# **[2006 Summer Session Syllabus]{.underline}**

### Graduate School of Public Health

**[Introduction to Public Health Emergency Preparedness]{.underline}**

**[BCHS 2579 (two credits)]{.underline}**

**[Wednesdays, 4:00-5:30pm, Room A115 Crabtree]{.underline}**

**[Faculty:]{.underline}**

Dave Piposzar, MPH

Adjunct Assistant Professor

Department of Environmental and Occupational Health

<dpiposzar@msn.com>

Gail S. Cairns, MA, MPH

Assistant Professor of Public Health Practice

Department of Behavioral and Community Health Sciences

\(412\) 383-2400

<cairnsg@edc.pitt.edu>

#### Course Description

Health departments and other public health service providers must be
integrated into community emergency management in order to provide
coordinated community response to all types of disasters. This course
will address planning for the public health response to natural
(hurricanes, earthquakes) and technological (transportation crashes,
chemical spills) disasters and terrorist attacks. The course will cover
both theory and practice of emergency management, the incident command
system, the role of state and federal agencies, the role of public
health in local planning and response, mental health response, emergency
surveillance and information systems, training and evaluation.

#### Learning Objectives 

After taking this course, students will be able to:

> 1\) Identify public health responsibilities during and after
> emergencies and outline strategies for response;

2)  Describe how emergency response services are coordinated among
    responding agencies;

3)  Analyze and critique response plans of local jurisdictions;

4)  Identify roles of different public health professionals and
    specialists in emergency response;

5)  Discuss strategies for limiting the psychosocial impact of disaster;

6)  Describe different approaches to design and evaluation of public
    health responses to disaster.

#### Requirements 

a.  Access to internet for research and preparation for classes.

b.  Purchase of *Public Health Management of Disasters: The Pocket
    Guide* by Linda Young Landesman, DrPH, MSW, American Public Health
    Association, 2006, available at the Health Bookstore.

c.  Discussion questions to be submitted before indicated classes.

d.  Two short papers and a final exercise.

e.  Attendance and participation in class.

#### Grading 

A, B, C, D, F, I

Grades will be based on:

15% Class attendance and participation

15% Submission of discussion questions

30% Short papers (2 at 15% each)

40% Final Exercise

Discussion questions: Students are required to submit two discussion
questions based on the readings before classes as indicated in the
calendar on the next page. Questions must be received by 5pm on the
Tuesday before the class.

Papers:

[Two short papers of 6-8 pages each will be required.]{.underline}
Students will be asked to select a journal article, website report or
book excerpt (excluding items in the assigned reading) about an actual
emergency response by public health workers, relate it to one of the
strategy areas, and describe and critique it in their paper. For
example, in North Carolina after severe flooding, public health nurses
provided vital information services to the public; in New York City, the
Department of Health set up injury surveillance of rescue and recovery
workers following the attacks of September 11.

[A final tabletop exercise during the last two class session is
required]{.underline}. Faculty will provide a disaster scenario and
students will be asked to develop a public health response plan.

**Academic Integrity**

The Provost Office maintains a website that provides details on the Code
for Academic Integrity; please see
<http://www.pitt.edu/~provost/ai1.html>. This code includes obligations
for faculty and students, procedures for violations and other critical
information. Please take time to read the code.

**Disability**

If you have a disability for which you are or may be requesting an
accommodation, please contact one of us as soon as possible.
Additionally, you should contact the Office of Disability Resources and
Services, 216 Pitt Union, (412) 648-7890 or (412) 383-7355 (TTY) as
early as possible in the semester. DRS will verify your disability and
assist with determining reasonable accommodations for this course.

Calendar for Summer Session 2006, Wednesdays, 4:00 to 5:30 pm

May 17 Class 1: Public Health Responsibilities in Emergencies

*Submit two questions for discussion on May 31 based on the readings for
this week and next week; submit by May 30.*

May 24 Class 2: Trip to Allegheny County Emergency Operations Center

*Submit two questions based on the readings for next week by May 30.*

May 31 Class 3: Overview of Public Health and Emergency Management

Agencies

June 7 Class 4: Legal Authority and Law Enforcement

*Submit two questions based on readings for next week by June 13.*

June 14 Class 5: Strategies for Public Health Response: Information
Systems

(First paper due)

