Presentation on theme: "Introduction to Quarantine and the EMS Public Health Role"— Presentation transcript:
1 Introduction to Quarantine and the EMS Public Health Role Danitza Tomianovic, MPHAssistant Officer in Charge, CDC Miami Quarantine StationDivision of Global Migration & Quarantine (DGMQ)National Center for the Preparedness, Detection, and Control of Infectious Diseases (NCPDCID)Centers for Disease Control and Prevention (CDC)
2 Overview Intro to DGMQ Basics of quarantine Our missionBasics of quarantineDefinitionsHistoryQuarantine Station functionsIllness surveillance and responseEMS collaborationOngoing activitiesPartner Needs Assessment ProjectPublic Health PreparednessSummary
3 Department of Health and Human Services (DHHS) Federal StructureDepartment of Health and Human Services (DHHS)↓Centers for Disease Control and Prevention (CDC)↓Coordinating Center for Infectious Diseases (CCID)↓Here is the structure for the location of the Quarantine and Border Health Services Branch within the federal government, starting with the Department of Health and Human Services…Slide Action:Click 1– CDC flies in from topClick 2– CCID flies in from topClick 3– DGMQ flies in from topClick 4– QBHSB flies in from top and pulsesDivision of Global Migration and Quarantine (DGMQ)↓Quarantine and Border Health Services Branch (QBHSB)
4 Quarantine and Border Health Services Branch (QBHSB) Mission To protect the health of the public from communicable diseases through science, partnerships, and response at U.S. portsThe quarantine stations at our ports of entry are part of CDC’s Quarantine and Border Health Services Branch.The mission of the Quarantine and Border Health Services Branch is to protect the health of the public from communicable diseases through science, partnerships, and response at U.S. ports.Our partnership with EMS is invaluable – we included the term, “partnerships” in our mission statement because Quarantine Station personnel rely on the assistance of partner agencies to achieve the mission of protecting the health of the public. In particular, EMS is one of several partners at ports of entry that recognize and notify CDC of public health events.Photo description: A Quarantine Public Health Officer responds to a call in San Francisco.Photo credit: Ramesh Krishnamurthy, courtesy of the San Francisco Quarantine Station
6 Definition: Isolation Separation and restricted movement of ill persons with contagious diseaseOften in a hospital settingPrimarily individual level, may be applied to populationsOften voluntary, but may be mandatoryFundamental, commonly used public health practiceNow that you know about some of our functions, it is important to understand the distinction between the terms “isolation” and “quarantine.” The word isolation refers to the separation and restricted movement of ill persons with contagious disease. These persons have symptoms of the infectious disease.Isolation is often in a hospital setting.It is usually applied at the individual level, but may be applied to populations.It is often voluntary, but may be mandatory.Overall, isolation is a fundamental, commonly used public health practice, especially in healthcare facilities.
7 Definition: Quarantine Separation and restriction of movement of well persons presumed to have been exposed to contagionoften at home or residential facilitymay be voluntary or mandatoryIn contrast to “isolation,” the word “quarantine” refers to the separation and restriction of movement of well persons (i.e. those without symptoms) presumed to have been exposed to contagion. Quarantine can be accomplished at home or in a residential facility and may be voluntary or mandatory.Photo Note: Atlanta EMS responding to ill person in quarantine during Atlanta live exercise.Photo Credit: George Clark
8 History of U.S. Quarantine Before 1967Quarantine Inspectors monitored passengers disembarking from aircraft, ships, and across land bordersLarge workforce enabled direct inspection, observation, and response[This slide contains automated animation]Up until 1967, with a large workforce of Quarantine Inspectors, passengers were visibly screened and examined on board and as they disembarked from aircraft and ships, and crossed land borders. [mouse click] The Quarantine Inspectors looked for symptoms of illness, most notably telltale signs of smallpox infection, other rash illnesses, and jaundice, a yellowing of the skin and whites of the eyes. Passengers would be routed down segregated hallways and processed by U.S. Customs and Immigration agents separately from other arriving passengers.Photo description: This photo illustrates the visual screening of disembarking passengers by a Quarantine Inspector, highlighted by the red oval.Photo credit: Courtesy of the National Library of Medicine (reference number A018018)
9 History of U.S. Quarantine, cont. Reorganization of quarantine station system reduced staff and facilitiesReorientation of quarantine staff roles2003-presentNewly emerging threats initiated an expansion of quarantine systemBeginning in 1967, the quarantine system underwent a reduction in size and presence at ports of entry. Guided by a new perspective on the threat of communicable diseases (U.S. Public Health thought communicable diseases were no longer a threat), the reorganization of the program generated a reduction in stations and staff, and prompted a revision of quarantine roles and activities. Rather than conducting direct observation of arriving travelers, Quarantine Inspectors shifted to a passive response role, where they relied upon reports from other federal agencies to initiate a response.The emergence of new illnesses such as SARS and the threat of bioterrorism, combined with an evaluation of the current capacity of the quarantine station system, sparked a revision of operations and an expansion of stations, staff, and resources in 2003.
