Emergency Preparedness in California Indian Health Clinics

1
Emergency Preparedness in California Indian
Health Clinics

• CSULB Disaster Management Workshop
• Principal Investigator Louise Gresham
• Presented by Susan Cheng
• May 19, 2007

Pauma Valley, CA
2
NAAEP Team Past Present

• Louise Gresham, PhD, MPH (PI) SDSU
• Deven Parlikar, MBA (Co-Founder) SDAIHC
• Lucy Cunningham, MS SDSU
• Sonya Ingmanson, MPH SDSU
• Brian Tisdale, MS Riverside-San Bern.
• Heidi Kvitli, MBA SDAIHC
• Suzanne Lindsay, PhD, MSW, MPH SDSU
• Deborah Morton, PhD, MFA UCSD
• Stephanie Brodine, MD SDSU
• Denny Amundson, DO Army Medical
• J. Scott Parrish, MD, FCCP Army Medical
• Asha Deveraux, MD, MPH Medical
• Lee Rickland, MD, PhD UCSD

3
History of the NAAEP Project

• Indian Health Services Funded Pilot Project, 2001
• Collaboration Indian Health Council (lead), San
  Diego State University, County of SD Health
  Human Services Agency
• Terrorism Preparedness Training Workshops
• Focus on biological/chemical/radiological
  terrorism preparedness and response for clinic
  health care workers
• Website and online resources (http//www.naaep.org
  )
• Self-guided and interactive tutorials
• Disaster Preparedness
• Emergency Operations Plan template and training
  workshops
• Avian and Pandemic Influenza Preparedness
• Inter-Agency Collaboration
• Federal, State, Local, and Tribal Organizations

4
Background
5
History of Epidemics in New World

• Brought by sailors and colonists
• Incubated on the ships
• Lack of hygiene
• Fatigue
• Vitamin-deficient diets
• Close quarters
• Immune naïve indigenous population highly
  susceptible

• Long history of epidemics in Native Americans
  from European agents
• Smallpox
• Influenza
• Plague
• Yellow Fever
• Malaria
• Measles
• Tuberculosis
• Typhus
• Whooping Cough (Pertussis)

6
Impact of Epidemics

• Depopulation of the indigenous populations of
  North America
• Estimates as much as 95 in certain areas
• E.g. decimation of the Ohlone in northern CA
• Today
• newly emerging infectious diseases still threaten
  tribes and reservations

7
Current Emerging Diseases

• Influenza
• Bird/Avian (H5N1)
• Pandemic
• Haemophilus influenzae type b
• Respiratory tract infections
• Antimicrobial-resistant infections
• Zoonotic diseases
• Viral hepatitis
• Helicobacter pylori
• Group A and B streptococcus
• Tuberculosis
• Bacteremia and meningitis from streptococcus
  pneumoniae

8
Risks to Native Americans

• Infectious diseases overall are 4th leading cause
  of US deaths
• AI/ANs have 20 40 times greater rates of
  zoonotic and/or vector-borne disease
• Higher rates of mortality
• Rural communities more susceptible due to greater
  contact with land/animals through homes/work in
  agriculture
• Isolated communities limited access to care

9
Vulnerable Population Native Americans

• Emerging diseases warrant understanding of
  specifics of bioagents to better identify
  outbreaks potential terrorism events
• Historical relationship between AI/AN and
  Europeans necessitate cultural sensitivity in
  community education
• Rural clinics require unique, custom Emergency
  Operations Plans

10
Recent Outbreaks Native Americans

• Community-acquired invasive group A strep
  infections in Zuni Indians
• Epidemiology of Four Corners hantavirus outbreak
• TB outbreak on an American Indian reservation,
  Montana
• Outbreak of gastroenteritis in Galena, Alaska

11
Rationale for customizing BT Training

• Tribal IHS facilities
• First Responders in the event of a terrorist
  attack
• Serve as emergency health services, disaster
  response, law enforcement
• Health care disparities
• Coordination integration of tribal governments
• Local national homeland security plan
• Geographic isolation
• Enable clinicians in early detection response
• Biological
• Chemical
• Radiological

