#  Cincinnati Public School District 

# Multi-Hazards Management: 

# Creating an Emergency Management Plan

# 2005 - 2006 

# 

# Environmental Public Health Leadership Institute Fellow:

# Jessica L. Shelly, B.A., M.B.A., R.E.H.S., R.S.

*Supervisor, Building Operations & Food Services*

## Cincinnati Public Schools

*2315 Iowa Ave, 2nd Floor*

*Cincinnati OH 45206*

*(513) 363-0818*

*Shellyj@cps-k12.org*

# Mentor:

### **CAPT. Craig A. Shepherd, R.S., M.P.H., D.A.A.S.**

> *U. S. Public Health Service; Chief Environmental Health Officer*
>
> *Senior Environmental Health Officer\
> Environmental Health Services Branch\
> Division of Emergency and Environmental Health Services\
> National Center for Environmental Health\
> Centers for Disease Control and Prevention\
> 4770 Buford Highway, NE (F28)*
>
> *Atlanta, GA 30341-3724\
> (770) 488-7026\
> cfs4@cdc.gov*

# Acknowledgements:

### **Thomas Gunnell, B.A., M.S.**

*Chief Operations Officer;* Cincinnati Public Schools

> ![](media/image1.jpeg){width="1.3756944444444446in"
> height="0.6368055555555555in"}

# EXECUTIVE SUMMARY:

In light of current world and national events, there is recognition of
the need for schools to be prepared for multiple hazards. It is
holistically implied that schools have an obligation to care for
students, staff, and the community in the event of a terrorist emergency
or natural disaster. Yet, many school districts do not have an emergency
management plan, have not received any preparedness training, lack
coordination with local emergency agencies, and have not established an
effective communication system with the community.

After evaluating Cincinnati Public Schools's (CPS) current emergency
procedures, it was determined that CPS was not prepared to manage a
multi-hazard event caused by terrorist activity or natural source. CPS
faces both challenges and opportunities in meeting its obligation to
provide for the safety and preservation of life of its students and
staff. CPS made the decision that it needed to strengthen and improve
its Emergency Management Plan for implementation at CPS's 79 public
schools.

The Emergency Management Plan was designed to meet one of CPS's highest
priorities: to provide for the safety and preservation of life of
students and staff in Cincinnati's school. While CPS faces many
challenges in pursuing this priority, the district has committed to
developing a comprehensive strategy for emergency response and crisis
management aligned with the National Incident Management System.

Two major and concurrent initiatives at CPS created a tremendous need
for emergency management planning. Together, these initiatives create a
particular need for a district-wide Emergency Management Plan that can
be adapted to create individualized School Response Plans that keep
overall policies and procedures consistent while accounting for
site-specific threats and vulnerabilities.

First, Cincinnati Public Schools is undertaking the largest
restructuring in its history. The district is in its third year of a
10-year building plan that will construct dozens of new schools and
fully renovate many more. Schools are being transformed from
traditional, stand-alone buildings into campus-like Community Learning
Centers. In some cases, larger traditional buildings are being renovated
to hold two or three smaller schools. The impact of these changes is
great. The fact that many schools are in transition creates the need for
enhanced planning and coordination for emergency response. As newer,
more modern facilities are built, the potential for some hazards---like
fire---will diminish. But others will be created or exacerbated---for
example, as schools become community centers with campus layouts that
involve more entry and exit points, chances increase for intrusion by
potentially violent outsiders.

Second, the district has undertaken an aggressive, disciplined program
to eliminate a \$23 million deficit in a very short time frame to bring
the school district in line with its budget. This has involved
streamlining of departments and cutbacks in staff on all levels. The
2005-2006 school year will be the district's first year of staff
reduction. Reduced staff necessitates better planning and coordination
to mitigate, prevent and prepare for potential crises and clearer
understanding of what is needed to respond to and recover from
emergencies.

One of the biggest constraints identified was lack of budget for
emergency preparedness; therefore, a \$500,000 grant from US Department
of Education for Emergency Response and Crisis Management was applied
for and subsequently awarded to CPS in October 2005.

The grant monies have allowed for CPS to excel quickly in development of
an emergency management plan, major equipment, supplies, and training
materials purchases, and Multi-Hazard Emergency Planning for Schools
training culminating in NIMS IS 700 certification for all School
Incident Response Team members.

The next steps for CPS will be to conduct WMD/Hazmat Awareness training
for SIRT members, complete individual School Response Plans, conduct all
school site vulnerability assessments, create community awareness
events, and perform a major simulation and post-assessment.

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal:*** To help prepare Cincinnati Public Schools for multi-hazard events including terrorist incidents or natural source.

####### ***Health Problem:*** Cincinnati Public Schools are not prepared to manage a multi-hazard event caused by terrorist activity or natural source. This is an exceptional problem for environmental public health since many schools throughout the country will be used as Points of Distribution for mass prophylactic and immunizations and/or as community shelter areas.

####### ***Outcome Objective:*** Cincinnati Public Schools are prepared to handle multi-hazards through development of emergency management plans, emergency management training, and emergency management exercises & drills. Cincinnati Public Schools will also begin to distribute emergency management information to students/families/communities through website development, educational presentations, and other measures.

#######  

####### ***Determinant:*** Cincinnati Public Schools do not have access to or understanding of emergency management fundamentals and CPS does not have the time or resources for development of an emergency management plan, training, exercises & drills, or community information.

####### ***Impact Objective:*** By December 2006, CPS will have a working Emergency Management Plan that is supported by training, emergency exercises & drills, and student/family/community educational information.

