Every community should be prepared for natural or man-made disasters. The federal government establishes Strategic National Stockpile (SNS) to protect the public when a public health emergency causes local medical supplies to run out. Many state governments encourage local health departments (LHDs) to promote local readiness and maintain capacities in receiving, re-packing, and distributing SNS assets.
It has been challenging for rural counties to promote public health emergency preparedness messages and to conduct real-life simulating drills for testing local response capacities due to residents are geographically disconnected. Other than the common rural nature, Oswego County, New York sits on the southeastern shore of Lake Ontario and sees severe winter weather conditions. To overcome these challenges, Oswego County Health Department (OCHD) has involved with regional Girl Scout Troops and other partners in annual SNS drills in the past three years.
In addition to LHD and Girl Scout Troops, law enforcement, transportation, county government employees, news media, local business and organizations were involved and more than a quarter of 122,000 county residents were covered in each of the drills.
The community involvement approach has innovatively enhanced the authenticity of the SNS drills, boosted accountability to the simulated SNS assets, promoted emergency preparedness messages, tested the resilience of the emergency response capacities, and strengthened community partnerships.
In the drills, Girls Scout cookies were used to simulate the SNS assets to be received, re-packed, and distributed, and Girl Scout Troops simulated health care providers, either coming to pick up the re-packed assets themselves or waiting for delivery. The County Highway Garage served as the central receiving, inventorying, re-packing, and distributing site. The Highway Department loaded cookies on trucks and delivered to remote sites. The Sheriff’s Department provided security check for the Garage and escorted cookie transportation. Media and other community emergency preparedness partners were invited to observe the events.
Over these years, county’s capacities in response to the public health emergency were assessed, adjusted, and improved. The resilience of these capacities was tested in severe weather conditions. The continuous community involvement in the emergency preparedness has been committed by all key partners.
The goal was to exercise the new SNS plan that extensively involved community partners and simulated real-life responses to an emergency. The following objectives were expected: (1) build partnerships with the Girl Scouts of NY PENN Pathways, Sheriff’s Department, Highway Department, and Closed POD partners; (2) test the capability of activating public health emergency operations in less than 60 minutes; (3) use Girl Scout Cookies to simulate medical supplies (assets), (4) inventory, pack, re-distribute orders of the assets; (5) test security capabilities provided by the Sheriff’s Department on route and at the receiving site for distributing and delivering cookies; (6) complete the assets receiving and dispensing in a timely manner without error or damage; (7) provide pre-drill training for staff and volunteers; and (8) coordinate volunteers from Girl Scouts and other county departments.
Review of the pre-drill training and community outreach efforts and the implementation of the drill according to the plan indicate that the goal and objectives to build a community with the CDC outlined emergency response capacities were achieved.
The partnership between OCHD and the regional Girl Scout Troops has been proved sustainable and will continue to grow because the needs of the both side complement each other.
Oswego County Health Department
Enhancing Strategic National Stockpile (SNS) Drill through Involving Girl Scout Troops
Oswego County occupies 951 square miles of land on the southeastern shore of Lake Ontario in central New York. With two small cities, ten villages, and 22 towns, the county mostly sits in rural areas, producing dairy products, apples, corn, and onions. While rich in natural beauty, the proximity to Lake Ontario and the Tug Hill Plateau located in the eastern portion of the county subjects the area to heavy lake-effect snowfall that can reach over 180 inches a season.
Demographically, Oswego County has 122,000 residents. Approximately 61% of the population lives in a rural area. Socioeconomically, Oswego County experiences difficulties, such as a high unemployment rate, high poverty rate, and low education attainment rates. Approximately 25% of the County population receives Medicaid.
The Oswego County Health Department (OCHD) is responsible for responding to threats to public health from a variety of sources such as biological, radiological, and chemical threats. Due to the rural nature of the county and the extreme weather it was a challenge to increase the public's awareness of emergency preparedness and to involve the public’s participation in these drills.
In developing and revising the County’s Strategic National Stockpile (SNS) and Medical Counter Measures (MCM) plans, OCHD chose to use an innovative approach to exercise the County’s SNS plan.
