**Environmental Health Promotion**

**Campaign In West Virginia**

**2005 -- 2006**

# Environmental Public Health Leadership Institute Fellow(s):

**Michelle Cochran, B.S., R.S.**

*Readiness Coordinator*

*Office of Environmental Health Services,*

*Bureau for Public Health,*

*WV Department of Health and Human Resources*

*Capitol and Washington Streets*

*1 Davis Square, Suite 200*

*Charleston, West Virginia 25301-1798*

*(304) 558-6981, <michellecochran@wvdhhr.org>*

**Ann Spaner, J.D., B.A.**

*Director, Public Health Regulations*

*Bureau for Public Health*

*West Virginia Department of Health and Human Resources*

*350 Capitol Street, Room 702*

*Charleston, West Virginia 25301*

*(304) 558-2971, <annspaner@wvdhhr.org>*

**Barbara S. Taylor, B.S., M.S.**

*Director\
Office of Environmental Health Services*

*Bureau for Public Health*

*West Virginia Department of Health and Human Resources*

*Capitol and Washington Streets*

*1 Davis Square, Suite 200*

*Charleston, West Virginia 25301-1798*

*(304) 558-2981, <barbtaylor@wvdhhr.org>*

# Mentor(s):

**Vince Radke, MPH, RS, CFSP**

*Senior Environmental Health Officer*

*Centers for Disease Control and Prevention\
National Center for Environmental Health*

*Division of Emergency and Environmental Health Services\
Environmental Health Services Branch*

*4770 Buford Highway, NE*

*Mailstop: F28*

*Atlanta, GA 30341-3724*

*Ph: 770.488.4136*

*Fax: 770.488.7310*

*E-mail: <vradke@cdc.gov>*

[*http://www.cdc.gov/nceh/ehs/*](http://www.cdc.gov/nceh/ehs/)

 

# (Acknowledgements):

### **Cathy Taylor**

*Workforce Development Coordinator*

*Bureau for Public Health*

*West Virginia Department of Health and Human Resources*

*350 Capitol Street, Room 702*

*Charleston, West Virginia 25301*

**Nancy J. Tolliver**

*Tolliver Consulting*

*830 Walters Road*

*Charleston, West Virginia 25314*

*304-342-8237*

# 

# 

# EXECUTIVE SUMMARY:

The West Virginia EPHLI project is a collaborative effort to expand
understanding, increase awareness and earn a greater appreciation of the
crucial role played by Environmental Health professionals in protecting
public health. Environmental health practitioners routinely practice
preventative measures, through many programs of sanitary inspection and
enforcement. In emergencies, environmental health is called upon to act
quickly in events ranging from floods, to chemical spills, food-borne
contamination to disease outbreaks including bioterrorism. Sadly, many
response partners do not understand that the environmental health
response to disasters can continue for months, even years, after the
initial impacts have been felt.

The West Virginia team has embarked on a campaign of Environmental
Health Promotion. Efforts to increase the knowledge, understanding, and
respect of a wide spectrum of community partners should lead to the
recognition of the importance of this branch of public health.

# INTRODUCTION/BACKGROUND:

In West Virginia, the environmental public health program and the
environmental regulatory programs work together on many issues, but the
general public and others in decision making positions are virtually
unaware of the significance of environmental public health until a
disaster strikes. Environmental health practitioners must become more
collaborative in their efforts as most citizens, politicians, and
legislative members do not recognize their role in protecting and
improving the health of citizens in their community. Environmental
health should also be more active in environmental policy issues that
affect the health of the communities.

Bolstering collaborative efforts with response partners and with state
legislative officials may contribute to a greater awareness of
environmental public health and provide opportunities to improve
funding.

####### ***Problem Statement:*** 

####### The general public often discounts or is unaware of the many public health interventions, including sanitary inspection, education and enforcement made on their behalf by environmental health practitioners. In emergency situations or other public health crisis, the demand for qualified environmental health professionals greatly exceeds the number of people available and willing to do this difficult but important work. The lack of qualified professionals is due in part to insufficient funding which in turn can be blamed on the lack of understanding, visibility and appreciation of the crucial role played by environmental health professionals in protecting public health. Moreover, insufficient funding also inhibits training opportunities for existing staff. Consequently, when an emerging issue or disaster arises, staff may not be fully aware of all of the means available to protect public health. 

An in depth evaluation of the invisibility of environmental health in
West Virginia, helped to determine the applicable archetypes. Several
possible diagrams were utilized in analyzing potential solutions. The
diagram and archetype are discussed in the following. Figures 1 and 2
illustrate what were determined to be the most common "fixes" that
applied.

####### ***Causal Loop Diagrams and applicable archetypes:***

[Archetype:]{.underline} An archetype that applies to the West Virginia
project is clearly "Fixes that backfire"

[The Problem]{.underline}: In emergency situations or other public
health crises, the demand for capable and qualified public health
professionals to do a wide variety of tasks greatly exceeds the number
of people available and willing to do this difficult but important work.