*Submit two questions based on reading for next week by June 20.*

June 21 Class 6: Strategy: Communications

*Submit two questions based on reading for next week by June 27.*

June 28 Class 7: Strategy: Control of Infectious Diseases

*Submit two questions based on reading for next week by July 3.*

July 5 Class 8: Strategy: Environmental Response

*Submit two questions based on reading for next week by July 11.*

July 12 Class 9: Strategy: Mental Health Services

(Second paper due)

July 19 Class 10: Strategy: Drills and Exercises

July 26 Class 11: Final Exercise

August 2 Class 12: Review of final exercise

**[Week 1. Public Health Responsibilities in Emergencies]{.underline}**

At the end of this session, students will be able to:

-   Outline basic areas of public health responsibility in emergencies

-   Relate public health responsibilities to the 10 essential services

Required Reading:

[Pocket Guide]{.underline}, pp. 7-11, 17-19, 21, 27

Policy Perspectives, Coping with Calamity: How Well Does Health Care
Disaster Planning Work? *Journal of the American Medical Association,*
272(23); 21 December 1994, 1875-1879.

Carr SJ, Leahy SM, London S, The Public Health Response to Los Angeles'
1994 Earthquake, *American Journal of Public Health*, 86(4), Apr 1996,
589-590.

"Notice to Readers: New York City Department of Health Response to
Terrorist Attack, September 11, 2001", *Morbidity and Mortality Weekly
Report*, 50(38), September 28, 2001, 821-822.

Peters MS, Hospitals Respond to Water Loss During the Midwest Floods of
1993: Preparedness and Innovation, *Journal of Emergency Medicine,*
14(3) 1996, 345-350.

VanRooyen, M, Leaning, J, After the Tsunami---Facing the Public Health
Challenges, *New England Journal of Medicine,* 352(5):435-438, February
3, 2005.

Nieburg P, Waldman RJ, Krumm DM, Evacuated Populations---Lessons from
Foreign Refugee Crises, *New England Journal of Medicine*, 353(15),
October 13, 2005, 1547-1548.

# **[Week 2. Visit to Allegheny County Emergency Operations Center]{.underline}**

At the end of this visit, students will be able to:

-   Discuss the role of the EOC in emergencies

-   Describe how the EOC coordinates responding agencies

**[Week 3. Overview of Public Health and Emergency Management
Agencies]{.underline}**

A.  Structure of state and local public health agencies

B.  Structure of state and local emergency management agencies

C.  Incident Command System

At the end of this session, students will be able to:

-   Describe local public health and emergency management agencies'

-   Discuss how federal resources are accessed

-   Articulate the basic principles of ICS and apply them to public
    health agencies

"Introduction to the Incident Command System", Unit 1, Incident Command
System Basic Course (IS 100), Federal Emergency Management Agency
(FEMA), Emergency Management Institute (EMI). Located at
<http://www.training.fema.gov/EMIWeb/IS/crslist.asp>.

(Handout) Christen, HT, Maniscalco, PM, *Mass Casualty and High-Impact
Incidents: An Operations Guide,* Prentice Hall,2002, Chapter 10,
Response Agency Management Systems.

*(Handout) SW PA Emergency Response Group Region 13 Metropolitan Medical
Response* *System Basic Plan*, January 17, 2002, pp. 1-37.

[www.pa-region13.org](http://www.pa-region13.org/)

Lurie N, et al, Local Variation in Public Health Preparedness: Lessons
from California, *Health Affairs,* June 2, 2004. Available
at[http://search.epnet.com/login.aspx?direct=true&db=aph&an=15592370](http://search.epnet.com/login/aspx?direct=true&db=aph&an=15592370)

Link to full text at bottom of abstract.

## **Week 4. Legal Authority and Law Enforcement**

Required readings for week 4:

(Handout) New York City Agreement between NYC Department of Health and
Mental Health, NY Police Department and the Federal Bureau of
Investigation, November 26, 2004.

Gostin, Lawrence O., Pandemic Influenza: Public Health Preparedness for
the Next Global Health Emergency, *International and Comparative Health
Law and Ethics: A 25-Year Retrospective,* Winter 2004. Available at
<http://search.epnet.com/login.aspx?direct=true&db=aph&an=17721278>.
Link to full text at bottom of abstract.

**Website** [www.publichealthlaw.net](http://www.publichealthlaw.net/)
Look at the Model State Emergency Health Powers Act.