12
Proximity to Reservations and Tribes
13
EPA 1999 US Geological Survey 1995 http//www.epa
.gov/region09/air/maps/ca_tribe.html
14
(No Transcript)
15
Terrorism Preparedness Training Workshops
16
NAAEP Trainings and Purpose

• A collaboration to increase capacity among health
  care providers across Californias Indian Country
  to respond appropriately to natural and man-made
  disasters and health emergencies

• Original Partnership between
• CA Area Office Indian Health Service
• Indian Health Council
• San Diego State University
• County of San Diego Health and Human Services
  Agency

17
NAAEP History (2003-2004)

• Year 1 (2003) Development of health provider
  training workshops focused on Terrorism
  Preparedness (bio/chem/rad)

18
Biological, Chemical, Radiological

• Nuclear, Biological, Chemical (NBC) Terrorism
  Preparedness Workshops
• Local Preparedness and Response (Epidemiology)
• Psychosocial Impact

19
Biological Agents of Concern

• Goals
• Recognize new patterns of some old diseases
• Identify sentinel cases of biological terrorist
  outbreaks
• Trace contacts (investigation)
• Advise people on appropriate protective measures
  to take
• Liaise with public health and reference
  laboratories to help the coordinated response

20
Biological Agents of Concern

• How to distinguish intention from natural event
• Simultaneous epidemics
• Serial epidemics
• Epidemic outside of normal geography or season
• Unusual presentation of a disease (severity,
  attack rate)
• Dead animals, as most of the agents are zoonotic
  (multiple species)
• Strange resistance patterns
• Direct evidence found

21
Biological Agents of Concern

• Influenza Like Illnesses (ILI)
• Common presentation of both natural and
  intentional outbreaks
• Extreme fatigue, fever, muscle aches, and
  nonspecific constitutional complaints
• Knowledge of seasonality and community illnesses
  key to a differential diagnosis
• Surveillance, identification, response
• E.g. anthrax often presents as ILI but progresses
  rapidly so early detection/diagnosis important
• Anthrax indigenous to many rural areas in US with
  close proximity to Native American reservations

22
Chemical Agents of Concern

• Clues of a chemical attack
• Large ill persons with similar syndromes
• Large cases of unexplained diseases/deaths
• Unusual illnesses in a population/individuals

23
Chemical Agents of Concern

• Goals
• Overview possible chemical agents
• Clinical presentation resulting from exposure
• Initial treatment considerations
• Decontamination issues
• Clinic preparedness

24
Chemical Agents of Concern

• Categories of Chemical Agents
• Pulmonary agents
• e.g. phosgene, chlorine, ammonia)
• Blood agents
• e.g. cyanide)
• Incapacitating agents
• e.g. Stimulants, barbituates, opiods
• Riot control agents
• Skin agents/vesicants
• Nerve agents

25
Chemical Agents of Concern

• Basic Principles of Chemical Agent Management
• Decontamination
• Because the skin absorbs most chemical agents
  rapidly and because of evaporation, it is
  unlikely that there will be a significant amount
  of agent left on the skin by the time the
  casualty reaches the medical treatment facility.
  Skin decontamination is not mandatory after
  exposure to nerve agent vapor, especially in a
  life threatening emergency.
• Antidote administration
• Supportive therapy

26
Radiological Agents of Concern

• Potential Radiological Scenarios
• Dispersal of Radioactive Substances without
  explosives
• Radiological Dispersion Device
• Dirty Bomb
• Sabotage of Nuclear Reactors
• Detonation of Nuclear Weapons

27
Radiological Agents of Concern

• Sources of radioactive materials
• Irradiators at research institutes and
  universities for biological research
• Irradiators for cancer therapy
• Heavy industrial irradiators for industrial
  sterilization
• Industrial radiography and gauging sources
• Nuclear power fuel rods
• Nuclear Medicine radioisotopes
• Other..

