Edited Version April 7, 1999 Transcript
EIIP Virtual Library Online Presentation

Quick Response Report #111
"Public Health Emergency Response:
Evaluation of Implementation of a New Emergency Management System for Public Health in the
State of Georgia"

Anita Kellogg, CEM
Vice President, ICF Incorporated

EIIP Moderator: Amy Sebring

The original unedited transcript of the April 7, 1999 online Virtual Library presentation is available in EIIP Virtual Forum Archives (http://www.emforum.org). The following version of the transcript has been edited for easier reading and comprehension. Typos were corrected, date/time/names attributed by the software to each input were deleted but the content of questions and responses are as stated by each participant. Answers from the participants to questions by the audience are grouped beneath the appropriate question to facilitate meaning.


Amy Sebring: Welcome to the EIIP Virtual Library!

For the benefit of our first-timers, when you see a blue Web address, you can click on it and the referenced Web page should appear in a browser window. After the first one, the browser window may not automatically come to the top, so you may need to bring it forward by clicking on a button at the status bar at the bottom of your screen. Right before we begin the discussion portion I will review how to submit questions/comments.

For background info on today's session, please see <http://www.emforum.org/vlibrary/990407.htm>


We are pleased to welcome Anita Kellogg, CEM, Vice President with ICF Incorporated, and lead for ICF's Emergency Management Practice. A more complete bio is posted on the background page. Anita is with us today to present Quick Response Report #111, "Public Health Emergency Response: Evaluation of Implementation of a New Emergency Management System for Public Health in the State of Georgia."

Welcome and thank you for taking time to be with us today, Anita.


Anita Kellogg: Good afternoon, my name is Anita Kellogg. Today's presentation is based on an evaluation ICF employees, my peers, did after the 1998 floods and tornadoes in Georgia. Amy, SLIDE 2, please.


Anita Kellogg: Our role in Georgia began as a result of the 1994 floods in Georgia when public health staff were called upon to act as responders and they felt unprepared. Amy, SLIDE 3, please.


Anita Kellogg: Issues that arose included: damaged infrastructure to their communications system, water contamination, injuries and disease, access to pharmaceuticals, and staffing shelters, including shelters for persons with special needs. Amy, SLIDE 4, please.


Anita Kellogg: Our work in Georgia included 4 phases:

1: research/assessment of readiness;
2: development of procedures to address the roles of public health staff in preparedness, response, recovery, and mitigation;
3: implementation (training and exercises); and
4: the purpose of today's talk, our real-world evaluation of how the system worked as a result of real tornadoes in 1998. Amy, SLIDE 5, please.


Anita Kellogg: Key findings of our original research phase were that public health staff were rarely involved in state level or county level emergency management preparedness plans, training, or exercises. Exceptions included emergency medical services who regularly practice with hospitals. Amy, SLIDE 6, please.


Anita Kellogg: Based on our findings, we drafted procedures that defined a management structure, functional positions (based on ICS), procedures for EOC management, and coordination mechanisms with partners in response. Amy, SLIDE 7, please.


Anita Kellogg: This is the ICS-based management structure. We recommended a structure more parallel to the traditional ICS, but this is the system that Georgia was most comfortable with. Amy, SLIDE 8, please.


Anita Kellogg: This slide summarizes the three times when the system was tested, concluding with the ultimate test, the tornadoes of 1998 that resulted in at least 5 Presidential disaster declarations in Northern GA. Amy, final slide please.



Anita Kellogg: Conclusions from our real-world evaluation include: the system worked where public health staff had embraced it; they felt as if they managed the disaster response instead of being overwhelmed.

Take aways include:

1: make the system mirror existing mechanisms, e.g. we changed the traditional ICS into functional names that were familiar to GA public health staff, but kept the principles of one system that works for small and large incidents and is based on functional positions;

2: coordinate with internal and external partners, because no one responds alone.

Thank you.

Amy Sebring: Thank you, Anita for that introduction. We will take audience questions in just a moment but I would like to get a couple in first.


Amy Sebring: In your paper you mentioned the key role of a full time emergency coordinator at the state level, how critical do you feel that was to success?

Anita Kellogg: That position was and still is critical. The coordinator at the Division level coordinates and keeps the system alive in the districts. Like many emergency preparedness (EP) programs, there was no additional funding for EP. So it really needs a champion.


Amy Sebring: You also compared and contrasted two different counties in your paper, one that had previous disaster experience and one that really did not. Can you discuss that a little, please?

Anita Kellogg: Yes. District 8 in southern GA had been devastated by the 1994 floods; many people died and the public health staff were fully taxed. It was no surprise that they were the most active during the planning process. Steering us and providing a lot of input. As a result, they fully embraced the procedures and exercises.