10 This slide shows major human migration flow patterns during 1960 through 1975. Source: Population on Action International 1994.
11 By the 1990s, global migration had increased 4-fold since the 1960s and 1970s. Just imagine the increase today where air travel time between any two cities in the world is typically less than 36 hours. Circumnavigation of the globe takes less than 3 days. This is less time than the incubation period of many infectious diseases.This, in turn, makes our ports of entry even more vulnerable to the introduction, spread, and dissemination of communicable diseases. Because of this, port preparedness planning, surveillance, early detection, and rapid response are essential in containment of infectious diseases. This is where your part of the partnership is especially important to our mission: you are notified of illness more often than quarantine stations are notified, therefore with your help in notifying us, we can respond more rapidly to make a public health assessment and better protect our ports of entry.Source: Population on Action International 1994.
12 Not to mention the global challenges of emerging infx diseases such as SARS During this outbreak it became obvious that the Quarantine program can no longer rely on our history, as proud and distinguished as it is, if we wish to continue to play a role in and contribute to the safekeeping of public health in the United States today.Quarantine stations faced challenges in manpower while responding at ports (visual screening) and contact tracingPartnerships were importantQS were “rediscovered” as public health partners
13 U.S. Quarantine Program HEW 1953 HHS 2004 HHS 2008 52 seaports 41 airports17 border stations33 territory stations41 U.S. consulates50 maritime vessels600 employeesHHS 20048 airports70 employeesHHS 200818 airports2 border stations~100 employeesIn 1953, there were…[read from slide].Contrast that with 2004 when these numbers were reduced to…[read from slide].And now in 2007 we are expanding our quarantine system to include…[read from slide].Note: The Department of Health, Education, and Welfare (HEW) was formed in 1953, and CDC and the Public Health Service became part of this department. HEW became the Department of Health and Human Services (HHS) in 1979.
14 US Average Daily Entry: 1.16 Million (FY06) 1.16M PeopleQuarantine Stations326 POEs681,000 Private vehicle154 Landports176,000 Bus, Train, Walk~80 Staff20 QS240,000 Airline113 Airports44 User air1.16 million passengers and pedestrians enter the U.S. daily. This includes:240,000 air passengers at 133 airports, 44 user fee airports;681,000 travelers that arrive by private vehicle;and 176,000 people arriving via bus, train, foot, or boat to the 154 land ports.Maritime cargo is the largest method of trade movement for the U.S.Source: Slide was modified from DHS CBP June 200771,000 Ship15 SeaportsSource: CBP June 2007
15 CDC Quarantine Stations 2008 JurisdictionsAKMESeattleMinneapolisAnchorageChicagoVTNHWAMTNDDetroitMABostonMNNYRICTCTWIMINew YorkORIDSDPANJNewarkWYMDDEIAPhiladelphiaOHNENo.CAINWVILNVWashington, D.C.San FranciscoVAUTCOKSMOKYNCTNSo.CAOKDallasSCARAtlantaLos AngelesAZNM(Note to presenter: The map with contact list can be printed out as handouts fromTo date, there are 326 ports of entry in the United States: 157 airports, 154 land ports, and 15 sea ports. We share 5,000 miles of border with Canada, 1,900 miles of border with Mexico, and have 95,000 miles of shoreline. Keeping this level of operation in mind, there are only 20 quarantine stations, with close to 100 staff at 18 airports and 2 land border crossings.This map shows the 20 quarantine stations and their corresponding, color-coded jurisdictions, as redefined in Dallas and Philadelphia are our newest stations; they opened in Note that Texas is broken up by county lines; there are three areas that encompass this vast state – North, East, and West Texas, respectively. North Texas is managed by the Dallas station, East Texas is managed by the Houston station, and West Texas is managed by the El Paso station.Note: If participants would like a copy of this map and contact information, they can locate it on the Internet at:North TXALMSGASan DiegoWest TXEast TXLAEl PasoFLHoustonMiamiHonoluluGUHIPRSan JuanCDC Quarantine Station