**[Week 5. Strategies for Public Health Response: Information
Systems]{.underline}**

A.  Disaster epidemiology

B.  Rapid health assessments

At the end of this session, students will be able to:

-   Discuss the need for health information in emergencies

-   Describe appropriate collection methods

-   Articulate how different types of information may be used to improve
    response

Required Readings:

[Pocket Guide]{.underline}, 9, 85-88.

Mallonnee, S, et al, Physical Injuries and Fatalities Resulting from the
Okalahoma City Bombing, *Journal of the American Medical Association,*
276(5, Aug 7 19996, 382-387.

Semenza JC, et al, Heat-Related Deaths during the July 1995 Heat Wave in
Chicago, *New England Journal of Medicine* 335(2), July 11, 1996, 84-90.

O'Carroll PW, et al, The Rapid Implementation of a Statewide Emergency
Health Information System during the 1993 Iowa Flood. *American Journal
of Public Health,* 85(4), April 1995, 564-567.

Community Needs Assessment of Lower Manhattan Residents Following the
World Trade Center Attacks---Manhattan, New York City, 2002, *Morbidity
and Mortality Weekly Report,* 51, Special Issue, September 11, 2002,
10-12.

Assessment of Health-Related Needs After Tsunami and Earthquake---Three
Districts, Aceh Province, Indonesia, July-August 2005. *MMWR 55(4),
February 3, 2006.*

World Health Organization, Inter-agency rapid health assessment, End of
mission report, from the offshore platform---USS Abraham Lincoln, West
Aceh, Indonesia, 13-19 January 2005. Accessed at
<http://www.who.int/hac/crises/international/asia_tsunami/final_report/en/print.html>

. MMWR , Assessment of Health-Related Needs After Hurricanes Katrina and
Rita\-\--Orleans and Jefferson Parishes, New Orleans Area, Louisiana,
October 17-22, 2005, 55(2), January 20, 2006

MMWR, Rapid Needs Assessment of Two Rural Communities After Hurricane
Wilma---Hendry County, Florida, November 1-2, 2005, 55(15), April 21,
2006.

(Handout) Dewan, Sheila, "Storm Evacuees Found to Suffer Health
Setbacks," *New York Times,* April 18, 2006, page 1.

**[Week 6. Strategy: Communication]{.underline}**

At the end of this session students will be able to:

-   Outline the elements of a communications plan

-   Discuss the CDC's basic principles of risk communication

-   List the most common questions that need to be answered

Sly T, The Perception and Communication of Risk: A Guide for the Local
Health Agency, *Canadian Journal of Public Health,* Vol. 91, No. 2,
March-April 2000, 153-155.

Covello VT et al, Risk Communication, the West Nile Virus Epidemic, and
Bioterrorism: Responding to the Communication Challenges Posed by the
Intentional or Unintentional Release of a Pathogen in an Urban Setting,
*Journal of Urban Health,* Vol. 78, No. 2, June 2001, 382-391.

Kellerman AL, Todd KH, Killing Heat, *NEJM,* 335(2), July 11, 1996.

Washington Post/Kaiser Family Foundation/Harvard University, Survey of
Hurricane Katrina Evacuees, September 2005. Publication #7401 on
[www.kff.org](http://www.kff.org/).

(Handout) CDC Risk Communication pocket card

(Handout) Covello VT, Risk and Crisis Communication: 77 Questions
Commonly Asked by Journalists during a Crisis, 2002.

[www.psandman.com](http://www.psandman.com/)

[www.centerforriskcommunication.com](http://www.centerforriskcommunication.com/)

**[Week 7. Strategy: Control of Infectious Diseases]{.underline}**

At the end of this session, students will be able to:

-   Describe requirements for POD services

-   Discuss different methods of surveillance and their uses

Required Readings:

[Pocket Guide]{.underline} 53, 58, 70

Surveillance for Early Detection of Disease Outbreaks at an Outdoor Mass
Gathering---Virginia, 2005. MMWR, 55(3), January 27, 2006.

Marx MA, et al, Diarrheal Illness Detected Through Syndromic
Surveillance After a Massive Power Outage: New York City, August 2003,
*American Journal of Public Health,* 96:3, March 2006, 547-553.

MMWR, Monitoring Poison Control Center Data to Detect Health Hazards
During Hurricane Season---Florida, 2003-2005, 55(15), April 21, 2006.

Bell DM, Public Health Interventions and SARS Spread, 2003, *Emerging
Infectious Diseases,* 10(11), 2004.