28
Radiological Agents of Concern

• Signs and Symptoms of Chronic Radiation Exposure
• Headache
• Fatigue
• Weakness
• Nausea
• Vomiting
• Diarrhea

• Burns
• Epilation
• Ulceration
• Lymphopenia
• Thrombocytopenia
• Purpura
• Opportunistic Infections

29
Radiological Agents of Concern

• Signs and Symptoms of Chronic Radiation Exposure
• Also called radiation sickness
• ARS is a combination of syndromes
• Syndromes appear in stages directly related to
  amount of radiation received
• Dose rate is important

• Prodromal Phase
• Hematopoietic Syndrome
• Gastrointestinal Syndrome
• CNS or Neurovascular Syndrome

30
Radiological Agents of Concern

• Minimize Exposure
• Identify Source
• Decrease Exposure time
• Increase distance from source
• Utilize shielding

31
Radiological Agents of Concern

• Decontamination
• Purpose
• Prevent or minimize Internal contamination
• Reduce radiation to the victim but reducing
  external contamination
• Prevent the spread of contamination to other
  persons and to the environment
• Non-injured personnel should never be decon in
  med facility

• Removing clothes and shoes results in 90-95
  reduction of patient contamination
• Wash gently w/soap water cover wounds
• Flush cuts or breaks in skin with copious amounts
  of water ASAP
• Bandage wounds to prevent recontamination and and
  encourage sloughing

32
Local Preparedness and Response

• Centers of Disease Control Priorities
• Enhance Surveillance and Epidemiology
• Enhance Preparedness and Response
• Enhance Information Technology
• Enhance Laboratory Capacity
• Stockpile of Vaccines and Antibiotics
• (Strategic National Stockpile - SNS)

33
Local Preparedness and Response

• Early Detection enhanced surveillance for
  clinical syndromes, real-time data from
  heterogeneous data sources, early warning alerts,
  rapid epidemiological assessment and laboratory
  identification
• Rapid Response Team (RRT) - focuses on early
  detection of and rapid response to unusual
  disease occurrence outbreaks or clusters of
  acute communicable disease, rare or unusual
  diseases of unknown etiology, or suspected BT.

34
Local Preparedness and Response

• Disease and Syndromic Reporting
• Health care providers, laboratories, coroners, or
  medical examiners
• All cases of illness/health conditions that may
  be potential causes of a PH emergency.
• Pharmacists
• Unusual or increased prescription rates
• Unusual types of prescriptions
• Unusual trends in pharmacy visits
• Veterinarians, livestock owners, Vet lab or any
  animal caretaker

35
Local Preparedness and Response

• When and What to Report
• Atypical host - young, no underlying illness
• Serious, unexpected, acute illness
• Multiple similarly-presenting cases
• Increases in common syndromes occurring
  out-of-season
• severe flu-like illness in summer

36
Local Preparedness and Response

• Public Health Action
• Receive case report/conduct case investigation
• Arrange laboratory confirmation
• Determine if situation is unusual (baseline)
• Initiate active surveillance as indicated
• Find and remove source of outbreak
• Alert medical community/public as indicated
• Trace contacts and others potentially exposed
• Mobilize assets rx/vaccines for prophylaxis
• Coordinate with State DHS, CDC, FBI, and other
  authorities

37
Local Preparedness and Response

• Isolation
• The physical separation and confinement of an
  individual or group of individuals who are
  infected or reasonably believed to be infected
  with a contagious or possibly contagious disease
  from non-isolated individuals, to prevent or
  limit the transmission of the disease to
  non-isolated individuals.
• Quarantine
• The physical separation and confinement of an
  individual or groups of individuals, who are or
  may have been exposed to a contagious or
  possibly contagious disease and who do not show
  signs or symptoms of a contagious disease, from
  non-quarantined individuals, to prevent or limit
  the transmission of the disease to
  non-quarantined individuals

