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County Round Up Winter 2012
Pole Creek fire from Waldo Lake
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Public Health and the Pole Creek fire

By Tom Kuhn

On Sept. 9, 2012, a wildfire was discovered near the Pole Creek Trailhead, six miles southwest of Sisters, Oregon, in Deschutes County. While the fire began small, wind, dry conditions and fuel spread it to 26,795 acres by the time it was contained.   

Due to the proximity and topography of the area, smoke began to billow into Sisters at hazardous levels. Oregon Interagency Incident Management Team 4 assumed command on Sept. 10 at the Sisters Rodeo grounds.   

On recommendation from the Oregon Department of Environmental Quality, Deschutes County Health Services (DCHS) Public Health took an early lead in responding to the public’s health concerns.

By the second weekend of the event, the fire had more than doubled in size and, by Sept. 18, Particulate Matter 2.5 levels reached over 1,000, the highest DEQ had ever seen. The densest smoke was apparent during the morning hours with less unhealthy levels observed in the afternoon. At this time, DCHS asked the Oregon Health Authority (OHA) Health Security, Preparedness and Response Program to help develop health messaging for the Sisters area. 

Several discussions were held regarding potential school closures, but the informed decision was made for schools to remain open. The indoor air environments in the schools were likely to be less harmful than in most homes. Additionally, DCHS Public Health monitored the DEQ website daily to examine smoke particulate matter levels and determine any patterns in smoke concentration.

DCHS Public Health communicated its health advisory messages through numerous outlets and participated in semi-weekly school and Incident Command meetings. Messages focused on creating a clean-air environment and sheltering in place whenever possible. Other recommendations included cancelling all public outdoor activities in Sisters when the concentration of smoke in the area was at its highest. Public Health also monitored area medical clinics to assess increases in medical attention sought for smoke-related issues. Fortunately, the only increases were in clients renewing prescriptions for albuterol or nebulizers. Phone call volumes at DCHS were low to moderate throughout the fire, with the highest volumes seen when smoke concentration was at its heaviest. Phone calls came from both within and outside the community,  

Interested parties can access key recommendations through the Deschutes County Health Department Pole Creek Wildfire Information page.

By Sept. 26, the fire was 80 percent contained and Incident Command held its final community meeting in Sisters to announce that the Oregon Interagency Incident Management Team 4 would begin transitioning management to local fire organizations. Probable cause of the fire was determined to be lightning from a small isolated thunderstorm in the area of Pole Creek Trailhead on Sept. 8, 2012. Continued assessment of the Pole Creek wildfires occurred in the weeks following the event to further study the effect of the wildfires on the local community.

Preparing Together, A Discussion Guide and Toolkit

By Marilou Carrera

What sets apart “Preparing Together, A Discussion Guide and Toolkit” from other emergency preparedness tools is its emphasis on making a plan first. “A plan is free and relatively easy to set up because there are so many templates available,” explains Sue Mohnkern, Public Health Preparedness Program supervisor with Washington County Department of Health and Human Services. She says the emphasis on planning is a “way to get people to buy-in.”  

“Preparing Together” is the culminating product of a collaboration between Washington, Clackamas and Columbia counties. It began as a conversation among colleagues about community resilience — a newer concept in public health a couple of years ago. Mohnkern described visiting her local library and noted free toolkits were available on numerous topics. It occurred to her that a toolkit was a simple, yet effective way of reaching the half-million people in the tri-county area.  

Mohnkern worked with Cynthia Valdivia of Washington County, Anne Parrott of Columbia County, Kathy Thompson of Clackamas County, and Sherry Giles, Washington County graphic designer, to develop the guide. When the collaboration began, the group’s goals were to ensure the information presented was easy to understand and accurate and that it removed the fear inherent in risk-based information. The group also wanted to make sure the information was appropriate in terms of literacy and cultural levels, appealed to hearing- and vision-impaired groups, and was oriented to adult learning styles.

The toolkit and guide are available in a few formats: 1) as a narrated video on YouTube, 2) as an un-narrated presentation, in which a facilitator is necessary, and 3) a printed presentation. . The collaborative envisions a format for viewing the video followed by discussion around using the toolkit. “Preparing Together” is also available to check out from the Washington, Clackamas and Columbia county libraries. 

