1. Ruth Bachmeier, MS, RN John R. Baird, MD, MPH Doug Murphy, MBA, BMS Fargo Cass Public Health Fargo, North Dakota

2. Objectives Identify role of local public health during a major flood Recognize importance of collaboration and cooperation during a major flood disaster Evaluate the risk/ benefits and decision making involved in evacuation of vulnerable populations

3. Red River at Fargo, ND River flows north Very flat land Wet autumn Record snow fall Flood stage: 18 ft Major flood stage: 30 ft Record flood of 1997: 39.57 ft March 28: crested at 40.82 ft FEMA photo

4. Role of Fargo Cass Public Health Historically Tetanus shots Post flood environmental concerns Minimal EOC 2009 Limited Tetanus shots Pre-post environmental concerns Full EOC involvement Evacuation of vulnerable populations Shelter coordination and staffing Sandbag supervision PIO backup Fargo Cass photo

5. Emergency Operations Director of public health: city cabinet meets weekly Weekly flood meetings : first part of March EOC activation: city and county Public health in both EOCs Twice daily flood briefings Bob Collins Photo Minnesota Public Radio/mpr.org

6. Collaborating Partners Local hospitals, long-term care facilities, congregate living sites for vulnerable populations North Dakota Long Term Care Association North Dakota Department of Health North Dakota Department of Human Services FM Ambulance and transportation providers

7. Poll 1 My jurisdiction has distinct geographic characteristics which should be taken into consideration in our PH emergency planning. A Strongly Agree B Agree C Disagree D Strongly Disagree Click on the down arrow if you can’t see the response choices.

8. Speed of River’s Rise

9. Crest Predictions

10. Poll 2 Health facilities and facilities housing vulnerable populations in our jurisdiction have role and staff specific, up-to-date emergency plans in place, and have exercised those plans including mandatory or advised evacuation procedures. A Strongly Agree B Agree C Disagree D Strongly Disagree Click on the down arrow if you can’t see the response choices.

11. Evacuation Planning Conflict between protecting city and evacuation “Evacuation is not an option” Plan for vulnerable populations Frequent partner meetings Teleconference Interactive video network FEMA photos

12. Secured shelter sites Evacuated 2500 hospital, long term care and other vulnerable population facilities Coordinated evacuation plans with nursing homes and group homes Formalized evacuation plans for four facilities Transportation arranged More EMS resources requested through EOC Met with healthcare facilities Timeline: Monday – Saturday 3/23 3/24 3/25 3/26 3/27 3/28 2 nd crest

13. Transportation Coordination vital Limited resources in high demand School buses, facility buses, planes, private companies, ambulance Staff assist on evacuation vehicles Federal transportation/ evacuation team arrived shortly after mission over Bus seat configuration Daniel Reetz photo

14. Poll 3 In our jurisdiction, we have a clear understanding of Red Cross services and terminology and what our role would be in partnering to set up an emergency shelter in the event of an evacuation. A Strongly Agree B Agree C Disagree D Strongly Disagree Click on the down arrow if you can’t see the response choices.

15. Shelters Primary site unavailable: affected by flooding Shelters placed in small community 20 miles west of Fargo Two churches, two public schools Lots of resources, Red Cross, DMAT: not always clear who was in charge Resources missing for provision of basic cares

16. Blizzard Fargo Forum photos

17. Details Tracking people Lists Spreadsheets Transport hotline Single point dispatch

18. Repatriation: Second Crest Shelters for other community’s evacuees Engineering assessments Potential second evacuation risk Transporting stretcher patients delay Fewer buses available Fargo Forum photo

19. Lessons Learned Staff deep enough and soon enough (sleep is a good thing) Incident command system works for a public health emergency Communication: internal / external need improvement Wording of evacuation order: voluntary versus mandatory important Specific flood vulnerability assessments important for each facility

20. More Lessons Learned PH not an expert on transportation (but we are now) Patient identification: triage tags Definition of shelters for special populations Facilities evacuating to “sister” facilities worked well FEMA Photo

21. Resources Fargo flood Web site www.ndsu.nodak.edu/fargoflood USGS http://nd.water.usgs.gov/floodtracking/charts Fargo Forum www.in-forum.com/ Fargo Cass Public Health www.cityoffargo.com/CityInfo/Departments/Health/