[The short term fix]{.underline}: Certain individuals and persons in
certain job classifications, who are already spread too thin, to step up
and to get the work done. These are capable hardworking people who have
responded to emergencies and crises for years.

[Unintended consequences:]{.underline} When these highly motivated and
dedicated people are out of the office and in emergency mode, their
daily duties and activities suffer. In most instances, there are not
capable and competent back up workers in their offices to pick up the
slack. Therefore, normal or ordinary jobs and tasks remain undone and
pile up until the hard-workers return from the emergency. They are
exhausted and their morale is down because of the work that has piled up
in their absence and a lack of support. These conditions make even the
best employees hesitant to take on the needed extra work in the next
emergency or crisis.

***Figure 1:***

![](media/image1.wmf){width="6.0in" height="4.079861111111111in"}

[Archetype]{.underline}: Another archetype that applies is "Shifting the
burden."

[The Problem:]{.underline} There is not enough money to support public
health programs

[The short term fix:]{.underline} Recommend to the Secretary of the
Department that funding earmarked for legislative projects, having
minimal impact on public health programs, in the budget digest be
eliminated.

[Unintended (but obvious) consequences:]{.underline} Legislators would
rather fund a local pork project than save a statewide public health
program that they see as being of marginal use to their constituents.
Proposed cuts are reinstated and existing lean programs are forced to
make further cuts, often through elimination of vacant positions.

***Figure 2:***

![](media/image2.wmf){width="5.875in" height="3.8819444444444446in"}

Collaboration to enhance the understanding of environmental health
creates an opportunity to avoid both the shifting the burden and fixes
that backfire archetypes. As seen in the behavior over time graph found
in Figure 3, the increased collaboration with other state, local and
federal partners, over a period of time should serve to promote the role
of environmental health.

####### 

####### 

####### ***Figure 3: Behavior over Time Graph***

####### ![](media/image3.wmf){width="4.125694444444444in" height="2.9256944444444444in"}

####### ***10 Essential Environmental Health Services:***

West Virginia currently faces dilemmas in retention and recruitment of
qualified employees due primarily to the inability to provide
competitive salaries with other state and local agencies that employ
practitioners with environmental health skills. Without trained
qualified staff it is impossible to assure a competent workforce
(Essential Service #8) or effectively implement any of the other nine
services in West Virginia's communities.

![](media/image4.png){width="2.2708333333333335in" height="2.3125in"}
Lawmakers are a significant part of their local community. Not only is
it important to have them on-board when developing policy (Essential
Service #5), but it is equally important during the enforcement of
environmental health laws and regulations (Essential Service #6). Often
the response of a business or individual to enforcement actions is
contact with their local lawmakers to convey their concerns. When
delegates and senators are informed and aware of how environmental
health law and regulations protect the public, they are more likely to
be supportive of agency actions. The ability for lawmakers to understand
critical environmental health and public health issues can only come
from increased collaboration.

In fact, efforts to promote environmental health support all ten (10) of
the Essential Environmental Health Services. Adequate funding is crucial
to full implementation of all of the ten (10) essential services since
without knowledge, understanding and recognition of the importance of
environmental health, funding for environmental health programs will be
continually limited.

> Figure 4: Relation of Essential Services to Core Functions developed
> by Carl Osaki in Essential Services of Environmental Health

####### 

####### 

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

The focus of the West Virginia project clearly is consistent with CDC's
Health Protection Goal of "People Prepared for Emerging Health Threats."

Unfortunately, the narrow valleys and high mountains which make West
Virginia a destination for outdoor recreation enthusiasts, also make the
people of the state extremely vulnerable to catastrophic flood events.
Typically, severely damaging floods occur multiple times per year in
some local communities.

In recent years 500 to 1000 year flood events have occurred in the state
resulting in simultaneous impacts to many communities, multiple
counties, and extensive geographic areas of West Virginia. Such
large-scale events have been challenges for environmental health and
other responders from the local, state and federal levels. However,
floods have provided an opportunity to hone our environmental health
response skills and identify areas that need additional focus. The
response of environmental health professionals in a flood event is not
unlike the response to other potential and emerging public health
threats.

The West Virginia project has focused on getting more information out to
those involved in the response to emerging health threats. The
expectation is that more information will result in a stronger response
from environmental health professionals and a more prepared citizenry.
Some of the products of the project have included a course on *Public
Health Emergency Law,* a *Disaster Response Protocol Manual*, and a
*Health Guide for the Public in Disaster Planning and Recovery.* The
West Virginia team also finds that it is vitally important to ensure
that those charged with public policy decisions are also part of the
targeted audience to receive more information. Copies of the protocol
manual will be provided to state and local environmental health
professionals as well as West Virginia Homeland Security officials. The
Health Guide will be marketed through a Department of Health and Human
Resources news release, made available to local health departments in
hard copy format, and made available to the public and others through
hard copy and through posting on the agency website. The Emergency Law
course was held in the fall of 2005 and focused on a wide array of
officials including law enforcement, public health, hospitals, county
prosecutors and homeland security. Copies of the Protocol Manual and a
draft copy of the Health Guide have been submitted with this project.
Information regarding the Emergency Law course can be found in Appendix
A.