***Contributing Factors:***

-   All of the 79 CPS are within three miles of manufacturing or
    industrial sites

-   No district-wide Emergency Response Plan in place due to the lack of
    resources

-   CPS staff reductions are expected and will require even better
    planning

-   CPS responded to nearly 100 incidents involving weapons such as guns
    and knives

-   CPS is spending \$890 million to rebuild or remodel every school
    building by 2010

-   CPS budget does not allow for expenditure of supplies

####### ***Process Objectives:*** The major milestones will be as follows:

-   Emergency Management Plan written and approved by Board of Education
    by October 2005

-   Major equipment, supplies, and training materials expenditures
    complete by December 2005

** **

-   Multi-Hazard Emergency Planning for Schools training culminating in
    NIMS IS 700 certification for all SIRT members by the end of March
    2006

-   WMD/Hazmat Awareness Training completed for SIRT members by April
    2006

-   School Response Plans developed and approved for all schools by May
    2006

-   All school site vulnerability assessments completed and evaluated by
    June 2006

-   Community awareness events completed by October 2006

-   Major simulation and post-assessment completed by October 2006

-   All central office, teachers, and building support staff trained on
    CPS Emergency Management Plan policies and procedures by December
    2006

# INTRODUCTION/BACKGROUND:

Located on the Ohio River in the southwestern-most corner of Ohio,
Cincinnati is the hub of a tri-state region of Ohio, Indiana, and
Kentucky. The Ohio River joins the Licking River at Cincinnati, and the
many tributaries of these streams periodically create flooding hazards
throughout much of the school district. Additionally, the valley creates
what can be a deadly path for tornados, the most large-scale climatic
threat for Cincinnati. Other weather events, including severe
thunderstorms and especially snow/ice storms can bring the city to a
halt. Their effects are exacerbated by Cincinnati's extremely hilly
terrain, which, even without hazardous weather conditions, can hinder
radio communications, making it critical for CPS and other emergency
responders to have backup communications capabilities and access. Also,
the 79 schools of the Cincinnati Public School district are distributed
over 91.8 square miles of widely varying topography, increasing
challenges to incident command and emphasizing the need for coordination
and preparedness.

Cincinnati is a leading center of manufacturing, commerce and
transportation in the Midwest. It is home to major chemical and
industrial plants---in fact, all 79 CPS schools are within three miles
of a manufacturing or industrial site---and serves as a through-center
and transshipment point for chemicals and other hazardous materials
originating in other parts of the nation. These materials move through
the city via the rail network, the highways, the Ohio River, and the
Cincinnati/Northern Kentucky International Airport. The airport is a
Delta hub and is among the busiest air-cargo facilities in the nation.
In addition to commercial activity, defense activities in Cincinnati
include the General Electric Aircraft Engine facility and the Fernald
Uranium Enrichment Plant. Most recently, three CPS schools were directly
impacted by a Styrene tanker car leak that caused the evacuation and
subsequent closure of the schools for over a week.

In particular, CPS shares the serious problems facing urban school
systems and communities throughout the country---high drop-out rates,
crime, violence, drug abuse, gangs, and lack of supervision for
children. While CPS is believed to have an overall safe environment for
students to learn, it has a comparable number of threatening incidents
to other large urban districts: in the 2004-2005 school year, CPS
responded to 98 incidents involving weapons, 11 of those involving guns
and 61 involving knives.

As the first part of this project, a CPS Emergency Management Plan was
drafted. It includes policies and procedures to address these
conditions, but the district needs training to put these policies and
procedures into practice and to adapt them strategically to the
individual school level. The plan also addresses the general concerns
facing the nation at large, including the potential for terrorism.
Cincinnati, which composes most of Hamilton County, has been designated
by the Department of Homeland Security as an Urban Area Security
Initiative, allowing federal funding to flow directly to the local
level. This designation was made with the understanding that urban areas
are the most likely targets for terrorism.

To address potential emergencies, and to allow the CPS Emergency
Management Plan to fully provide for crisis mitigation/prevention,
preparedness, response and recovery, CPS needs to develop the following
tasks:

-   **[Training]{.underline}**: Provide appropriate content and levels
    of *training* for the district-wide Emergency Management Team,
    School Incident Response Teams (SIRTs), teachers and other school
    staff, students, and partner schools.

-   **[Coordination]{.underline}**: Strengthen CPS's *coordination* with
    emergency response partners, including Hamilton County Homeland
    Security Office, Cincinnati Police Department, Cincinnati Fire
    Department, Cincinnati Health Department, Cincinnati Community Board
    of Mental Health, and American Red Cross.

-   **[Communication]{.underline}**: Plan for and enable effective,
    agreed-upon emergency response procedures among staff,
    first-responders, parents and guardians to ensure *communication* of
    information and safe and timely reunification of students with their
    parents or guardians.

####### ***Behavior Over Time Graph:*** It was beneficial for CPS to graph out the different variables that affected our project. This helped us understand what our challenges would be in accomplishing our objective.

####### 

####### 

####### ***Causal Loop Diagram and Applicable Archetype:*** We also discovered how we were shifting the burden by creating a causal loop diagram. 

####### 

####### ***10 Essential Environmental Health Services:*** This project utilizes five of the 10 Essential Environmental Health Services^1^: 

-   *[Essential Environmental Health Service #4]{.underline}: Inform,
    educate and empower people about health issues*

    -   Parents will receive a brochure outlining what to do in the
        event of an emergency at their child's school. They will be made
        available in English and the main five other languages spoken in
        district homes. Brochures will also be made available to parents
        with children at non-CPS schools.

-   *[Essential Environmental Health Service #5]{.underline}: Mobilize
    community partnerships to identify and solve health problems*

    -   The CPS project design benefits from and reinforces CPS's
        partner relationships with first responders: Cincinnati Fire
        Department, Cincinnati Police Department, Hamilton County
        Community Mental Health Board, Cincinnati Health Department,
        Hamilton County Homeland Security, and the American Red Cross.
        These partners are involved in every area of CPS preparedness
        planning, from assessment to training to practice to
        communication with parents and the community.

-   *[Essential Environmental Health Service #6]{.underline}: Link
    people to needed personal health services*

    -   Overall preparedness will be introduced to parents and the
        community-at-large through events at four schools in different
        parts of the district. At these events, parents and the
        community will be introduced to the full scope of the CPS
        Emergency Management Plan as well as to the larger plans of
        Hamilton County and Cincinnati. In particular, parents will be
        informed of school emergency communications and reunification
        procedures, i.e., where to find information in an emergency and
        how to use that information. The events will feature
        opportunities for parents and the community at large to hear
        from all of the CPS first responder partners as well as other
        supporting partners from business and industry, the Alliance for
        Chemical Safety and Cincinnati Youth Collaborative, which
        coordinates CPS's Partners in Education program, whereby
        businesses sponsor programs and activities at individual
        schools.

-   *[Essential Environmental Health Service #7]{.underline}: Evaluate
    effectiveness, accessibility, and quality of personal and population
    based health services*

    -   Cincinnati Public Schools will use an evaluation process
        designed around the principles of learning, practicing,
        continuous improvement, and sustainability of results. Several
        levels and types of assessment will be included in an overall
        evaluation process conducted by CPS's Department of Research,
        Evaluation & Testing. To accomplish the scope of evaluation
        intended, CPS will create a project performance database in a
        secure area on the CPS intranet. The database will be designed
        to count, track, and document progress on performance measures
        related to outcomes, and provide feedback to inform decisions
        about needed adjustments in Emergency Management Plan policies
        and procedures.