38
Psychosocial Impact

• Psychiatric Disorders
• Acute Stress Disorder (ASR)
• insomnia
• lack of concentration
• emotional lability (instability)
• fearfulness, including fear of travel
• increase in alcohol and tobacco use
• Post-traumatic Stress Disorder (PTSD), with
  persistent symptoms of
• re-experiencing event (e.g., flashbacks)
• increased arousal (e.g., outbursts of anger)
• avoidance of stimuli associated with the
  particular trauma

39
Psychosocial Impact

• Risk Factors for Disorders
• Intense exposure to death and injury
• Manmade disasters vs. natural
• Little or no warning
• First disaster experience
• External Stressors
• The medical systems can be overwhelmed
• Patient clientele
• Stressed
• Acute autonomic arousal (in both exposed and
  unexposed)
• In Sarin event, ratio of patients with exposure
  to none 14 !!
• Riot panic if uneven access to treatment
  perceived

40
Psychosocial Impact

• Internal Stressors
• HCWs are susceptible to same symptoms of fear and
  grief
• Concern for personal safety
• More likely to be unavailable for own family
  members
• Requirement for barrier protection
• increases the level of difficulty, fatigue, heat
• Communication with patients impaired

41
Psychosocial Impact

• Preparation
• Realistic disaster drills
• Planning should include procedures to protect
  HCWs across the categories of events
• Drills should include practice with the necessary
  barrier precautions
• Mitigation
• Establish work-rest schedules early on in event
• Keep fearful healthcare workers busy
• HCWs need to be protected from exposure to the
  grotesque and dead
• Debriefing
• Key components elicit testimonies, emphasis is
  on events not performance, provide guidance

42
Terrorism Prep Workshop Evaluation

• Pre/Post-test Evaluation
• Overall, improved on Post-test on objectives
• Increase 38 correct answers
• Speakers ranked well in comments
• Areas for improvement
• Adapt scenarios for tribal lands/situations
• Need to establish key partnerships between
  clinics and local entities
• Too much information, too little time

43
Terrorism Prep Tutorials

• In response to workshop evaluation comments,
  self-guided and interactive tutorials were
  created
• Self-guided
• Power Point presentations from workshops with
  audio track and embedded Questions Answers
• Interactive
• scenario based, developed for Native American
  populations/clinics
• Available online http//www.naaep.org

44
Terrorism Prep Tutorials Self-guided

• Self-guided Tutorials
• Developed from Workshop Presentations
• Includes specific objectives for each tutorial
• Also includes topical questions and answers
  throughout tutorial
• Biological Agents of Concern
• Chemical Agents of Concern
• Radiological Defense
• Local and Emergency Preparedness and Response
• Psychosocial Impact

http//www.naaep.org/
45
Terrorism Prep Tutorials Interactive
Audio file, didactic, embedded question and
answers, scenario-based references
46
NAAEP History (2003-2004)

• Year 2 (2004) Development of tabletop exercise
  for health providers previously attended
  terrorism preparedness training workshops

47
Table Top Exercise

• Four hour module focusing on
• Module I Emergency Response
• Module II Initial Bioterrorism Response
• Module III Bioterrorism Response Recovery
• Multi-step process
• Introduce scenario/situation briefing
• Breakout into small group discussions
• review situation, discuss critical issues, confer
  on key decisions, response actions
• Return to large group debrief
• facilitated discussion on key issues, ideas, and
  possible short-comings

48
Table Top Exercise Evaluation

• Each of four modules had
• Best Practices
• Areas of Improvement
• Key issues from modules include
• Education
• Communication
• Equipment
• Coordination
• Initial response
• Recovery

49
NAAEP (2005-2006)

• Year 3 (2005)
• Development of Emergency Operations Plan Template
  for clinics and implement all-hazards plan
  development training workshop
• Final terrorism-preparedness workshop

