# Defining the Emergency Response Roles of Environmental Health Specialists in Northwest Ohio

# 2006 - 2007 

# Environmental Public Health Leadership Institute Fellows:

# Aaron Otis, M.P.H., R.S.

*Northwest Ohio Region Public Health Coordinator*

*Toledo-Lucas County Health Department*

*635 N. Erie St.*

*Toledo, OH 43604*

*(419) 213-4075*

*otisa@co.lucas.oh.us*

# Niki Lemin, M.S., R.S.

## Program Manager 

## Center for Public Health Preparedness 

## Office of Workforce Development

## School of Public Health

## The Ohio State University 

*1212 Kinnear Rd.*

*Columbus, OH 43212*

*(614) 292-2047*

*nlemin@sph.osu.edu*

# Mentor:

### **CAPT Mark D. Miller, R.S., M.P.H.**

*U.S. Public Health Service*

*Senior Environmental Health Officer*

*Environmental Health Services Branch*

*National Center for Environmental Health*

*Centers for Disease Control and Prevention*

*4770 Buford Highway, NE (F28)*

*Atlanta, GA 30341-3724*

# Acknowledgements:

### Aaron would like to acknowledge the following people: 

### **Eric Zgodzinski, MPH, RS**

*Community Services Supervisor;* Toledo-Lucas County Health Department

### **Barbara Gunning, PhD, BSN**

*Director of Health Services;* Toledo-Lucas County Health Department

### **Larry Vasko, MPH, RS**

*Deputy Health Commissioner;* Toledo-Lucas County Health Department

### **David Grossman, MD**

*Health Commissioner;* Toledo-Lucas County Health Department

Niki would like to acknowledge the following people:

### **David L. Rosebrock, MPH**

*Health Commissioner;* Allen County Health Department

### **Bill Kelly, BS, RS**

*Environmental Health Director;* Allen County Health Department

### **Frank Holtzhauer, PhD**

*Director;* Office of Workforce Development, The Ohio State University

### **Joanne Pearsol, MA, CHES**

*Assistant Director;* Office of Workforce Development, The Ohio State
University

### **Sharon A. R. Stanley, PhD, RN, RS**

*Program Director;* Office of Workforce Development, The Ohio State
University

Thank you for allowing us the opportunity to participate in the
Environmental Public Health Leadership Institute, and for your continued
commitment to our leadership development. Thanks to our mentor, Mark
Miller, for your input, direction, and passion for environmental health,
and to Dr. Laura Green, for your assistance with our survey tool. Thanks
also to Amy, Rob, Nathan, Kyla and Kyle, whose support did not falter as
we traveled the country this past year "chasing the wind".

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

# EXECUTIVE SUMMARY:

Involvement of environmental health specialists (EHS) during emergency
response is low in Northwest Ohio. This lack of involvement during
emergency response has led to non-public health agencies making public
health decisions. Over time, this has resulted in a perceived lack of
need for environmental health involvement during emergencies. Initial
findings through a scoping survey found that role clarity and training
were major contributors to the problem of low environmental health
involvement.

In 2005, the Ohio Center for Public Health Preparedness conducted a
public health local preparedness training needs survey. Environmental
health specialists in Northwest Ohio rated "Describe your functional
role(s) in emergency response and demonstrate your role(s) in regular
drills" as their number one training need (*1*). However, before
training can be developed, the roles for EHS must be clarified.

To clarify and define the role, we developed a self-administered survey
that was given externally to partners such as emergency management
directors and 20 randomly chosen fire departments in Northwest Ohio, as
well as internally to EHS and health commissioners. Expectations were
that respondents would:

-   identify food, water, waste and vector control as EHS emergency
    response functions;

-   [not]{.underline} identify hazardous materials, building
    assessments, and outbreak investigations as EHS emergency response
    functions;

-   identify the level of EHS involvement as "slightly involved"; and,

-   agree that EHS should be involved in emergency response.

In addition, we expected the results of this survey to provide a
well-rounded, all-hazards definition of the EHS role during emergency
response, and to help guide the development of policies and procedures,
and focus training on emergency response roles.

