On Monday, August 29^th, Hurricane Katrina made landfall as a category 4 hurricane near Grand Isle, Louisiana. About 3,000 individuals who fled from the devastation ended up in Galveston County hotels, shelters, churches, and private homes. Galveston County Health District staff worked in coordination with hospitals, Red Cross, Emergency Management, and other agencies to provide relief to those whose lives were turned upside down by this storm. The 4C’s clinics provided medical care and prescriptions to those displaced. Community Health Nurses conducted health assessments and provided care to evacuees housed in shelters. WIC staff provided food vouchers and infant formula to those who qualified. EMS staff transported patients who had been evacuated by air from hurricane affected areas to area hospitals. Public Health Preparedness staff worked with agencies and community groups to identify resources and to coordinate response activities. The HIV program linked individuals to needed treatment and medications. The Consumer Health program visited shelter operations to insure they were preparing food properly and operating in a safe, sanitary manner. And Animal Services provided shelter to animals that were evacuated from storm and flood ravaged areas. Health District staff also attended meetings of Galveston Community leaders, Carnival Cruise Company representatives and FEMA officials to discuss the housing of Hurricane Katrina evacuees in two cruise ships at the port of Galveston. In the course of the meetings, many logistical issues were worked out to accommodate the two ships and evacuees; however it was later decided by FEMA officials not to use the ships in Galveston to house victims of the storm. 

Early in the development of Hurricane Rita, Health District staff closely monitored its progress and landfall forecasts. When forecasts began predicting the storm would make landfall in Southeast Texas, Health District staff began taking actions to protect district facilities, safeguard data, and provide ample opportunity for employees to secure their homes and evacuate the area.  Galveston EMS worked with local hospitals to evacuate patients to safety.  On the morning of Saturday, September 24^th, not long after Hurricane Rita made landfall in the Sabine Pass area, Health District staff initiated recovery operations bringing up computer systems, preparing the Public Health Lab for water sampling operations, and calling in staff to assist in food safety inspections and animal control activities. Staff also worked with county emergency management to identify available healthcare resources in the area. In the days following Rita’s arrival, Health District staff worked to address public health concerns by issuing boil water notices to the media, conducting tests of municipal drinking water, conducting inspections of grocery stores, restaurants and schools, providing tetanus shots those in affected areas, and addressing debris burning and disposal issues. For more information, please contact Brian Rutherford, Public Health Planner at (409) 938-2275 or email brutherford@gchd.org 

On September 11^th, the Galveston County Daily News published an article encouraging Katrina evacuees to seek out medical homes in the community instead of accessing health care in the Red Cross shelters.  Local Red Cross leaders were quoted encouraging this effort and suggesting the 4C’s clinics as an option.  This article can be found at http://www.galvnews.com/story.lasso?ewcd=3b390900d86d29d3.

Galveston Island EMS was the subject of a press release issued on September 28^th.  The successful evacuation took ten hours to complete and involved many community partners.  This release can be viewed at http://www.gchd.org/press/2005/09Patients.htm.

Public Information staff developed an advertisement promoting the 4C’s Clinics printed in a “Who’s Who in Medicine” supplement to the Galveston Daily News on October 16^th.  To see the advertisement visit www.gchd.org/press/2005/4csAd.pdf.

A volunteer in the District’s Texas City animal shelter was the subject of a story published in the October 18^th edition of the Galveston Daily News.  The story can be found at www.gchd.org/press/2005/10AnimalLover.htm. 

  4C’s Clinic Updates For more information, please contact Mike Carr, JD, 4C’s Business Manager at (409) 949-3406 or email mcarr@gchd.org or Pam Jahnke, RN, Strategic Plan Evaluator at (409) 938-2256 or email pjahnke@gchd.org.

4C’s Redesign – The 4C’s clinic staff continues to work in refining the redesign process for our clinics.  The model is finished and patients are being seen under this process on a full time basis.  Redesign is now an integral part of clinic operations.  Monitoring and review are ongoing parts of regular clinic operations.  A Redesign open house and employee appreciation luncheon is scheduled for Wednesday, November 14, 2005 at both clinic locations.