Innovations included:• Involving Girl Scout troops to enhance the authenticity of the Strategic National Stockpile (SNS) drill and to promote emergency preparedness in a rural county;• Using Girl Scout cookies as inventory to simulate medical supplies and to boost dispensing accountability for accuracy and timeliness; and• Setting drill dates in the period of severe weather to examine partners’ coordination, participants’ safety, volunteer management, and the preparedness capacity for resilience.
The goal was to exercise the new SNS plan. Objectives were to: (1) build community partnerships for public health emergency preparedness; (2) test capabilities to activate public health emergency operations in less than 60 minutes; (3) receive (unload) inventory, re-pack according to orders, and distribute and deliver Girl Scout Cookies; (4) test security capabilities related to receipt and delivery of SNS assets; (5) complete this task in a timely manner with all cookies delivered and accounted for without damage; (6) provide safety training for staff and volunteers to minimize risk of injury; (7) offer opportunities for other county organizations, including news media, to observe a public health emergency preparedness drill; and (8) manage internal and external volunteers.
In the past three years, the innovated approaches were implemented in the annual SNS drills, and these goals and objectives were achieved. The drills were conducted in February and March when a blizzard could occur and cause school and office closings while snow is common for many winter days in Oswego County.
By using thousands of boxes of Girl Scout cookies as stand-ins for the likes of antibiotics, vaccines or respirator masks, the health department, involving regional Girl Scout Troops and other community partners, demonstrated how it would distribute medical supplies in an SNS emergency. In every drill in the past three years, the county was able to activate its emergency response operation within 60 minutes. A tractor trailer truck delivered nearly 30,000 boxes of cookies to the Oswego Highway Department’s garage. Oswego County staff volunteers unloaded, sorted and processed the cookies for shipment. These shipments either were picked up by Girl Scout parent-volunteers or delivered by County Highway Department staff with trucks to distant sites where local scout leaders picked up their orders. All of these were completed without error in less than several hours, within normal business hours, after the inventory was received.
Factors leading to the success were: community involvement, planning and improvement, partners' commitments, pre-drill training, a real value commodity (Girl Scout cookies), and most importantly complemented goals and tasks between the health department and the principal partner.
This drill impacts local public health emergency preparedness in many ways: (1) it built the department’s readiness to receive, distribute, and manage a large quantity of supply accurately and timely, (2) it tested the capacity of the department to involve many partners to work in response to public health emergencies; and (3) through the media, Girl Scouts, and partners, emergency preparedness messages spread in the community. Additionally Closed Points of Distribution (POD) partners came to the drills as observers, for education and training, to effectively run a POD during a public health emergency.
Planning and preparation are the foundations of effective emergency response and recovery. Over the past several years, the New York State Department of Health (NYSDOH) has required local health departments (LHDs) to make sure that every county will be ready for emergency events.
No community, large or small, is immune to natural or man-made disasters. When they do occur, a quick and efficient public health response is crucial to reduce injury, prevent or control illness, and save lives. LHDs should promote local readiness, foster community partnership, and ensure a resilient, comprehensive and efficient response, should disaster strike.
Threats to public health are always present but have often been overlooked by the public, especially in rural areas where residents are geographically disconnected. Oswego County considers itself to be particularly vulnerable from three nuclear power plants, a great lake port, extreme winter weather and a rural population. In the event of a large-scale emergency, it is the commitment of OCHD to have a mechanism in place to receive, store and deliver vital assets of the SNS.
The SNS drill is created for a better response by providing large quantities of essential medications and equipment when local or regional supplies have been exhausted in a real emergency. Receiving and distributing large amounts of medical supplies requires coordinated capabilities; strength in one category is unlikely to compensate for deficiencies in the other. Preparing before real events, for the worst, is vital to Oswego County's response and recovery efforts during an actual emergency. For a rural county like Oswego, the challenges are: How to increase the public awareness of preparing for an emergency? How to involve multiple partners? And how to engage hundreds of residents for more than a couple hours to achieve a meaningful emergency preparedness drill?