“Preparing Together” was presented for the first time Aug. 24 at the Genentech Employee Health Fair. It was presented again at the Cedar Hills Community Participation Organization. Mohnkern says the collaborating group wants to develop future collaborations with other organizations, including Community Emergency Response Teams, Medical Reserve Corp, and community organizations active in disasters. The group would also like to use the training in their own county departments.  

Additional next steps for the group include building upon the existing toolkit, developing toolkits for other preparedness topics, such as for pets and populations with functional needs requirements. Mohnkern said, “If we can take this out to the community and really reach out to them, I think it will be really beneficial.” 

For additional information, visit “Preparing Together, Discussion Guide and Toolkit.” 

Multnomah County Health Reserve Corps supports flu shot clinics
By Zumana Rios, MHA

The Multnomah County Health Reserve Corps (HRC) activated its volunteers to support the Health Department's seasonal flu shot clinics this fall in collaboration with a variety of community partners, including the Mexican Consulate, African American Health Coalition and Immigrant and Refugee Community Organization (IRCO). Volunteers included registered nurses and vaccine-certified pharmacists. Volunteers supported three flu shot clinics during the months of October and November. Eleven HRC volunteers signed up to administer flu vaccines. These volunteers contributed a total of 55 hours of time. 

The HRC was established in 2002 to house a cadre of licensed volunteer health care workers who would be mobilized to support the Health Department's response to large-scale emergencies or non-emergency public health activities. Volunteers are non-Health Department employees who serve as resources to expand communities' response capacity in Multnomah County and work under the Health Department's direction.

There are currently more than 400 licensed health care volunteers in the HRC. To learn more about the program, please visit the HRC website.

The Measles Model — a Jackson County innovation
By Holly Groom 

Jackson County public health staff have long been recognized for their pioneering work in addressing vaccine hesitancy. Building on this work, a team of public health staff along with a particularly committed volunteer developed an exciting and innovative tool known as the Measles Model.

Nicole Dzialowy, a volunteer with Jackson PHD and a graduate student the London School of Hygiene and Tropical Medicine, worked closely with Jackson County Health Officer James Shames, as well as county PHD staff Trish Styer and Eva Scuratowicz. They built a complex and well-vetted statistical model for predicting the impact of a single measles case if it were introduced into one of the seven Jackson County schools known to have high vaccine exemption rates.

The team spent considerable time perfecting the vision. Members got key input from Manoj Gambhir, Ph.D., a researcher with the National Center for Immunizations and Respiratory Diseases (NCIRD) at the CDC, and from state Immunization Program staff. The team considered various ways this tool could be used. It offers a visual representation of how many cases a school could conceivably end up with, day by day, because of one infectious case.

In the seven schools included in the original model, there is a strong correlation between those with higher exemption rates (and high numbers of disease-susceptible children) and a higher number of measles cases. This potentially shows a considerable effect on student and staff absenteeism, as well as general disruption to the school setting following a single, preventable case of measles. Bringing this message into schools and communities could set off a startling realization for parents, administrative staff and the community at large as they consider how their lives might be affected. The benefits of getting the measles vaccine, which is known to be very effective in preventing disease, might seem to outweigh any risks once a person sees what a full-scale outbreak would really mean.

The possibilities that come with this tool are yet to be fully explored. Jackson County has inserted the Measles Model into a preparedness tabletop exercise and is continuing to explore ways to bring the model into conversations with school administrative staff. Oregon currently holds the highest kindergarten vaccine exemption rate in the country, and this tool — which represents the county’s and its federal partners’ vision and input — can help immunization advocates sway those who are not convinced of immunization’s benefits.

Honoring Dr. Oxman's 28 years of service to public health and health care system preparedness

By Kathryn Richer

Retiring Multnomah County Health Officer Dr. Gary Oxman’s many contributions on behalf of the OHA were recognized Nov. 13 when Jere High, HSPR program deputy planning and evaluation chief, presented him with a beautiful plaque. It read, "Thank you for your outstanding dedication, performance and professionalism in Oregon's public health and preparedness efforts."  

Dr. Oxman has worked tirelessly for Multnomah County’s public health for 27 years. He started his career in Portland as a family physician in primary care prior to becoming Multnomah County medical director. In 1987 he assumed the position of health officer for the Multnomah County Health Department. He added public health consultation, leadership and medical direction for Washington and Clackamas County health departments in 2006.

