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Public Health
Streamlining Multnomah County's structure and efficiency
By Talia Gad
The Multnomah County Health Department (MCHD) has significantly enhanced its Incident Management Team (IMT) program by revamping two of its features. One is a major reorganization of the program’s response capabilities by restructuring IMTs. The second is developing a dynamic new training database that tracks response capacity. Both changes have radically transformed MCHD’s structure and efficiency.
Most local health departments note the challenges of activation. Staff sometimes leave their regular roles for weeks or months at a time. The consequences are mounting workloads and incomplete grant deliverables. Upon their return, they are greeted by an overwhelming amount of work. They may not be able to meet requirements.  
Jerusha Kasch, MCHD Emergency Preparedness and Response coordinator, introduced a new system to combat these obstacles. The proposal breaks the existing IMT members into three predefined teams. Each of the teams has two members for each position.
With this new structure, emergency managers can predetermine how long each group will be on the Incident Command Team. Each manager can pre-identify both a primary and a back-up person to fill each role.
As a result, individuals no longer need to fully abandon day-to-day responsibilities during an event. A manager can choose to rotate each of the teams for one week at a time. This leads to fewer problems with backlogged work such as what occurred during H1N1.  Some individuals were away from their everyday jobs for months in that instance.
“This system of rotation-and-bench strength had promoted support from department managers and reignited interest from health department staff who are still suffering H1N1 shellshock,” said Kasch. “People generally want to feel like they are doing a great job with the stewardship that they have been given. When we open doors for staff to accomplish outcomes in multiple areas, we emerge as a highly efficient work force. In these fiscally troubling times, this is no longer a lean forward approach; it’s a must.”
MCHD is admittedly large relative to other Oregon counties’ IMT programs. However, this new structure can be adapted and applied to smaller health departments around the state. “Local health departments that don’t have the staff for three teams might still be able to arrange for two teams to rotate during an incident,” said Kasch. “Any amount of relief helps, and the system definitely offers much-needed program support.”
“This new organizational structure has balanced COOP [Continuity of Operations] staff and response staff,” said Amy Sullivan, Communicable Disease manager. “It analyzes the staff distribution across teams such that it will not leave our communicable disease short-handed during a crisis. It has also increased the amount of direct communication and input that managers have when dedicating staff for team participation.”
Multnomah County has also addressed barriers to establishing and tracking training standards for public health emergency responders. One obstacle to continuing education was IMT members were often not able to take the time for these necessary updates. Trainers sometimes couldn’t remove themselves from their primary responsibilities to deliver the trainings, and managers were sometimes unable to release their staff for the hours required for the trainings.
Kasch suggested outlining predefined training programs to be delivered based on the minimum number of hours required for proficiency. As a result, each IMT member now receives a standard cadre of Incident Command System (ICS) courses to qualify for a position on the team.
Quarterly IMT in-service trainings provide ongoing ICS knowledge, skills and abilities (KSAs). They are offered to all teams to keep skills fresh and to review and educate members on emergency plans, policies and systems The in-service trainings involve a great deal of hands-on training that helps IMTs stay up-to-date and ready to serve in an incident command center.
Moreover, MCHD has developed a new database to track every training, exercise and real event response for each IMT member. Through this tracking system, each member’s KSAs are detailed and tracked in the database. KSAs include their particular credentials, languages spoken and field experience gained during previous activations. The result is a dynamic, searchable database where specific skills can be identified for individual events.
In an incident where pre-designated individuals cannot work as planning section chiefs, the database could search for others who had particular KSAs, training and/or experience in the planning section. As a result, the role would be executed without a hitch.
KaRin Johnson, MCHD deputy director, was the primary force in conceptualizing and developing the new searchable database. “We’re already seeing how these shifts will make a difference during both active and steady states,” said Johnson. “Our managers are on board, and the IMTs are more prepared than ever. It’s been a very exciting transition.”
For more information about the new rotation and training schedules, contact Jerusha Kasch, Multnomah County Health Department emergency preparedness and response coordinator. Email him at or call 503-988-3663, X 22999. For more information about the database, contact KaRin Johnson, Multnomah County Health Department deputy director, at or 503-988-3663, X 22999.