-   *[Essential Environmental Health Service #9]{.underline}: Develop
    polices and plans that support individual and community health
    efforts*

    -   CPS Emergency Management Plan includes policies and procedures
        to support the City of Cincinnati and federal goals of making
        sure all citizens are prepared for a multi-hazard emergency at
        any school in our district. The plan also addresses the general
        concerns facing the nation at large, including the potential for
        terrorism.

####### ***National Goals Supported*** 

**1) [CDC 21^st^ Century Health Protection Goals]{.underline}**^2^: This
project sustains CDC's strategy to help the public prepare for
multi-hazard events such as environmental threats and terrorism through
*customer-centricity* and *leadership*. CPS recognizes that we have
access to a large percentage of the community and can help market to our
students, staff, parents, and community at large the importance of
preparing for a multi-hazard event. Our district has an established
level of trust within our community and the public is confident our
leadership and direction. Therefore, we can educate many citizens on how
CPS is prepared and how their household can be prepared for an emerging
health threat.

Two of the four new health protection goals are addressed in this
project: People Prepared for Emerging Health Threats, and Healthy People
in Healthy Places -- Schools.

-   *[People Prepared for Emerging Health Threats]{.underline}*: Through
    distributed literature, our website, and our community information
    events we will be able to teach our community how to prevent illness
    from naturally occurring health hazards and terrorist hazards. By
    making the information applicable to our school community, CPS is
    giving our students, staff, and parents the information they want
    and the information the need to choose to be prepared and stay safe
    and healthy.

-   *[Healthy People in Healthy Places -- Schools]{.underline}*: By
    preparing every one of our schools for a multi-hazard, Cincinnati
    Public Schools will be safer and healthier environments. From
    individualized School Response Plans for each school based on threat
    and vulnerability assessments to assemblies for students that
    explain proper Shelter-in-Place at school and at home to evacuation
    and lockdown drills, CPS is protecting and promoting the health and
    safety of not only students and staff, but the community as a whole.

**2) [National Strategy to Revitalize Environmental Public Health
Services]{.underline}**^3^: This project supports the CDC's overarching
goal of enhancing the environmental public health service of
multi-hazard preparedness in the City of Cincinnati. Specifically, it
achieves two direct goals and their objectives:

-   *[Goal IV: Communicate and Market]{.underline}*

    -   CPS has worked diligently to help communicate and market the
        importance of emergency preparedness with their stakeholders.
        CPS has attended city of Cincinnati council meetings to help
        support the environmental health service of multi-hazard
        preparedness. We are also working with the national organization
        of Parents for Public Schools to have them assist in developing
        the strategy of distributing educational materials to students,
        staff, parents, and community on emergency management and
        preparedness. CPS also supports other agencies and
        organization's educational approaches on emergency preparedness.
        For example, CPS is assisting the American Red Cross in setting
        up a series of Community Emergency Response Training (CERT) for
        all parents and staff at several CPS schools.

-   *[Goal VI: Create Strategic Partnerships]{.underline}*

    -   CPS is dedicated to involving all critical stakeholders in the
        development of the multi-hazard Emergency Management Plan for
        our district. We are working in cooperation with city, county,
        state, and federal agencies that we have identified as
        influential and will assist us in our plan development and
        execution. CPS has been a strong supporter of attending training
        programs (FEMA training in Emmetsburg, Maryland and DHS training
        in Anniston, Alabama, for example) with local fire, police, and
        city representatives so that the environmental health goal of
        multi-hazard preparedness can be worked on together. CPS
        conducts regular quarterly meetings with all stakeholders, and
        all stakeholders receive monthly email updates on CPS
        preparedness progress so that communication lines are open and
        information is being shared in real-time.

####### ***Project Logic Model:*** The logic model below helped develop the various inputs, outputs, and outcomes CPS expects from implementation of this project:

