Public health preparedness for bioterrorism, epidemics and other public health threats and emergencies involves all areas of the Department of Health and Environmental Control (DHEC). South Carolina is unique among the states, in that DHEC is the state’s public health agency and is also the state’s environmental protection agency, hospital and health facility regulatory agency, and ocean and coastal resource management agency. There are diverse, complex functions that must be coordinated in order to respond rapidly and successfully to an act of bioterrorism, a serious epidemic or other public health emergency. Emergency management and response functions are integrated into each program and into each employee’s job duties. These functions must be coordinated with the other state agencies and organizations involved in emergency preparedness and operations. This is done largely through joint planning and exercises carried out under the State Emergency Operations Plan.
Concept of Operations
The CDC Public Health Preparedness and Response for Bioterrorism cooperative agreement strengthens public health infrastructure for a response to bioterrorism, outbreaks of infectious diseases, and other public health threats and emergencies. Because this infrastructure includes many specific organizational units within DHEC, it is important to have an overall concept of agency operations to understand how the critical functions are integrated into the organization. Overall authority for emergency management for all hazards, rests in the Commissioner’s Office of Public Health Preparedness. Health Services manages the Bioterrorism Surveillance and Response Program in the Division of Acute Epidemiology of the Bureau of Disease Control. Health Services Bureau of Disease Control has responsibilities for emergency response to disease outbreaks and bioterrorism, as do the Bureau of Laboratories and the Bureau of Environmental Health. The Environmental Quality Control Division of Waste Assessment and Emergency Response has specific responsibilities for emergency management related to hazardous materials and radioactive materials.
Emergency Operations
Under the State Emergency Operations Plan, DHEC has leadership responsibility for two critical emergency support functions: ESF-8 Health and Medical Services and ESF-10 Hazardous Materials. In addition, DHEC plays an important support role in the emergency support functions of Public Works and Engineering; Information and Planning; Mass Care and Emergency Welfare Services; Search and Rescue; Animal Emergency Response and Specific Impact Hazards. Agency leadership and staff from all program and administrative areas are mobilized to staff the State and County Emergency Operations Centers, operate state and Regional DHEC Emergency Operations Centers, and participate in the emergency operations under the state plan. Many people participate in emergency operations, and they work in capacities that may have little to do with their regular duties in protecting health and the environment.
District Health Directors, District Public Health Preparedness Coordinators, nursing, environmental health and key management staff coordinate local public health response through County Emergency Operations Centers. Local public health staff, district surveillance and response coordinators and district epidemiology teams conduct investigations during disease outbreaks and may assist first responders during bioterrorism threats.
Environmental Quality Control staff provide an initial response to environmental emergencies. EQC program areas such as Drinking Water, Agricultural Wastewater, Waste Assessment and Emergency Response maintain an immediate response capability for hazardous material emergencies. EQC Disaster Coordination Team and Technical Assistance teams were created to respond to consequence management activities following an emergency. EQC provides technical expertise in the areas of hazardous materials identification and public safety/ health assessment, hazardous materials containment, countermeasures for local responders and SLED, and decontamination of team members and equipment.
EQC provides staff to the State Emergency Operations Center for ESF 10 duties related to chemical or radiological events and staffs the DHEC emergency operations center.
The Nuclear Response and Environmental Surveillance Section coordinates response to nuclear accidents or incidents at the four commercial nuclear power plant facilities in SC and other nuclear sites or in transportation-related radiological emergencies. The state has a radiological emergency response plan with detailed plans for each site, as required by the Nuclear Regulatory Commission. The section trains first responders in radiological hazards awareness. In the event of an emergency involving the release of radioactive materials, there are plans for evacuation, emergency medical response, and protection of food and water supplies.
The Bioterrorism Program takes the lead in responding to bioterrorism threats, attacks, or epidemic disease outbreaks. As part of the Division of Acute Disease Epidemiology, the Bioterrorism Section conducts disease outbreak surveillance and investigations. It provides communications, technical assistance, consultation, training and other support functions during emergency responses.
Bioterrorism Response
Bioterrorism involves a deliberately caused epidemic of life-threatening disease and represents a serious public health emergency. It is critical for South Carolina to have the capability to prevent or rapidly respond to acts of bioterrorism that could cause epidemic disease and mass casualties. Two federal cooperative agreements are providing South Carolina with funds to improve the preparedness of the public health and medical care system.
Public Health Preparedness and Response for Bioterrorism Program
The Public Health Emergency Preparedness Program strengthens public health capabilities for epidemic disease control and emergency response. The cooperative agreement with the US Centers for Disease Control and Prevention requires:
- Public health leadership for emergency management
- A state Bioterrorism Advisory Committee
- Assessment, planning and priority setting
- Review and updating of statutory authority
- State and regional medical emergency response plans
- Deployment plans for the National Pharmaceutical Stockpile
- 24 hour/7 day capability for disease reporting, epidemiology and response
- Biological laboratory testing
- Statewide Health Alert Network
- South Carolina’s National Electronic Disease Surveillance System
- Risk communication and public information, and
- Training for public health, medical, emergency and other personnel.
