Milk Mayhem The following slides represent a realistic public health crisis event and you are charged with developing first messages for the public.

Setting the Stage Oak County has a population of 1 million people residing within one city and several surrounding rural towns. It is economically diverse with a mix of industrial and farming operations. Oak County is a distribution hub for the entire southwest region of the state. It is an educational hub for the region, with an old, prestigious school of agriculture and several community colleges.

DAY 1: Tuesday – 9:00 a.m. Oak County Hospital Oak County Hospital reports a patient with a positive blood test for Q-fever to the Oak County Public Health Department. The 24 year old male patient’s symptoms included fever, migraine-like headache, non-productive cough, muscle and chest pain. Q-fever was suspected because the individual works in a dairy plant—Purity Brands.

DAY 3: Thursday – 1:00 p.m. Purity Brands Dairy Plant An investigation reveals that 8 other individuals at the Purity Brands Dairy Plant, where milk from multiple dairies is pasteurized, bottled, and distributed, have also had Q-fever symptoms. None of the individuals symptoms are as severe as the 24 year old male patient. A total of 15 people work at the plant. The milk is distributed statewide.

Additional Information About Q-Fever Q-Fever is transmitted via infected animals’ urine, milk, feces and birth products. People become infected when they inhale contaminated droplets or dust. High temperature pasteurization kills the organism that causes Q-Fever.

Additional Information About Q-Fever Only about one-half of all people infected show signs of clinical illness. It is difficult to test for an accurate diagnosis. Symptoms: high fevers (up to 104-105° F), severe headache, weakness, muscle pain, confusion, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Fever usually lasts for 1 to 2 weeks. Q-Fever is treated with the antibiotic, Doxycycline.

Additional Information About Q-Fever A small number of people develop Q-Fever Fatigue Syndrome which can last for years. Chronic Q-Fever, Endocarditis, is more difficult to treat and surgery may be needed to remove damaged heart valves. Although rare, complications may involve the liver, heart and bones. Only 1 to 2 percent of people with acute Q-Fever die.

DAY 3: Thursday – 2:00 p.m. Purity Brands Dairy Plant The additional 8 dairy workers are given blood tests to confirm the diagnosis and are treated with antibiotics. The likely route of infection is through an aerosolized bacteria that workers breathed in as it entered the plant.

Review the Facts What is currently known? 9 individuals are sick with an illness that resembles Q-fever. One illness is confirmed. The 9 ill people are taking antibiotics and are being monitored closely. All 9 individuals work at the same dairy plant. Dairy plants and farms are associated with Q-fever. Milk products are pasteurized at the plant. Pasteurization kills infectious agent in milk and no milk leaves the plant without being pasteurized. Optional Group Discussion: BEFORE you press enter to advance the talking points below the question, you can use this slide to facilitate a group discussion about possible answers to the question. Keep track of time and be careful not to let the discussion run too long.

Review the Facts What is currently unknown? If the 8 additional illnesses are caused by Q-fever or if it is another disease. If any infected milk has left the plant. Optional Group Discussion: BEFORE you press enter to advance the talking points below the question, you can use this slide to facilitate a group discussion about possible answers to the question. Keep track of time and be careful not to let the discussion run too long.

Could the Word Get Out? Although you have not made any public announcements, could the word get out? Yes! How could the word get out? Purity Brands employees Hospital staff Optional Group Discussion: BEFORE you press enter to advance the talking points below the question, you can use this slide to facilitate a group discussion about possible answers to the question. Keep track of time and be careful not to let the discussion run too long.

DAYS 4 and 5: Friday & Saturday Local Hospitals Over the next few days, hospitals across the state begin to experience a rise in emergency room visits from people with severe flu like symptoms.

DAY 6: Sunday – 9:00 a.m. Purity Brands Dairy Plant The State Department of Agriculture investigation does not find any cows with Q-fever at local dairy farms. Pasteurization controls at the plant were found to have been disabled. Thousands of people in the state were likely exposed to Q-fever. State Agriculture Department contacts the Food and Drug Administration (FDA). The FDA issues a recall for Purity Brands without informing the Oak County Public Health Department first.

DAY 6: Sunday – 11:00 a.m. Patients Search World Wide Web Self published “Blog” Web sites proclaim Q-Fever victim input : “I have been unable to work for 10 years.” “No one knows how to treat Q fever. I have been left without treatment or support.” “Q Fever could be developed for use in biological warfare and is considered a potential terrorist threat.”

DAY 6: Sunday – 1:00 p.m. Media Calls Local news reporters begin paging the Public Information Officer of the Oak County Public Health Department as they have been contacted by patients with Q-Fever.

Communicating With the Media What is the best way to handle the media during a crisis? Do you … respond to reporters on a one-on-one, first-come-first-served basis OR, issue a news release OR, hold a news conference?

Communicating With the Media The best way to handle the media during this crisis is to … Hold a news conference. This is fast-breaking news, the public will want to know what’s happening and who’s in charge. Talking to reporters individually could lead to inconsistency of information given to the public. After the news conference, send a news release to your full media list with all of the same information that was presented at the news conference.

What Are You Going to Say? Break into groups of 4 to 6 people, develop your first messages using the six proven steps.

Deliver An Effective First Message Express empathy. Share what you know – only confirmed facts. State what you don’t know. Describe the process and plans to fill in knowledge gaps. State your agency’s commitment to helping people through the crisis. Guide people to where they can get more information.

Sharing Your First Messages Report to the large group the first messages your group developed.

Sharing Your Group Results Sample First Message: Optional Group Discussion: After each group has shared their first message results, distribute the Sample First Message Handout. Read the Sample First Message aloud and advance to the next slide.

Now … Anticipate the Questions In your groups of 4 to 6 people, develop a list of questions you would expect the media and the public to ask.

Anticipate the Questions What are the questions that are likely to be asked as a crisis unfolds? Anticipate questions from the people that are directly impacted by the crisis. Anticipate questions from the general public. Anticipate questions from the media.

Share Your Group Results Sample questions: Is it safe to drink our milk? What have you found that will affect us? What caused this problem? What is being done to help the victims? Who is in charge? Optional Group Discussion: BEFORE you press enter to advance the sample questions, ask each group to share the group results. Keep track of time and be careful not to let the discussion run too long.

Intentional Milk Mayhem The investigating federal agencies report that no other dairy plants in the state appear to have any problems with pasteurization control. Thus, the milk at the plant did not come from a local dairy. The milk supply was intentionally contaminated with Q-fever.

Intentional Milk Mayhem The FBI announces they have in custody a professor from the agricultural school in connection with the milk tampering. The professor had been in the plant, researching infection control measures. He said he wanted to “see if he could do it” and purposefully used a generally non-lethal pathogen.

Next Steps