CRITICAL BENCHMARK #9: Assess current epidemiologic capacity and prepare a timeline for achieving the goal of providing at least one epidemiologist for each Metropolitan Statistical Area (MSA) with a population greater than 500,000.

This Benchmark is met; the Bureau of Epidemiology has completed an assessment and verified there is at least one professional epidemiologist in each MSA with a population of over 500,000. The FDOH has recently enhanced the state’s epidemiologic capacity (6 new epidemiologists) through the creation of the Florida Epidemic Intelligence Service. With resources from this cooperative agreement, the size of the Service will double (Objective 3 and Critical Capacity C, Objective 4). Additionally, resources from this cooperative agreement will allow county health departments to hire non-EIS epidemiology staff (Objective 3).

During the past three years the Florida Department of Health has made considerable progress in the development of its plan to respond to potential terrorist events. The state’s response capabilities were emphatically tested during the anthrax event in the fall of 2001. While gaps were identified in the response effort, overall the state’s plan worked effectively.

The Florida Department of Health has a well-organized system of disease outbreak response with a focus on the initial action occurring at the county health department (CHD) and a partnership between the county health departments and the state health office. The anthrax attack of October 2001 clearly illustrates the effectiveness of this partnership. The initial case was identified by an astute clinician, who reported his suspicion to the county health department. The CHD director sought consultation from the state epidemiologist, who notified the State Health Officer who, in turn notified CDC and initiated state level assistance. Within hours, an epidemiology assistance team was on the ground at the site, the CDC was en-route and an emergency operations center had been opened. In any outbreak event, bioterrorism or otherwise, outbreak assistance is available from the state health office to all county health departments 24 hours a day seven days a week through its on-call epidemiologists. In addition, with post-anthrax funds received from the state legislature, the state has implemented The Florida Epidemic Intelligence Service, which provides six epidemic intelligence officers (based in county health departments) to add to its rapid response plan and ensure that all state metropolitan areas are served with adequate epidemiology personnel.

Following the anthrax event, the Florida Department of Health accelerated its bioterrorism response planning. Senior managers representing the state office and county health departments participated in a series of "hot washes" to review activities related to the anthrax response. Problems identified became part of a "task list" for incorporation in further bioterrorism plans. Also following closely behind the anthrax outbreak was a governor’s staff level smallpox tabletop exercise. More issues were brought into the planning process. A "model" preparedness and response plan was developed using the CDC smallpox response plan, which was released during the anthrax event. The Florida smallpox response plan is modeled closely after the CDC plan and guidelines. This plan addresses communication, pre-event development, response needs, surveillance, epidemiologic investigation, surge capacity, patient mitigation, mass immunizations and prophylaxis, etc. The Bureau of Epidemiology conducted a series of weekly teleconference "training sessions" with county health department and state office staff to review the components of the plan. It has been developed as a "living document" and will continue to be updated and modified in order to effectively plan and respond to a potential smallpox outbreak. It will serve as the "gold standard" for the continued development of the state’s overall bioterrorism preparedness and response plan.

Epidemiologic and bioterrorism response training has been developed and implemented via regional training workshops, a yearly statewide epidemiology seminar, grand rounds Development and implementation of trainings sponsored by the state health office are ongoing. Several different media forms such as phone conferencing and satellite broadcasting are being used and evaluated to allow for the best possible access and participation to all state and local health department employees.

An important part of the investigation and response plan is information transfer through effective and organized communication. The state health office has mass fax capabilities to public and private physicians and facilities, the Epi Update a newsletter delivered via email to over 1000 public and private constituents, portable communication devices have been purchased and outfitted to state health office professionals who will be key in responding to terrorist events, and the Epi Com system which is being developed to provide internet access to key public and private health professionals for reporting outbreaks or other identified abnormal events. The Epi Com system will also provide a forum for identified professionals to share key epidemiologic information.

The Florida Department of Health response plans have served adequately but can be improved by addressing the following needs:

• There is no clear plan for non-declared emergency events or bioterrorism surveillance.

• The county health departments need a standardized epidemiology investigation plan and handbook.

• The state health office and county health departments need to improve the plan and development of activities to reach more private physicians and healthcare professionals.

• The lack of surge capacity was identified as a key problem at the anthrax "hot washes."

• Communication from the epi-center to the state health office was identified as another weakness.

• Not all county health departments have a 24 hours a day, 7 days a week response plan and adequate epidemiology trained staff to respond to outbreaks, a bioterrorism event, or other health emergencies.

• The state health office needs to improve the county health department regional training plan, frequency, and drills.

• A hospital training plan needs to be developed to address the general lack of understanding of the importance of epidemiologic surveillance within the general population and the hospital setting.

The Florida Department of Health will improve all aspects of its comprehensive epidemiologic response plan in order to rapidly and effectively respond, investigate, and resolve all potential terrorist events.

• The Florida Department of Health will finalize the state emergency operations plan, terrorism plan, and bioterrorism plan.

• The Florida Department of Health will provide standardized epidemiologic response materials to support county health department event response.

• The Florida Department of Health will ensure the collaboration of all partners in the development of response plans and materials.

• The Florida Department of Health, state health office will provide staff and epidemiology/surveillance support to county health departments when requested.

• The Florida Department of Health will provide hospital training in epidemiology and surveillance (coordinated with focus area "G").

1. By October 15, 2002, the Florida DOH will have completed a final plan for surveillance and epidemiology which includes the state health office, county health departments, hospitals, and others providers and healthcare agencies.

2. By November 01, 2002, all county health departments will have the capacity to receive disease reports and/or key information 24/7 in order to respond to an outbreak or potential bioterrorism event.

3. By November 30, 2002, the state health office and county health departments will have increased staff and completed a plan to ensure 24/7 response to an outbreak, potential bioterrorism event, or other health related emergency.

4. By December 31, 2002, the state health office and county health departments will have updated the Florida Smallpox Response Plan and Guidelines.

5. By August 31, 2003, the Florida DOH will have conducted a regional epidemiology and surveillance hospital training program in four out of seven regions of the state. The program focus areas will be: disease and infection control awareness, surveillance and epidemiology, communication, and planning.

6. By august 31, 2003, the Florida DOH will have conducted bioterrorism training and drills with the county health departments in four out of seven regions of the state.