Introduction to NC Epi Teams

Presentation Overview

• What is an Epi Team?

• Who belongs to an Epi Team?

• What are the responsibilities of an Epi Team?

• How does an Epi Team function?

• What are some examples of Epi Team investigations?

Learning Objectives

• List the roles on a local health department Epi Team

• Describe the four (4) primary responsibilities of an Epi Team

• Give an example of a successful NC Epi Team investigation

What is an Epi Team?

• Multi-disciplinary public health team

• “The purpose of an Epi Team is to prevent, respond to, and recover from disease outbreaks and other public health threats identified in the community.”

Epi Team Roles

• Team Leader

• Epidemiologist

• Microbiologist

• Environmental Health Specialist

• Interviewer(s)

• Clinician

• Media Spokesperson

Team Leader

• Description– Experience in outbreak investigation and

epidemiology– Leader may be different for different

outbreaks– Role can be filled by:

• County health director• Public health nurse • Epidemiologist• Environmental health specialist

Team Leader

• Responsibilities– Convenes Epi Team– Provides oversight for investigation– Assigns tasks to other team members– Serves as contact with other agencies– Conducts regular meetings– Facilitates outbreak interventions– Reports outbreaks

Epidemiologist

• Description

– Expertise in field epidemiology methods

– Experience developing case definitions

and questionnaires

Epidemiologist

• Responsibilities– Tracks surveillance data

– Creates case definitions

– Maintains line listing of cases

– Trains team members on case finding and follow-up

– Provides daily reports on case finding and case

counts

– Ensures data quality

Clinician

• Description– Training in medicine, nursing

– Knowledge of disease prevention and treatment

– Experience in health education

Clinician

• Responsibilities– Consults regarding disease signs and

symptoms, transmission, incubation period, and treatment

– Administers vaccines and prophylaxis

– Collects clinical specimens

– Educates cases and contacts

– Visits health care providers

– Monitors contacts for symptoms

Environmental Health Specialist

• Description

– Experience with environmental field

investigations

– Knowledge of food and water safety

regulations

– Knowledge of environmental sampling

Environmental Health Specialist

• Responsibilities

– Monitors environmental surveillance data

– Conducts field investigations and traceback

investigations

– Collects environmental samples

– Provides guidance on food and water safety

regulations and engineering

– Implements facility-related control measures

Public Information Officer

• Description

– Experience developing media messages

– Knowledge of risk and crisis communication

Public Information Officer

• Responsibilities

– Reviews provider and public alerts, fact

sheets, and reporting reminders

– Prepares/reviews press releases

– Responds to media inquires

– Ensures availability of appropriate educational

materials

Laboratorian

• Description

– Expertise in laboratory testing

– Knowledge of proper specimen collection and

transport procedures

Laboratorian

• Responsibilities

– Provides information on proper collection and

transport of clinical specimens

– Coordinates submission of specimens to

State Laboratory of Public Health

Administrator

• Description

– Knowledge of local health department

policies and procedures

– Experience handling staff expenses

Administrator

• Responsibilities

– Distributes meeting agendas

– Records minutes and keeps records of

meetings

– Tracks staff expenses (overtime, travel

reimbursement)

– Assures after hours building and cell phone

access

IT Specialist

• Description

– Knowledge of local health department

computer system

– Experience with database development

and management

IT Specialist

• Responsibilities

– Assists in database development,

modification, and maintenance

– Provides technical support

– Assists with data entry

– Equips team with necessary equipment

Responsibilities of an Epi Team

• Coordinate disease surveillance activities

• Conduct epidemiologic investigations

• Gather and analyze information from investigation

• Implement public health control measures

• Educate the public

Coordinate Disease Surveillance

• Monitor routine surveillance data

• Compare expected to observed numbers and rates

• Investigate reports from healthcare providers

• Confirm or refute rumors of outbreaks

Conduct Epidemiologic Investigations

• Define cases

• Find cases

• Collect data

• Analyze data

• Report findings

Gather and Analyze Information

Implement Public Health Control Measures

• Decide upon appropriate control measures

• Work with community partners to implement control measures

• Communicate necessity of control measures to affected groups

Educate the Public

• Assist hospitals or other healthcare facilities with outbreak management

• Provide guidance to agencies dealing with outbreaks– Institutional settings (e.g. long-term care

facilities, correctional facilities)

How Does an Epi Team Function?

• Communication

• Logistics

• Incident Command Structure

• Coordination with PHRST and DPH

• Resources

Epi Team Contact Information

• Maintain database of all team members– Name, specialty, best way to contact– Phone Numbers (work, home, cell)– Pager Number– Email Address– Emergency Contact

• Distribute to all team members

• Update regularly

Internal Communication

• Information flows in both directions – Leader should update Epi Team via

meetings, conference calls, or email

– Members provide regular updates to team leader

• Acts as tool for measuring progress• Enables leader to provide feedback and direction

to team members

Document Investigation Progress

• Keeps team members up to date

• Provides material for communication with external partners

• Can be used final report

Maintain Daily Log

• All steps taken in the investigation

• Decisions made and rationale

• Contacts: name, position, contact information

• Meeting Documentation– Minutes– Follow up actions and those responsible

• Photographs

External Communication

• Provide regular updates to external partners– NC Division of Public Health– Public Health Regional Surveillance Team– Local stakeholders – hospitals, healthcare

providers, other government leaders/agencies, community organizations

– General public

• Maintain routine communication

Epi Team Logistics

Incident Command Structure

How To Work in A Team

• Know what is expected

– Team member responsibilities

– Team member expertise

– Resources available for tasks

• Know your role

• Know who is in charge

Delegation

• Team leader will delegate tasks to appropriate team members

• Other team members may also need to delegate tasks when overwhelmed

• Assign an alternate team leader as a back-up

Stress Triggers

• Long hours, lack of rest

• Personal health and safety concerns

• Local sensitivities

• Unexpected or traumatic event

• Legal concerns

• Intense pressure to investigate quickly

• Interaction with multiple agencies

• Security concerns

Stress Management

Strategies:– Enough sleep, good nutrition– Strategic pauses– Using humor– Talking to someone– Visualization– Self-talk– Massage– Debriefing

After-action Discussions and Reports / Evaluation

• Identifies what worked

• Identifies what did not work

• Creates a record

• Can be used as a reference

Resources for Investigation

• Personnel

• Equipment

• Physical space

NC Epi Team Investigation

• DESCRIBE A SUCCESSFUL INVESTIGATION OF ONE OF NC’S EPI TEAMS – INCLUDE MISTAKES AND LESSONS LEARNED

NC Epi Team Investigation 2

• DESCRIBE A SUCCESSFUL INVESTIGATION OF ONE OF NC’S EPI TEAMS – INCLUDE MISTAKES AND LESSONS LEARNED

Conclusion

• Working as a team requires:– A wide range of expertise– Clear communication– A rapid but careful and systematic approach

in dealing with outbreaks

References

• Butler JC, Cohen ML, Friedman CR, Scripp RM, Watz CG. Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response. Emerg Infect Dis 2002;8(10):1152-6.

• Frace RM, Jahre JA. Policy for managing a community infectious disease outbreak. Infect Control Hosp Epidemiol 1991;12(6):346-7.

• Sobel J, Griffin PM, Slutsker l, Swerdlow DL, Tauxe RV. Investigation of multistate foodborne disease outbreaks. Public Health Rep 2002;117(1):8-19.