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| th    |   |          |           |   |           |           |          |
| rough |   |          |           |   |           |           |          |
| we    |   |          |           |   |           |           |          |
| bsite |   |          |           |   |           |           |          |
| de    |   |          |           |   |           |           |          |
| velop |   |          |           |   |           |           |          |
| ment, |   |          |           |   |           |           |          |
| e     |   |          |           |   |           |           |          |
| ducat |   |          |           |   |           |           |          |
| ional |   |          |           |   |           |           |          |
| pres  |   |          |           |   |           |           |          |
| entat |   |          |           |   |           |           |          |
| ions, |   |          |           |   |           |           |          |
| a     |   |          |           |   |           |           |          |
| nd/or |   |          |           |   |           |           |          |
| other |   |          |           |   |           |           |          |
| meas  |   |          |           |   |           |           |          |
| ures. |   |          |           |   |           |           |          |
+-------+---+----------+-----------+---+-----------+-----------+----------+
| **[I  |   | **[A     |           |   | **        |           |          |
| nputs |   | ctivitie |           |   | [Outcomes |           |          |
| ]{.un |   | s/Output |           |   | --        |           |          |
| derli |   | s]{.unde |           |   | Imp       |           |          |
| ne}** |   | rline}** |           |   | act]{.und |           |          |
|       |   |          |           |   | erline}** |           |          |
|       |   | ***Ac    |           |   |           |           |          |
|       |   | tivities |           |   | ***Short  |           |          |
|       |   | Ou       |           |   | Term      |           |          |
|       |   | tputs*** |           |   | Medium    |           |          |
|       |   |          |           |   | Term Long |           |          |
|       |   |          |           |   | Term***   |           |          |
+-------+---+----------+-----------+---+-----------+-----------+----------+
| *     |   | **1)     | **1)      |   | **1) CPS  | **1) CPS  | **1) CPS |
| *NIMS |   | Par      | Emergency |   | increases | develops  | performs |
| Train |   | ticipate | M         |   | their     | their own | appro    |
| ing** |   | in       | anagement |   | awareness | Emergency | priately |
|       |   | multiple | Plan for  |   | of        | M         | during   |
| *     |   | training | CPS**     |   | ap        | anagement | an       |
| *FEMA |   | c        |           |   | propriate | Plans,    | event**  |
| Train |   | lasses** | **2)      |   | mul       | Training, |          |
| ing** |   |          | Emergency |   | ti-hazard | Exercises | **2)     |
|       |   | **2)     | M         |   | re        | & Drills, | Increase |
| **DHS |   | Become   | anagement |   | sponses** | and       | in       |
| Train |   | NIMS     | Training  |   |           | Emergency | safety   |
| ing** |   | cer      | for CPS   |   | **2)      | Pre       | of       |
|       |   | tified** | em        |   | Ident     | paredness | students |
| **ODP |   |          | ployees** |   | ification | Info      | and      |
| Train |   | **3)     |           |   | of        | rmation** | c        |
| ing** |   | Develop  | **3)      |   | district  |           | ommunity |
|       |   | e        | Emergency |   | specific  | **2) CPS  | during   |
| **Ame |   | mergency | M         |   | problems  | par       | an       |
| rican |   | ma       | anagement |   | with      | ticipates | event**  |
| Red   |   | nagement | Exercises |   | pre       | in        |          |
| Cross |   | plan     | & Drills  |   | paredness | mult      | **3)     |
| Train |   | from     | conducted |   | and       | i-hazards | Increase |
| ing** |   | training | at CPS**  |   | action in | act       | in       |
|       |   | infor    |           |   | the event | ivities** | public   |
| **    |   | mation** | **4)      |   | of an     |           | co       |
| EPHLI |   |          | Emergency |   | em        | **3)      | nfidence |
| su    |   | **4)     | Pre       |   | ergency** | Rela      | with     |
| pport |   | Col      | paredness |   |           | tionships | respect  |
| (CDC  |   | laborate | In        |   | **3)      | developed | to the   |
| m     |   | with     | formation |   | De        | with      | safety   |
| entor |   | American | and       |   | velopment | health,   | and      |
| suppo |   | Red      | website   |   | of        | fire,     | prep     |
| rt)** |   | cross to | link      |   | s         | police,   | aredness |
|       |   | develop  | developed |   | trategies | American  | of CPS** |
|       |   | e        | by CPS to |   | to        | Red       |          |
|       |   | xercises | d         |   | address   | Cross,    |          |
|       |   | & drills | istribute |   | pre       | EMA, and  |          |
|       |   | tem      | to        |   | paredness | other     |          |
|       |   | plates** | students, |   | or action | emergency |          |
|       |   |          | families, |   | problems  | response  |          |
|       |   | **4)     | &         |   | ide       | a         |          |
|       |   | Work     | comm      |   | ntified** | gencies** |          |
|       |   | with     | unities** |   |           |           |          |
|       |   | local    |           |   |           |           |          |
|       |   | EMS to   |           |   |           |           |          |
|       |   | develop  |           |   |           |           |          |
|       |   | e        |           |   |           |           |          |
|       |   | mergency |           |   |           |           |          |
|       |   | prep     |           |   |           |           |          |
|       |   | aredness |           |   |           |           |          |
|       |   | infor    |           |   |           |           |          |
|       |   | mation** |           |   |           |           |          |
+-------+---+----------+-----------+---+-----------+-----------+----------+

# METHODOLOGY:

CPS formed an Incident Management Team (IMT) in January 2005 consisting
of CPS staff and representatives of the Cincinnati Police Department and
Cincinnati Fire Department. This team meets regularly, and eight members
were certified in FEMA and NIMS IS 700 through training completed in
March 2005. The team has met with community stakeholders, such as
parents, teachers, students, the Local School Decision Making Committees
(LSCMC) at each school in the CPS district, local government, non-CPS
schools, and other key emergency responders. Based on these meetings,
the IMT has composed an Advisory Committee that will enhance the core
IMT, specifically including the coordinating partners in this proposal.
The team wrote an Emergency Management Plan using a best-practices
national template and in consultation with the Hamilton County Office of
Homeland Security. The plan adopts the principles and policies of the
NIMS, which the district has formally recognized.

One of the biggest constraints identified was lack of budget for
emergency preparedness; therefore, a \$500,000 grant from US Department
of Education for Emergency Response and Crisis Management was applied
for and subsequently awarded to CPS in October 2005.

The overarching principle in forming CPS's project design is the safety
and preservation of life of students and staff in the schools. The goal
for the proposed project is to improve and strengthen CPS's emergency
response and crisis management plans, at both district and
school-building levels, in a manner that addresses the four phases of
emergency management: mitigation/prevention, preparedness, response, and
recovery.

This goal will be realized through the following objectives:

-   Training teachers, staff, and students using materials and practices
    reflecting the best available knowledge and employing a
    train-the-trainer philosophy that ensures sustainability;

-   Improving CPS's already-strong coordination with emergency
    first-responders and key community partners; and

-   Developing and implementing school emergency communications
    procedures and policies, including those for reunification of
    students with parents/guardians following a crisis.

The CPS's Emergency Management Plan incorporates all four phases of
Emergency Management, Mitigation/Prevention, Preparedness, Response, and
Recovery. The project design considers training, coordination, and
communication in each of the four phases**:**

**[Phase One: Mitigation/Prevention]{.underline}**

***Training*** -- Having an accurate accounting of vulnerabilities at
each school is the first step to site-specific mitigation and
prevention. Included in the program design is training for staff from
each school in on-going threat and vulnerability assessment. This
training will be implemented through a contracted assessment firm
selected in consultation with the Hamilton County Office of Homeland
Security and offered on a train-the-trainer basis. Threats and
vulnerabilities identified will be both general in terms of common
dangers, such as fire, and specific in terms of the particular
environment of the school---for example, if it is located in a
floodplain or close to a chemical facility. The training will involve
awareness of school-particular stresses, such as crime, gang rivalries,
racial unease, etc. Prevention training will operate not as a static
check-off list, but as an ongoing process involving recommendations of
teachers, students and staff. Procedures for this input are included in
the draft Emergency Management Plan.

***Coordination*** ***with Partners*** -- CPS and its emergency
responder partners, together comprising the IMT, will carefully align
all mitigation and prevention policies and procedures with the Hamilton
County Office of Homeland Security. This will involve constant
communication regarding specific threats. Also, the IMT, through the
expertise of its member partners, will monitor and adjust
prevention/mitigation techniques and practices based on relevant local
information, such as the heightened racial tension present in
Cincinnati.