16 Quarantine Station Staff Roles Officer in Charge (OIC)/ Assistant OICOversees the administration and management of the stationQuarantine Medical Officer (QMO)Oversees the clinical and medical activities and scientific researchQuarantine Public Health Officer (QPHO)Handles daily operative functionsU.S. quarantine stations have staff in three types of positions/job categories. [Read from slide](Note to presenter: If possible, insert a picture of your quarantine station staff. If you don’t include a photo of the Quarantine Station staff, use this slide as an opportunity to introduce the names of the your staff.)
17 CDC Miami Quarantine Station Jurisdiction:State of Florida, Mississippi, Alabama, and Bahamas Pre-clearance portLocated:Miami International Airport (MIA)Concourse E, 3rd Floor FIS AreaStaff:1 ROIC/OIC + 1 AOIC + 1 QMO (in Atlanta) + 3 QPHO’s + 2 Admin Assistants24-hour Phone Number:
18 Air Transport Assoc. of America The Quarantine SystemAir Transport Assoc. of AmericaNetworkSystemCoreQ Stations DGMQ HQ CDCCBPEMSInt. Org. for MigrationState PHAsHospitalsHealth-care providersPort officialsUSFWSUSDA APHISPH labsForeign Gov'tsCourtsInt. Council of Cruise LinesCanadian/ Mexican Border AuthoritiesPHACDHSFAAFBIState Dept.WHONews MediaCSTENACCHOASTHOBIDSAPHLDOTMedia (general)Int. Civil Aviation Org.USCGFBI (local)LPHAsOverseas Panel PhysiciansUSCG (local)FDASource: IOM ReportRelationships among the Quarantine Core System and Network for U.S. Ports of Entry
19 Quarantine Station Functions Illness Surveillance and ResponseEMS Collaboration
20 Quarantine Station Functions Responding to reports of illnesses on maritime vessels (cruise, cargo), airplanes, and at land border crossingsPerforming inspections of animals, cargo, and hand-carried itemsEmergency planning and preparednessQuarantine stations achieve the mission of protecting the public from communicable diseases through a number of activities.The primary activity of quarantine public health officers is responding to reports of illnesses on ships, aircraft, and at land border crossings.Quarantine staff inspect hand-carried items, certain animals, and animal products for possible risks to human health.Quarantine station personnel work closely with other federal agencies, airport authorities, health departments, and other organizations to prepare for public health emergencies, such as pandemic influenza. The training exercise depicted in this photograph is an example of interagency collaboration in preparing for emergency situations. This exercise in Atlanta involved more than 60 different partner groups and accurately reflects the critically important aspect of partnerships in responding effectively to public health threats.Note: Although the Quarantine Public Health Officer shown here is wearing an N-95 respirator; the use of a respirator is extremely rare. Respirators are almost never worn when boarding an aircraft. More commonly, the officer will provide the patient with a surgical mask to contain respiratory droplets, if necessary.Photo description: This photo shows a Quarantine Public Health Officer boarding an aircraft during a live action exercise in Atlanta.Photo credit: George Clark
21 Quarantine Station Functions, cont. Distributing life-saving immunobiologics and investigational drugsProviding travelers with essential health informationQuarantine staff also distribute special immunobiologic agents and drugs through the CDC Drug Service, Division of Scientific Resources. These limited supply agents and drugs are distributed only through eight quarantine stations nationally and are used solely for emergency immunobiologic therapy and/or prophylaxis. For example, someone may be suffering from botulism poisoning and CDC can send botulism antitoxin quickly to the health care provider requesting it. EMS may assist with this at some quarantine stations.Staff also provide travelers with essential health information. CDC’s Travelers’ Health Web site provides detailed health information for international travelers. Public information campaigns around specific issues, such as an illness outbreak, are often conveyed through the use of posters, such as the measles poster for travelers returning from Germany during the 2006 Soccer World Cup.