In the past, planning and exercising for SNS operations typically consisted of table top or simulated activities, with agencies sending and receiving requests by faxing, or sitting around a table sliding papers to partners, or delivering empty boxes. Therefore, the Oswego County Health Department had not fully tested its capabilities to respond to SNS activation with real community involvement, asset accountability, and volunteer management before these innovative drills were introduced.
Since 2013, each year, OCHD has involved close to two dozens of troops consisting of more than 300 girls and parent-volunteers from the Girl Scouts NY PENN Pathways region to participate in the drills. The target populations for the drills were from the regions including the City of Oswego, Town of Parish, Town of Mexico, and Village of Lycoming representing a total population of over 32,500, more than a quarter of the county's population. The drills used Girls Scout cookies simulating medical supplies and reached 100% of the targeted populations in the allotted time frame.
These new drills replicate an almost real-life emergency response event with a real valuable commodity. They fully involve community partners and volunteers. Everyone in the drill handles an actual commodity and contributes to the final accuracy and timeliness. Attention to detail, safe handling of assets, engagement of dozens of volunteers, ensuring every participant's safety, security of assets and public information were all addressed in a real event approach. These are things that often cannot be fully imitated in a table top exercise. Without the involvement of Girl Scouts, it would be difficult to get the required number of people to complete drills for a rural county like Oswego.
The creative use of existing practices by involving Girl Scout troops, include:• Using Girl Scouts’ connections to their families and individuals in the community as an effective way to reach and involve rural residents, and to promote emergency preparedness messages in rural communities;• Using Girl Scout Cookies as an actual commodity with real value to challenge participants and increase their enthusiasm and responsibility;• Setting the drill date within a severe weather condition period is a true test for building the community’s resilience in emergency response; and• Providing Closed POD partners opportunities to observe drills and to increase their knowledge and skills needed for their emergency preparedness roles.
The current practice is not evidence-based and does not address any CDC Winnable Battles. However, the development of capabilities to rapidly distribute and dispense medical countermeasures to large populations in response to an emergency remains a national priority. The bioterrorist attack of 2001, Hurricanes Katrina and Sandy, the H1N1 pandemic and the Ebola outbreak posed significant challenges to the public health infrastructure and exposed significant gaps in multi-sector coordination and response. It is particularly important for rural LHDs to creatively explore sustainable community involvement in simulated real-life situations for true public health emergency preparedness.
Goals and objectives of this drill were based on CDC outlined Public Health Emergency Preparedness (PHEP) capabilities:
The goal was to exercise the new SNS plan that extensively involved community partners and simulated real-life responses to an emergency.
• Capability 1: Community Preparedness- Functions 2-4o Build Community Partnerships to support Health Preparedness.? Specifically: Build community partnerships for public health emergency preparedness in the County.o Involve community organizations to foster public health, medical and mental/behavioral health social networks.? Specifically: Offer opportunities for other county organizations, including news media, to observe a public health emergency preparedness drill.o Coordinate training or guidance to ensure community involvement in preparedness efforts.? Specifically: Offer multiple pre-training opportunities to enhance involvement and preparation.
• Capability 3: Emergency Operations Coordination: Function 2o Activate public health emergency operations.? Specifically: Test capabilities to activate public health emergency operations in less than 60 minutes.
• Capability 8: Medical Countermeasures Dispensing: Function 2o Receive medical countermeasures.? Specifically: Receive (unload), re-pack according to orders, and distribute and deliver Girl Scout Cookies. In this plan, cookies simulate medical supplies, and local Girl Scout Troops simulate healthcare facilities/providers.
• Capability 9: Medical Material Management and Distribution: Function 4-5o Establish and maintain security.? Specifically: Test security capabilities related to receipt and delivery of SNS assets.o Distribute medical countermeasures.? Specifically: Complete this task promptly with all cookies delivered and accounted for without damage.
• Capability 14: Responder Safety and Health: Function 3o Coordinate with partners to facilitate risk specific safety and health training.? Specifically: Provide safety training for staff and volunteers to minimize the risk of injury.
• Capability 15: Volunteer Management: Function 1-4o Coordinate volunteerso Notify volunteerso Organize, assemble and dispatch volunteerso Demobilize volunteers? Specifically: Manage internal and external volunteers.