***Communication*** -- Emergency communication with parents and the
community will be addressed through an automated telephone and email
contact system and through creation of an Internet emergency information
system detailing the nature of the crisis, what to do, and reunification
plans. These improved communications will mitigate or prevent an
emergency situation exacerbated by uninformed parents. For example, in a
shelter-in-place or lockdown, response efforts would be hindered by
panicked parents arriving on the scene**.** Problems inherent in
after-crisis reunification will be lessened through agreed-upon and
practiced procedures involving students, their guardians, teachers,
first-responders, and CPS staff. Reunification areas and communication
channels will be identified to lessen confusion and assist in resolution
of the crisis. Also, emergency communications equipment will be
installed in an Emergency Response Command Vehicle already in CPS's
possession. The equipment will allow command staff to access all
databases needed for response as well as to communicate to all
appropriate audiences.

**[Phase Two: Preparedness]{.underline}**

***Training*** -- The CPS Emergency Management Plan involves four levels
of individuals arranged in pyramid fashion. At the top is the IMT
consisting of CPS and first-responders. The second level consists of
incident teams at each school. A school incident commander, who is the
principal, leads these School Incident Response Teams, or SIRTs.
Teachers and other building staff constitute the third level, and
students and parents, the fourth.

Each of these levels will be trained in the appropriate roles and
responsibilities. For the top, this involves continual updating of the
Emergency Management Plan and ensuring its compliance with the Hamilton
County Emergency Operations Plan. The IMT has completed and been
certified through the Multi-Hazard Training for Schools
Train-the-Trainer course provided by the Emergency Management Institute
of FEMA and has overall responsibility for the emergency planning for
all of CPS. This team will also receive an 8-hour WMD/Hazmat Awareness
Training provided by the Cincinnati Health Department.

At the school level, principals are responsible for forming 7-member
School Incident Response Teams (SIRT) to direct emergency planning,
mitigation, preparedness, response and recovery at their respective
schools, building on a template provided by the district-wide Emergency
Management Plan. SIRT members will include the principal, the assistant
principal, a lead teacher, head secretary, head of security, plant
supervisor, and a nurse or school counselor, if present. All SIRT
members will go through a range of training classes to prepare them for
a multi-hazard emergency. Below is a diagram of the training:

![](media/image2.png){width="5.502777777777778in"
height="2.6222222222222222in"}

First, these individuals will undergo a one-day Multi-Hazard Emergency
Planning for Schools training led by the FEMA and NIMS-certified IMT and
will be certified through the IS 700 NIMS Certification Course. This
one-day training for SIRTs will be conducted by geographic quadrant in
Cincinnati. The SIRTs will also undergo a half-day of locally specific
and district-wide emergency management training.

Two members of each SIRT will be designated as threat and vulnerability
assessors and will receive 2-hour training and site-specific technical
support from the contracted assessment firm for conducting assessments
at their respective schools. These two SIRT members will then train
other SIRT members as well as selected teachers. Three members of the
SIRT -- the principal, plant supervisor, and head of security -- will
also receive WMD/Hazmat Awareness Training.

In addition, and in terms of preparation, 200 CPS personnel received
Critical Incident Stress Management Training (CISM) provided by the
Southwest Ohio Critical Incident Stress Management Team in 2003.
Security personnel took a two-day course in *Group Crisis Intervention*,
and more than 125 school psychologists, social workers, guidance
counselors, and nurses took a further four days of training that will
assist and support the SIRTs.

Teachers and other building staff will receive a half-day in-service
training on the CPS Emergency Management Plan and how it is being
adapted for implementation at their schools. Training will center on
site-specific emergency potentials and procedures, use of the school's
emergency supply kit (GoKit), and around classroom emergency flip
charts.

An in-house training coordinator will facilitate instruction for and by
the SIRTs. Teachers, in turn, will provide age-appropriate instruction
to their students regarding emergency procedures, such as evacuation
routes, shelter-in-place locations, location of the emergency flip chart
and how to read it, what to do in a lockdown, etc. They will be assisted
by CPS-produced videos demonstrating shelter-in-place and lockdown
procedures. Actual shelter locations for shelter-in-place at each CPS,
private and parochial school in Cincinnati have already been identified
by the fire department in school-by-school walk-throughs. Signage for
CPS and partner-school shelter-in-place locations, in the form of
laminated "turtle" posters, will be produced using grant funds.

Central office staff will be provided a separate overview of the
Emergency Management Plan by the IMT. Each department is also required
to develop its own plan.

***Coordination with Partners*** -- The CPS project design benefits from
and reinforces CPS's partner relationships with first responders:
Cincinnati Fire Department, Cincinnati Police Department, Hamilton
County Community Mental Health Board, Cincinnati Health Department,
Hamilton County Homeland Security, and the American Red Cross. These
partners are involved in every area of CPS preparedness planning, from
assessment to training to practice to communication with parents and the
community.

Important preparedness coordination will involve collecting and sharing
assessment information on every school in the district. The fire
department is developing a major computerized Cincinnati Area Geographic
Information Systems (CAGIS) database of critical emergency response
information for more than 54,000 buildings in the city. CPS, through its
assessment of schools, will help that effort by collecting information
for the district's buildings in the format needed for the CAGIS
database.

Also for the school-by-school assessments, CPS will use the threat and
vulnerability assessment template recently developed by the Hamilton
County Office of Homeland Security for its own use in assessing hazards
in the region. By conducting the assessments on behalf of Homeland
Security, CPS is both attending to the safety of its own buildings and
adding to overall county homeland security.

Another example of preparedness coordination is the agreement between
CPS and the Cincinnati Health Department for provision of WMD/Hazmat
Awareness Training. The health department will provide training and
materials, free of cost, to three individuals in each SIRT. CPS will
provide facilities to the health department for its WMD/Hazmat Awareness
Training and also has designated eight schools as points of distribution
for emergency immunizations. Also, the Cincinnati Health Department will
supply GoKits to each of the schools, pending grant funding, and the
American Red Cross will provide training on their use and maintenance.
Finally, CPS and the Cincinnati Police Department have long-established
cooperation and coordination in security and crisis management through
the provision of 11 School Resource Officers covering all of the
district's high schools, and through partnership programs such as
Student Crime-Stoppers.