22 Quarantine Station Functions, cont. In addition, Travel Health Alert Notices (T-HANs) may be provided. These are small cards distributed to international travelers who may have been exposed to an ill person during travel. The cards provide valuable health information, such as the symptoms of the illness, vaccination, treatment and provide instructions for monitoring health and seeking medical care if select symptoms appear. The image on the slide shows the T-HAN for measles and alerts the traveler that he or she may have been exposed to measles. The backside of the card includes information for doctors who may provide follow-up care for the traveler.
23 Quarantine Station Functions, cont. Monitoring health and collecting medical information of newimmigrants,refugees,asylees, andparoleesResponding to mass migration emergenciesEight quarantine stations serve at U.S. ports of entry that receive refugees and asylees. World conflict causes many people to seek refuge in the United States. The quarantine public health officers meet each plane containing refugees, check their temperature, and review their medical paperwork.(Note to Presenter: If you are one of the 8 QSs that receive refugees, give recent examples of arrivals, such as: Somali refugees arrived from Kenya and Ethiopia, asylees arrived from Iran, etc.)Quarantine staff also respond to mass migration emergencies. In these situations, staff monitor the health of migrating populations and assist with reviewing and managing the health information as part of their entrance to the United States.Photo notes/credits:Somali refugees in Kenya (Photo courtesy of the White House,Glossary Notes:Immigrant: An alien admitted to the United States as a lawful permanent resident.Refugee: Any person who is outside his or her country of nationality who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution based on race, religion, nationality, particular social group, or political opinion. Refugees are subject to ceilings by geographic area set annually by the President in consultation with Congress and are eligible to adjust to lawful permanent resident status after 1 year of continuous presence in the United States. (Persons who seek U.S. refugee status must apply for admission to the U.S. Refugee Program while overseas. )Asylee: Same as a refugee, except that an asylee applies for asylum status either upon arrival at a U.S. port of entry or after entry into the United States. Students, visitors, and other nonimmigrants who fear to return home sometimes have no alternative but to apply for asylum after arrival in the United States.Parolee: An alien who appears to be inadmissible to the inspecting officer, but are allowed into the United States for urgent humanitarian reasons or when that alien’s entry is determined to be for significant public benefit. Parole does not constitute a formal admission to the United States and confers temporary status only, requiring parolees to leave when the conditions supporting their parole cease to exist.For a glossary of terms, see: ,
24 Quarantine Station Functions, cont. Building partnerships for disease surveillance and controlEach quarantine station has very few staff members (some have only one person), so we rely on our partners to serve as our eyes and ears to work with us to protect the health of the public from communicable diseases.Photo note:Photo on left, shown here are Danitza Tomianovic and Thomas George, Miami Quarantine Public Health Officers, with a Customs and Border Protection officer.Photos on right taken during a live action exercise in Atlanta.Photo credit:Photo on left taken by David HunterPhotos on right taken by George Clark
25 Responding to an Ill Traveler on a Conveyance The captain of a plane, ship, or other conveyance is required by federal law to report any “illness” or death on board to a public health authority (i.e. quarantine station or local health department) prior to arrival at the port of entry.As mentioned earlier, one of a quarantine station’s many functions is responding to illnesses of public health threat on incoming international conveyances. Our function of responding to reports of illnesses on maritime vessels and airplanes is defined in 42 Code of Federal Regulations Part 71. The regulations to prevent the introduction, transmission, and spread of communicable diseases from foreign countries into the United States are codified in Part 71 of Title 42 of the Code of Federal Regulations. The interstate part is found at Part 70 and addresses illnesses on domestic flights. CFR 42 part mandates that the “master of a ship destined for a U.S. port shall report immediately to the quarantine station at or nearest the port at which the ship will arrive, the occurrence, on board, of any death or any ill person among passengers or crew” during the 15 days before arrival or during the period since departure from a U.S. port.Photo Credit: Microsoft Clip Gallery