Under the State Emergency Operations Plan, DHEC is the lead agency for the critical emergency support functions of Health and Medical Services and of Hazardous Materials. The cooperative agreement supports the personnel and equipment needed to carry out these public health functions in the event of bioterrorism or other public health emergency.
Bioterrorism Hospital Preparedness Program
The separate, but related, Bioterrorism Hospital Preparedness Program cooperative agreement with the US Health Resources and Services Administration provides for:
- Assessment of response capacity and implementation of bioterrorism preparedness plans for hospitals and other health care providers;
- Training of hospital and other health care personnel in bioterrorism;
- Collaboration among state and regional emergency medical systems, emergency management agencies, public health departments, primary care providers, and law enforcement;
- Contracts with hospitals and health care providers to fund medical preparedness and response capabilities.
Preparedness Planning
The Office of Public Health Preparedness directs program management for the CDC and HRSA cooperative agreements and emergency management planning for the agency. Each Deputy area and the Regional Public Health Preparedness Coordinators are responsible for coordinating emergency operations plans and standard operating procedures for their organizational units. Plans required under the CDC and HRSA cooperative agreements include: state and regional plans for response for Mass Casualty Response, for the Strategic National Stockpile deployment, and for smallpox vaccination.
The eight Regional Public Health Preparedness Coordinators are responsible for public health emergency management functions at the county and health district levels, and work closely with the agency planners in the development of the regional mass casualty response plans. A Health Regulations planner and a trauma center coordinator support statewide development of mass casualty plans, hospital emergency plans, and trauma systems. In Environmental Quality Control, emergency preparedness planning activities center on response to radiological threats at fixed nuclear facilities and transportation of nuclear materials, and on response to incidents involving chemicals and hazardous materials. An EQC planner facilitates state and regional environmental emergency plans and participates in the agency’s overall public health preparedness plans. Each EQC Region has an emergency management and response coordinator. All of these plans represent the Department’s contribution to the State Emergency Operations Plan.
Surveillance and Epidemiology
Disease surveillance, investigation and control are the responsibility of Health Services. A senior public health physician was hired as Medical Director for Health Services to give overall direction to medical services. The Bureau of Disease Control manages the immunization, tuberculosis control, HIV/sexually transmitted disease control, disease surveillance, and acute disease epidemiology divisions. The Bureau of Environmental Health is responsible for food service inspection (including food borne disease investigation), vector control, dairy sanitation, on-site wastewater disposal and other sanitation programs. The Bureau of Laboratories is a key partner in disease surveillance and epidemiology efforts. There are epidemiology teams in each public health district, which include environmental health, nursing, disease investigation and other staff assigned to disease outbreak investigation duties. Under the cooperative agreement, there are full-time Region Disease Surveillance and Response Coordinators assigned to disease surveillance, epidemiology and emergency preparedness duties.
The cooperative agreement supports the Bioterrorism Surveillance and Response Program within the Division of Acute Disease Epidemiology, which houses the Department’s epidemiology and communicable disease experts. In addition, support is included for the development and implementation of the National Electronic Disease Surveillance system.
Laboratory
The Bureau of Laboratories facility has Level-3 biosafety capability for testing biological agents. Laboratory capacity for testing human tissue samples for chemical agents was added in the FY 2004 cooperative agreement. A full range of testing services is available. The cooperative agreement provides for strengthening the public health laboratory’s staffing, improving laboratory training capabilities, coordinating response activities with hospital laboratories, and purchasing needed equipment and supplies.
Health Alert Network / Communications and Information Technology
The Health Alert Network provides capability for emergency communications, protection of data and information systems, and the secure electronic exchange of public health information. The HAN is a statewide network providing connectivity among the public health districts, medical care providers and the central program offices. The network requires significant technical support, thus much of the grant funding for this function is dedicated to technical staff, equipment and communications. DHEC’s Health Alert Network is integrated into the REACH SC emergency notification system, in partnership with the State Emergency Management Division.
Risk Communication and Health Information Dissemination
The Commissioner’s Division of Media Relations carries out public information functions for the Department, including the execution of the agency's crisis communications plan for public health emergencies. Public information spokespersons are available in each of the public health districts, as well as in the central office in Columbia. Under the grant, the Division of Media Relations provides training, media and public relations, media research, internet technology and improved public information. Also, the division conducts risk communications training for DHEC employees, public officials and hospitals across the state.
Education and Training
The Commissioner’s Office of Quality Assurance is responsible for coordinating agency training functions. Under the cooperative agreement, training resources have been strengthened in the Division of Communication Resources, Division of Emergency Medical Services, and the Division of Acute Disease Epidemiology. Trainers coordinate bioterrorism-related training for DHEC personnel, emergency medical personnel, and other health care providers. The Division of Acute Disease Epidemiology in Health Services participates in training related to bioterrorism, infection control, and epidemiology. The EQC Division of Waste Assessment and Emergency Response conducts training and drills for nuclear and hazardous materials response.
For additional information, contact: (803) 898-3708