When the 1998 floods hit, they felt tested and ready to go; this is in contrast to a district in Northern Georgia that has rarely been tested --- affected --- by disasters; they were not convinced of the merit of the procedures that were developed. As a consequence, when they were hit by tornadoes in 1998, they, according to some, were not as well prepared because they didn't really use the procedures.


Amy Sebring: I think you also alluded to the importance of a single point of contact in the local EOC?

Anita Kellogg: Right, the coastal districts had good relationships with local emergency management agencies because of regular practice for hurricanes. Other places in the state, where no one had told public health staff that they would have a role in emergency response, were less connected.

Amy Sebring: Thank you, let's open it up to our audience now. If you have a question for our speaker, please input a question mark (?) and wait for recognition from the moderator before sending your question. You may compose your question and have it ready to submit but do not send it in until you are recognized. Ready for first question/comment, please?

[Audience Questions]


Claire Rubin: Are you familiar with the Georgia study that Elliott Mittler did (monograph for Colorado NHRAIC)?

Anita Kellogg: I'm afraid I am not.

Claire Rubin: I was wondering if what he said about recovery provides a context for your experience there.


Amy Sebring: Anita, can you address recovery there in your experience?

Anita Kellogg: If you can paraphrase his thoughts, I will try to respond.

Claire Rubin: He did an extensive study of the politics of community state relations and I was wondering if your health work fit in with what he says about the general context.

Anita Kellogg: The recovery process was very slow mostly because public health staff were not prepared. They didn't know their roles, they hadn't practiced, they didn't have rosters for subsequent shifts. For example, there was a lot of debate about a disease surveillance protocol to be used to monitor short and long term health effects. Ideally that protocol would have been established.

Claire Rubin: Sounds like a few places I have worked!


Avagene Moore: How does the new planning tie in with the overall emergency management concept and planning at state, region (state), and local government levels?

Anita Kellogg: When we entered the scene there had been little coordination between public health and the State of Georgia Emergency Management Agency (GEMA). We started at the basics, to make sure the Division (state) public health plan met the objectives in GEMA's plan.

After we developed procedures at the state level, we were tasked to develop procedures for the 19 public health districts and the 159 county boards of public health. The client was very clear that they wanted a system that worked throughout the public system for large and small incidents.


Rick Tobin: Two pronged question: Are you aware of HEICS (Hospital Emergency Incident Command system) and what are your hospital clients doing about Y2K?


Amy Sebring: Do you work with hospitals, Anita?

Anita Kellogg: I was not aware of this system but I'd like to learn more. And ICF doesn't currently have clients that are hospitals. Our Georgia client was the state.


David Crews: Were your recommendations translated to Public Policies at the State/Local levels? (e.g. Legislative action and Emergency Operations Plans)

Anita Kellogg: The plan/procedures were adopted by the State Public Health Office, it did not require legislative action.


Amy Sebring: Did your planning for the public health system include mitigation and recovery as well and what were your recommendations in these areas?

Anita Kellogg: Amy, yes. The plan included a concept of operations and procedures for preparedness, response, recovery and mitigation, although in public health, mitigation is closer to prevention.


David Crews: How about the Georgia EMA?

Anita Kellogg: David, GEMA did not need to adopt the plan for Public Health. GEMA has functional annexes in their plan, much like the Federal Response Plan, so it was our job to create the state version of ESF #8, if that makes sense.


Amy Sebring: Along the lines of David's follow up question, is there a Public Health position in the state EOC? Or I guess that comes under ESF 8?

Anita Kellogg: Yes, there are two, one for mass care and one for emergency medical services.


Amy Sebring: I also found some of your findings with respect to sheltering challenges quite interesting. Can you share some of that, in terms of special needs sheltering?

Anita Kellogg: During the floods of 1994 the biggest issue was one of surprise that public health nurses (PSN) were required to staff any shelter. There had been a lack of communication between public health and the American Red Cross. That communication is working better now and the two have established a MOU (Memorandum of Understanding) about a pool of nurses, some public, some private to fill the role.

With regard to PSN, the county EMA really took that on, in terms of establishing the shelter and to the sensitivity of the clients, an EMS unit regularly supported those clients.


Amy Sebring: Is that a statewide MOU or in one of the affected divisions?

Anita Kellogg: It is statewide, although the ARC does not have active chapters statewide, so there are some holes. I imagine that is true in most states.


Amy Sebring: What was the impetus for this project in the beginning Anita, perceived shortcomings?

Anita Kellogg: Yes, the Division of Public Health was very forthcoming that they had been unprepared and didn't want to repeat their mistakes.