The following objectives were expected: (1) build partnerships with the Girl Scouts of NY PENN Pathways, Sheriff’s Department, Highway Department, and Closed POD partners; (2) test the capability of activating public health emergency operations in less than 60 minutes; (3) use Girl Scout Cookies to simulate medical supplies (assets), (4) inventory, pack, re-distribute orders of the assets; (5) test security capabilities provided by the Sheriff’s Department on route and at the receiving site for distributing and delivering cookies; (6) complete the assets receiving and dispensing in a timely manner without error or damage; (7) provide pre-drill training for staff and volunteers; and (8) coordinate volunteers from Girl Scouts and other county departments.
The following outlines the community involvement and drill operation in one of the three drills held on March 12, 2014:In November 2013, the Oswego County Health Department held three training sessions for potential Closed POD partners. Sixteen community organizations came to the training and learned about the SNS process and the local responsibility in Public Health Emergency Preparedness. After the training, four organizations officially signed on as Closed POD partners. These four cover 20,000 residents, either by direct employment or through related family members. Later, the four Closed POD partners were invited to observe the upcoming SNS drill.
In January 2014, Oswego County Health Department (OCHD) reached out to the Girl Scouts of NY PENN Pathways, as the primary stakeholder, and met the troops with information on general emergency preparedness and SNS operations. The following points were explained at the meeting: why the SNS drill was relevant to the Girl Scouts’ mission, why Girl Scout cookies were ideal for testing the county’s capabilities in emergency preparedness, and how a collaboration would reach a win-win situation. Through the drill, the Girl Scout troops would be able to receive their sorted cookie orders in a timely manner, and the OCHD would be able to exercise its capacities in response to an emergency. Girl Scout troops agreed that (1) they would spread public health emergency preparedness information in the communities, and (2) troops would come to the county garage to pick up their orders or wait at off-site locations in different towns/villages for the County Highway Department to deliver their orders.
Next the health department set out to garner the support of other county departments that were needed to make this project successful. First was the County Highway Department, since their facility, equipment, trucks, and manpower were needed to make the drill work. Giving that the time frame for cookie deliveries was still well within the Highway Department's busy snow season, this was a concern. Once realizing the importance of the drill for smooth highway functions in the event of a true emergency, the Highway Department agreed without hesitation.
Next, the Sheriff’s Department was approached. Public health emergencies pose unique challenges for law enforcement, whether the threat is man-made or naturally occurring. Policing strategies will vary depending on the cause and level of the threat, as will the potential risk for the responding officers. In a public health emergency, law enforcement will need to coordinate its response quickly with public health and medical officials, many of whom they may not have worked with previously. Depending on the threat, law enforcement's role may include enforcing public health orders (e.g., quarantines or travel restrictions), securing the perimeter of contaminated areas, securing health care facilities, controlling crowds, investigating scenes of suspected biological terrorism, and protecting national stockpiles of vaccines or other medicines. For the SNS drill, the sheriffs would be required to provide security. They agreed to participate and provide two officers: (1) an officer to man a checkpoint leading to our receiving, storage and shipping site, and (2) an officer to escort the deliveries made to the community.
Other county departments also got involved. The Promotion and Tourism Department helped notify media of the event, manage media coming to the event, and took photos at the event. Staff in the departments of health, personnel, buildings and grounds were also recruited for volunteering in the drill.
In February 2014, four training sessions were held providing an overview of different roles with different partners and participants in the SNS drill. All Oswego County Health Department Staff, key Girl Scouts of NY PENN Pathways volunteers, all Closed POD partners, and other County Departments with staff participating were invited to attend these sessions. In addition, another four sessions were held to provide safety practice for all participants prior to the drill, focusing on moving and lifting boxes safely to prevent injury, use of hand carts, safety around tow motors and forklifts, and slips, trips, and falls prevention.