In summary, West Virginia has built upon its experience with natural
disasters to bolster its ability to respond to other emerging threats.
This endeavor is in step with the CDC goal of People Prepared for
Emerging Health Threats.

***The National Strategy to Revitalize Environmental Public Health
Services***

In addition to it's consistency with CDC's Health Protection goals, the
West Virginia project also supports goals contained in the National
Strategy to Revitalize Environmental Public Health Services.

The Public Health Emergency Law course conducted under this project
brought together diverse partners, which in the event of a public health
threat, will be working collaboratively together. These partners need to
be familiar with the role of environmental health in responding to
natural disasters and emerging threats. The Emergency Law course is not
the first, nor is it the only time that West Virginia has brought the
partners together. West Virginia's Bureau for Public Health leads the
public health preparedness activities in the state and many of those
participating in the course are also active in the larger preparedness
arena.

The focus of the *Disaster Response Protocol Manual* developed as part
of this project is to provide information to environmental health
professionals in local health departments, the state Bureau for Public
Health, and others involved in response activities. The *Health Guide
for the Public in Disaster Planning and Recovery* is focused on
providing easy to understand information to the public to assist them in
preparing for emergencies. Each of these efforts individually and
collectively foster communication among partners and the public
consistent with Goal VI to Create Strategic Partnerships.

Not only do these activities support Goal VI but they are also in line
with communicating and marketing the role of environmental health. Never
before in West Virginia have any of these products been available to the
partners or the public. The distribution of the Disaster Manual and the
Health Guide will put environmental health in front of new audiences and
enhance the understanding of those that already have some understanding
of our role.

Lastly, the participation of the West Virginia Team in the Environmental
Public Health Leadership Institute has a direct linkage to Goal III of
the National Strategy to Foster Leadership. The West Virginia Team has
had an opportunity to participate in the first class of the Leadership
Institute which is a product of Goal III.

####### 

# DESCRIPTION/DELIVERABLES:

***Program Goals***

-   Practice collaboration with response partners.

-   Educate response partners to public health's, and more specifically
    environmental health's role in protecting the public as a part of
    disaster response.

-   Educate the public about environmental health related activities
    that they can do to prepare for or respond to emergencies.

-   Educate response partners to various roles that they may have in a
    public health emergency.

-   Build communication networks by getting to know response partners
    better.

-   Build an overall better understanding of the role that environmental
    health plays in the daily lives of all West Virginians.

***Health Problem***

Environmental health remains invisible to most of the citizens of West
Virginia, including its lawmakers. The lack of appreciation of the role
that environmental health plays results in continual inadequate funding.
The inadequate funding subsequently results in an inability to meet
demands for emerging issues or emergency response.

***Outcome objective***

A fundamental understanding, appreciation, and respect for environmental
health and its role in protecting the health of the citizens of West
Virginia.

***Determinant***

Ability to get response partners to the table to begin the
communication, collaboration, and education processes.

***Impact Objective***

Long term, the educational bridges that are built through this process
will serve to provide West Virginia Environmental Health Services with
increased funding so as to better protect the health of the public.

***Contributing Factors***

Often those who are best able to provide increased funding are unwilling
to do so because the programs that are under the purview of
Environmental Health impact them with regulatory enforcement.

***Process Objectives***

Bring response partners into the planning and drafting processes so that
they will be able to provide input into the final product, resulting in
a fundament core knowledge basis and buy-in in the final products.

# METHODOLOGY:

####### ***Events and Activities***

Several activities were undertaken for the environmental health
promotion project. They include:

-   holding the Public Health Emergency Law Courses

-   holding the ATSDR TIC/TIM course

-   development of two documents to communicate actions in the event of
    an emergency.

    -   Disaster Response Protocol Manual for West Virginia
        Environmental Health, is focused on appropriate environmental
        health protocols for professional staff during an emergency
        event.

    -   The second document is focused on providing preparedness and
        response information to the general public.

-   Re-integrate OEHS into the Zoonotic Task force

# RESULTS: (NEXT STEPS)

To date, the activities are in various states of completion. The Public
Health Emergency Law course has been fully accomplished. Detailed
information about that course can be found in the appendix. OEHS has
been re-integrated into the Zoonotic task force and planning is underway
for the ATSDR Toxic Industrial Chemical/Toxic Industrial Materials
course. Of the 2 publications, one has been completed and distribution
to response partners has begun. A copy has been attached for reference.
The second is near completion and additional funds have been secured to
ensure a more broad distribution (a copy of the draft is attached for
reference).

