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Partner, Train, Respond: Increasing Global Emergency Management Capacity

People walking a busy street in Zanzibar.

Countries in Africa are no strangers to major disease outbreaks that can result in illness and death of millions of people.  In the past two years alone the continent has experienced infectious disease outbreaks of cholera, meningitis, Ebola Virus Disease, Lassa fever, and Yellow fever, and other public health emergencies such as drought and famine.

Understanding the big picture

Training participants from Zanzibar discuss the development of an emergency management program
Training participants from Zanzibar discuss the development of an emergency management program.

It is vitally important to have a big picture perspective on emergency management and response – if one country is not prepared for a public health emergency, then all the countries in the region are susceptible to public health threats that can easily cross borders and impact surrounding countries. This is where public health emergency management (PHEM) comes in. In-country PHEM capacities and systems can be strengthened to support global health security. When the workforce is trained, emergency management infrastructure is in place, and functional systems exist, a country is better positioned to execute a coordinated response that can mitigate risk and save lives.

CDC and other international partners support ongoing efforts to help countries across Africa build capacity in outbreak detection and response. This includes preventing avoidable epidemics, detecting public health threats early, and responding rapidly and effectively to outbreaks of international concern. CDC provides expertise in PHEM to train emergency management technicians, provide input on emergency management operations, and guide development of functional processes and systems for ministries of health around the globe.

Getting the workforce ready to respond

In August 2017, CDC spearheaded a 5-day PHEM workshop in partnership with the World Health Organization, the United States Defense Threat Reduction Agency, and Public Health England.  The workshop brought together 55 emergency management staff members from across Africa to learn from experts in the field about how to enhance coordination and response capabilities of their country’s PHEM programs.

Participants came from seven countries – Tanzania, Uganda, Kenya, Ethiopia, Liberia, Sierra Leone, and Nigeria – which all share common interests and challenges related to emergency response. The training focused on developing core principles in PHEM, including trained staff, physical infrastructure, and processes to run a fully functional Public Health Emergency Operations Center (PHEOC). The training highlighted best practices, but since many of the participants had first-hand accounts of responding to public health events in their own countries, they were encouraged to share experiences and network with their peers.

Sharing knowledge and expertise

Public health professionals who work in emergency response know that it’s important to build relationships before an incident so that during a response you work effectively and efficiently with partners. One participant noted that the “rich, valuable contributions from other people’s experiences to build upon what I already knew” was one of the most rewarding parts of the workshop.

The tabletop exercises at the end of the workshop emphasized the importance of information and idea sharing. Participants engaged in tabletop exercises that simulated a response to a Yellow Fever outbreak in northern Tanzania. Participants were divided into 7 teams: management, plans, logistics, operations, finance and administration, communication, and partners. Each team had a mix of participants from different countries.  Teams utilized information they had learned throughout the workshop to developed response products, including an organizational structure chart, objectives for the response, and an initial situation report. This exercise led to a robust conversation about different approaches to public health emergency response.

Seeing response in action

Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.
Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.

A highlight of the training was when Dr. Ally Nyanga, the Tanzania Ministry of Health PHEOC Manager and an alumni of the CDC Public Health Emergency Management Fellowship, took workshop participants on a tour of the Tanzania PHEOC, a small room on the third floor of the Ministry of Health building. Previously used as a storage area for the library, the 10 x 20 foot PHEOC is now an efficient space that staff can use when they respond to public health emergencies and outbreaks.  To date, Tanzania’s PHEOC has been activated to respond to widespread cases of Aflotoxicosis, a type of severe food poisoning, and cholera outbreaks in Tanzania.

While the workshop is over and participants have returned home, the work that they do to prepare for the next public health emergency is ongoing. The workshop highlighted some important takeaways – you do not need a big space and high-tech equipment to respond quickly and efficiently to a public health emergency.  Instead, coordination to share information, resources, and ideas is vital to a successful emergency response, both in-country and across an entire region.

Learn more

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Preparing for College Life: A Healthy Guide

student studying outdoors.

Zoey Brown joined the Office of Public Health Preparedness and Response during this past summer to help with a data analysis project. She saw a number of CDC programs and activities, and authored the following post to the Public Health Matters blog. The views expressed are her own, and do not necessarily represent those of CDC, HHS or other government entities. A number of the links included take those interested in these topics to both CDC and non-CDC sites for more information. The Office was pleased to have this talented young woman on staff for an internship experience.