• Year 4 (2006)
• Continued all-hazards training
• Formed inter-agency collaboration
• Implemented clinic disaster preparedness
  questionnaire (winter summer 2006)

50
Emergency Operations Plan Development Training
Workshops
51
Emergency Operations Plan Training Workshop

• Topics
• Emergency Operations Plan Template
• Pandemic and Avian Influenza Prep
• Personal Protective Equipment
• Clinic Disaster Preparedness Questionnaire
  Results
• Interactive, case-based mini-tabletop

52
Emergency Operations Plan Template

• All-hazards approach
• Natural and manmade disasters
• Incident Command Systems Emergency Operations
  Centers
• SEMS/NIMS compliant
• Adapted for Indian Health Clinics
• Pilot tested for Indian Health Council

53
Emergency Operations Plan Template

• Mitigation
• Hazard Vulnerability Analysis ID
• Preparedness
• Continuity of Operations
• Internal Command Structure
• Communications
• MOAs
• Plan Development/Maintenance
• Response
• Alert Notification
• Emergency Management Organization
• Clinic Command Center
• Surge Capacity
• Supplementing Staff
• Increase Security
• Public Information
• Evacuation, etc.

• Recovery
• Deactivation of Emergency
• Account for Disaster-Related Expenses
• Restoration of Services
• After-Action Report, etc.
• Attachments
• Emergency Incident Command System
• Staff Callback List
• Emergency Contact
• Emergency Procedures
• Evacuation Procedures
• Supplementing Staff
• Triage Treatment
• Increasing Surge Capacity
• Shelter-In-Place, etc.

54
Pandemic Influenza Preparedness

• Pan Flu Presentation
• The Influenza Viruses
• Possibility of Influenza Pandemic
• Pandemic Preparedness Response
• Point of Dispensing (POD)
• Continuous Operations Planning (COOP)

55
Human H5N1 Disease

• Incubation period may be longer than regular
  flus 48 hours (up to 8 days)
• Persons may be contagious a day before they have
  symptoms
• Initially looks like regular influenza
• Perhaps fewer upper respiratory symptoms
• Perhaps greater vomiting and diarrhea
• May rapidly progress to a viral pneumonia
• In severe cases
• Respiratory failure
• Secondary multiple organ failure
• May have associated neurologic symptoms

56
Pandemic Influenza Preparedness

• Pan Flu Plan Template
• Emergency Management Priorities
• Relationship Plan to other EOP
• Pan Flu Prep and Response
• Roles Responsibilities
• Planning Prep in Inter-Pandemic Period
• Response
• Recovery
• Mitigation

57
Online Resources (pending)

• Webcasting and Audio/Visual Recording

58
Inter-Agency Collaboration
59
Multi-agency Collaboration

• New collaboration formed to better serve all
  Indian Health Clinics
• CA Indian Health Service
• CA DHS Indian Health Program
• CA DHS Emergency Preparedness Office
• CA Governors Office of Emergency Services
• CA Governors Office of Homeland Security
• Native American Alliance Emergency Preparedness

60
Multi-agency Collaboration Members

• NAAEP
• Louise Gresham (NAAEP, PI)
• Susan Cheng (NAAEP, Consultant)
• Brian Tisdale (NAAEP, Consultant)
• Indian Health Service, CAO
• David Sprenger (IHS, CMO)
• Margo Kerrigan (IHS, Director)
• Edwin Fluette (Assoc. Dir. OEHE)
• CA DHS, Indian Health Program
• Sandra Willburn (IHP, Chief)
• Andrea Zubiate (Proj. Manager)
• Patricia Lavalas-Howe (Nurse Consultant)

• CA DHS, Emergency Prep Office
• Anne Arroyo (Chief)
• Gov. Office, Office of Emergency Services
• Laurie Smith
• Gov. Office, Office of Homeland Security
• Denise Banker
• CA Tribal Nations, Emergency Management Council
• Chris Walters (Chair person)

61
Multi-agency Collaboration

• Purpose
• To support the development, implementation, and
  exercise of Emergency Operations Plans for
  individual Indian Health Clinics in California
• To update all collaborators on individual goals,
  progress, and products of each participating
  agency/group
• To share resources (expertise of personnel,
  existing protocols, needs assessment and
  analysis, EOP templates, monitoring of individual
  clinics, etc.)
• To reduce redundancies and duplication of efforts
  between groups

62
Multi-agency Collaboration

• Products
• Establishing Partnerships and Networking
• Letters to all California Public Health Officers
  and Indian Health Clinics, paired together by
  county serviced
• Encouraging collaboration and sharing of
  resources
• California Health Alert Network (CAHAN)
  Enrollment
• Early alert network for medical staff
• On-Site Technical Assistance
• Identified target clinics from needs assessment
  surveys (see below)
• Two consultants contracted by Indian Health
  Program, visited clinics and assisted in
  Emergency Operations Plan development
• Calvin Freeman
• Barbara Aragon
• Clinic Disaster Preparedness Questionnaire
• Needs assessment survey for California Indian
  Health Clinics

63
Multi-agency Collaboration

• California Health Alert Network (CAHAN)
  Enrollment
• State and local government disaster officials
  response coordinators involved in contingency
  planning management of disasters affecting
  public health
• Populated with public health officers, local
  health administrators, California Department of
  Health Services staff
• Can accommodate at least 12 contacts per local
  health jurisdiction
• Secure web portal requiring user authorization
  not available for public

64
Clinic Disaster PreparednessQuestionnaire Results
65
Clinic Disaster Preparedness Questionnaire

• Clinic Disaster Preparedness Questionnaire
• Winter 2006 Baseline implemented (Q1)
• Originally IHS questionnaire with 52 questions
• Summer 2006 Follow-up implemented (Q2)
• Added questions regarding accreditation and
  access/utilization of resources (website,
  technical assistance)
• Summer 2007 Follow-up planned (Q3)

66
Results Baseline (Winter 06)

• Most clinics have emergency plan (gt90)
• Participated in annual drill
• Worked with local entities to coordinate planning
• Few clinics have completed hazard vulnerability
  assessment
• Few clinics have procedures/policies, training,
  facilities, equipment, or supplies for biological
  or chemical event
• Overall better prepared for natural rather than
  intentional disaster

67
Results Follow-up (Summer 06)

• Major improvements from baseline in
• Provisions for vulnerable populations in plan
• Ability to increase capacity by 10 30
• Communications systems (T-3 internet amateur
  radios available)
• Satellite based tutorials for training

68
Results Follow-up (bio/chem)

• Better prepared for bio/chem event
• Infectious disease/syndromic surveillance
• Testing for bio/chem agent
• Mass prophylaxis plan
• Enough prophylaxis for all staff
• Inclusion in Strategic National Stockpile
• N95 masks available and fit-tested for staff

69
Results Follow-up (goals)

• Following specific goals for 2005 2006 project
  year also improved
• California Health Alert Network (CAHAN)
  participation
• Staff trained in Incident Command System (ICS)
• Staff assigned to specific roles in ICS

70
Results Follow-up (priority)

• Priority Settings (Follow-up vs. baseline)
• Clinics downgraded planning and preparedness
  tools and communications from higher priority to
  lower priority
• Potentially project activities (workshop and T/A)
  helped address these topics
• Most clinics still rank supplies as a high
  priority

71
Results Follow-up (bio/chem)

• Still need to improve preparation for bio/chem
  outbreak or event
• Isolating segments of facility
• Surveillance for outbreak
• N95 masks and staff fit-tested
• Staff training on bio/chem/rad prep and
  contaminant ID

72
Results Follow-up (coll./part.)

• Collaboration and Partnerships
• Inclusion in local hospital plan
• Evidence collection procedure with law
  enforcement
• Inclusion in strategic national stockpile
• Comm. plan w/local media, public health, tribal
  reps
• Participation in CAHAN
• Provisions for accessing supplies from others

