushed package can be
placed at a location as requested by the requesting state. If you're familiar with SNS,
you're probably familiar with the term TARU. TARU has now been replaced with the
stockpile service advanced group so that is a team of professionals that go out and as-
sist the locals with the administration of the SMS assets. I'm sorry, I pushed the wrong
button. Distributing SNS during H1N1 response, the strategic national stockpile has a
large quantity of medicine and medical supplies to protect the American public if there's
a public health emergency, whether it's a terrorist attack, flu outbreak or earthquake,
which is severe enough to cause local supplies to run out. Once federal and local
authorities agree that the SNS is needed, as I stated previously, they will be provided
within 12 hours of the formal request. The items that were provided by the SNS during
the H1N1 response were specifically earmarked for healthcare workers and included 12
million doses of antiviral which were primarily Relenza and Tamiflu. Eighty four and a
half million N95 masks and then over 19 million pieces of other PPE which was face
Video Presentation Transcript
shields, goggles, gloves and hand sanitizer, for the most part. As I indicated earlier the
first couple of weeks of the H1N1 response was very fast. On the 15th of April was the
first identification of the 2009 H1N1 at the CDC lab. Whenever there is an unsubtypable
influenza sample, it is sent to CDC lab to determine what type of influenza it is. So the
15th, that was one of the first red flags that popped up. On the 23rd we identified that
there was a multistate and international outbreak and that's when the CDC emergency
operation center was activated. And then one of the things that really amazed me was
that within a week of the 15th of April, they had completed the GENOME sequence for
the California H1N1, which served as the building block for being able to develop the
vaccine for H1N1, which was done in a remarkably short period of time on top of still
providing the seasonal vaccine. By the 26th of April, SNS had begun to release their 25
percent pro rata to the request in states which is all of the equipment that I mentioned
on the previous slide and on the first of May, CDC test kits to identify the H1N1 virus
were sent out to labs across the nation and even across the world. Again, that to me is a
remarkably fast development. If you have any other questions about how CDC operates
in an emergency response you can take a look at the website that's provided there on
the screen. Even though our name has changed, some things do take time to change.
Some of the URL's and documents on the web have been updated. My business cards
say OPHPR but the website
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