So far, efforts to more fully educate the West Virginia environmental
health response partners has been received enthusiastically by those who
had already been at least limitedly engaged with West Virginia Bureau
for Public Health's Office of Environmental Health Services (OEHS).
Hopefully, completion of the remaining activities that are underway will
aid in helping to engage, more broadly, other community partners by the
end of the calendar year.

# CONCLUSIONS:

**Increasing environmental health's visibility with community partners
should enhance respect and recognition for the importance of
environmental health not only in times of emergency response, but as it
impacts daily lives. We've only just begun. This process is not at all
easy but is critical to the viability of environmental health.**

# ABOUT THE EPHLI FELLOW(s)

**Michelle Cochran**

Michelle Cochran is a Registered Sanitarian with the Bureau for Public
Health's Office of Environmental Health Services. She currently holds
the position of Readiness Coordinator in which she works to coordinate
the environmental health disaster response for West Virginia. She has
held this position since it was created in June 2004.

Prior to Readiness Coordinator, Michelle was the Sanitarian Training
Officer for West Virginia. She was responsible for ensuring that all
newly hired Sanitarians in the state received the required 300 hours of
training. She coordinated the Sanitarian Training Course along with
assisting in the trainings at the Sanitarian's mid year training, the
Environmental Health Section of the Public Health Conference and the
District In-service Meetings.

Michelle has conducted inspections in the Infectious Medical Waste and
Asbestos Abatement Programs. She began her public health career as a as
a field Sanitarian at a local health department in 1991.

Michelle is a past scholar in the Southeast Public Health Leadership
Institute where she won an award in 2004. She graduated from Marshall
University with a Bachelor of Science degree, majoring in biology and
minoring in chemistry.

**Ann Spaner**

Ann A. Spaner is an attorney with the West Virginia Bureau for Public
Health. She has worked in the state Public Health agency for four and ½
years. She has an undergraduate degree from the University of Maryland
and received her law degree from West Virginia University College of Law
in Morgantown, WV.

**Barbara Taylor**

Barbara Taylor is the director of the Bureau for Public Health's Office
of Environmental Health Services. She holds a Bachelor of Science Degree
in Wildlife Resources from West Virginia University and a Masters Degree
in Environmental Science from Marshall University. Barbara also was a
member of the 2002 class of the Southeast Public Health Leadership
Institute.

Barb began her career with the Division of Natural Resources, as a
biologist assistant. She later spent several seasons with the National
Park Service at New River Gorge National River and then moved onto what
is now the Department of Environmental Protection's Division of Water
Resources and Waste Management. Barb spent nearly 16 years with DEP and
served as the Chief of Water Resources from August 1995 until January
2000, when she accepted her current position with the Bureau for Public
Health as Director of the Office of Environmental Health Services.

Barb and her staff are responsible for variety of environmental health
programs including the safe drinking water and source water regulation
and protection, food safety, asbestos licensing and abatement, lead
assessment, radiological health, on-site wastewater treatment and
various other environmental public health programs.

**BIBLIOGRAPHY**

Public Health Emergency Law, A CDC Foundation Course for Front-Line
Practitioners, National Train-the-Trainers Conference in Atlanta, GA,
April 12-14, 2005. For technical assistance and for additional
information about public health law contact the CDC Public Health Law
Program at: [http://www.phppo.cdc.gov/od/phlp]{.underline}.

Goodman RA, Rothstien MA, Hoffman RE, Wlfredo L, Mathews GW, Law in
Public Health Practice, *Oxford University Press*, 2003.

Senge P, Kleiner A, Roberts C, Ross, R, Smith B, The Fifth Discipline
Fieldbook, *Doubleday* 1994.

Rowitz L, Public Health Leadership - Putting Principles into Practice,
*Jones and Bartlett Publishers, Inc*, 2003.

Musselwhite C, Jones, R, Dangerous Opportunity: Making Change Work,
*Xlibris Corporation*, 2004.

Mitroff I, Crisis Leadership - Planning for the Unthinkable, *John Wiley
& Sons, Inc*.,2004.

Klann, G, Crisis Leadership - Using Military Lessons, Organizational
Experiences and the Power of Influence to Lesson the Impact of Chaos on
the People You Lead, *Center for Creative Leadership Press,* 2003.

Osaki, Carl, Essential Services of Environmental Health, Northwest
Center for Public Health Practice, 2004

**Appendix A: Public Health Emergency Law Course**

***Goal:***

####### To advance the knowledge, understanding, recognition and appreciation of the crucial role of environmental and public health services during emergencies and daily life.

####### ***Health Problem:***

#######  The knowledge, understanding and awareness of the legal and technical requirements for responding to public health emergencies is insufficient among the very persons and professions who need to know and will be called upon to respond quickly and correctly.

####### ***Outcome Objective:***

####### Offer specific subject matter training on the legal and environmental aspects of emergency response to disasters (declared or not) through the development and delivery of a one day seminar.