Blank S, Moskin LC, Zucker JR, An Ounce of Prevention is a Ton of Work:
Mass Antibiotic Prophylaxis for Anthrax, New York City, 2001, *Emerging
Infectious Diseases, 9(6)* June 2003.

Agency for Healthcare Research and Quality, Community-Based Mass
Prophylaxis: A Planning Guide for Public Health Preparedness, available
at <http://www.ahrq.gov/downloads/pub/biotertools/cbmprophyl.pdf>

See Section 1, pp. 1-12.

**[Week 8. Strategy: Environmental Response]{.underline}**

At the end of this session, students will be able to

-   Identify key federal, state and local agencies responsible for
    environmental and occupational health

-   Identify roles and responsibilities of environmental health
    professionals in carrying out Emergency Support functions #1-15
    within the National Response Plan and National Incident Management
    System.

-   Identify the anticipated effects of disasters on environmental
    health facilities and services

-   Identify environmental factors and current issues relating to avian
    influenza

Injuries and Illnesses Among New York City Fire Department Rescue
Workers After Responding to the World Trade Center Attacks (1-4);
Respiratory Illnesses During the 11 Months after the Attacks (4-5);
Stress-related Illnesses During the 11 Months after the Attacks (5); Use
of Respiratory Protection Among Responders at the World Trade Center
Site---New York City, September 2001 (6-8); *Morbidity and Mortality
Weekly Report,* 51(Special Issue), September 11, 2002.

**Websites:**

WHO Publication: Environmental Health in Emergencies and Disasters: A
Practical Guide, Chapter 2 and [one other self-selected
chapter]{.underline} for class discussion.

<http://www.who.int/water_sanitation_health/emergencies/emergencies2002/en/index.htm>

and click on Publications.

WHO Report: "Review of Latest Available evidence on Risks to Human
Health through Potential Transmission of Avian Influenza (H5N1) through
Water and Sewage," 3/24/06.

[http://www.who.int/water_sanitation_health](http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf)
and click on Publications.

Resources:

<http://www.apha.org/public_health/environmental.htm>

<http://who.int/hac/techquidance/pht/envhealth/en/index.html>

**[Week 9. Strategy: Mental Health Services]{.underline}**

At the end of this session students will be able to:

-   Describe how mental health support services in emergencies differ
    from traditional mental health services

-   Discuss common reaction of individuals to emergencies'

-   Suggest strategies to improve mental health and public health
    collaborations in emergencies

Required Reading:

[Pocket Guide]{.underline}, 65

North, CS, et al, Psychiatric Disorders Among Survivors of the Oklahoma
City Bombing, *Journal of the American Medical Association,* 282(8); Aug
25, 1999, pp755-762.

Pfefferbaum B, Call JA, Sconzo GM, Mental Health Services for Children
in the First Two Years after the 1995 Oklahoma City Terrorist Bombing,
*Psychiatric Services,* 50(7), July 1999, 956-958.

Vlahov, D, et al, Increased Use of Cigarettes, Alcohol, and Marijuana
among Manhattan, New York Residents after the September 11^th^ terrorist
Attacks, *American Journal of Epidemiology,*155(11), June 1, 2002, pp
988-996.

**[Week 10. Strategy: Drills and Exercises]{.underline}**

At the end of this session students will be able to:

-   Describe different types of exercises

-   Discuss methods of evaluation exercises

Fitzgerald DJ et al, Chemical Weapon Functional Exercise---Cincinnati:
Observations and Lessons Learned from a Typical Medium-sized City's
Response to Simulated Terrorism Utilizing Weapons of Mass Destruction,
*Public Health Reports,* Vol. 118, May-June 2003, 205-214.

Hoffman RE, Norton JE, Lessons Learned from a Full-Scale Bioterrorism
Exercise, *Emerging Infectious Diseases,* 6(6), Nov-Dec 2000.

Inglesby TV et al, A Plague on Your City: Observations from TOPOFF,
*Clinical Infectious Diseases,* Vol. 32, 1 February 2001, 436-445.

IS-139, Exercise Design, see Chapters 4, Exercise Design Steps, and
Chapter 8, Exercise Evaluation, at
<http://www.training.fema.gov/emiweb/IS/crslist.asp>.

(Handout) PEMA, Emergency Management Guidance & Information Circular No.
C2003-1, Weather Emergency Preparedness Exercise, January 2, 2003.

## 

**Week 11. Final Exercise**

**Week 12. Review of final exercise**