26 International Travelers (42 Code of Federal Regulations Part 71) Applies to all international travelers: crew and passengers; U.S. citizens and non-U.S. citizensDefinition of “ill person”:Fever ≥100°F persisting for >48 hoursFever and certain other symptoms:Fever ≥100°F AND rash, orFever ≥100°F AND swollen glands, orFever ≥100°F AND jaundiceSevere diarrhea (with or without fever)ORThe definition of an ill person – which applies to ALL travelers, crew, and passengers, U.S. citizens or non-U.S. citizens – is someone who has fever of greater than or equal to 100 degrees for more than 48 hours OR someone with these specific symptoms:Fever and rash ORFever and swollen glands ORFever and jaundice ORSevere diarrhea (with or without fever)The list of reportable syndromes is being revised and will be expanded to include respiratory symptoms.In the case that these symptoms are not easily detected, we look for anyone who appears very sick with fever. We ask EMS to report any traveler, crew, or passenger with any of these symptoms of illness or death to the quarantine station.OR
27 Additional Reportable Syndromes Current regulations being revisedProposed regulations will have additional reportable syndromes (“requested” reporting for now)Fever and any one of the following:Difficulty breathing or suspected/ confirmed pneumoniaCough of more than 2 weeks’ duration or cough plus bloody sputumHeadache with neck stiffnessReduced level of consciousnessUnexplained bleedingTimeline of new regulations unknown. Currently open for comment.In addition to previous syndromes also include…
28 Executive Order 13295Revised List of Quarantinable Communicable DiseasesCholera; diphtheria; infectious tuberculosis; plague; smallpox; yellow fever; and viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named)Severe acute respiratory syndrome (SARS)Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemicOnly in the case of these nine illnesses listed in the Executive Order signed by the President of the United States does CDC have the authority to quarantine. SARS and novel or reemergent influenza viruses, such as avian influenza, are the most recent additions.CDC Quarantine Station staff has the authority to detain pax/crew for conducting public health assessment. CBP and MDPD are our law enforcement arms in enforcing this authority.President George W. BushApril 1, 2005
29 Domestic Travelers (42 Code of Federal Regulations Part 70) Applies to all domestic travelers: crew and passengers; U.S. citizens and non-U.S. citizens“Domestic travel”: From any State to a point of destination in any other State; or Between points in the same State“Ill person”: a case or suspected case of a communicable disease
30 Notification and Response Protocol at POE IdentificationSigns or symptoms indicative of communicable diseaseTraveler on international or domestic conveyanceNotificationInternational traveler: EMS notify CDC Quarantine Station (QS)Domestic traveler: EMS notify County Health DepartmentPublic Health authorities share notification with EMSResponseInternational traveler:CDC QS staff not on-site communicate by phone and obtain the EMS assessment or CDC QS staff in-person with EMSIn airport settings, the following notification and response protocol is followed:1. NotificationWe receive notification of arriving death or “ill” passenger or crew (defined in 42 CFR Part 71.1) by airline, EMS, or CBP, either before flight landing or after landing. If we receive notification from a partner agency other than EMS, then we will notify EMS, accordingly. If we receive notification before landing or disembarkation, we instruct the pilot or lead flight attendant to have everyone remain seated until a public health evaluation can be completed.2. ResponseIf CDC quarantine station staff are on site, we will board the aircraft with EMS and conduct a public health assessment after an EMS assessment has been completed. If quarantine station staff are not on site we will obtain the EMS assessment and communicate with EMS by phone.Photo Note: Chicago Quarantine Public Health Officer (Shannon Bachar) interviewing an ill passenger on board an airplane.Photo Credit: David Hunter
31 Public Health Information Needed Medical InformationSigns, symptoms, complaints, historyItineraryMethod of travel, from where, U.S. entryExposure history and demographicsContact with ill person or livestock or poultryTravel history in last 10 daysOccupationDate of Birth, country of residencyTraveler contact informationThe notification and response protocol varies based on the port environment. As mentioned before, there are 20 quarantine stations at various locations across the country. There will be times in which we’ll need EMS to complete a public health assessment if quarantine staff are not on site, are unavailable, or if EMS responds first.The assessment, if done by EMS when quarantine station staff are off-site/unavailable, will be supported by CDC over the phone; we may prompt EMS staff with questions, or ask for specific information when they call. The following information, which differs from the standard information typically collected during an