***Communication*** -- Overall preparedness, including training, drills
and simulations, will be introduced to parents and the
community-at-large through events at four schools in different parts of
the district. At these events, parents and the community will be
introduced to the full scope of the CPS Emergency Management Plan as
well as to the larger plans of Hamilton County and Cincinnati. In
particular, parents will be informed of school emergency communications
and reunification procedures, i.e., where to find information in an
emergency and how to use that information. The events will feature
opportunities for parents and the community at large to hear from all of
the CPS first responder partners, such as Cincinnati fire Department,
Cincinnati Police Department, Hamilton County Emergency Management
Agency, Cincinnati Health Department, and the American Red Cross, as
well as other supporting partners from business and industry, the
Alliance for Chemical Safety and Cincinnati Youth Collaborative, which
coordinates CPS's Partners in Education program, whereby businesses
sponsor programs and activities at individual schools.

Parents will also receive a brochure outlining what to do in the event
of an emergency at their child's school. The brochures will be a concise
guide reflecting the latest information on best practices as identified
by CPS in conjunction with the Hamilton County Emergency Operations
Plan. They will be made available in English and the main five other
languages spoken in district homes. Brochures will also be made
available to parents with children at non-CPS schools.

**[Phase Three: Response]{.underline}**

***Training*** -- Training in emergency response rests heavily in all
parties knowing who is in charge under what circumstances. The CPS
Emergency Management Plan carefully assigns responsibility according to
the gravity and type of crisis and is in close alignment with NIMS lines
of command. For instance, a minor incident such as a small and contained
hazardous material spill would be handled by the SIRT alone and would
not activate the Emergency Management Plan. An emergency or disaster
such as a building fire or tornado would activate the plan and call for
transfer of overall authority from the SIRT to the district incident
commander, who in the case of CPS is the chief operating officer. Once
the Emergency Management Plan is activated and under the control of the
district incident commander, CPS activates specific response procedures,
i.e. the public information officer follows an emergency communications
plan.

These response procedures, outlined in the Emergency Management Plan,
will be tested through tabletop exercises and physical, on-site
simulations. Two 3-hour tabletop drills will be conducted by October
2006: one for lockdown, and one for a CBRNE (chemical, biological,
radioactive, or nuclear explosive) incident. The training coordinator
will develop and coordinate the tabletop drills using materials (and
certification) from the FEMA Multi-Hazard Training for Schools
Train-the-Trainer course. The trainees will consist of the SIRTs and
first-responder personnel.

These drills will include accommodation for students with disabilities
and limited-English proficiency. In addition, two simulations will test
response procedures for managing multi-faceted crises. One will involve
a building-compromising event in a school with children with
disabilities. It will be carried out in the last two hours of a school
day and will involve evacuation, transporting of students, participation
of first responders, and notification of parents and reunification of
students with parents. The other will be a lockdown simulation to be
conducted and videotaped. Lockdown simulations require involvement of
police, Homeland Security, the health department, and the mental health
board.

Also, and in conjunction with the fire and health departments, a
shelter-in-place drill will be conducted at each of CPS's 79 schools and
up to 35 of the Archdiocese partner schools by December 2006. Finally,
CPS personnel already trained in Critical Incident Stress Management
will remain an integral part of response training support.

***Coordination*** ***with Partners*** -- CPS and its first-responder
partners will be the primary coordinating entities involved in the
crisis. Each will have been trained and have up-to-date expertise on the
Emergency Management Plan, the Hamilton County Emergency Operations
Plan, and their own fields of emergency responsibilities. They will
report to the overall incident commander and have operational
flexibility as warranted by the local situation while also operating in
the agreed-upon NIMS command structure.

***Communication*** -- Communication in time of response will involve
both appropriate hardware and processes. Hardware will include
communications systems capable of mass broadcast (automated phone and
email notification) and access to relevant CPS databases, such as the
location and special needs of students with disabilities. Hardware will
also involve equipping the Command Vehicle with these types of
communications abilities. Processes will involve who communicates what
information when and to whom. CPS and its first-responder partners will
speak with one voice through either the CPS public information officer
or the incident commander, as outlined in the Emergency Management Plan.
This information will be relayed via the Internet, automated phone
systems, and the media. Information will include both general reporting
on the crisis as well as actions to be taken in response.

**[Phase Four: Recovery]{.underline}**

***Training*** -- CPS staff will be trained in the importance of
returning to equilibrium in terms of physical plant and educational
instruction. In terms of mental health, CPS staff trained in Critical
Incident Stress Management will offer this expertise to staff, students
and parents. All staff, partners and students will also be apprised of
what worked correctly in the response to the emergency, and what did not
work correctly. This information will be added to the Emergency
Management Plan and will be the subject of subsequent training.

***Coordination with Partners*** -- After an emergency incident, all
partners will assess the efficacy and practicability of the policies and
procedures in the Emergency Management Plan, as well as the accuracy of
school-specific threat and vulnerability assessments. They will
recommend changes, improvements and possible re-assessments. Also, the
Hamilton County Board of Mental Health, which works in conjunction with
the Red Cross and the Inter-Agency School Crisis Team, a coalition of
non-profit groups---will assist CPS in meeting the mental and emotional
health needs of staff, students, parents, and first-responders.

***Communication*** -- Staff, students, parents and all members
responsible for the Emergency Management Plan will be apprised of the
response to the crisis, and, if possible, its cause. Again, this
communication will emanate from a selected "voice" or "voices" within
CPS, such as the public information officer, the chief operating
officer, or the superintendent. Actions, such as the re-scheduling,
resumption or relocation of classes, will also be communicated via the
Internet, media, and, in the case of parents, by Cincinnati Parents for
Public Schools.

# NEXT STEPS:

Crisis mitigation and prevention are based on accurate knowledge of
actual and potential threats on a site-specific basis. As a result of
CPS's building plan, conditions at school sites are changing. External
threats to each location---for instance, weather events, proximity to a
chemical plant or a flood-prone creek---might not change, but their
potential effects might. At present, the Cincinnati Fire Department has
paper records, by quadrant of the Cincinnati area, of the location of
external hazards near the schools, and is engaged in an effort to
compile a Cincinnati Area Geographic Information Systems database that
eventually will make such information available on a site-by-site basis
for Cincinnati's 54,000-some large buildings, including schools. But
this information now exists only on paper, and CPS has very uneven,
non-systematized data for the schools. CPS has a strategic approach to
gain this site-specific knowledge and sustaining its accuracy on an
ongoing basis: the program design includes contracting, in consultation
with Hamilton County Homeland Security, with a highly credentialed
vulnerability assessment firm to train, supervise, and advise the IMT
and staff from each school on a train-the-trainer basis to assess their
site vulnerabilities.