The drill was scheduled to be held during normal business hours for the Health Department, 8:30-4:00 on March 12, 2014. As luck would have it, Winter Storm Advisories were issued for the day but the drill was rolled out as planned. Snow totals ranged from 8-16 inches for the area, high winds brought visibility to under a half mile, with blizzard conditions being reported. On the day of the exercise:
1. Staff call out was scheduled using a state electronic system, that would send automated calls and emails to participants, but it failed due to internet connection issues. The tractor trailer carrying 29,000 boxes of Girl Scout cookies arrived at the Highway Garage at approximately 9 am, about one hour earlier than expected.
2. Since the electronic notification system failed and the truck arrived early, phone and other means of notification started at 9:05 AM to all 35 volunteers, asking them to report to the County Highway Garage immediately.
3. Security was in place with a Sheriff’s Deputy checking identification of participants and media as they arrived on scene. The second deputy was stationed with the assets.
4. Just-in-Time training was provided at the County Highway Garage for a review of participant's roles and responsibilities, and safety practices to all volunteers.
5. Highway Department staff unloaded Girl Scout cookies from the tractor trailer. Cookies were inventoried by type and quantity of cookie and compared to the bill of lading. All cookies were accounted for by inventory control staff and re-stacked to assemble the orders for each of the 22 Girl Scout troops.
6. Once orders were assembled, they were checked by our Quality Assurance team for accuracy. Some stacks were waiting for pick up by the troops and others were loaded by forklift onto Highway Department vehicles for delivery to the distant sites. When trucks left the facility with the cookie assets, they were escorted by a Sheriff’s Deputy.
In all, 16,452 boxes of cookies were packed and delivered to these three locations. The remainder 12,548 boxes of cookies were picked up by Girl Scout “cookie parents”. In addition to their cookies, each Girl Scout troop was given information on emergency preparedness.
In addition to the county employees and Girl Scouts that participated, one Closed POD partner came to observe (another was scheduled but was not able to attend because of the snow storm), five representatives from the local media came to cover the drill, and the local Zonta Club provided hospitality for exercise participants, offering lunch and coffee.
The Oswego County Health Department has been continuing to foster community involvement. It makes staff available to attend meetings of local community groups, provides staff in-service training and invites partners to come to additional training when possible. It continues to keep partners informed. The department realizes the importance of maintaining and testing its capabilities and meeting deliverables, and continues to involve Girl Scout volunteers in emergency preparedness. Since the drill on March 12, 2014, the department has conducted two additional drills partnering with Girl Scouts of NY PENN Pathways, and offered closed POD partners additional opportunities to participate in and observe Emergency Preparedness Activities.
There was no extra cost for all county departments, other than Sheriff’s Department, as the drill ran during normal business hours. The only additional cost was to cover the overtime for the two County Sheriff’s Deputies since the task was considered a special assignment.
Through the three innovative drills, the health department was able to determine that the plan in place for SNS was practical and achievable and that there is a workforce with appropriate skills able to complete the local SNS mission through community involvement. Each of the drills was able to test successfully many of Public Health Preparedness Capabilities, collect feedback from participants and observers, and make appropriate adjustments to improve the plan. The department was able to test successfully and complete the capabilities and functions via these drills.
The following is an itemized review of the drill held on March 12, 2014, against the CDC’s outlined Public Health Emergency Preparedness (PHEP) capabilities:• Capability 1: Community Preparedness- Functions 2-4o Build Community Partnerships to support Health PreparednessResults: 22 Girl Scout Troops from NY PENN Pathways and several county departments participated in the drills.o Involve community organizations to foster public health, medical and mental/behavioral health social networksResults: One Closed POD partner observed, and one planned to come but was not able to make it due to the weather. Five local media attended the drills. Public health emergency preparedness information was spread via Girl Scouts in one small city, two towns, and one village.o Coordinate training or guidance to ensure community involvement in preparedness effortsResults: (1) Presentations were made to 11 Girl Scout Troops. The ripple effects of these presentations attracted a total of 22 Troops that ended up participating. All 22 Troops that participated received informational handouts on Emergency Preparedness prior to the drill. (2) All Health Department staff and some staff from other county departments were trained in emergency preparedness and safety practice. (3) The public was informed on these drills.
