Operation PPE – Developing a Safety First Culture for Iowa Environmental Public Health Cory Frank, BA, Iowa Department of Public Health Des Moines, Iowa February 2007

Background Recent emergencies that involved environmental health responders or responders effected Recent emergencies that involved environmental health responders or responders effected by environmental contaminants- such as the collapse and cleanup of the World Trade Center Towers in 2001, Hurricane Katrina, and local public health outbreaks in Iowa involving endemic fungal species and parasitic organisms like H. capsulatum and Cryptosporidium. by environmental contaminants- such as the collapse and cleanup of the World Trade Center Towers in 2001, Hurricane Katrina, and local public health outbreaks in Iowa involving endemic fungal species and parasitic organisms like H. capsulatum and Cryptosporidium. Flooding events in rural Iowa have created the need for environmental assessments by local environmental health specialists to respond to local emergency management requests. Flooding events in rural Iowa have created the need for environmental assessments by local environmental health specialists to respond to local emergency management requests. Funding provided to local public health agencies has not incorporated environmental health responders into agency safety programs if even available. Funding provided to local public health agencies has not incorporated environmental health responders into agency safety programs if even available. Local environmental health agencies have developed emergency response plans. Local environmental health agencies have developed emergency response plans. The need for this safety first attitude and agency culture has become especially evident due to recent events involving environmental public health factors, preparedness planning efforts, and local funding gaps including:

Problem Statement Why with the important role that environmental health plays in response efforts in the post 9/11 and Hurricane Katrina era, do local environmental public health practitioners not have adequate knowledge or levels of personal protection equipment (PPE) or active occupational safety programs? Why with the important role that environmental health plays in response efforts in the post 9/11 and Hurricane Katrina era, do local environmental public health practitioners not have adequate knowledge or levels of personal protection equipment (PPE) or active occupational safety programs?

Behavior Over Time Graph

Contributing Factors Creation of local environmental public health response plans involves the use of local EH in the response curve. CDC Preparedness grant funding was created to involve local and State EH agencies; incorporating the need and use of PPE in job action sheets and when responding. Creation of local environmental public health response plans involves the use of local EH in the response curve. CDC Preparedness grant funding was created to involve local and State EH agencies; incorporating the need and use of PPE in job action sheets and when responding. ●Current grant project surveyed local EH to determine that they lack essential job related PPE. Local health departments do not have occupational safety programs to prevent injury during regular job duties let alone an environmental public health emergency. ●Current grant project surveyed local EH to determine that they lack essential job related PPE. Local health departments do not have occupational safety programs to prevent injury during regular job duties let alone an environmental public health emergency.  Local public health agencies have purchased PPE for some public health responders such as nurses but not EH. Also, items such as N95 respirators have been purchased and distributed without proper fit testing or medical monitoring of users.  Local public health agencies have purchased PPE for some public health responders such as nurses but not EH. Also, items such as N95 respirators have been purchased and distributed without proper fit testing or medical monitoring of users.  Creation of the IDPH EHRT (team) has promoted the roles of EH in emergency response.  Creation of the IDPH EHRT (team) has promoted the roles of EH in emergency response.

Limits to Success REAL World emergencies and tragedy have increased the need for Safe EH emergency response Local/State EH NEED TO use PPE performing daily work and respond to emergencies R No enforcement and buy in of local or State occupational safety programs B Lack of Occupational health programming envelopment in EH education and training B We don’t need to use PPE because we don’t ever respond I won’t get hurt and won’t take my work home with me SO WHY DO I NEED IT! Funding to local EH from Grants EH response training and information including credentialing in Iowa Little or no data showing risk or actual injury or death from EH workers or responders I never have used PPE before WHY SHOULD I NOW?

Local EH lacks PPE Fix – Money, tools, templates given to local public health Unintended Consequences-Local EH when provided funding did not purchase PPE B R Fixes That Backfire Increased EH involvement in emergency response activities Collaboration with Public Health Nursing Flexibility provided R I don’t have a voice and opinion is not validated We don’t need PPE we never use it

Program Goal To reduce the risk of disease and injury to local Iowa Environmental health professionals due to the availability and knowledge of use of PPE (Personal Protection Equipment) by creating an occupational safety culture within local and State environmental public health. To reduce the risk of disease and injury to local Iowa Environmental health professionals due to the availability and knowledge of use of PPE (Personal Protection Equipment) by creating an occupational safety culture within local and State environmental public health.

Process Objectives 1. By July 30th, % Iowa local environmental health departments will have received awareness materials and training regarding the critical value and use of PPE while performing normal job functions and response activities.

National Goals Supported 10 Essential EH Services 10 Essential EH Services  Monitor environmental and health status to identify community health problems.  Diagnose and investigate environmental health problems and health hazards in the community.  Develop policies and plans  Enforce laws and regulations that protect health and ensure safety  Assure a competent environmental health workforce CDC Health Protection goals CDC Health Protection goals  People prepared for emerging health threats CDC National Strategy to Revitalize Environmental Public Health CDC National Strategy to Revitalize Environmental Public Health

Thank You! Cory Frank Iowa Department of Public Health, EH Services Bureau, Des Moines, Iowa (515)