CPS also aims to address weaknesses in its communications and
coordination on three fronts: First, at present there is no consolidated
information available on the CPS website regarding the district's
Emergency Management Plan and procedures for parents and community
members. With the grant assistance, CPS will create a user-friendly
webpage that provides emergency response information in one place. The
webpage will also serve as one route of notification of an ongoing
emergency. Second, staff time will be used to upgrade the district's
notification procedures to automated phone calling and email. Third,
Cincinnati's hilly terrain and the spread of the school district pose
special challenges in maintaining incident command communications and
coordination. CPS needs to mitigate such difficulties by outfitting a
Command Vehicle (already in CPS's possession) with communications
equipment, high-speed Internet capacity, backup power, and other
emergency supplies.

The IMT has created a coherent, logically structured, and effective
program of training for staff and students that will ensure consistency
of action and command while at the same time accommodating different
conditions at individual school sites. CPS now needs to contract with a
training coordinator and implement a comprehensive and coordinated
training program that will include NIMS IS 700 certification for staff
down to the individual school building level. The program will be based
on train-the-trainer methodology to ensure sustainability.

Another gap in preparedness is actual emergency supplies for each school
in the form of a crisis response kit (GoKit). The purchase of GoKits for
CPS schools will now be possible through our grant monies if the
Cincinnati Health Department cannot provide them to us through their own
grant monies.

While CPS currently keeps fully documented information for students with
disabilities and/or language limitations, this information is not
available in a single-source, easily accessible report for first
responders. CPS will support staff time for the data collection and
entry needed to create this report, which will be invaluable in
reunification of students with their parents following a crisis.

Finally, since CPS has only recently created its Emergency Management
Plan, its policies and procedures have not been communicated to prepare
parents, students, and the public at large. The following initiatives
will be undertaken: 1) four community events will be sponsored that will
include all CPS responder partners as well as key members of the
business community; 2) a contract with the Cincinnati chapter of Parents
for Public Schools for parent involvement; and 3) production of a
brochure in the several languages spoken in CPS homes providing concise
information about CPS's emergency management and actions for parents to
take in the event of a crisis.

CPS and its coordinating partners have strong working relationships, and
all are committed to testing emergency response procedures through
practice drills and exercises. For example, several shelter-in-place
exercises have been conducted at CPS schools with the participation of
the Cincinnati Fire Department and Health Department. However, funds are
lacking to support the sustained level of practice required to reinforce
staff training and to ensure that students, staff, and responders
actually carry out procedures they have been taught. CPS will support a
series of two tabletop exercises and one major crisis simulation, as
well as a shelter-in-place exercise at every CPS school in the district.
Additionally, CPS will support production of laminated shelter-in-place
posters designating the shelter location in each school and production
of a shelter-in-place video for classroom use.

CPS has provided training in Critical Incident Stress Management (CISM)
to its security personnel and advanced CISM training for 125 of its
school psychologists, nurses, social workers, and counselors. These
staff will serve as a resource in coordination with Cincinnati Community
Mental Health Board for following up with staff, students, and parents
after an emergency. Again, staff and responders are lacking in practice
for crisis situations, which will be gained through the drills and
simulation.

Cincinnati Public Schools will use an evaluation process designed around
the principles of learning, practicing, continuous improvement, and
sustainability of results. Several levels and types of assessment will
be included in an overall evaluation process conducted by CPS's
Department of Research, Evaluation & Testing.

To accomplish the scope of evaluation intended, CPS proposes to create a
project performance database in a secure area on the CPS intranet. The
database will be designed to 1) count track, and document progress on
performance measures related to intended outcomes, and 2) provide
feedback to inform decisions about needed adjustments in CPS's emergency
management policies and procedures.

The project performance database will track quantitative and process
information in six areas bearing on the intended outcomes for the
project:

-   *Vulnerability Assessment* -- Cincinnati Public Schools presently
    has only general information about risks and hazards at each school
    site, so establishing useful, quantitative, and accessible baseline
    information is a top evaluation priority. Quantitative and process
    measures will include: number and dates of individuals trained;
    number/dates of vulnerability assessments completed; and
    number/dates of completed vulnerability assessments evaluated and
    revised.

-   *School Response Plans* -- Each SIRT is responsible for adapting a
    template provided in the district-wide Emergency Management Plan to
    prepare a School Response Plan customized to their school.
    Quantitative and process measures will include: number/dates of
    schools adapting their plans; number/dates of plans uploaded to CPS
    secure website for access by responders; number/dates of plans
    revised to reflect changes from vulnerability assessments.

-   *Meetings of the Emergency Management Team and Advisory Committee*
    -- The database will be used to document meeting dates, number/names
    of attendees, and decisions taken.

-   *Training* *and Practice* -- Quantitative and process measures will
    include: number/dates of SIRTs completing training in FEMA
    Multi-Hazard Training for Schools, CPS Emergency Management Plan,
    WMD/Hazmat, use and maintenance of GoKit; number/dates of
    individuals achieving NIMS IS 700 certification; number, dates,
    participants, and response time in tabletop exercises, drills, and
    simulations.

-   *Parent and Community Awareness* -- The database will be used to
    track number/dates of parent and community participation in the four
    community events; number/dates of parent, student, and community
    members taking American Red Cross workshops; names/date of formation
    of Parent Advisory Council; number/dates of parents participating in
    Parents for Public Schools awareness survey.

-   *Special Populations* -- The database will be used to document that
    information regarding students with disabilities or language
    challenges has been added and is accessible as needed.

Several sources of qualitative information will also be electronically
captured:

-   The vulnerability assessment firm will evaluate how well each school
    team carries out its assessment, including whether the training has
    been followed to ensure that all relevant hazard information is
    captured, whether and how successfully the team used the assessment
    template adapted from Hamilton County Homeland Security, the extent
    to which potential obstacles were identified and addressed, and
    whether the process needs action or improvement;

-   A crisis management expert will evaluate the tabletop exercises and
    the simulation; key evaluation questions will include whether
    participants are able to identify the communication, resources,
    coordination, and organizational elements associated with an
    emergency response; whether they are able to identify policy issues
    that need to be considered in responding to a large-scale event, and
    how each individual assesses his/her own preparedness;

-   The Fire Department regularly completes an evaluation for each
    shelter-in-place drill it conducts, following key questions in a
    pre-exercise packet given to the school -- as examples, Are they
    prepared to respond? Do they have appropriate internal
    communications? How will they assign tasks to individuals in the
    school?