EMS assessment, is needed for effective quarantine station communication and public health assessment:The demographics and contact information of the ill traveler(s).The traveler’s itinerary – that is, his or her departure country, intended destination, airline or cruise ship, flight number, seat or cabin number, and their date and time of entry into the United States.The signs, symptoms and complaints of the ill traveler.The past medical history and known diagnosis of the ill traveler.The traveler’s exposure history –Who’s been in contact with the ill person?Has this person been in contact with livestock or poultry?Has this person visited farms or poultry markets?What does the traveler do – what is their occupation?What’s the ill person’s travel history in the past 10 days?(Note to presenter: The goals/purpose of an EMS assessment and a public health assessment are very different. EMS assessments focus solely on life threatening, acute care vs. public health assessments which focus solely on communicable disease suspicion, epidemiology and clinical care/treatment. Inasmuch, the information they normally collect is very different than what we need to conduct our PH assessment.)
32 Health Insurance Portability and Accountability Act (HIPAA) 45 CFR (b)Allows for disclosure, without individual authorization, protected health information to public health authoritiesCDC authorized by law to collect or receive protected health information for:Preventing or controlling disease, injury, or disabilityReporting of disease, injury, vital eventsConducting public health surveillance, investigations, and interventionsBecause we ask EMS to share information with us, it’s important to understand that CDC is covered by HIPAA. The Health Insurance Portability and Accountability Act (HIPPA) governs disclosure of protected health information to public health authorities. CDC quarantine stations are considered public health agencies and therefore can collect protected health information without individual authorization for purposes of prevention and control of disease, surveillance, public health investigations, and interventions.Note: Examples of vital events: births or deaths.Note: The Privacy Act of 1974 governs disclosure by federal agencies of certain personally identifiable information on U.S. citizens and lawful permanent residents. The privacy act should be considered prior to action being requested or taken under these operational protocols. Covered agencies may legally disclose for public health purposes protected health information to CDC, which should include disclosures of medical information on persons suspected or known to have a quarantinable disease or other communicable disease constituting a public health threat.
33 CDC Quarantine Station Illness Surveillance and Response Protocol Goal of CDC Staff : Determine public health risk and appropriate public health actionThree possibilities:Recommend seeking medical care and/or delay travel until noninfectious1Require transfer to Memorandum of Agreement Hospital if quarantinable disease suspectedRequire transfer to hospital if quarantinable disease suspected2Our goal during surveillance and response is to assist you in determining if the illness is a public health threat and, if so, that appropriate public health actions are taken.Three possible outcomes follow our assessment:We recommend that the ill traveler seek medical care and/or delay travel until noninfectious if they have a communicable disease, but not one of the nine quarantinable disease, orRequire the ill traveler to transfer to a Memorandum of Agreement Hospital if they are suspected of having a quarantinable disease, orThe ill traveler may resume travel if desired, if the illness is not a public health threat.Note: a Memorandum of Agreement Hospital is a hospital that agreed to receive patients with communicable diseases, per the Memorandum of Agreement. EMS may be advised to transport to this type of hospital, but only specific state or local health department personnel and quarantine station Staff know which are MOA hospitals.Allow travel to continue, if desired3
34 EMS Role in Illness Surveillance and Response IdentificationNotificationAssist CDC on site and by phone to assess public health riskAssist with transportThe overall objective of EMS in assisting CDC in illness surveillance and response is to help CDC determine if the traveler’s illness is a public health threat and, if so, to assist in providing immediate response.EMS typically takes on the following roles:NotificationQuarantine stations receive reports of illness and death most commonly through EMS and CBP. Because of daily interaction with all travelers, EMS and CBP are the “eyes and ears” for public health issues at our ports of entry.Assist CDC on-site and by phone to assess public health risks.EMS assesses traveler based on standard EMS protocol, in addition to conducting a public health assessment (if necessary).Help transport ill travelers to a specialized hospital or other public health facility.