73
Results Follow-up (surge)

• Surge Capacity Staffing
• Personnel recall policy in place
• Plan to expand operational capacity
• Staff trained and assigned role in ICS

74
Results Comparisons

• NAAEP workshop attendee clinics were overall
  better prepared for an emergency than
  non-attendee clinics
• Clinics who visited the NAAEP website
  (http//www.naaep.org) were better prepared for
  an emergency than clinics who had not visited the
  website
• Clinics with current accreditation were better
  prepared for an emergency than clinics without
  current accreditation
• Clinics with past accreditation also better
  prepared for an emergency than clinics without
  past accreditation

75
Results Technical Assistance

• Based on the questionnaire results, select Indian
  Health Clinics were identified to receive on-site
  technical assistance (by Calvin Freeman Barbara
  Aragon)
• Clinics chosen to receive technical assistance
  were less prepared overall for an emergency
  compared to clinics not chosen for T/A on the
  baseline (winter) questionnaire
• However, after receiving T/A, those clinics
  chosen receiving of T/A were just as prepared
  as clinics who had not been chosen and had not
  received T/A
• Therefore, the T/A successfully closed the gap
  between the vulnerable clinics and all other
  clinics

76
Follow-up (Q3) planned Summer 07

• Minor revisions to questionnaire in progress
• New questionnaire will be implemented June 2007
• Available online and electronically by email
• Can complete by hand and mail or fax back
• Can complete electronically and email back
• Can complete online and submit online
• Previous follow-up results will be available for
  clinics for their convenience/reference

77
Follow-up (Q3) Why is this important?

• Continued participation important for
• Preparedness surveillance
• Priority/funding setting
• Identify clinics for technical assistance
• Advise project staff on workshop content and
  emphasis

78
Online Resources Website
79
Online Resources

• Terrorism Preparedness Workshop Presentations
  (Power Point)
• Self-Guided Tutorials
• Interactive Tutorials
• Disaster Preparedness
• Training Workshop Presentations (Power Point)
• Emergency Operations Plan Template
• Bird and Avian Influenza Preparedness
• Self-testing Questions
• Inter-Agency Collaboration
• About Us
• Contact Us

http//www.naaep.org/
80
Terrorism Prep Presentations

• Biological/Chemical/Nuclear Terrorism
  Preparedness Workshops
• Power Points from Workshops
• Biological Agents of Concern
• Chemical Agents of Concern
• Radiological Defense
• Local and Emergency Preparedness and Response
• Psychosocial Impact

http//www.naaep.org/
81
Tutorials Self-Guided Interactive
http//www.naaep.org/
82
Disaster Preparedness

• Emergency Operations Plan Template
• EOP Training Materials
• Risks and Threats to Indian Health Clinics
• Unique Roles of Indian Health Clinics
• Hazard Vulnerability Assessment
• EOP Template
• Incident Command Systems
• Exercising the Plan
• EOP Workshop Materials
• Agenda
• Goals and Objectives
• Hazard Vulnerability Assessment Worksheet
• Pandemic and Avian Influenza Prep

http//www.naaep.org/
83
Inter-Agency Collaboration

• Purpose
• Products
• Agencies

http//www.naaep.org/
84
About Us

• About Us
• Brief History of the Project (Yr 1-5)
• Faculty (current and past)
• Partners
• California Native American Research Center for
  Health (CA-NARCH)
• Science Media
• Council of Community Clinics
• Presentations and Publications

http//www.naaep.org/
85
Acknowledgements

• Big, Big Thanks!!
• All California Indian Health Clinics
• Inter-Agency Partners
• NAAEP Staff

86
Contact Information
W. Susan Cheng, MPH, PhDc Consultant/Environmental
Health Safety Specialist Native American
Alliance for Emergency Preparedness Indian Health
Program Indian Health Services Phone[phone]
9 Fax[phone] Email
wscheng_at_ucsd.edu http//www.naaep.org
87
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