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2003 Model Practice Application (Public)

Application Name: 2003 Model Practice Application (Public) : Buncombe County Health Department : Buncombe County Forensic Epidemiology Team
Applicant Name: Gibbie Harris
Practice Title
Buncombe County Forensic Epidemiology Team
Submitting LHD/Agency/Organization
Buncombe County Health Department


The Buncombe County Forensic Epidemiology Team is a collaborative group of first responders that includes law enforcement, fire, HazMat, public health, hospitals, attorneys, EMS, and Emergency Management. The team's mission is to educate and collaborate on areas in which public health and law enforcement overlap, and to develop policies and procedures that will enhance mutual preparedness capacity for terrorism, weapons of mass destruction, and other disasters. The team grew out of the Centers for Disease Control and Prevention’s (CDC) Forensic Epidemiology program, which brings together public health and law enforcement, using didactics and small group discussion to create understanding and explore the viewpoints of both groups. Buncombe County extended this model by creating an ongoing work group for mutual education and specific efforts to improve community preparedness. The team’s current focus areas are local quarantine protocols, local field officer response protocols, and evidence collection protocols. The team's mission is to build knowledge and collaborate on areas in which public health and law enforcement overlap, and to develop policies and procedures that will enhance mutual preparedness capacity for terrorism, weapons of mass destruction, and other disasters. The target audience has been almost universally represented in the team.

Responsiveness and Innovation
The anthrax episodes of 2001 heightened awareness of the tension between the differing approaches of law enforcement and public health in evidence collection, information sharing, confidentiality, and differences in terminology, such as differing definitions of such terms as "case," "surveillance," and "evidence." CDC's Forensic Epidemiology course innovatively brings together law enforcement and public health to clarify differences and commonalities and to enable usually unprecedented one-on-one discussion between the groups. However, the CDC course has been aimed at national and state levels and was designed as a one-time presentation. Buncombe County saw that the Forensic Epidemiology model could be applied to an ongoing team to not only address the aforementioned issues, but also to form a collaborative group to address current community issues. Law enforcement, other first responders, and public health in Buncombe County for the first time have been able to discuss common issues and create mutual protocols. Many of the participants, including FBI, SBI, NC Highway Patrol, Asheville Police Dept., Regional Response Team 6 (HazMat), Buncombe County Health Center, Buncombe County District Attorney, and Mission St. Joseph's Hospital had never worked collaboratively in this manner before. Buncombe County sees this as the first local group to develop the CDC Forensic Epidemiology model in this way.

Agency Community Roles
This is a collaborative venture between the Buncombe County Sheriff's Department and PHRST 6. The latter is one of seven regional teams which consist of an MD epidemiologist, a nurse/disease investigation specialist, an industrial hygienist, and a program assistant. Its mission is to prepare for and respond to bioterrorism, infectious disease outbreaks, and other public health threats in western NC through surveillance, education, investigation, and collaborative planning. BCSD and PHRST 6 invited participants from the above groups and supplied meeting space, introductory didactic materials, and facilitation. The dynamics of the county (Buncombe) and county seat (Asheville) were considered carefully, and all potential responding agencies and organizations who might be involved in forensic response were invited. Task groups were formed with representatives from the entities listed. Initial group-building activities to engage disparate entities were determined by both law enforcement and public health, and included didactics from LE and PH, case discussions, and development of a glossary of terms. Each meeting includes a presentation by a group member. Examples include police evidence collection, HIPAA, microbiologic aspects of bioterrorism, updates on terrorism investigations nationwide and locally, and Buncombe County's community exercise at FEMA's Emergency Management Institute (EMI). Facilitators assure that representatives from each entity attend each meeting, and that task group follow-up occurs. In addition, observers from two other counties have been welcomed. They plan to create FE teams in their localities.

Costs and Expenditures
Program costs are limited to staff time for meetings, preparation of presentations, travel time, and task group efforts. Participating entities donate in-kind for meeting venues, printing, and any other incidental expenses. The most important cost consideration is for the participating entities to commit their staff to attend on an ongoing basis.

Outcome Process Evaluation
The FE Team began meeting in December 2002. A survey of participants to measure how well the Team has met its initial objectives at the six-month mark is in process. Desired outcomes are specific protocols for quarantine, field officer response, and evidence collection. The first two will be complete by June 30 and will be evaluated then. The third has just begun and a deadline has not been set. No impact data are available at this time.

The Buncombe County FE Team's quarantine protocol is the only such local protocol that has been developed in depth in NC. Team partners hope to have the protocol evaluated by state partners and it may become a model for NC. Similarly, local field protocols for law enforcement in response to calls suspicious for bioterrorism have not been developed in detail in NC.

Lessons Learned
  • Buy-in at upper management levels from each entity is essential, as is participation in planning by non-public health partners.

  • Having a single representative who attends each meeting is optimal for continuity, but difficult in the first responder community.

  • Assertive follow-up by facilitators is very helpful to assure continued participation and guide the group to specific outcomes. Sometimes this can take the form of one-on-one meetings with supervisors.

  • Starting with brief didactic sessions and especially case discussions is helpful to "break the ice" and immediately clarify differences and similarities.

  • Strong facilitation is essential to stay on track, and to assure both wide participation and maintained interest in such disparate groups.

  • Showing up is half the battle.

  • Follow-up is the other half.
Key Elements Replication
1) At least one person from law enforcement and one from public health must be committed to working and planning together, and to long-term development and nurture of the team.

2) Team organizers must be familiar with CDC's Forensic Epidemiology course. They may attend the course or work through materials supplied by CDC and SAIC. There is no "how to" in the CDC course for creating a local FE Team, so organizers must know their first responder community and its politics well enough to be able to convene the appropriate preparedness partners and support their attendance and participation.