####### ***Determinant:***

####### There is little actual or recent experience dealing with the type of public health emergency that is envisioned and, yet, we are more keenly aware that such emergencies are likely to occur in the future. It is also apparent that advance planning, awareness and cooperation are the best hope to minimize death, disease and widespread public hysteria

####### ***Impact Objective:***

####### By October 21, 2005, 60 -- 100 people (or more) should receive this basic training on Public Health Emergency and Environmental Law.

####### ***Contributing Factors:*** 

1.  Last quarantine order in WV was 30+ years ago. Law is old.

2.  Smallpox and flu pandemic last his almost 100 years ago.

3.  New and emerging diseases, SARS, Ebola, Monkeypox are little known
    without much practical experience.

4.  We know that multi-disciplinary plans to share the task of
    responding are essential in public health emergencies.

####### ***Process Objectives***

1\. By October 21, 2005, a core group of environmental health
professionals in Public Health Emergency Law and Environmental awareness
are to be educated.

**Event:** One day conference to be split into two half- day sessions.

**Activities:** ½ day covering Public Health Emergency Law issues, such
as isolation and quarantine, where examples of public health emergencies
from our past will be explored, and; ½ day for an overview of
Environmental Health's role in responding to emergency situations with
specific emphasis on environmental first responders and hazardous
material and radiological awareness.

2\. **Target audience:** The audience included public health
sanitarians, local board of health members, nurses and staff, local
health officers, state environmental health services, public health and
other state employees, law enforcement officials at the local, state and
federal levels, prosecuting attorneys, assistant Attorneys General,
Judges, Justices, epidemiologists, veterinarians, homeland security and
emergency services workers, funeral directors and other interested
persons. The objective of the seminar is to educate this diverse group
of people on the laws, rules and public policies applicable before,
during and after a public health emergency. Issues of isolation and
quarantine, emergency declarations, evaluating building safety,
maintaining order and site security, establishing the Incident Command
System and reliance on environmental inspections, sampling,
investigation and data will be some of the topics covered.

3\. **Course evaluation: A** full day course can be offered in two
locations, Morgantown and Charleston in order to train twice as many
participants. A short pre-seminar questionnaire was used to evaluate
what the participants know about the history of environmental emergency
response before they take the seminar and we will repeat some of the
same questions on a post-seminar course evaluation to provide a
measurement of what has been learned. Some examples of pre-seminar
questions might include:

> Q.1 When was the last time that a quarantine order was issued
>
> and enforced in West Virginia?
>
> Q.2 Approximately when (what year) was the last death from
>
> smallpox in WV?

Q.3 When was the last death from Tuberculosis (TB) in WV?

> Q.4 Can you recall any incident(s) in which mass casualties
>
> were caused by one event in West Virginia?

4\. **Prominent Speakers:** A lunch speaker will continue the education
during that time frame and the course will use the resources of the
Bureau for Public Health as well as colleagues from CDC as course
instructors. Gene Mathews from CDC will provide an overview of Emergency
Public Health law.

Pre-test/Post-test: As part of evaluating the effectiveness of the
Public Health Emergency Law course, a pre-test was administered to all
participants and collected for data evaluation. Following the conclusion
of the course, a post-test was administered and collected for
evaluation. The pre-test/post-test is contained in Figure 6.

**Public Health Emergency Law**

**Course Overview**

![](media/image5.png){width="1.4771653543307086in"
height="0.7984251968503937in"}![](media/image6.png){width="1.704724409448819in"
height="0.7980314960629922in"}![](media/image7.png){width="1.0389763779527559in"
height="1.0874015748031496in"}Knowledge of public health emergency law
is critical in today's environment. Public officials at local, state,
and federal levels who are charged with preparing for and responding to
public health emergencies need to know what actions are authorized and
how to minimize liabilities. In large-scale public health emergencies,
they also should know how to engage other agencies in a coordinated
effort.

**Training Goals:** This course is designed to assist in strengthening
the capacities of those involved in public health emergency response by
enhancing knowledge and understanding of the legal basis for public
health emergency management and decision-making. The course was
developed by the Centers for Disease Control and Prevention (CDC), the
West Virginia Bureau for Public Health (WVBPH), and the North Carolina
Center for Public Health Preparedness.

**Who Should Attend:** Attendees should include law enforcement; first
responders; federal, state and local public health and environmental
public health practitioners; local health officers; environmental
managers; academics; prosecuting attorneys; local boards of health;
county commissioners. There is no cost to attend this program!

**Public Health Emergency Law**

**Course Agenda**

**October 17, 2005 October 19, 2005**

**Charleston, West Virginia Morgantown, West Virginia**

8:00-8:30 am Continental Breakfast

8:30-8:45 am Welcome and Pre-test

> *Ann Spaner, Director, Public Health Regulations, WVBPH*

8:45-9:05 am Public Health Quarantine in West Virginia: The Quarantine
at Nuvrindabem

> *Ronald Forren, RS, Acting Deputy Commissioner, WVBPH*

9:05-10:10 am Protection of People: Isolation and Quarantine

*Ann Spaner, Director, Public Health Regulations, WVBPH*

10:10-10:30 am Mass Fatalities: The Buffalo Creek Experience

> *Jim Lowery, President, WV Funeral Home Directors Association*

10:30-10:45 am Break

10:45 am-12:00 pm Management of Property in a Public Health Emergency

> *Gene Matthews, Institute of Public Health Law, CDC Foundation*

12:00-12:15 pm Instructions for Small Group Scenarios and Group
Assignments

*Jennifer Horney, MPH, NC Center for Public Health Preparedness*

12:15-1:15 pm Lunch Provided

1:15-2:30 pm ***Tabletop Scenario 1***

> Public Health Closure of an Industrial Polluter: Public Health, Legal,
> and Community Implications

2:30-2:45 pm Break

2:45-4:00 pm ***Tabletop Scenario 2***

> Pandemic in West Virginia: How Do You Respond?

4:00-4:30 pm Anticipating the Moment When Laws and Policies Change
Following an Emergency

*Gene Matthews, Institute of Public Health Law, CDC Foundation*

4:30-4:45 pm Post-test and Evaluation

**To Register for Public Health Emergency Law:**

**\*\*There is no cost to attend this program\*\***

> Fax your application form to: 919-966-5692 attn: Yolanda Hamer
>
> or
>
> Mail your application form to: Office of Continuing Education, attn:
> Yolanda Hamer
>
> UNC-CH School of Public Health, CB \# 8165
>
> Chapel Hill, NC 27599-8165

Name SSN (optional)

Agency

Address

County

Day phone Evening phone

Fax E-mail

Job title Occupation

**\*Please select which date/location you are registering for\***

Course Title: [Public Health Emergency Law / Environmental Public
Health]{.underline}

Choose one:

\[ \] Location: [Embassy Suites Charleston]{.underline} Date: [October
17, 2005]{.underline} Course Number: [HCE7260106]{.underline}

\[ \] Location: [Radisson Morgantown]{.underline} Date: [October 19,
2005]{.underline} Course Number: [HCE7260206]{.underline}

When your registration has been processed, you will receive a
confirmation letter

containing details about the course and information about hotels.

+--------------+---------+---------+---------+-----------------------+
| **Table 1**  |         |         |         |                       |
|              |         |         |         |                       |
| **Public     |         |         |         |                       |
| Health       |         |         |         |                       |
| Emergency    |         |         |         |                       |
| Law Course   |         |         |         |                       |
| Evaluation** |         |         |         |                       |
|              |         |         |         |                       |
| **           |         |         |         |                       |
| Participants |         |         |         |                       |
| N=105**      |         |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Course       | Useful  | Not     | No      | Comments              |
| Topic/       |         | Useful  | R       |                       |
|              |         |         | esponse |                       |
| Question     |         |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Public       | 103     | 0       | 2       | Some wanted more      |
| Health       |         |         |         | information, while a  |
| Quarantine   |         |         |         | few wanted less       |
|              |         |         |         | background.           |
| (New         |         |         |         |                       |
| Vrindaban)   |         |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Protection   | 104     | 1       | 0       | Some desired more     |
| of People:   |         |         |         | information or role   |
| Isolation    |         |         |         | of local health       |
| and          |         |         |         | officer. Some had     |
| Quarantine   |         |         |         | presentation style    |
|              |         |         |         | comments.             |
+--------------+---------+---------+---------+-----------------------+
| Mass         | 98      | 6       | 1       | Many wanted handouts  |
| Fatalities:  |         |         |         | or slides or some     |
| The Buffalo  |         |         |         | sort of visual. Some  |
| Creek        |         |         |         | wanted public health  |
| Experience   |         |         |         | implications of the   |
|              |         |         |         | crisis.               |
+--------------+---------+---------+---------+-----------------------+
| Management   | 105     | 0       | 0       | One person wanted     |
| of Property  |         |         |         | more information on   |
| in a Public  |         |         |         | Hurricane Katrina     |
| Health       |         |         |         | post recovery.        |
| Emergency    |         |         |         | Several wanted more   |
|              |         |         |         | information on how to |
|              |         |         |         | work with the         |
|              |         |         |         | Legislature.          |
+--------------+---------+---------+---------+-----------------------+
| Anticipating | 88      | 1       | 16      | One participant       |
| the Moment   |         |         |         | wanted more           |
| when Laws    |         |         |         | interaction during    |
| and Policies |         |         |         | this presentation.    |
| Change       |         |         |         | Two mentioned that    |
| Following    |         |         |         | they really enjoyed   |
| and          |         |         |         | the comparison of     |
| Emergency    |         |         |         | Toronto and SARS to   |
|              |         |         |         | New Orleans and       |
|              |         |         |         | Hurricane Katrina.    |
+--------------+---------+---------+---------+-----------------------+
| Course       | Info    | S       | Not     | Not                   |
| Topic/       | rmative | omewhat |         |                       |
|              |         |         | Info    | Responding            |
| Question     |         | Info    | rmative |                       |
|              |         | rmative |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Table top    | 71      | 27      | 1       | 6                     |
| scenarios in |         |         |         |                       |
| general      |         |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| **Course     | **Com   |         |         |                       |
| Topic/**     | ments** |         |         |                       |
|              |         |         |         |                       |
| **Question** |         |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Table top    | C       |         |         |                       |
| scenario 1   | omments |         |         |                       |
|              | were    |         |         |                       |
|              | varied. |         |         |                       |
|              | Some    |         |         |                       |
|              | thought |         |         |                       |
|              | it was  |         |         |                       |
|              | not     |         |         |                       |
|              | re      |         |         |                       |
|              | alistic |         |         |                       |
|              | or well |         |         |                       |
|              | thought |         |         |                       |
|              | out.    |         |         |                       |
|              | Others  |         |         |                       |
|              | related |         |         |                       |
|              | and     |         |         |                       |
|              | thought |         |         |                       |
|              | dis     |         |         |                       |
|              | cussion |         |         |                       |
|              | was     |         |         |                       |
|              | h       |         |         |                       |
|              | elpful. |         |         |                       |
|              | Some    |         |         |                       |
|              | were    |         |         |                       |
|              | unable  |         |         |                       |
|              | to      |         |         |                       |
|              | resolve |         |         |                       |
|              | qu      |         |         |                       |
|              | estions |         |         |                       |
|              | in      |         |         |                       |
|              | their   |         |         |                       |
|              | group   |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Table top    | Most    |         |         |                       |
| scenario 2   | c       |         |         |                       |
|              | omments |         |         |                       |
|              | were    |         |         |                       |
|              | p       |         |         |                       |
|              | ositive |         |         |                       |
|              | about   |         |         |                       |
|              | the     |         |         |                       |
|              | s       |         |         |                       |
|              | cenario |         |         |                       |
|              | and     |         |         |                       |
|              | time    |         |         |                       |
|              | liness. |         |         |                       |
|              | One     |         |         |                       |
|              | thought |         |         |                       |
|              | it      |         |         |                       |
|              | ended   |         |         |                       |
|              | un      |         |         |                       |
|              | realist |         |         |                       |
|              | ically. |         |         |                       |
|              | And two |         |         |                       |
|              | wanted  |         |         |                       |
|              | more    |         |         |                       |
|              | info    |         |         |                       |
|              | rmation |         |         |                       |
|              | as to   |         |         |                       |
|              | who     |         |         |                       |
|              | would   |         |         |                       |
|              | be in   |         |         |                       |
|              | charge  |         |         |                       |
|              | in such |         |         |                       |
|              | a       |         |         |                       |
|              | sit     |         |         |                       |
|              | uation. |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Most useful  | The     |         |         |                       |
| part of the  | s       |         |         |                       |
| course       | pecific |         |         |                       |
|              | nature  |         |         |                       |
|              | of the  |         |         |                       |
|              | info    |         |         |                       |
|              | rmation |         |         |                       |
|              | to West |         |         |                       |
|              | V       |         |         |                       |
|              | irginia |         |         |                       |
|              | and     |         |         |                       |
|              | time    |         |         |                       |
|              | liness. |         |         |                       |
|              | Sc      |         |         |                       |
|              | enarios |         |         |                       |
|              | were    |         |         |                       |
|              | pos     |         |         |                       |
|              | itively |         |         |                       |
|              | r       |         |         |                       |
|              | eceived |         |         |                       |
|              | in part |         |         |                       |
|              | due to  |         |         |                       |
|              | the     |         |         |                       |
|              | small   |         |         |                       |
|              | group   |         |         |                       |
|              | size    |         |         |                       |
|              | and the |         |         |                       |
|              | ability |         |         |                       |
|              | to      |         |         |                       |
|              | "pr     |         |         |                       |
|              | actice" |         |         |                       |
|              | their   |         |         |                       |
|              | le      |         |         |                       |
|              | arning. |         |         |                       |
|              | Focus   |         |         |                       |
|              | on      |         |         |                       |
|              | collab  |         |         |                       |
|              | oration |         |         |                       |
|              | during  |         |         |                       |
|              | an      |         |         |                       |
|              | eme     |         |         |                       |
|              | rgency. |         |         |                       |
|              | Info    |         |         |                       |
|              | rmation |         |         |                       |
|              | about   |         |         |                       |
|              | laws    |         |         |                       |
|              | i       |         |         |                       |
|              | nvolved |         |         |                       |
|              | with    |         |         |                       |
|              | is      |         |         |                       |
|              | olation |         |         |                       |
|              | and     |         |         |                       |
|              | quar    |         |         |                       |
|              | antine. |         |         |                       |
+--------------+---------+---------+---------+-----------------------+
| Least useful | Some    |         |         |                       |
| part of the  | said,   |         |         |                       |
| course       | the     |         |         |                       |
|              | Buffalo |         |         |                       |
|              | Creek   |         |         |                       |
|              | story;  |         |         |                       |
|              | it      |         |         |                       |
|              | seemed  |         |         |                       |
|              | to be   |         |         |                       |
|              | more of |         |         |                       |
|              | a story |         |         |                       |
|              | than a  |         |         |                       |
|              | prese   |         |         |                       |
|              | ntation |         |         |                       |
|              | to gain |         |         |                       |
|              | useful  |         |         |                       |
|              | kn      |         |         |                       |
|              | owledge |         |         |                       |
|              | or      |         |         |                       |
|              | skills  |         |         |                       |
|              | from.   |         |         |                       |
|              | Some    |         |         |                       |
|              | said    |         |         |                       |
|              | sc      |         |         |                       |
|              | enarios |         |         |                       |
|              | were    |         |         |                       |
|              | the     |         |         |                       |
|              | least   |         |         |                       |
|              | useful  |         |         |                       |
|              | part    |         |         |                       |
|              | and     |         |         |                       |
|              | pr      |         |         |                       |
|              | eferred |         |         |                       |
|              | the     |         |         |                       |
|              | lecture |         |         |                       |
|              | po      |         |         |                       |
|              | rtions. |         |         |                       |
+--------------+---------+---------+---------+-----------------------+