35 Primary EMS* and Total QARS† Reports, by Quarantine Station, Jan 2006- Sep 2007 Primary EMS CallsTotal IllnessPercent primary EMSANC1615510%ATL4785%HNL34901%MIA2018111%SFO1373%IAD57JFK89BOS238HOU1032%MSP185SEA7838%Total6514964%*Primary EMS is when QS first informed by EMS† Exclude other information reports‡ Quarantine Stations not listed had no primary EMS reports
36 Partner Needs Assessment Project Public Health Preparedness Ongoing Activities:Partner Needs Assessment ProjectPublic Health Preparedness
37 Goals of Needs Assessment Project Build and strengthen relationships with key partners at ports of entryDevelop appropriate training and education content and communication messagesDeliver through preferred and effective formatsA large scale needs assessment project is being done with 10 port partners to address our training and education needs. The goals of the current Needs Assessment Project are:To build and strengthen relationships with key partners at ports of entryTo develop appropriate training and education content and communication messagesTo deliver valuable training through preferred and effective formatsQTET carries out the goals of the needs assessment thru the formation of workgroups, interviews with people involved in training and education, and roundtable discussions and surveys with frontline personnel.
38 Partners (and Audience) U.S. Customs and Border Protection (CBP)AirlinesCruise linesEMSCustoms BrokersBorder PatrolU.S. Department of Agriculture (USDA)U.S. Fish & WildlifeU.S. Transportation Security Administration (TSA)This is a list of our needs assessment partners and audiences. Representatives from each agency are part of a workgroup to guide the direction of the needs assessment. We also have a representative from NASEMSO.
39 Needs Assessment Topics Knowledge, attitudes, and beliefs related toHealth issuesPublic health rolesBarriers to fulfilling public health roleCurrent training related to public health issuesTopics for which staff want trainingTo position ourselves to be able to build and strengthen relationships as well as develop appropriate training for key partners such as EMS, QTET has been focused on learning more about these specific topics:Knowledge, attitudes, and beliefs related to:Health issuesPublic health roles – How does EMS feel about taking part in surveillance and response; are there barriers to understanding the role/purpose of public health; is public health a priority?Barriers to fulfilling public health role – what are those barriers and how can we overcome them?Current training related to public health issues – what training is required of EMTs; where does this training take place; how often?Topics for which staff want training – would EMS staff prefer training on specific topics (e.g., TB, malaria, etc); how would these trainings be best delivered (online, in person, at conferences)?
40 Needs Assessment Topics, cont. Preferred formats for timely and effective communicationsPreferred formats for trainingMethods usedFrequencyOpportunities to work togetherPreferred formats for timely and effective communications – what are the preferred formats for communication; what has proven effective for this audience and what hasn’t?Preferred formats for trainingMethods used – what methods/technologies do EMS staff work well with and/or have access to?Frequency – how often are EMS staff trained?Opportunities to work together
41 Roundtable Discussions EMS & CDC Collaborative Meeting 70 participants from EMS and CDCPresentations and roundtable discussionsPurposeStrengthen the partnership between CDC and EMSIdentify ways to improve reporting of illnesses to CDCIdentify opportunities to collaborate in training and educationIdentify opportunities for sharing dataIn July and September, QTET members had the opportunity to get feedback on the job aids that were drafted for the EMS audience. In July, CDC hosted an EMS/CDC Collaborative meeting in Atlanta, Georgia.There were 70 participants from EMS and CDC presentPresentations and roundtable discussions took place with the purpose of:Strengthen the partnership between CDC and EMSIdentify ways to improve reporting of illnesses to CDCIdentify opportunities to collaborate in training and educationIdentify opportunities for sharing dataThe roundtable discussions were very successful.
42 Aircraft Rescue Firefighting Working Group Annual Meeting Roundtable DiscussionsAircraft Rescue Firefighting Working Group Annual Meeting~200 attendees from airports around the worldCDC presentationRoundtable discussions with 10 attendees from international airportsIn September, Aircraft Rescue and Fire Fighting Working Group (ARFF) held their annual meeting.There were around 200 attendees from airports around the world.CDC presentation on agendaRoundtable discussions with nine attendees who work in airport settings.