-   The Cincinnati chapter of Parents for Public Schools will conduct
    and analyze two parent perception surveys, one toward the beginning
    and one at end of the project. The first survey will assess the
    extent to which parents understand what they should do in the event
    of an emergency at their child's school. The second will be
    administered after 12 months to determine how much has changed in
    parent responses, what still needs to be done, and if there are
    particular populations that need outreach and education.

Both quantitative and qualitative feedback will be used by the IMT and
the Advisory Committee so that appropriate actions or interventions can
be taken and determinations made whether particular policies and
procedures should be continued or discontinued, practiced more or less
frequently, or monitored for further information. This ongoing monthly
analysis and reporting will be the basis for revision and continuous
improvement of CPS's Emergency Management Plan.

In addition to the monthly reporting to project stakeholders, there will
be two formal interim reports and a final report. The two interim
evaluations will analyze the quantitative and process information from
the database and the qualitative information from these external sources
to provide reports of progress focusing on the outcomes CPS intends. The
final evaluation will include the summary of all data collected and
reported through the database, "lessons learned" throughout the project,
and recommended future steps to assure that vulnerability assessments
are conducted routinely, plans are updated as needed, and communication
around the plans to all stakeholders is ongoing.

# EXPECTED OUTCOMES:

CPS expects the following significant outcomes:

-   As the result of a coherent program of training, practice, and
    assessment -- including vulnerability assessment at each school site
    -- CPS staff and students will have the knowledge and practical
    capacity to respond quickly, appropriately, and with less fear to a
    range of emergency situations that could arise at school.

-   As the result of collaborative decision making in the Advisory
    Committee and joint conduct of an ambitious program of frequent
    drills, tabletop exercises, emergency simulation, and response
    assessment, CPS and its first responder and other key community
    partners will have a higher efficiency and deeper quality of
    coordination.

-   As the result of carefully developed and implemented communications
    -- including information translated into five additional languages
    other than English -- parents and guardians will know where and how
    to proceed in an emergency to be reunited with their children, and
    the public will be aware of CPS policies and procedures for
    emergency response.

-   As the result of CPS's train-the-trainer strategy and its philosophy
    of continuous improvement through assessment and evaluation,
    emergency response knowledge and capacity will be increased and
    sustained.

-   As the result of a dedicated effort to identify the locations and
    particular needs of students with disabilities or limited English
    proficiency in a single easily accessible report, CPS staff and
    first responders will be better able to assist these students in an
    emergency to mitigate any anxiety for these students and their
    parents easing reunification.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

EPHLI has provided me with a valuable opportunity to take on new
challenges in my career. It has strengthened my dedication to making a
difference in Environmental Health.

The participation in the Environmental Public Health Leadership
Institute has been a phenomenal growth experience for me. One of the
greatest advantages I have gained is the ability to meet peers and
mentors. It has been a great honor to collaborate with other fellows who
face similar problems and issues in Environmental Health. Mentors laid
the groundwork for future collaboration prospects and provided excellent
leadership. The instructors through their various activities,
assignments, exercises, and lectures helped all the fellows become
self-motivated to apply the new techniques they were learning and begin
to make a difference immediately at their work place.

Another advantage was that EPHLI gave me the chance to gain more context
knowledge and help me immediately apply new ideas and concepts to my
normal day-to-day tasks. I have been able to incorporate many of the new
methods, such as critical thinking and systems modeling to name a few,
into daily operations and large projects.

I believe my participation in EPHLI shows that there is no boundary for
Environmental Health. I work for a school district and under the normal
umbrella of Environmental Health, I would not be invited to the table as
a player. It is a common mistake to not consider schools and private
companies as groups who are stakeholders in Environmental Health and can
make a positive contribution to Environmental Health advancements.
Environmental Health reaches into all aspects of our world and efforts
like EPHLI will be what helps bring the importance of Environmental
Health into the national spotlight where it belongs.

# ABOUT THE EPHLI FELLOW:

Jessica Miller Shelly, RS, REHS, MBA is a Supervisor of Building
Operations & Food Services for Cincinnati Public Schools. She is
responsible for overseeing the daily operations at 79 schools along with
serving as a core member of the Incident Management Team.

Before joining the school district, Ms. Shelly worked in local health
department jurisdictions for ten years. Most recently, she was a Senior
Registered Environmental Health Specialist for the Cincinnati Health
Department. Jessica was responsible for a myriad of tasks including:
serving on the Bioterrorism Public Health Response Team; teaching
ServSafe® to foodservice operators; conducting internal audits of state
and local mandated programs; developing inspection methodology for
sanitarians; presenting environmental health issues to companies and
community groups; and composing and submitting grants, position papers,
and publications.

Ms. Shelly has received many accolades for her dedication and work in
environmental health. She has received three City of Cincinnati
Outstanding Customer Service Awards, The Educational and Career
Development Award from the City of Cincinnati, and Ms. Shelly was a City
of Cincinnati Seasongood Award winner for her ServSafe® program which
helped demonstrate that food safety education lead to a dramatic decease
of critical violations in food establishment inspections.

Ms. Shelly was chosen to participate in the Center for Disease Control
and Prevention's 1^st^ Annual Emerging Leaders Workshop in Atlanta in
December 2003. Ms. Shelly was also selected to be part of the 2003-2004
Ohio Public Health Leadership Institute for her "Clean Streets, Safe
City" agenda.

Ms. Shelly has been a speaker at several conferences including the Ohio
Environmental Health Association Southwest Conference, the Ellenbee
Leggett Food Show, and most recently she was the spotlight speaker at
the School Nutrition Association's national conference in Baltimore,
Maryland in July 2005.

Ms. Shelly is a member of various professional organizations including:
Junior League of Cincinnati; National Environmental Health Association;
International Food Safety Council; Professional Association of Code
Enforcement, and National Association of Female Executives.

Ms. Shelly's undergraduate degree in Zoology is from Miami University.
She graduated *summa cum laude* with her MBA in Management,
International Business, and Marketing from the University of Cincinnati
and was honored as the 2002 Outstanding Graduate Student of the Year.

# REFERENCES:

1.  10 Essential Public Health Services,
    http://www.cdc.gov/nceh/ehs/home/HealthService.htm

2.  CDC Health Protection Goals,
    http://www.cdc.gov/about/goals/default.htm

3.  National Strategy to Revitalize Environmental Public Health
    Services, http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf