# Presentation: 152303

## Mid-America Alliance

**Dr. Richard Raymond**
- Chief Medical Officer
- Nebraska Health and Human Services System
- www.hhs.state.ne.us

## Slide 2

## What the Mid-America Alliance is not:Emergency ManagementAssistance Compact

## Emergency Management Assistance Compact ...provide for mutual assistance between the states in “managing any emergency or disaster that is duly declared by the governor of the affected states, whether arising from natural disaster, technological hazard, manmade disaster, civil emergency aspects of resources shortages, community disorders, insurgency or enemy attack.”

## Responsibility for planning
Exercises and training
Licenses and permits
Liability
Compensation (Including death benefits)
Planning for evacuation

**EMAC **

- Responsibility for planning
- Exercises and training
- Licenses and permits
- Liability
- Compensation (Including death benefits)
- Planning for evacuation

## What the Mid-America Alliance is:

- Purpose
- Provide a framework for mutual assistance between states during a public health emergency that does not initiate a governor declaration of emergency
- Augment EMAC regionally

## Mid-America Alliance

- Need
- Protocols and mechanisms for responding to a public health emergency not meeting the governor-declared emergency threshold do not exist.
- Rapid assistance requires pre-event planning
- No one state has capability to address all potential scenarios
- In multi-state mass casualty event, Fed government will be fully occupied

## Events simultaneous with emergencies that occupy federal resources

## We need to develop regional cooperative programs for mutual aid and support.Most PH staff are already quite busy with their important daily work.Emergencies, even small ones, put daily work on hold. Mutual aid allows that work to resume more quickly

- We need to develop regional cooperative programs for mutual aid and support.Most PH staff are already quite busy with their important daily work.Emergencies, even small ones, put daily work on hold. Mutual aid allows that work to resume more quickly

## Mid-America Alliance

- Examples
- Laboratory
- New episode of anthrax in regional US mail
- West Nile virus in adjacent states
- Epidemiology
- Anhydrous ammonia spill
- Outbreak of vaccine preventable disease in rural area
- Cross border events (metropolitan areas)

## Region VII

**Region VIII**

## Mid-America Alliance

- Acknowledgements
- State Health Officials from Colorado, Iowa, Kansas, Montana, Missouri, Nebraska, North Dakota, South Dakota, Utah, Wyoming
- HHSS Regional Administrators
- Joann Schaefer, Sharon Medcalf
- Public Health Leadership training program project 2003
- Joe Henderson,
-  Director OTPR, 2003
- Steve Hinrichs, MD, NPHL

- Identify and negotiate sharing of assets and resources
- Laboratory surge capacity and connectivity
- Epidemiology workforce planning, common reportable diseases
- Model medical license 					endorsement act

**Four projects**

**Advisory board**
**Administrative support**
**Data base, directory**

## Personnel
Epidemiology staff
Laboratory staff and equipment
Equipment and supplies
Mobile response units
Translator services

- Personnel
- Epidemiology staff
- Laboratory staff and equipment
- Equipment and supplies
- Mobile response units
- Translator services

## Examples of potential shared resources 

- Colorado: Medical Assistance team
- South Dakota: Mobile lab
- Nebraska: Hospital biocontainment unit
- Utah: Mobile autopsy unit
- Utah: Translation services
- North Dakota: Mobile communication system
- Montana: Mobile command center
- Kansas: Readiness indicators
- Iowa: Mobile showers and kitchen

## Determine mechanism for activation of plan, State Health Official
Mechanism to exchange public health personnel  across state boundaries
Establish interstate dialogue between epidemiologists and laboratorians
Inventory and prenegotiate loan of resources

- Determine mechanism for activation of plan, State Health Official
- Mechanism to exchange public health personnel  across state boundaries
- Establish interstate dialogue between epidemiologists and laboratorians
- Inventory and prenegotiate loan of resources

## Proposed early activities of Mid-America Alliance 

- Model legislation for state licensure endorsement
- Information technology development and data exchange
- Surge capacity for epi and lab services
- Strategy development for achieving readiness
- Needs and resources identification
- Testing public health readiness indicators

## Objectives 

- 1 Develop regional cooperative programs for mutual aid and support to respond to public health events.
- 2 Establish a state-based pilot program for testing pubic health readiness indicators.

## Objective One 

- Develop regional model for establishing mutual assistance programs
- Provide Laboratory technical assistance, epidemiology services
- Create regional database of human resources
- Establish model legislation to allow exchange of health professionals

## Slide 20

## Objective Two 

- Establish a state-based pilot   program for testing pubic health readiness indicators.

## Objective Two: operational plan 

- Define a regional all-hazards response system with  escalating capability
- Evaluate options for prototype
- Identify obstacles and solutions
- Conduct an analysis of capability
- Document staffing needs

## Conceptual frameworkprocess for implementation 

- Approval by all state health officers
- Involvement of key leaders from Focus Areas, epidemiologists, lab directors
- Flexibility for participation in all or selected components by states
- Advisory committee
- Administrative and legal support

## Advisory Committee Membership 

- State health officer or their designee
- Federal representatives of Regions VII and VIII
- Representation from each program focus group

## Mutual assistance program director 

- Approved by the Advisory Committee
- Job duties:
- oversee development of mutual aid programs
- identify new funding sources
- serve as point of contact
- coordinate field activities
- direct Center staff

## Roles for CenterDuring Initialization 

- Creation of template agreements
- Identification of qualified legal advice
- Assistance in obtaining buy-in
- Administrative support

## Continuing Center Activities

- Coordinating program activities
- Sponsoring organizational meetings
- Contracting with schools of public health and professional groups
- Employ project facilitators
- Provide training and consultation

## Measures of Success 

- Participation of more than 80% of SHO
- Participation of 75% of intra-state health jurisdictions
- Adoption of legislation by majority for exchange of personnel
- Approval of epi and lab support agreements among 50% of states or approval of mutual aid plans

## Current focus 

- Meetings being arranged:
- Advisory Committee in Denver
- Public Health Law Advisors - consultant hired
- Lab Director
- Director position posted and being recruited

## Emphasize coordinated activity within the highest levels of state governmentInclude private sector, academic community, medical schools, poison control centers, food safety programs, Veterinary Schools and laboratories. 

## Mid-America Alliance

**Dr. Richard Raymond**
- Chief Medical Officer
- Nebraska Health and Human Services System
- www.hhs.state.ne.us