Zoey BrownAs a rising high school senior, college looms large on my horizon. Everywhere I turn, there’s another form to fill out, essay to write, and decisions to make. And although I’ve had plenty of help during the application process, no one seems especially concerned with what happens after I choose a school. I’ve lived in the same town my whole life; how do I pick up my life and move it to a campus one thousand miles away?

For all the students out there like me, who aren’t quite sure how to prepare for college, I want to share some tips to help you prepare to start this school fall.

You are what you eat

Odds are, your parents have had some control over your food up until now. A lot of kids go to college without any sense of how to manage their diet; hence, the infamous Freshman 15. With that in mind, here’s some helpful tips on maintaining your nutrition on a meal plan.

  • Talk to your doctor. Before you go back to school make sure you understand what your body needs. Everyone has different nutritional needs based on a variety of factors, like age, sex, size, and level of activity.
  • Stay well stocked. Keep your dorm room stocked with healthy snack alternatives. My personal favorites are carrots, cashews, apples, granola bars, and popcorn.
  • Make the swap. Consider switching out some fried foods for grilled versions and soda for juice or water
  • Consistency matters. Develop a consistent meal schedule that complements your schedule. Don’t skip a meal to study or party.

Stay active

If you’re anything like me, finding the motivation to exercise can be tough. Sleeping in a few extra minutes or catching up on Netflix are more tempting than getting in that cardio workout. Without the high school sport or fitness-loving parent to which you’re accustomed, you’ll have to take your health into your own hands. So, what are the best ways to stay in shape on campus?

  • Hit the gym. College is a great place to take advantage of free access to gyms and fitness classes. This is probably one of the last times in your life that you’ll have a free gym membership, so you might as well use it!
  • Get in your steps. Just walking on campus can also be a great source of exercise. Or think about a bike for transportation around your new town.
  • Try out a new sport. If you enjoy playing sports but don’t want to commit to varsity athletics, consider joining an intramural team. There’s no pressure to be an intense athlete, and it’s a great way to let off a little steam.
  • Join the club. Most colleges also offer clubs that go hiking, biking, climbing, and more. These are great way to expand your social circle.

Be mindful

As someone who has struggled with mental health issues over the past few years, I must admit that I’m a little concerned about my transition to college. Luckily, there are a ton of tips out there for maintaining and improving mental health in a new environment.

  • Battle feeling homesick. One of the most common mental health issues new college students experience is homesickness. This can be especially tough if you’ll be attending a college far away from home, like me. There’s no perfect solution, but one of the best things you can do is immerse yourself in college life – join clubs and activities, try to make friends with the people living near you, and make your dorm room feel a little more like home.
  • Avoid anxiety. College is a completely new environment, so it’s understandable that over 40% of college students suffer from anxiety. To help keep anxiety to a minimum make sure you exercise regularly, try to get at least 7 hours of sleep a night, drink less caffeine, and do something you enjoy every day. Of course, if feelings of intense anxiety persist, you should seek help through your school’s health services.
  • Watch your mood. It’s normal to feel down occasionally, but if these feelings persist, you may be suffering from depression. You should visit a counselor at your college’s health service if you experience any of the following for more than two weeks:
    • sleeping problems
    • lack of energy or inability to concentrate
    • eating issues
    • headaches or body aches that persist after appropriate treatment
    • You should also seek help if you are experiencing suicidal thoughts

Know about safe sex

I am fortunate to attend a school with a decent sex education program. However, many teenagers haven’t, so there are a few things that the average college student should know about safe sex.

  • Know it’s a choice. The choice to have sex is yours to make, and abstinence is a completely viable option.
  • Avoid sexually transmitted diseases and pregnancy. If you do choose to have sex, you should take steps to protect yourself. Use condoms, male or female. Be sure to check that the condom is intact and has not expired before use.
  • Talk to your partner. Ask your partner about their sexual health first. If they refuse to answer, they probably don’t deserve to have sex with you.
  • Get tested. If you are already sexually active, you should consider going into your college’s health clinic to get tested.

Drink responsibly

Drinking under the age of 21 is illegal in the US, but that isn’t always the reality on college campuses. With this in mind, I wanted to lay out some of the dangers of drinking on college campuses so everyone can be informed.