+--------------+-------------------------------------------------------+
| **Table 2**  |                                                       |
|              |                                                       |
| **Public     |                                                       |
| Health       |                                                       |
| Emergency    |                                                       |
| Law Course   |                                                       |
| Evaluation** |                                                       |
|              |                                                       |
| **           |                                                       |
| Participants |                                                       |
| N=105**      |                                                       |
+--------------+-------------------------------------------------------+
| **Question** | **Comments**                                          |
+--------------+-------------------------------------------------------+
| Three things | -   Add a general overview of public health law for   |
| to change    |     newcomers.                                        |
| regarding    |                                                       |
| the course   | -   Increase time for question and answer.            |
|              |                                                       |
|              | -   Ensure the pre-test questions are answered        |
|              |     through the presentations.                        |
|              |                                                       |
|              | -   Provide handouts with list of law and how they    |
|              |     can be used.                                      |
|              |                                                       |
|              | -   Decrease the length of the course, only do one    |
|              |     scenario.                                         |
|              |                                                       |
|              | -   Require law enforcement to attend, starting at    |
|              |     the top down.                                     |
|              |                                                       |
|              | -   More details on who's in charge during a          |
|              |     pandemic.                                         |
|              |                                                       |
|              | -   Discuss state's disaster response plan.           |
|              |                                                       |
|              | -   Public health needs to be told where its place in |
|              |     an emergency response is, might not always be in  |
|              |     charge.                                           |
+--------------+-------------------------------------------------------+
| Changes as a | 68 respondents indicated they would do something      |
| result of    | differently as a result of this course, 9 would not   |
| completing   | (28 people did not respond). Comments included: would |
| the course   | review the current laws and determine where they need |
|              | to network with other organizations; prepare more     |
|              | thoroughly in the event an emergency occurs; share    |
|              | information with staff and constituents; not overlook |
|              | basic infrastructure in emergencies (sewer, water,    |
|              | garbage, etc.).                                       |
+--------------+-------------------------------------------------------+
| Were the     | 57 responded that the right people were at the        |
| right people | training, but many made notes that there were         |
| trained      | additional people that should have been included. 19  |
|              | indicated that the right people were not at the       |
|              | training. Suggestions included representation from    |
|              | the Office of Emergency Operations, EMS, prosecuting  |
|              | attorneys from the county level, and law enforcement; |
|              | transportation professionals; Board of Health         |
|              | members; state health department staff; and judges.   |
+--------------+-------------------------------------------------------+

The following Table 3 presents the pre-test and post-test results. A
T-test comparison of the pre-test results with the post-test results
found the improvement to be significant.

+----------+------------+------+------------+------+------------------+
| Table 3  |            |      |            |      |                  |
|          |            |      |            |      |                  |
| Public   |            |      |            |      |                  |
| Health   |            |      |            |      |                  |
| E        |            |      |            |      |                  |
| mergency |            |      |            |      |                  |
| Law      |            |      |            |      |                  |
|          |            |      |            |      |                  |
| Pr       |            |      |            |      |                  |
| e-Test/P |            |      |            |      |                  |
| ost-Test |            |      |            |      |                  |
| Results  |            |      |            |      |                  |
+----------+------------+------+------------+------+------------------+
| **Partic | **\# of    | **   | **\# of    | **   | **T-test         |
| ipants** | pretests   | Mean | Post-tests | Mean | Comparison of    |
|          | returned** | Sco  | returned** | Sco  | Pre and          |
|          |            | re** |            | re** | Post-test        |
|          |            |      |            |      | scores**         |
+----------+------------+------+------------+------+------------------+
| N=105    | 65         | 5.55 | 58         | 9.88 | \<.0001          |
+----------+------------+------+------------+------+------------------+