43 Training & Materials Draft EMS Public Health Card In developmentSize of ID cardConsultation with Miami-Dade Fire RescueNeed for quick assessment of communicable diseasesNeed to know triggers for contacting CDC Quarantine StationNeed 24-hour contact telephone numberQTET began drafting training and materials to appropriately address key partners. The EMS Public Health Card is a quick reference job aid developed for EMS staff. Its designed to be the size of an ID card for EMTs, to carry and reference when they are working.A consultation with Miami-Dade Fire Rescue showed us:There is a need for materials that will help with the quick assessment of communicable diseasesThere is a need to know triggers for contacting CDC Quarantine StationEMTs still will need contact information, including 24-hour contact telephone number
44 Training & Materials Draft EMS Public Health Card FrontBack
45 Roundtable Discussion Results Identified needs forClear protocols for responses to public health situationsJob aids to support protocolsInclude algorithms and diagramsUse sticker format instead of cardTraining and education (signs and symptoms)Active outreach by Quarantine StationsTraining opportunities = conferences and certification programsState Medical Director plays pivotal role
46 Public Health Preparedness MIA Communicable Disease and Bioterrorism Response PlanDeveloped in collaboration with Miami-Dade County Health Department, CBP, Airport Authorities, MD Police Department, MD EMS & Fire rescue, TSA, Red CrossSurge capacity training for Florida Department of Health employeesTrainings and regular communication with EMS partners
47 Public Health Preparedness, cont. Full-scale exercise at MIA (2005)SARS and Smallpox on aircraftLead to refining MIA CDR PlanTabletop exercise at POM (2005)Cruise arriving with avian flu and plagueIdentified major gaps in resources and surge capacityTabletop exercise at MIA (2007)Avian Influenza on aircraftQuarantine entire flightIntroduced new pandemic influenza preparedness strategiesWe’re hoping a plan similar (mimic) that were doing with airport can be developed in seaport(97 participants)
48 Public Health Preparedness, cont. Developing Comprehensive Communicable Disease Response Plans at major Florida POE’sMiami International Airport (ongoing)Ft. Lauderdale-Hollywood International AirportOrlando International AirportSanford International AirportNext steps: seaportsFinalizing Public Information, Media and Communications PlanDiscussions of Pandemic Influenza PlanningPartnerships are essential!In addition, we’ve been providing input to RCCL and ICCL for dvlpmt of standard industry pan flu plan. Kiren is at WHO meeting with maritime and airport partners, implementation of revised WHO IHR.Trying to dvelop ed matieral for maritmie on reporting reqrmts. Process developing standards mechinism reporting and repsonse. One is to work with VSP in getting reporting. Exploring mechanisms. If look at illness reponse sheet, formatted to fax. Hope to make electronic perhaps with collaborations with VSPRevised dear capt leterIf don’t know(97 participants)
49 SummaryEMS is a vital partner in CDC quarantine station efforts to detect and control communicable diseaseIdentification, Notification and Response of:An international ill traveler (crew or passenger) with any symptoms that meet the federal definition of an ill personA death during international travelCDC wants to work with EMS to help develop appropriate training and find opportunities for collaborationIn summary, the EMS partnership with CDC quarantine stations is necessary for communicable disease surveillance and control.Please call your local CDC quarantine station if you become aware of:An ill traveler (crew or passenger) with any symptoms that meet the federal definition of an ill passenger, orA recently deceased traveler.
50 More Information Contact CDC Miami Quarantine Station 305-526-2910 VisitVisit for health information for international travelersFor more information or for area-specific questions, please contact your local quarantine station.You will also find useful information on CDC’s Quarantine Web site atIn addition, if you are looking for health information for travelers, visit
51 To conclude, the potential for an explosion of a communicable disease is always lurking given our highly mobile global population. Our division and Q stations are in the forefront in preventing the importation, transmission and spread of communicable illnesses from foreign countries into the United States.We rely on cooperation from EMS in meeting our mission.