  • Beware of binge drinking. One of the biggest concerns regarding drinking on college campuses is the high rate of binge drinking – 90% of underage drinking is binge drinking. Frequent binge drinking in young adults can lead to alcohol dependence, liver problems, brain damage, and heart troubles. Binge drinking can also lead to poor decision making, including driving under the influences.
  • Don’t get hurt. Underage drinking is also linked to unintentional injuries, violence, school performance problems, and other risky behaviors.

Best of luck to those of you heading off to college and thank you to the Office of Public Health Preparedness and Response for the chance to experience public health in action at CDC!

Step it up outdoors

Mother and father swinging daughter outdoors

Physical activity can improve your health. People who are physically active tend to live longer and have lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. Physical activity can also help with weight control, and may improve academic achievement in students. Walking is an easy way to start and maintain a physically active lifestyle, and parks are a great place to start.

Physical activity made easy

People of all abilities can benefit from safe and convenient places to walk, run, bike, skate, or use wheelchairs. The decision to walk is personal, but that decision is easier if community walkability is improved. It is important to connect places that people regularly use with sidewalks or paths that are safe and attractive, especially between schools, worksites, parks, recreational facilities that are within walkable distance of each other.

A walk in the parkThe community of West Wabasso, Florida, worked with the Indian River County Health Department and other government agencies to create safe public places for walking, exercise, and play. The project established bus routes, installed streetlights and sidewalks, and improved local parks. Residents filled out a survey about the changes to their community. Ninety-five percent of respondents said they spent more time exercising outside than they had 2 years earlier. They said the changes to their neighborhood, especially the streetlights and creation of safe places to exercise and walk outside, made a big difference.

Less than 40% of people in the United States live within one-half mile of a park boundary, and only 55% of youth have access to parks or playgrounds, recreation centers, and sidewalks in their neighborhoods. However, there is evidence that people with more access to green environments, like parks and recreation areas, tend to walk more than those with limited access. Well-designed parks and trails can promote physical activity and community interaction and provide mental health benefits, such as reduced stress.

Design matters

To help people be active, parks and recreation spaces can offer opportunities for various types of activity, such as walking, hiking and team sports. Programs can be designed to attract a wide range of visitors—age groups, cultures, and ability levels—throughout the year. Park programs can also help participants address barriers to physical activity, including physical limitations and safety concerns. Walking groups or buddy systems can help provide people with multiple opportunities to walk each week. Park entrances with universal access for multiple types of active transportation can promote biking and walking to and from the park.

In September 2015, the Office of the Surgeon General in the US Department of Health and Human Services released Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities (the Call to Action) to recognize walking as an important way to promote physical activity among most people. The Call to Action is intended to increase walking across the United States by calling for improved access to safe and convenient places to walk and wheelchair roll, as well as a culture that supports these activities for all ages and abilities.

 Learn more

Why Diarrhea & Swimming Don’t Mix

 

Kids by PoolThe summer swim season is here, and millions of Americans will be flocking to local pools for fun in the sun and exercise. However, swimming, like any form of exercise, does not come without health risks. The good news is that we can all take a few simple but effective steps to help keep ourselves and other swimmers we know healthy and safe.

While sunburn and drowning might be the health risks that first come to mind when you think about swimming, diarrhea is another culprit. Outbreaks of diarrheal illness linked to swimming are on the rise. And this Healthy and Safe Swimming Week, we want to make sure you know these important facts about diarrhea-causing germs at aquatic venues, like swimming pools and water playgrounds, and how to protect yourself and loved ones.

  1. When swimmers have diarrheal incidents in the water, they release diarrhea-causing germs into the water. For example, a swimmer infected with the parasite Cryptosporidium can release 10–100 million infectious germs into the water. Swallowing 10 or fewer Cryptosporidium germs can make someone sick.
  2. Don't leave your mark at the pool this summerSome diarrhea-causing germs can survive in properly treated water for days. Standard levels of chlorine and other disinfectants can kill most germs in swimming pools within minutes. However, Cryptosporidium has a tough outer shell and can survive for up to 10 days in properly treated water. Outbreaks of diarrhea linked to pools or water playgrounds and caused by the parasite Cryptosporidium have doubled since 2014.
  3. Swim diapers won’t keep diarrhea out of a pool. Using swim diapers might give parents a false sense of security when it comes to containing diarrhea. Research has shown that swim diapers might hold in some solid feces but these diapers only delay diarrhea-causing germs, like Cryptosporidium, from leaking into the water by a few minutes. Swim diapers do not keep these germs from contaminating the water.
  4. Don’t swallow the water you swim in. Swallowing just a small amount of water with diarrhea germs in it can make you sick for up to 3 weeks.
  5. Don’t swim or let your kids swim if sick with diarrhea. We all share the water we swim in. Do your part to help keep loved ones healthy by not getting in the water if you or your children have diarrhea.