In his role as health officer, Gary has led several community initiatives with a long-lasting positive effect on Multnomah County and the region. A few examples are:

  • Tirelessly convened representatives from the Portland metropolitan area’s majorhealth systems to develop opioid prescribing policies that reflectcommon, acceptable community prescribing standards and guidelines to reduce opiate overdose and misuse harms;
  • Pioneered an innovative regional public health approach with the development of the Tri-County Health Officer group that provides regional public health leadership with a unified voice;
  • Worked with historically alienated communities to ensure their input and voice in public health matters that affect them, in particular engaging African Americans around maternal and child health outcomes;
  • For more than a decade, mentored and supervised preventive medicine residents and shaped the preventive medicine residency experience overall through participation with the OHSU Department of Public Health and Preventive Medicine’s Residency Advisory Group, and mentoring residents directly in Multnomah County Practicum Experiences;
  • Interpreted and applied public health law, particularly in the realm of school attendance and communicable disease as it relates to justice issues and the very real consequences of absenteeism on the lifelong health outcomes of youth;
  • Provided executive leadership for the development of the NW Oregon Healthcare Preparedness Organization, a regional emergency planning collaboration of regional hospitals and health systems, local and state public health, county emergency management, emergency medical services, medical societies, safety net clinics, and behavioral health;
  • Oversaw the development of community-accepted, practical local health response strategies and tools for providing coordinated delivery of essential health care services in the face of a pandemic influenza event. This included a Health/Medical Multi-Agency Coordination Group and its ethical framework, which received a NACCHO Model Practice Award.

This is just a sample of Dr. Oxman's leadership and contributions to public health in Multnomah County during his career. He does his work with enthusiasm, compassion, and with a constant eye on social justice and health equity. When Dr. Oxman retires in December 2012, he will not only leave behind a legacy but a cadre of protégés, fans and committed colleagues that have been influenced by his unfettered dedication. With the full support of the Multnomah County Health Department, we wish him all the best!

Making sure we’re ready — Oregon’s Strategic National Stockpile program
By Holly Groom

The Oregon Immunization Program would like to acknowledge Sonya Andron and Maureen Cassidy for the excellent work they do to coordinate Oregon’s Strategic National Stockpile (SNS) program for the past four years. Sonya has built and strengthened Oregon’s capacity to efficiently and effectively respond to emergencies. Sonya’s job involves many layers of training and coordinator, pulling together partners from within OHA and external organizations, all of which play critical roles in Oregon’s response efforts. 

The SNS program resides within the state Immunization Program. Building on the important framework that Kathy Scott put in place, Sonya works hard to keep SNS activities well integrated into the functions and responsibilities of the Immunization Program. Sonya works continuously to organize the Immunization Program staff by assigning roles for exercises as well as real-life response efforts, most of which involve standing up the state’s Receipt, Stage and Store (RSS) site for delivery of medical countermeasures throughout the state.  

As the SNS backup, Maureen Cassidy provides constant planning and implementation support and assistance to Sonya. Other Immunization staff take on roles for asset allocation, inventory management, picking and packing assets for delivery, and documentation and communication with the Agency Operations Center to ensure timely and accurate communication. However, the work of the Immunization Program staff would be ineffective without the support of Health Security, Preparedness and Response (HSPR) program staff, who help organize logistics and IT support for SNS operations. Sonya partners closely with HSPR staff in order to keep those roles and relations strong and inter-dependent.

Even more, Sonya spends a great deal of time building new and maintaining existing partnerships with external organizations — partners who are critical to the safe and secure transport of medical countermeasures throughout Oregon. Sonya meets regularly with these partners and has expanded our current RSS site network to locations in various parts of Oregon. These efforts are part of building an optimal SNS program that has backup contingency plans in case an emergency should incapacitate any aspect of state operations. 

Sonya and Maureen are currently preparing for a full-scale exercise in spring 2013. The exercise will require involvement of all staff and partners. It will provide an opportunity to fully test Oregon’s capacity to receive, stage and distribute assets by various modes of transport. By walking through all parts of a response effort, the exercise will be essential in identifying our strengths and weaknesses and finding ways to continually strengthen the Oregon SNS program. 

We are grateful for the hard work that Sonya and Maureen do to improve our state’s readiness for emergency response.


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