# INTRODUCTION/BACKGROUND:

"Environmental health practitioners have the task of protecting the
public's health from harmful elements in the environment" (*2*).
However, unlike other staff in public health agencies, there has been
difficulty identifying emergency response roles for environmental health
personnel (*3,4*). "There is still uncertainty about where environmental
health professionals specifically fit in" (*4*). According to Rebecca
Berg, for environmental health specialists "the duties seem to break
down into three categories: sampling, processing samples, and providing
information to first responders; shelter management; and limiting
exposure and injury" (*5*).

However, because of funding issues and a lack of resources, over the
past 30 years public health and environmental health have decreased
their "ability across the board to do anything" (*5*). They have been
pushed into a situation of "do more with less" and emergency response
took the back seat to other programs. According to Francesca Lyman, "the
September 11 terrorist attacks shed dramatic light for the first time on
the pivotal role of environmental health in terrorism response" (*6*).

There is a desire among environmental health specialists to be involved,
but there is some reluctance as well. This reluctance stems from
frustration, a lack of resources, as well as a lack of self-confidence.
Environmental health has become an "invisible profession", in part due
to an inability to communicate effectively the environmental health
specialists' role in achieving a "clean environment" (*5,7*). As a
result, the workforce no longer has a clear understanding of their
roles, outside of what has been defined as normal duties or daily
operations.

This trend has been no different in Northwest Ohio. Until recently,
environmental health specialists have been content to conduct their
"normal" activities. Recently, the impact of tornadoes, floods, ice
storms, hazardous material spills, and power outages have demonstrated
that, in fact, environmental health hazards are present during these
incidents. "Environmental health is grounded in food, water, shelter,
air quality, and sewage disposal issues. Those issues almost inevitably
come into play when normal life is disrupted, whether through a natural
disaster or through a terrorist attack" (*5*).

According to Captain Mark Miller, Senior Environmental Health Officer
with CDC, "experienced environmental health practitioners are needed to
lead the environmental health response to emergencies" (*2*). To
accomplish this, environmental health must be at the table with other
local emergency planning committees and first responders, prior to an
incident occurring; they should be a part of the incident command system
structure (*5,8,9*). "We must be engaged in planning and preparedness
efforts to ensure that our roles are well defined and understood by
other emergency responders and the public we serve" (*2*).
"Environmental public health practitioners play an important role in the
protection of public health. Every day we conduct inspections and
provide education to prevent foodborne, waterborne, and airborne
illnesses. Responding to emergencies requires these same skills, coupled
with emergency response protocols and procedures" (*9*).

However, prior to engaging environmental health in emergency
preparedness and response activities, we must first clarify the role of
environmental health specialists in emergencies. By defining the role
the foundation will be laid for the environmental health specialists in
Northwest Ohio to become active partners in emergency response. In time,
environmental health specialists and first responders alike will
understand the critical role and contributions that can be made.

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

Involvement of environmental health specialists during emergency
response is low in Northwest Ohio. A major contributor to this problem
is the lack of a clearly defined role for environmental health
specialists during emergency response.

####### Figure 1. Behavior Over Time Graph

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The graph in Figure 1 illustrates that, over time, as the number of
incidents where non-public health agencies made public health decisions
increased, environmental health involvement decreased. The low
involvement of environmental health specialists during emergencies has
resulted in an overall lack of role clarity. However, recent events have
shifted the overall priority for involvement, which has increased
awareness for environmental health specialists to be involved during
emergencies. Even though awareness exists, environmental health
specialists' involvement has been stagnant due to the lack of role
clarity. As the role is clarified, it should result in the decrease of
non-public health agencies making public health decisions, which should
increase environmental health specialists' involvement.

Figure 2. Current Mental Models

Figure 2 represents some of the current mental models of public health,
specifically EHS and administration. These mental models are reinforced
through a lack of environmental health involvement. This, in turn,
reinforces non-public health agencies making public health decisions
during emergencies, which further fuels the mental models.

####### ![](media/image2.png){width="5.458267716535433in" height="3.9192913385826773in"}Figure 3. Shifting the Burden

Figure 3 depicts the archetype used for the project. The Shifting the
Burden archetype describes the reasons, the problems and the
consequences associated with low environmental health involvement during
emergencies. This model found that environmental health involvement is
historically, and currently, low due to a variety of reasons. Initially,
there is pressure on traditional first responders for a quick response,
which leads to non-public health agencies making public health
decisions; confidence in public health is affected, as well as the
overall priority for involvement. As the involvement of public health
agencies in emergencies decreased -- supported by non-public health
agencies making public health decisions -- a lack of perceived need for
environmental health involvement developed, resulting in confusion of
roles; a decrease in training; and an overall reduction in supporting
policies, procedures, practices, and processes.

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

This project seeks to fulfill the following aspects of the 10 Essential
Services of Environmental Health (*10*):

[Assure Competent Workforce]{.underline} -- Initially, we are seeking to
assure a competent workforce by defining and clarifying the role of
environmental health specialists during emergencies, and providing
training focused on the emergency response role.

[Monitor Health]{.underline} -- Once the role of environmental health
specialist is defined for emergency response, environmental health
specialists should become more involved in assisting to identify the
status of environmental health problems in the community.

[Diagnose & Investigate]{.underline} -- Environmental health divisions
should be able to utilize the defined role to enhance their public
health preparedness programs. Activities could include the expansion of
environmental health surveillance and the addition of an environmental
surety section in the local health department's response plan. In
addition, they should develop investigation and response procedures.

[Inform, Educate, Empower]{.underline} -- As this project progresses,
environmental health divisions should be able to utilize the information
developed to inform, educate and empower the community to prevent,
prepare for, respond to and recovery from environmental health hazards
during emergencies.

[Develop Policies]{.underline} -- In addition to being present at
emergencies, local environmental health divisions should be able to
develop efficient and effective policies, procedures, plans and
processes based on their clarified roles.

[Enforce Laws]{.underline} -- With a defined role, environmental health
specialists should be better able to educate, evaluate, improve,
recommend and enforce applicable laws, regulations, and ordinances.

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

This project seeks to fulfill the following national goals:

CDC Health Protection Goals

Four themes are addressed in the CDC's health protection goals. Our
project addresses one of those goals: People Prepared for Emerging
Health Threats (*11*). By clarifying the role of EHS during emergencies,
we anticipate that environmental health involvement will increase during
emergency preparedness and response activities. This could potentially
increase protection of communities during infectious, occupational,
environmental, and terrorist threats.

CDC Preparedness Goals

Our project seeks to address the following CDC Preparedness Goals
(*12*): Prevent, Detect & Report, Investigate, Control, Recover, and
Improve.

[Prevent]{.underline} -- As stated previously, EHS must be at the local
"planning table" to ensure that it is part of the local ICS. Identifying
EHS for core functional roles in ICS for public health will meet the
measure for this goal.

[Detect and Report]{.underline} -- Increasing the involvement of EHS
will improve information gathering and sharing, recognition of
indicators, and warning, as well as planning; thus meeting the measure
for this goal.

[Investigate]{.underline} -- The measure for this goal will be met
through a decrease in the time to identify causes, risk factors, and
appropriate interventions when conducting epidemiological surveillance
and investigation.

[Control]{.underline} -- EHS involvement will increase the number of
staff available to receive alerts, which will decrease alert
notification and distribution times, and ICS activation times. In
addition, their involvement would improve the following activities:
emergency public information and warning, responder health and safety,
isolation and quarantine, mass prophylaxis, medical surge, mass care,
and citizen evacuation and shelter-in-place.

[Recove]{.underline}r -- Involving EHS will "decrease the time needed to
restore health services and environmental safety to pre-event levels"
(12).

[Improve]{.underline} -- Involving EHS during exercises and emergencies
will improve preparedness and response plans, and will decrease the time
needed to identify deficiencies in plans, organizational structures,
equipment, and personnel.

