#  Pandemic Influenza Preparedness for Local Utilities

# 2006 - 2007 

# 

#  Environmental Public Health Leadership Institute Fellow:

# Ronald E. Freeman, P.E., M.P.A.

*Professional Engineer Administrator; Volusia County Health Department*

*1350 South Woodland Boulevard, DeLand, Florida 32720*

*Ronald_freeman@doh.state.fl.us*

# Mentor:

### **Daneen Farrow-Collier, M.S.P.H.**

*Public Health Advisor; Center for Disease Control and Prevention*

# Acknowledgements:

### **Peter D. Thornton, R.S., M.P.H., D.A.A.S.**

*Environmental Administrator;* Volusia County Health Department

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

# EXECUTIVE SUMMARY:

The avian influenza (H5N1) virus is rapidly expanding throughout bird
populations worldwide. Although this flu has not yet developed the
ability of person-to-person transmission, with a current human mortality
rate of 50% public health officials have become increasingly concerned
about the potentially devastating impact of this virus upon our society.

It is a concern of Volusia County Environmental Health that a lack of
planning by local utilities could lead to loss of operational
capabilities in the event of pandemic influenza. The loss of utility
service would lead to unsanitary and unhealthful conditions in our
community. Public health would be at risk.

The goal of this project is to help local municipal water; wastewater
and electric utilities develop an emergency response plan that addresses
pandemic influenza. The outcome objective of this project is by April
15, 2007, 90% of local utilities will have developed the relevant
response plan.

This project seeks to educate local utilities about the possibility of
pandemic influenza. They will be informed about the necessity to plan
and prepare for this eventuality. They will be provided information and
resources to help them prepare the necessary emergency response plan.

To accomplish this goal staff will become educated about pandemic
influenza and develop a presentation and resource materials for the
local utilities. A website concerning influenza issues will be
established and maintained. Staff will meet with local utilities to
educate them about pandemic influenza and encourage them to develop
emergency response plans to address this threat.

As of this date the website has been established and the initial meeting
held. The attendees were surveyed and their response was positive
indicating the information and resources provided to them were useful
and relevant.

On October 19, 2006 staff again surveyed the utilities to judge their
progress. The return rate of the survey was low and not satisfactory.
Further communication and follow up with the utilities is warranted.

# 

# 

# 

# INTRODUCTION/BACKGROUND:

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

The water, wastewater and power utilities serving Volusia County are
required to develop emergency response plans. Over time, the number of
possible emergency situations has increased. Emergency response plans
were originally written for acts of nature such as flooding, fire, and
hurricanes. The list has grown to include not only simple acts of
vandalism, but terrorist acts such as the use of chemical, biological or
radioactive weapons. When emergencies do not occur, less time, thought,
and resources are put into emergency response planning and exercises.
Emergency response plans need to be reviewed regularly to see if they
address the latest possible threat. An "all disaster" response plan
needs to be developed, maintained and implemented.

Currently the utilities are not knowledgeable about the possibility and
implications of pandemic influenza. They have not been educated and have
not developed emergency response plans that address this issue. Their
lack of knowledge and planning will have a negative effect on public
health and safety in the event of a flu pandemic. This needs to be
addressed now. In the long term all new emerging threats need to be
considered and planned for in a timely manner.

Figure 1: Behavior Over Time Figure 2: Causal Loop Diagram ^1^
![](media/image2.wmf)

####### ***10 Essential Environmental Health Services:^2^***

This project seeks to enhance or fulfill the following essential
environmental health services:

**Essential Environmental Health Service 3** Inform, educate, and
empower people about environmental health issues. This will be
accomplished by meeting with the utilities to educate them about
pandemic influenza

.

**Essential Environmental Health Service 4** Mobilize community
partnerships to identify and solve environmental health problems. This
will be accomplished by encouraging the utilities to work with each
other and the Health Department to develop their plans and provide
mutual support in the advent of pandemic influenza.

**Essential Environmental Health Service 5** Develop policies and plans
that support individual and community environmental health efforts. This
will be accomplished by encouraging the utilities to develop emergency
response plans that address pandemic influenza.

**Essential Environmental Health Service 7** Link people to needed
environmental health services and assure the provision of environmental
health services when otherwise unavailable. This will be accomplished by
establishing working relationships with the utilities whereby they know
our technical expertise and services are available to them.

**Essential Environmental Health Service 8** Assure a competent
environmental health workforce. This will be accomplished by educating
staff about pandemic influenza.

![](media/image3.png){width="3.75in" height="3.8125in"}

Figure 3: Source - Public Health Functions Steering Committee (July
1995)

####### 

####### 

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

This project seeks to support the following CDC Health Protection
Goals:^3^

**Healthy People in Every Stage of Life**

All people, and especially those at greater risk of health disparities,
will achieve their optimal lifespan with the best quality of life in
every stag of life.

**Healthy People in Healthy Places**

The places people live, work, learn, and play will protect and promote
their health and safety, especially those at greater risk of health
disparities.

**People Prepared for Emerging Health Threats**

People in all communities will be protected from infectious,
occupational, environmental, and terrorist threats.

**Healthy People in a Healthy World**

People around the world will live safer, healthier and longer lives
through health promotion, health protection, and health diplomacy.

This project seeks to support the following goals and objectives of the
CDC National Strategy to Revitalize Environmental Public Health
Services:^4^

**Goal I: Build Capacity**

Objective I-A: Expand the nation\'s capacity to anticipate, recognize,
and respond to environmental public health threats and to improve access
to technology.

> Activity I-A-3: Provide guidance, training, consultation, and
> technical assistance to state, tribal, territorial, and local
> agencies.

Objective I-B: Support, evaluate, and disseminate the results of new
demonstration programs, best practices, and CDC-supported projects
designed to improve livability and to prevent and control
environmentally related illness.

> Activity I-B-3: Promote institutional and strategic changes to foster
> ongoing coordinated efforts with strategic partners (e.g., Department
> of Housing and Urban Development, EPA, state and local health
> departments) and other stakeholders to implement and evaluate
> environmental interventions to improve health and well-being for urban
> and rural residents.

**Goal II: Support Research**

Objective II-D: Implement environmental public health service
demonstrations and evaluations in the built and natural environments
that lead to healthier communities.

> Activity II-D-2: Evaluate best practices and gaps related to laws,
> ordinances, and regulations that affect environmental public health
> service delivery and practice.

Objective IV-A: Identify and promote community-based strategies to
elevate the image, importance, and need to improve environmental public
health services.

> Activity IV-A-1: Sponsor, support, and participate in national,
> regional, state, and local conferences and meetings pertaining to
> environmental public health services.

**Goal IV: Communicate and Market**

Objective IV-B: Support educational approaches and models of best
practices to gain community support and participation in addressing
environmental public health service issues, concerns, and best models to
organize, deliver, and market environmental public health services.

> Activity IV-B-1: Support activities and projects that demonstrate
> effective methods for interacting with environmental public health
> stakeholders.
>
> Activity IV-B-2: Recommend and disseminate the best environmental
> public health service models to engage and empower local communities.
>
> Activity IV-B-3: Support activities that demonstrate effective methods
> for marketing environmental public health services to policy makers
> and the public.

**Goal VI: Create Strategic Partners**

Objective VI: Coordinate and promote activities that identify critical
stakeholders, and foster communication and interaction among agencies,
organizations, and interests that influence environmental public health
services.

> Activity VI-AI-1: Identify stakeholders who influence all components
> of the environment (built and natural) that have an impact on
> environmental public health services.
>
> Activity VI-AI-2: Support activities (e.g., conferences, meetings,
> seminars, etc.) that influence stakeholders to work together to
> improve environmental public health.
>
> Activity VI-AI-3: Develop mechanisms for regular communication and
> coordination among stakeholders.

####### 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal:*** To ensure local municipal water, wastewater and electric utilities develop an emergency response plan that addresses Pandemic Influenza.

####### ***Health Problem:*** Lack of planning by local utilities for an influenza pandemic could lead to disruptions or loss of operational capabilities in the event of an outbreak. Disruptions or loss of utility service will lead to unsanitary and unhealthful conditions in our community. Public health will be at risk.

####### ***Outcome Objective:*** By April 15, 2007, 90% of local municipal water, wastewater and electric utilities will have developed emergency response plans addressing pandemic influenza.

####### ***Determinant:*** The determinant of the effectiveness of this project is the number of local municipal water, wastewater and electric utilities that have developed emergency response plans that address pandemic influenza.

####### ***Impact Objective:*** Local utilities will be educated about the possibility of pandemic influenza. They will be informed about the necessity to plan and prepare for this eventuality. They will be provided information and resources to enable them to prepare emergency response plans for pandemic influenza.

####### ***Contributing Factors:*** Utilities lack of awareness of the possibility of pandemic influenza.

Lack of knowledge of the possible impacts of pandemic influenza on
utility operations.

Lack of knowledge of appropriate response.

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

By April 7, 2006, Volusia County Environmental Health staff will become
educated about pandemic influenza.

By April 7, 2006, Volusia County Environmental Health staff will develop
a presentation and resource materials for the local utilities.

By April 14, 2006, Volusia County Environmental Health staff will
establish a web-site concerning pandemic influenza issues.

By April 15, 2006, Volusia County Environmental Health will meet with
local utilities to educate them about pandemic influenza and encourage
them to develop emergency response plans to address this threat.

By October 15, 2006, Volusia County Environmental Health staff will
survey utilities to judge their progress and determine the need for
additional meetings. Hold additional meetings as may be necessary.

By April 15, 2007, survey utilities to determine if they have completed
their Emergency Response Plans.

# METHODOLOGY:

***Events and Activities:***

-   Research pandemic influenza

-   Educate Volusia County Environmental Health staff.

-   Develop objectives.

-   Develop handouts.

-   Design and populate website.

-   Confirm utility contact information.

-   Schedule meeting place.

-   Announce meeting to the utilities.

-   Conduct meeting.

-   Inform utilities about pandemic influenza.

-   Present resource materials.

-   Encourage utilities to develop and maintain all disaster emergency
    response plans to include pandemic influenza.

-   Survey utilities to determine their progress and need for follow up
    meeting.

-   Schedule follow up meetings as may be necessary.

# RESULTS:

Volusia County Environmental Health staff met all of the process
objectives leading up to the public water, wastewater and power
utilities meeting according to the proposed time frames. Staff hosted
the meeting on Thursday April 13, 2006.

Staff presented the attendees with valuable information concerning the
H5N1 virus and it's potentially devastating effects. Also discussed was
the Volusia County Environmental Health Pandemic Influenza website
([www.volusiahealth.com/eh/panflu/](http://www.volusiahealth.com/eh/panflu/))
which contains influenza information valuable to the utilities and
general public. The website is updated regularly as new information and
resources become available. The utilities were encouraged to develop and
maintain all disaster emergency response plans that include pandemic
influenza. The utilities were given a "Public Utility Pandemic Influenza
Planning Checklist" to help them with their planning efforts.

The conference served to provide a forum for the utilities to learn more
about the virus, to encourage them to begin their planning for such a
pandemic event and to facilitate networking opportunities for their
mutual support.

Forty four persons representing twenty-five utilities as well as nine
Environmental Health staff members were in attendance. At the end of the
conference the attendees were given an evaluation form intended to
determine the effectiveness of the presentations. Twenty three (23)
forms were returned with twenty (20) giving the conference an overall
rating of "Excellent" (87 %) and three (3) responses giving a rating of
"Average" (13 %). The responses indicated that the information and
resources were presented in a quality manner and that the conference had
been useful and relevant to the utilities' interests.

On October 19, 2006 the utilities were surveyed in an effort to
determine what progress they had made with their pandemic influenza
planning. Thirty nine (39) surveys were sent by e-mail. Tracking
indicated that all e-mails were received and opened. Only three (3)
surveys were returned (8 %). The three (3) surveys represented mixed
results. One water/wastewater and electric utility responded that their
planning was complete and attached a copy of their plan. In the second
response a water/wastewater utility reported that they had made
significant progress and their plan was nearly complete. The third
respondent, a water/wastewater utility, reported they had not begun the
planning process yet.

# CONCLUSIONS:

Based on the survey response it is evident that further communication
and follow up with the utilities is warranted. Perhaps the utilities
were hesitant to return a survey that would indicate they had not made
significant progress in developing their plan. At this point we plan to
assign our Environmental Specialists to have face to face meetings with
the utilities. Through these meetings we hope to gain a better
understanding of the utilities' needs and how we may be of further
assistance to them in their planning efforts.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Ron Freeman***

Attending the Environmental Public Health Leadership Institute has been
a very rewarding experience. It has allowed me to embark on a guided
process of self-assessment, self- improvement and leadership
development. The use of the Skillscope, Myers-Briggs Type Indicator and
Change Style Indicator assessment tools gave me greater insight as to
why I think, make decisions and act as I do. This has helped me to
better understand my strengths, my weaknesses and encouraged me to make
a habit of on going self-assessment and development. The use of the
assessment tools also gave me a better understanding of others and an
increased appreciation of diversity of thought and personality types.
This will be of great benefit as I interact and work with others towards
improvements in environmental public health.

EPHLI introduced me to the concept of Systems Thinking and showed me how
to use it to understand the complexity of problems and develope better
long term solutions. Other topics of discussion such as ethical issues
in public health, the ten essential environmental health services,
leadership and organizational learning, and collaborative leadership
were extremely interesting and enlightening. The EPHLI staff was
phenomenal and the speakers were of the highest rank.

The curriculum fueled my passion for environmental health. I feel very
fortunate to be an environmental health professional and to be able to
serve my community in that capacity. There are many leadership training
venues available, but I am not aware of any that speak so directly and
eloquently to the needs of the environmental public health professional.

# ABOUT THE EPHLI FELLOW

Ron Freeman earned a Bachelor of Science degree in Petroleum Engineering
from the University of Tulsa, a Masters in Public Administration from
the University of Central Florida and is a Registered Professional
Engineer.

Mr. Freeman moved to Florida and began working for Volusia County
Environmental Management in 1989. He started there as an Environmental
Specialist inspecting wastewater treatment plants and bio-residual land
application areas. In 1991 he became the manager of the Volusia County
Petroleum Cleanup Program. He worked in that capacity until 2001 when he
joined the Volusia County Health Department. He now serves as the
Professional Engineer Administrator in the Health Department's
Environmental Health Engineering Section. His responsibilities include
administration of the Public Drinking Water Program, the Limited Use
Public Drinking Water Program, the Public Swimming Pool Construction
Program, the Well Construction Program, the Well Surveillance Program
and the Water Wise Irrigation System Program

Mr. Freeman is very active in professional associations, including the
National Environmental Health Association, the Florida Environmental
Health Association, American Water Works Association and the National
Conference of Local Environmental Health Administrators. Over the years
he has held several board positions in FEHA on both the state and
district levels, and is currently on the Board of Trustees of NCLEHA.

# REFERENCES

1.  Senge P, Kleiner A, Roberts C, Ross R, Smith B, The Fifth Discipline
    Fieldbook. *Doubleday*. 2004; 135-140.

2.  Osaki C, Essential Services of Environmental Health. *Northwest
    Center for Public Health Practice, University of Washington School
    of Public Health and Community Medicine*. 2004.

3.  Centers for Disease Control and Prevention, Health Protection Goals
    Fact Sheet. U.S. *Department of Health and Human Services*. 2006

4.  Centers for Disease Control and Prevention. A National Strategy to
    Revitalize Environmental Public Health Services. *U.S. Department of
    Health and Human Services*. 2003; 6-8.

.