CDC’s Michele Hlavsa is a nurse and the chief of CDC’s Healthy Swimming Program. As a parent, it is important for her to know how to protect her children from not only diarrhea, but all types of germs and injuries linked to swimming. Michele encourages swimmers to follow a few easy and effective steps each time they swim in a pool or get in a water playground this summer and year-round.

 

This Is a Test: Georgia Practices for Bioterrorist Threats

Safety officer delivers briefing

It is November 2015, and Georgia’s emergency personnel are preparing to respond to an outbreak of plague.

Don’t worry, it’s not the real plague. This is only a test. No one is actually sick or in any danger. But what if it were real?

Armed with the knowledge that practice makes perfect, the Georgia Department of Public Health is conducting a statewide exercise to test its systems and practice responding to a large-scale public health emergency. In this case, the state is simulating a bioterrorist attack involving an intentional release of the communicable Category A biological agent Yersinia pestis, commonly known as plague. It is a giant effort involving the entire state: all 18 regional emergency operations centers are activating, and they are working closely with CDC.

It’s all pretend, but for those participating, the exercise is very real. There are real phone calls and real trucks and drivers delivering real pallets of materials with real bottles (of pretend medicine). Each pallet and bottle has a real lot number for tracking. Real people – volunteers – will test their ability to dispense medicine quickly in every corner of the state. It’s a critical part of being ready to save lives in case of a bioterrorist attack.

Making the call

America's emergency medical supplies to protect the public's health
America’s emergency medical supplies to protect the public’s health

The exercise begins with a phone call from the Georgia Department of Public Health to the watch desk located inside CDC’s Emergency Operations Center. In an actual event, this would be the first step to set plans in motion.

“When the state makes that first call to request assistance from the Strategic National Stockpile, they need to be able to tell us who, what, when, where, and how many,” explains Pete Alvarez, an emergency management specialist in CDC’s Strategic National Stockpile who helps states coordinate exercises like this one. “The most vital piece of information we need in the beginning is how many people are potentially affected.”

This exercise uses an imaginary, but realistic, scenario: plague has been released by a person, or group of people, dressed as a gardener spraying “pesticide” at several large outdoor events across the state. The aerosolized plague has been detected and now presents a danger to everyone in the community.

The initial phone call reporting the incident to CDC sets off a cascade of activity. The watch desk officer takes note of the relevant information, particularly the large number of patients said to be presenting with symptoms. Immediately, the officer reaches out to CDC’s experts – both subject matter experts in plague and those who manage CDC’s stockpile, the nation’s largest supply of life-saving medicines and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.

Within 30 to 45 minutes, everyone, including CDC leadership, is on the line to discuss the specific health threat, consider the number of people affected, and make the best possible decisions to control the disease right away.

Getting things moving

Plague has a 2-day incubation period, and people who are exposed must receive antibiotic prophylaxis right away. Therefore, once plague is suspected or identified, state and local responders have to act fast. Due to the magnitude of this incident, authorities agree mass amounts of antibiotics from CDC’s stockpile need to be delivered to the affected area as quickly as possible.

Logistics experts with CDC’s stockpile quickly coordinate with commercial transportation partners who will provide trucks to deliver the medicines and relay anticipated delivery timelines to the state.

Meanwhile, a flurry of preparation takes place. While the trucks are on the way, the team in CDC’s stockpile warehouse pulls the requested products and prepares them for pick up. Georgia officials are getting ready to receive and stage the coming shipments. Emergency responders take their stations. Public health officials begins setting up “PODs” – points of dispensing – in public areas and at places of business. This is where people will come to get the medicine. Volunteers, both from the Medical Reserve Corps and the community, line up to act as “patients.”

Testing the system

Volunteers support POD operations
Volunteers support POD operations.

Many of the PODs are set up in large parking lots, at malls, and other places in the community. Some are set up as drive-thrus. People in cars can bring a pre-filled “head of household” form to the line and pick up antibiotics for their whole family. Cars pull up to three stations, one at a time. First is reception, where volunteers hand in their forms. Next is triage, where they answer questions about their health and the health of others who will be taking the antibiotics (a separate line handles those with health concerns, like those who are pregnant or have allergies). Next, they receive a supply of medication to take home.

At least 50 volunteers move through each POD to test how quickly and efficiently the system works. Every person and every bottle of medicine at every station across the state is tracked carefully and logged. The state and regional emergency operations centers stay nimble and ready to add resources or shift focus at a moment’s notice.

While the exercise is taking place, emergency planners insert what are called “injects” into the process. An “inject” is a surprise issue that comes up during the exercise, and it is meant to simulate the kinds of unexpected twists that can happen during a real response. For instance, a team in the field might send a message back to the state emergency operations center that they have not received the right amounts of each antibiotic or that a patient has presented with an allergic reaction to the medicine. Each “inject” tests how a different part of the system will react when things do not go as planned. In an emergency, you have to be ready for anything.

Help from all corners

To make this exercise as real as possible, Georgia invites other partners to join in the activities. They reach out to all the states in FEMA region 4 to figure out how neighboring states can help each other if an emergency like this actually happens.

They conduct a communication drill with ham radio operators in Tennessee, Alabama, Mississippi, and Florida. Ham operators are especially prepared to step in if regular communication channels are compromised, providing a critical lifeline in emergencies.

“We also practiced air transport with the National Guard,” said Charlisa Bell, planning and exercise manager at the Georgia Department of Public Health. “We put the request in through our state operations center. They brought in a Black Hawk, loaded it, and delivered medication to one of our remote districts.”

Lessons learned

In the end, the drill goes off without a hitch. But it teaches a few good lessons along the way, helping the state firm up its plans for staffing, volunteer training, and building security.

“The exercise was well planned and coordinated,” said Alvarez. “The state wanted to know its gaps – public health planners were not afraid of finding out what they needed to improve. They did really well.”

Collaborative exercises like the one in this story are a critical part of keeping our nation’s health secure. The Public Health Emergency Preparedness (PHEP) cooperative agreement provides funding guidance to Georgia and other state and local health departments to help them develop and test response plans so that, when a real event occurs, the state is better prepared to protect its citizens.

Read: Exercise alone won’t make you lose weight

Exercise has many virtues but, contrary to popular belief, it is not an efficient way to lose weight.

So what is?

“The idea that our obesity epidemic is caused by sedentary lifestyles has spread widely over the past few decades, spurring a multibillion-dollar industry that pitches gadgets and gimmicks promising to walk, run and kickbox you to a slim figure. But those pitches are based on a myth. Physical activity has a multitude of health benefits — it reduces the risk of heart disease, Type 2 diabetes, high blood pressure and possibly even cancer — but weight loss is not one of them.

“A growing body of scientific evidence shows that exercise alone has almost no effect on weight loss, as two sports scientists and I described in a recent editorial in the British Journal of Sports Medicine. For one, researchers who reviewed surveys of millions of American adults found that physical activity increased between 2001 and 2009, particularly in counties in Kentucky, Georgia and Florida. But the rise in exercise was matched by an increase in obesity in almost every county studied. There were even more striking results in a 2011 study published in the New England Journal of Medicine, which found that people who simply dieted experienced greater weight loss than those who combined diet and exercise.”

 

I encourage you to go read Dr. Aseem Malhotra’s entire article in The Washington Post.

If you prefer to listen to the information, check out my conversation with Timothy Caulfield, public health researcher at the University of Alberta, on the podcast Within Reason. It’s a lot of fun and you may find yourself confronted with an avalanche of myths you thought were true.

 

 

Exercise is safe during pregnancy, but not enough docs know that.

Pregnant women are getting the wrong messages on exercise—often because their doctors cling to old-fashioned ideas.

I was inspired to write about this after reading a post from another PLOS blog, Obesity Panacea, discussing whether exercise is safe for pregnant

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