Healthy People 2010

Chapter 8 and Chapter 10 of the Healthy People 2010 Objectives
specifically address environmental health (*13*). Some environmental
issues are becoming more important than others, including emerging
infectious diseases and bioterrorism; "other environmental issues, such
as drinking water, wastewater, and food safety, continue to be
priorities in environmental health" (*14*). Our project seeks to define
the role of environmental health in all these areas.

National Strategy to Revitalize Environmental Public Health Services

This project also seeks to support Goal V (Develop the Workforce) of the
National Strategy to Revitalize Environmental Public Health Services
(*15*). By clarifying the role of environmental health specialists
during emergency response, we anticipate that workforce development will
occur through appropriate and focused training. There is "a willingness
to contribute among environmental health staff, but uncertainty about
how they should do it" (*5*). In addition, various policies, procedures,
practices, and processes should be developed internally, and with local
partners, to ensure environmental health involvement during emergency
response.

####### *Project Logic Model:* Clarifying and Defining the Emergency Response Role of Environmental Health Specialists 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal*** 

####### Increase the involvement of environmental health specialists in Northwest Ohio during emergencies.

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

####### Northwest Ohio environmental health specialists' involvement in emergency response is low. This has led to non-public health agencies making public health decisions, and, ultimately, ineffective use of environmental health specialists during emergency response.

***Outcome Objective***

Define the emergency response role for environmental health specialists
in Northwest Ohio.

####### ***Determinant*** 

####### Consensus in Northwest Ohio on the environmental health specialists' emergency response role.

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

####### Create awareness of the emergency response role for environmental health specialists.

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

1.  Public health has traditionally been left out of emergency planning
    and response.

2.  Confidence in Public Health.

3.  Overall priority for Public Health involvement.

4.  Perceived need for Environmental Health involvement.

5.  Role clarity.

6.  Training.

7.  Policies, procedures, processes.

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

1.  Gain consensus in Northwest Ohio on the environmental health
    specialists' emergency response role.

# METHODOLOGY:

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

1.  Develop a potential list of emergency response roles for
    environmental health specialists.

2.  Develop a survey tool.

3.  Distribute a self-administered survey in Northwest Ohio.

4.  Utilize the survey results to define the EHS role for Northwest
    Ohio.

# RESULTS:

We expected the results of this survey to provide a well-rounded,
all-hazards definition of the environmental health specialist\'s role
during emergency response. We anticipated respondents to identify the
traditional roles of food safety, potable water, sewage, solid waste and
vector control as primary emergency response roles. Furthermore, we
hypothesized that the respondents would [not]{.underline} identify
hazardous materials, building assessments, outbreak investigations and
shelter inspections as a function of environmental health specialists in
emergencies.

What we found is...

-   80 (44%) of 183 surveys were returned.

Of the 80 respondents,

-   72 (90%) indicated that they believed EHS should be involved in
    emergency response.

-   58 (72.5%) were Registered Sanitarians.

-   46 (57.5%) indicated that, as a whole, EHS was somewhat or
    moderately involved in emergency response.

Of the 43 Environmental Health Specialists that responded,

-   37 (86%) believed that EHS should be involved in emergency response.

-   13 (30 %) indicated that their personal involvement in emergency
    response was moderate.

-   16 (37%) indicated that, as a whole, EHS were somewhat involved in
    emergency response.

Of the 72 (90%) who believed EHS should be involved in emergency
response, the majority (50% or greater) ranked highest to lowest:

> Emergencies that they would expect EHS involvement:

-   disease outbreaks,

-   biological incidents,

-   flooding,

-   hazardous materials,

-   mass casualties,

-   tornadoes,

-   power outages,

-   earthquake,

-   radiological incidents

-   terrorist event (WMD),

-   terrorist threat, and

-   fire.

> Functions EHS should perform:

-   food safety,

-   drinking water,

-   waste water,

-   public education,

-   solid waste,

-   epidemiology,

-   vector control,

-   public information, and

-   health & safety officer.

> Functions that EHS is currently involved in:

-   food safety,

-   public education,

-   drinking water,

-   epidemiology,

-   public information,

-   waste water, and

-   solid waste.

> Roles that EHS should serve:

-   consultative,

-   supportive,

-   technical specialist,

-   regulatory, and

-   collaborative.

Overall reasons for EHS not being more involved:

-   not my job,

-   lack of training,

-   funding,

-   public health is not a first responder, and

-   lack of support/leadership.

Table 1. Survey Tool and Data Summary for Northwest Ohio Region

+-------+------------------------------------+------+------+---------+
| **    |                                    | **   | *    | *       |
| Quest |                                    | Tota | *%** | *Return |
| ion** |                                    | ls** |      | Rate**  |
+=======+====================================+======+======+=========+
| **1** | **How would you describe the level |      |      |         |
|       | of your personal involvement in    |      |      |         |
|       | emergency response within your     |      |      |         |
|       | jurisdiction?**                    |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Not Involved                     | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Slightly Involved                | 12   | 15   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Somewhat Involved                | 14   | 17   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Moderately Involved              | 20   | 25   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Highly Involved                  | 27   | 33   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t Know                      | 2    | 2    |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > No Response                      | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| **2** | **Do you believe that              |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | should be involved in emergency    |      |      |         |
|       | response?**                        |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 72   | 90   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 8    | 10   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| **3** | **During which types of            |      |      |         |
|       | emergencies would you expect       |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | to be involved? Check all that     |      |      |         |
|       | apply.**                           |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Radiological                     | 46   | 57   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Disease Outbreak                 | 78   | 97   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Tornado                          | 57   | 71   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Fire                             | 40   | 50   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Flooding                         | 73   | 91   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Earthquake                       | 50   | 62   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Drought                          | 32   | 40   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Heat Wave                        | 30   | 37   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Cold Wave                        | 28   | 35   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Winter/Ice Storm                 | 37   | 46   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other Severe Weather             | 29   | 36   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Hazardous Materials Incident     | 61   | 76   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Power Outage                     | 59   | 73   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Bomb Threat                      | 12   | 15   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Terrorist Threat                 | 31   | 50   |         |
|       |                                    |      | .82% |         |
+-------+------------------------------------+------+------+---------+
|       | > Explosion                        | 20   | 25   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Terrorist Event - WMD            | 43   | 53   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Mass Casualty                    | 57   | 71   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Civil Disturbance                | 8    | 10   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Biological Incident              | 73   | 91   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Workplace Violence               | 6    | 7    |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 5    | 6    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+

+-------+------------------------------------+------+------+---------+
| **4** | **What should the role of          |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | be during emergency response?**    |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Technical Specialist             | 54   | 67   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Consultative                     | 56   | 70   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Collaborative                    | 46   | 57   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Supportive                       | 57   | 71   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Leadership                       | 25   | 31   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Regulatory                       | 49   | 61   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Liaison                          | 29   | 36   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > None                             | 0    | 0    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 2    | 2    |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > If response was none, please     |      |      |         |
|       | > indicate why:                    |      |      |         |
+-------+------------------------------------+------+------+---------+
| **5** | **How involved are environmental   |      |      |         |
|       | health specialists in emergency    |      |      |         |
|       | response?**                        |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Not Involved                     | 2    | 2    |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Slightly Involved                | 14   | 17   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Somewhat Involved                | 23   | 28   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Moderately Involved              | 23   | 28   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Highly Involved                  | 9    | 11   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t Know                      | 9    | 11   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| **6** | **In your opinion, why are         |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | not more involved in emergency     |      |      |         |
|       | response?**                        |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > No response                      | 20   | 25   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| **7** | **Which of the following functions |      |      |         |
|       | do you believe environmental       |      |      |         |
|       | health specialists should be       |      |      |         |
|       | involved in during emergency       |      |      |         |
|       | response?**                        |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Food Safety                      | 77   | 96   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Drinking Water                   | 75   | 93   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Waste Water                      | 71   | 88   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Solid Waste                      | 68   | 85   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Hazardous Materials              | 33   | 41   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Building Assessment/Re-occupancy | 35   | 43   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Epidemiology                     | 64   | 80   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Public Information               | 56   | 70   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Public Education                 | 72   | 90   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Health and Safety Officer        | 51   | 63   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Vector Control                   | 61   | 76   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > None                             | 0    | 0    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+

+-------+------------------------------------+------+------+---------+
| **8** | **In your jurisdiction, which of   |      |      |         |
|       | the following functions are        |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | currently involved in during       |      |      |         |
|       | emergency response?**              |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Food Safety                      | 68   | 85   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Drinking Water                   | 55   | 68   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Waste Water                      | 46   | 57   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Solid Waste                      | 42   | 52   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Hazardous Materials              | 19   | 23   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Building Assessment/             | 19   | 23   |         |
|       | > Re-occupancy                     |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Epidemiology                     | 48   | 60   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Public Information               | 43   | 53   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Public Education                 | 52   | 65   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Health and Safety Officer        | 21   | 26   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Vector Control                   | 38   | 47   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > None                             | 3    | 3    |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > No response                      | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| **9** | **During emergencies, are          |      |      |         |
|       | environmental health specialists   |      |      |         |
|       | typically involved when food is    |      |      |         |
|       | provided to first responders?**    |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 14   | 17   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 45   | 56   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 21   | 26   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Are environmental health         |      |      |         |
| *10** | specialists involved when food is  |      |      |         |
|       | provided to the public via mass    |      |      |         |
|       | feeding stations?**                |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 28   | 35   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 12   | 15   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 39   | 48   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > No response                      | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Are environmental health         |      |      |         |
| *11** | specialists involved when food is  |      |      |         |
|       | provided to the public at          |      |      |         |
|       | emergency shelters (for example by |      |      |         |
|       | the Red Cross)?**                  |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 24   | 30   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 22   | 27   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 34   | 42   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Besides food safety, are         |      |      |         |
| *12** | environmental health specialists   |      |      |         |
|       | involved when emergency shelters   |      |      |         |
|       | are opened (for example by the Red |      |      |         |
|       | Cross)?**                          |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 27   | 33   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 27   | 33   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 26   | 32   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+

+-------+------------------------------------+------+------+---------+
| *     | **Have environmental health        |      |      |         |
| *13** | specialists held any of the        |      |      |         |
|       | following ICS positions during     |      |      |         |
|       | emergency response?**              |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Safety Officer                   | 13   | 16   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Liaison Officer                  | 9    | 11   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Incident Commander               | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Public Information Officer       | 3    | 3    |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Finance/Administration           | 0    | 0    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Logistics                        | 17   | 21   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Operations                       | 15   | 18   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Planning                         | 13   | 16   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t Know                      | 27   | 33   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > None                             | 17   | 21   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > No Response                      | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Are environmental health         |      |      |         |
| *14** | specialists notified when the      |      |      |         |
|       | emergency operations center is     |      |      |         |
|       | activated?**                       |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 50   | 62   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 11   | 13   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 19   | 23   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Do environmental health          |      |      |         |
| *15** | specialists participate at the     |      |      |         |
|       | emergency operations center once   |      |      |         |
|       | it is activated?**                 |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Yes                              | 38   | 47   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > No                               | 16   | 20   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Don\'t know                      | 25   | 31   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > No response                      | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **What is the population of the    |      |      |         |
| *16** | jurisdiction you serve?**          |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > \<20,000                         | 2    | 2    |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > 20,001--50,000                   | 32   | 40   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > 50,001--75,000                   | 9    | 11   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > 75,001--100,000                  | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > 100,001--125,000                 | 13   | 16   |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > \>125,000                        | 19   | 23   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > No response                      | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   | 100  |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
| *     | **Which of the following describes |      |      |         |
| *17** | your jurisdictional                |      |      |         |
|       | responsibility?**                  |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Township                         | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > City                             | 7    | 8    |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > County                           | 72   | 90   |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Regional                         | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > State                            | 0    | 0    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+

+-------+------------------------------------+------+------+---------+
| *     | **What is the title of your        |      |      |         |
| *18** | position?**                        |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Health Commissioner              | 7    | 8    | 36.84%  |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Emergency Management Director    | 13   | 16   | 72.22%  |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Fire Chief                       | 4    | 5    | 18.18%  |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Environmental Health Director    | 12   | 15   | 63.16%  |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Environmental Health Specialist  | 43   | 53   | 40.95%  |
|       | > (Sanitarian)                     |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > *Total Responses*                | 80   |      | 43.72%  |
+-------+------------------------------------+------+------+---------+
| *     | **What is your discipline?**       |      |      |         |
| *19** |                                    |      |      |         |
+-------+------------------------------------+------+------+---------+
|       | > Registered Sanitarian            | 58   | 72   |         |
|       |                                    |      | .50% |         |
+-------+------------------------------------+------+------+---------+
|       | > Registered Nurse                 | 1    | 1    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Professional Firefighter         | 5    | 6    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > EMT                              | 5    | 6    |         |
|       |                                    |      | .25% |         |
+-------+------------------------------------+------+------+---------+
|       | > Law Enforcement                  | 0    | 0    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+
|       | > Emergency Management             | 15   | 18   |         |
|       |                                    |      | .75% |         |
+-------+------------------------------------+------+------+---------+
|       | > Other (Indicate)                 | 4    | 5    |         |
|       |                                    |      | .00% |         |
+-------+------------------------------------+------+------+---------+

# CONCLUSIONS & NEXT STEPS:

At the start of this project, our initial assumption was that
environmental health specialists did *not* want to be involved in
emergency response. However, what we found was that they *do* want to be
involved in emergency response. What they lack is a clearly defined role
and focused training on their roles. However, simply clarifying the role
for environmental health specialists during emergencies will not fix the
problem.

The solution to the problem is the development a system of training,
policies, procedures, practices, and processes based on a defined role,
followed by the implementation of these concepts. Environmental health
must be at the planning table with other responders, so that they
understand the role of the environmental health specialist. Future steps
are to develop policies and procedures, and to focus training on
emergency response roles. More research is needed on this subject.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Aaron Otis, MPH, RS***

Not until I arrived in Atlanta, did I start to realize the impact that
the leadership institute would have on me. While I am starting to
utilize these new skills, I am sure the true impact of the institute
will not be fully realized for years. In all, the institute has allowed
me to expand my leadership capabilities and connect with others who have
a passion and desire to enhance the field of environmental health.

####### ***Niki Lemin, MS, RS***

The EPHLI has opened many doors for me, and has enabled me to develop
personally and professionally. I have learned a great deal about myself,
as well as others, which has helped me to further develop my leadership
skills, such as conflict management and public speaking. Thank you for
the opportunity and the experience.

# ABOUT THE EPHLI FELLOWS:

**Aaron B. Otis, MPH, RS**

Aaron currently serves as the Regional Public Health Coordinator for
Northwest Ohio. His primary responsibilities include coordinating the
preparedness activities for an eighteen county public health region.
Current projects include the sustainment of a regional pharmaceutical
cache for responders, implementation of a public health incident strike
team, revising the region's public health command and control plan, and
the development of a comprehensive regional medical response plan.

Prior to serving as the regional public health coordinator, Aaron was an
active member of the Toledo-Lucas County Metropolitan Medical Response
System. Activities included the development of various trainings,
exercises, policies and procedures aimed at enhancing the community's
ability to effectively respond to all hazards. Along with the rest of
this planning team Aaron received the 2004 Outstanding Service Award
from the Owens Community College Alumni Association for his involvement
in Homeland Security Preparedness. Aaron's first experience in emergency
preparedness occurred while working as a field sanitarian when he was
responsible for assisting in the preparedness and response activities of
the Davis-Besse Nuclear Power Plant. In addition, to these collateral
duties Aaron performed the duties of a field sanitarian in the
environmental health division at the Toledo-Lucas County Health
Department.

Aaron received his Bachelor of Science degree in biological sciences
from Bowling Green State University in 1997, and his Master of Public
Health degree in Environmental and Occupational Health from the
Northwest Ohio Consortium for Public Health in December 2006. Aaron
currently resides in Perrysburg, Ohio with his wife, Amy and two
children, Nathan and Kyle and the family dog, Samantha.

**Niki Lemin, MS, RS, LMT**

Niki currently serves as a Program Manager in the Center for Public
Health Preparedness in the Office of Workforce Development at The Ohio
State University, School of Public Health. She is responsible for a
variety of training and education activities, such as mass prophylaxis,
exercise design, implementation and evaluation, and incident command, at
the regional/local level.

Niki began her career in environmental public health in 1997 at the
Allen County Health Department in Lima, Ohio, as a sanitarian in the
environmental health division. In 2002, she became Director of Emergency
Response, responsible for public health preparedness and response. She
received her Bachelor of Science degree in environmental studies from
Ohio Northern University in 1995 and her Master of Science degree in
environmental, health, and safety management from the University of
Findlay in 1998. She is a registered sanitarian in the State of Ohio, as
well as a licensed massage therapist. Niki is also a former scholar of
the Ohio Preparedness Leadership Institute. She currently resides in
Ada, Ohio with husband, Rob, daughter, Kyla, their dog, Satchel, and
cat, Pita.

# REFERENCES

1.  The Ohio State University School of Public Health, Office of
    Workforce Development. The Ohio public health preparedness training
    needs survey; Final reports and comparisons: Perceptions of local
    and state public health workforce and health commissioners. Spring
    2005: 26.

2.  Miller MD. The role of environmental health practitioners in a
    public health emergency. *Journal of Environmental Health*. 2006;
    69: 36-7.

3.  Golob BR, Sibbel SP. Bridging the EH/EP gap. National Association of
    County & City Health Officers; Advanced Practice Centers: Public
    Health Readiness E-LINK Newsletter: Advancing Local Practice
    page. 2005. Available at
    http://www.naccho.org/topics/emergency/APC/E-Link/Archive_2005.cfm.
    Accessed December 20, 2006.

4.  Forsting SL. Environmental health professionals and emergency
    preparedness: Canadian perspectives. *Journal of Environmental
    Health*. 2004; 67: 31-35.

5.  Berg R. Terrorism response and the environmental health role: the
    million-dollar (and some) question. *Journal of Environmental
    Health*. 2004; 67: 29-39.

6.  Lyman F. Messages in the dust: Lessons learned, post-9/11, for
    environmental health. *Journal of Environmental Health*. 2003; 66:
    30-31.

7.  Grimes, R. Glimpsing the future. *Journal of Environmental Health*.
    2006; 68: 4, 40.

8.  Parvis L. Disaster preparedness and the risky future. *Journal of
    Environmental Health*. 2002; 65: 46-47.

9.  Frank C. The response to Hurricane Katrina: Iowa's interstate
    cooperation and lessons learned. *Journal of Environmental Health*.
    2006; 69: 28-29.

10. Osaki C. Essential services of environmental health. Northwest
    Center for Public Health Practice, University of Washington School
    of Public Health and Community Medicine, Seattle, WA. July 2004.

11. CDC. Health Protection Goals page. January 27, 2006. Available at
    http://www.cdc.gov/about/goals/goals/htm. Accessed December 20,
    2006.

12. CDC. Cooperative Agreement Guidance for Public Health Emergency
    Preparedness; Program Announcement AA154 2006 (Budget Year 2007).
    June 6, 2006. Available at
    http://www.bt.cdc.gov/planning/coopagreement/#fy06. Accessed January
    18, 2007.

13. CDC. National Center for Health Statistics Healthy People 2010 page.
    Available at
    http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm.
    Accessed December 21, 2006.

14. Morrone M. Skills and abilities needed by environmental health
    science and protection professionals in the public sector. *Journal
    of Environmental Health*. 2003; 65: 9-16.

15. CDC. A national strategy to revitalize environmental public health
    services. Atlanta (GA): Dept. of Health and Human Services (US),
    CDC; 2003. Available at
    http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf. Accessed
    December 20, 2006.