• Capability 3: Emergency Operations Coordination: Function 2o Activate public health emergency operationsResults: The electronic system that was supposed to initiate the drill failed due to internet connection issues that day. Alternate means of communication were used. First off-site staff arrived at the County Garage approximately a half hour later than the originally scheduled time, with all staff reporting to the drill within one hour of the call out.
• Capability 8: Medical Countermeasures Dispensing: Function 2o Receive medical countermeasuresResults: Tractor Trailer containing 29,000 boxes of Girl Scout Cookies arrived at the drill location at approximately 9:00 am. Cookies were unloaded and completely inventoried by 11:00 am. All cookies were accounted for.
• Capability 9: Medical Material Management and Distribution: Function 4-5o Establish and maintain securityResults: Two Deputy Sheriffs participated. One established a checkpoint leading to the drill facility and requested identification that was cross-checked with a list of participants, including media press credentials. The second Deputy escorted Highway Department vehicles and staff on deliveries of cookies to Girl Scout locations in different towns and villages.o Distribute medical countermeasuresResults: 16, 452 boxes of Girl Scout Cookies were delivered by exercise personnel to 3 external sites. The additional 12, 548 boxes were split into separate troop orders and picked up at the drill location by Girl Scout volunteers. No errors occurred. All orders picked and packed correctly, and delivered without damage.
• Capability 14: Responder Safety and Health: Function 3o Coordinate with partners to facilitate risk specific safety and health trainingResults: Prior to the exercise, four safety training sessions were held for the participants.
• Capability 15: Volunteer Management: Function 1-4o Coordinate volunteersResults: Outreach was done with 11 Troops and two area Service Units of NY PENN Pathway Girl Scouts to get permission for participation in this exercise.o Notify volunteersResults: Volunteers were included in a state electronic system for notification by automated phone calls and emails. Internet problems caused electronic system failure on March 12, 2014, volunteers and participants outside of the Health Department Building were notified via manual phone calls; the Health Department intercom system was utilized to notify OCHD staff.o Organize, assemble and dispatch volunteersResults: Volunteers, staff, and media observers were asked to sign in, they were given color-coded vests according to functions, and the Just-In-Time Training outlined everyone’s roles, responsibilities, and safety measures.o Demobilize volunteersResults: Prior to the drill, Girl Scout volunteers were contacted and advised to come to the County Garage at different time slots to pick up the cookies to avoid traffic jams or delays. Once the job was completed, volunteers were asked to sign out, return vests and any equipment used, and was given an evaluation form to complete.
Oswego County Health Department has been involved with the Girl Scouts of NY PENN Pathways in Emergency Preparedness drills since 2012. Both sides are committed to the partnership. Most recently the health department and the Girl Scouts of NY PENN Pathways partnered in exercising Medical Countermeasures (MCM) Distribution plan. The exercise successfully put through over 400 people in less than 2 hours. Without Girl Scouts’ involvement, it is difficult to get this volume of people in such short period of time for a rural county. The partnership between Oswego County Health Department and the Girl Scouts of NY PENN Pathways will sustain and strengthen in the coming years.
An important lesson learned from these years is that the partnership between Oswego County Health Department and the Girl Scouts of NY PENN Pathways becomes successful because both sides have needs and these needs complement each other. The Oswego County Health Department is challenged to build and test emergency preparedness capacities that require significant planning, manpower participation and the delivery of supplies in a small window of time, due to the nature of its rural setting. And the Girl Scout troops are challenged to receive, sort and distribute cookies according to different troop orders in a short period of time. By involving Girl Scouts on an annual basis, the health department is able to exercise staff capabilities, test additional capabilities, train new staff, refine emergency response plans, and expand community partners; the Girl Scouts is able to receive their cookies promptly without any error.
Other than lessons learned for adjusting, refining and improving the drill processes over these years, lessons about community involvement learned through these drills/exercises include:
To invite the media generates big impacts in the community. The media highlighted the function of local public health in emergency preparedness and promoted preparedness information in the community that often goes unnoticed.
To invite Closed POD partners to observe SNS drills demonstrates the benefits of community involvement and facilitates Closed POD partners' planning their drills.