Amy Sebring: You also raise the possibility of sharing this with other states. Has anything been happening in that regard that you know of?

Anita Kellogg: Not that I know of. We presented this paper at the American Public Health Association conference in an attempt to share the findings.


David Crews: Did you use the FEMA ESF-8 as a guide to bridge between Federal and State?

Amy Sebring: I think she has already addressed that David, but if you would care to elaborate any, Anita?

Anita Kellogg: We used it to ensure that we were addressing all the issues, and we discussed the connections between federal and state/district/local in the concepts of operations. Being in Atlanta, they feel they are very close to ESF #8 RE:CDC (Center for Disease Control).


Rick Tobin: How did your planning process address a massive outbreak of disease, whether artificial(terrorism) or natural?

Anita Kellogg: As most plans do, we began with a set of planning assumptions that included those provided to us by GEMA, and we added unique public health issues. The procedures for preparedness and response were designed to be process oriented and if we did it right, they cover an outbreak of measles and tornadoes.


David Crews: I was in a FEMA DFO last year (Georgia - April) and was surprised by the communication problems between the State and FEMA IV. (FYI: FEMA IV is also located in the next building from CDC.)

Anita Kellogg: You know, there is tension between a few Region IV states and FEMA. In their defense, FEMA Region IV has 8 states and more disasters than other Regions, so maybe that causes some of the tension.


Avagene Moore: From your perspective, other than the fact that Georgia Public Health has good credible plans, what is the greatest benefit of this effort to the entire preparedness status of the state?

Anita Kellogg: That Public Health staff can respond immediately to the needs of its citizens in a coordinated manner. This project really proved the old adage that it's not the plan, it's the planning process that educated the players.


Rick Tobin: I have the disaster statistics map in front of me. I don't think Region IV has the most disasters. Sorry.

Anita Kellogg: OK, maybe it just feels that way.


Amy Sebring: Did you get a good response at the conference you mentioned? Do you think there will be further interest? And follow-up, is there a point of contact for further info?

Anita Kellogg: I hope so. We are also doing a poster session on this at the upcoming NDMS conference next month. I am willing to be a point of contact. If you want to talk to the state directly, the contact is Deborah Glover, Emergency Coordinator.


Jim Cook: Have you looked at biological terrorism? Do you see a change coming in how the nation's hospitals track and report patient information in order to get a better handle on where and when or if a biological terrorist act has taken place. It seems that the reporting requirements of hospitals today fall way short of what is needed. Have you heard much about this in your conferences?

Anita Kellogg: I think there is always room for improvement. I have heard quite a bit of conversation about the need for vaccine stockpiles, more hospitals with decontamination capability, and better trained/protected EMS.


Amy Sebring: I want to ask about your experience with the Olympics. Did you test the concepts there?

Anita Kellogg: Yes. At that point we had decided on the use of functional positions that different people can fill and we had just outlined some minimum requirements for an EOC or a Health Command Center as it was called. Two of us went to the HCC to see how it was working and support the effort.

The biggest issues were heat prevention/stroke, environmental health (ensuring the safety of hundreds of food vendors), and disease surveillance, that is until Centennial Park. The bombing was largely a EMS response. There were coordination issues at the scene between EMS and police and between local and federal players.

Final Question:

Amy Sebring: And finally, in those counties where a good EMA relationship does not exist, do you recommend that the public health agency take the initiative to establish one?

Anita Kellogg: Absolutely.

Amy Sebring: Thank you very much, Anita. I think we can take those kinds of services for granted sometimes and perhaps not realize the amount of planning it takes there as well.

Anita Kellogg: Thanks for asking me.

Jim Cook: Thanks Anita!

Amy Sebring: Avagene, a quick look at upcoming?

Avagene Moore: Yes, Amy. Happy to announce that we have a little different Round Table experience for everyone next week. On Tuesday April 13, 1:00 PM EDT, Jan Nickerson will lead an interactive discussion related to her card game, Y2K Connections. This is an opportunity to take a peek at and interact to some thought provoking scenarios for the upcoming millennium. Should be enjoyable as well.

On Wednesday, April 14, 12:00 Noon EDT, Dr. Don Wilhite will speak to us in the Virtual Classroom. Dr. Wilhite is the Director of the National Drought Mitigation Center (NDMC). Personally, I didn't know there was a NDMC until I heard Dr. Wilhite in a presentation at the Dialogue II meeting last December. Interesting work going on there. This is an opportunity to learn about drought and its impact in the States and worldwide.

Plan to attend both of these sessions. That's all for now, Amy.

Amy Sebring: Thanks. Thank you all for joining us today. We will close down the Library for now, but you are invited to adjourn back to the Virtual Forum room for some open discussion.