Submitted on Tue, 2014-11-04
By SMART Health Claims

Learn about the most important parts of the Ebola response for public health departments from Kirstin Short, Bureau Chief, Public Health Preparedness at Houston Department of Health and Human Services.

Houston HHS Interview

Our many thanks to Kirstin and the City of Houston, TX for taking the time to speak with us today about the important Ebola issue that faces local health departments. Her actionable advice on preparedness and response provide a wealth of insight for public health leaders everywhere.

Since local health departments play an integral role to isolating the impact of Ebola, it’s important for each one to be prepared for a case in their community. The Ebola virus is wreaking havoc throughout Africa and recently made its way onto American soil. The virus has infected more than 8,000 people in Western Africa so far this year, with a mortality rate of roughly 50%.

Find out how Houston’s health department is preparing for Ebola as Kirstin Short; Bureau Chief, Public Health Preparedness at Houston Department of Health and Human Services walks you through the most important things your local health department needs to do to get ready.


“There are two things every health department needs in preparation for Ebola”

  • Communication - ensure everybody knows the protocol for responding to a potential Ebola case by getting on the same page with departments and organizations throughout your community. One weak link in the chain could help the virus continue its spread. Have the processes in place so that all decision makers of the Ebola response meet frequently to talk through all the contingency plans for the potential outbreak.
  • 24/7 Notification System - provide your community with a singular place to call for reporting potential Ebola cases. 24/7 is important because you don’t want to find out about an Ebola case on Monday morning when it was called into your department on Friday night.

“Make sure you know who everybody is and make sure they know who you are too”

The main component of Ebola preparedness for local health departments is effective communication. There are so many moving parts involved in an outbreak response, therefore, you need to be absolutely certain everyone knows their role and can carry it out effectively. Forgetting to contact even a single responding organization could create one weak link in the chain and lead to further infection. At minimum, you want to be in touch with the following groups:

  • Neighboring Health Departments - form partnerships with other public health professionals nearby. In Houston’s case, their constituents also are part of the Harris County Public Health and Environmental Services Department, so the two local health departments work very close together to share resources and spread their messages more effectively.
  • Hospital and Non-Hospital Providers - alert local health departments for potential Ebola cases should it meet the case definition including a risk factor like travel to a country with active transmission (currently Guinea, Sierra Leone, and Liberia). Your hospitals will have the isolation treatment rooms necessary to combat Ebola, so you need to make sure they are ready. Education is key when working with healthcare providers. Make sure they are aware of Ebola’s symptoms and are performing risk assessments effectively. Make sure that all providers understand that they must call your department to alert you of any potential Ebola cases. Local health departments are vital for contact investigation and need to be brought in as soon as possible to stop the spread.
  • Medical Examiner’s Office - make a plan for the unfortunate event that a patient with Ebola were to expire. Safely handling the deceased body is of the utmost importance. Ebola patients are still highly contagious after death, one of the major reasons the disease reached its current levels in West Africa.
  • Academic Partners – Convene meetings to make sure you continue to remain informed of the best ways to halt the spread of the disease. Your academic partners should also support scientific inquiry and community risk education.
  • Emergency Management Partners - get everything you need from the professionals whose jobs are to manage emergencies. Your local office of emergency management will provide you with a lot of resources and hook you into the state/local resource request systems so you can tell them what you may end up needing down the road. It helps get the entire supply chain ready for the response.
  • Decontamination Partners - work with your legal department to make sure you have the agreements in place with qualified contractors so that contaminated waste is disposed of effectively.
  • Schools - work with school nurses and administrators to ensure they are on the lookout for signs of Ebola. Having hundreds of kids in a confined space can leave them more susceptible to a quick spread of disease. It is important for schools to continue normal operations, and make attendance decisions based on science and not fear. They should also encourage parents to do likewise and continue sending their children to school.
  • EMS - prepare your paramedics, police, and firefighters to respond effectively to Ebola and patient transport. They should also be ready to enforce necessary quarantines placed on the population.
  • Local Health Authority - learn more about what happens if you need to issue a Control Order for limitation of movement. You will also need to determine the cases where you’d place those orders. It may not be appropriate to issue them to everybody who has come into contact with the infected, but where do you draw the line?
  • Media - make sure the information they’re reporting about is accurate and fits with the best practices needed to control the spread of the disease.

“Everything that we're doing now is built off of the Preparedness Program Plans that we have for responding to any outbreak.” 

While the Ebola threat may be relatively recent, the response planning for Ebola and other diseases is not new. Houston’s preparedness program has been thriving for years and has been the basis for Ebola planning. Local health departments have been preparing for an event of this nature for a long time, so use your experience to help guide you through the Ebola response.


“Field testing will give you a lot of information to chew on that wouldn’t have come up otherwise”

Houston ran a patient transport drill a couple months ago to see just how prepared they were. From receiving a phone call, to assessing the patient, and then transporting them to the local hospital, the entire healthcare system in Houston was involved in the testing. Houston has learned a lot about the most effective ways to manage hand-offs and how the fire department, paramedics, and hospital teams work together. There were also a few other unforeseen lessons that popped up. For example, it’s almost 90 degrees with 75+% humidity in Houston today. How do you plan for having to wear a heavy HAZMAT suit all day in that type of heat? Without testing beforehand, the city wouldn’t have been fully prepared to keep their first responders safe.


 “Use Ebola as an opportunity to spread awareness about other vital preventative care services”

It’s a busy time for local health departments as vaccination season is upon us. To further stress the importance of preventative care throughout your community, you can actually use Ebola as an opportunity to do so. The early symptoms of the flu and Ebola closely mimic one another, so getting a flu shot can be a great way to save people from worrying about having Ebola at the first sign of illness, and reduce the number of false alarms being reported to our healthcare systems. Tens of thousands of people die every year from preventable flu-related deaths. Getting more people vaccinated will definitely help improve your community’s overall health.


“Budgets may be tight, but Ebola is something we need to fight”

There may be some additional strain on the system, but beating Ebola is too important to ignore. Much has been made about public health funding cuts recently, and while they certainly aren’t making our jobs easier, we must all still find a way to get the job done. Just like with the work police officers and firefighters do, fighting Ebola is a task that needs to be handled regardless of funding, so you just need to get out and do it. In order to do more with less, engage in constant communication with other healthcare organizations to ensure that your work isn’t being duplicated and that you are pushing out information jointly to larger communities. Work together to make the entire system more effective and efficient.

Coincidentally, Kirstin ended up with a stomach bug or GI virus last weekend and called her provider to go through her symptoms and see what her next steps for care would be. Right after she was through describing her symptoms to the triage nurse, the first question they asked was “Have you traveled out of the country recently?” As a public health professional, she was very glad to hear the triage nurses were doing their due diligence to check for Ebola.

We’re helping to spread awareness and learning how other departments utilizing the SMART billing suite are preparing for the potential Ebola outbreak in America. If you have advice that you think is important for the rest of America’s health departments to know in preparation for Ebola, contact us today and we’ll give you the platform to spread your message.

*The views expressed in this interview are those of Kirstin Short and the city of Houston, and may not reflect upon those of the state of Texas.

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