Texas City Clinic Renovation -  After receiving approval from the Governing Board, 4C’s executive staff have retained an architectural firm to develop a renovation plan for the Texas City 4C’s facility.  The intent is to include the space formerly occupied by the WIC program in the clinic while making it easier for staff and patients to be involved in patient care.  The process is in its early stages with preliminary ideas due in the next few weeks.

Electronic Medical Records - The 4C’s Clinic Leadership Team is beginning the process of adopting an electronic medical (health) record system.  During the last month, staff has attended two presentations on Electronic Medical Records (EMR).  The Champion Group and Business Computer Applications have both demonstrated their EMR products before clinic leadership and staff.  The process will continue with additional demonstrations and subsequently the development of list of requirements.  Current goals include implementing a system in the 4C’s during the next 24 months.

Animal Services Memorandum of Understanding – The City of Texas City approached the Health District to draft a Memorandum of Understanding that would allow for trustees to work off community service hours at the animal shelter.  The trustees would not actually handle any of the animals, they would simply clean and provide labor around the shelter itself.  Training will be accomplished by animal services staff and the hours worked in the shelter would be documented and credited in our Volunteer Services office.

Outreach Activities – Staff members participated in several outreach activities designed to raise environmental awareness and teach about chemical safety.  Educational materials about air and water pollution were distributed to over 200 adults and children at the Santa Fe Safety Fair.  Wally Wiseguy made appearances at 3 county elementary schools promoting his “Shelter-in-Place” against chemical emergencies.  Over 1400 students were entertained by Wally and provided important information on what to do during a chemical emergency.

 Office of Community Health Programs Updates: For more information please contact Susan Studebaker, RNC, Director of Community Health Programs at 409.938.2456, email sstudebaker@gchd.org

Community Health Services Outreach Activities -  The Robert Wood Johnson Diabetes program staff began a series of diabetes self-management classes at UTMB’s Department of Family Medicine and a series of cooking classes, “Whisking Your Way to Health” at the Agricultural Extension office in Dickinson and the First Presbyterian Church in Galveston.  They have also been asked to provide classes for participants in UTMB employees’ Commit to Life and for patients who attend the VA Clinics.  The Senior Health Coordinator presented information at 6 community events during September and October.  An Immunization Core Curriculum class was taught in October with 6 people attending.

GAAA performs first complete ambulance evacuation of Island – GAAA coordinated its first, full-scale evacuation of ambulance patients in preparation for Hurricane Rita. Using the entire GAAA full-time staff, the service mobilized to a service level of 13 ambulances. After requests from GAAA and UTMB, the State sent 80-100 ambulances to the Island to assist. The bed-bound evacuation took around 12 hours and evacuated 42 outside of UTMB, plus hundred from UTMB. 4 ambulances then remained on the Island to ride out the storm and the other nine ambulances evacuate to Iola, Texas. Iola Volunteer Fire Department graciously hosted GAAA’s staff and vehicles throughout the storm.

·Influenza Surveillance – Galveston County Health District Epidemiology Department is participating in statewide influenza surveillance.   Data on local flu activity is collected from local health care providers and institutions weekly and reported to the Department of State Health Services.  Reportable flu activity includes: Influenza-like illness activity (ILI) defined as: fever over 100⁰F and cough and/or sore throat; Lab confirmed case: Flu case confirmed by rapid test, culture, antigen detection, or PCR; Institutional outbreak: A lab confirmed outbreak in a nursing home, hospital, prison, school, etc.  All influenza activity reporting by states, laboratories, and health-care providers is voluntary and greatly appreciated.

Rabid Bat - Department of State Health Services reported that a bat submitted on September 2, 2005 by Galveston County Animal Control tested positive for rabies.  The bat was found outside on the ground at a commercial establishment in Texas City.  An investigation was initiated and warranted 2 people needing rabies post exposure.  The Health District assisted the victims with directions on obtaining and administering the post exposure immunizations. 

In-Services for Galveston ISD nurses- Since August 2005, Epidemiology Services have provided in-service for 4 independent school districts and 1 private school in Galveston County.  The training consists of disease reporting, changes on state immunization requirements, Health District services and frequently asked questions. 

Galveston County Emergency Response Collaborative - On September 8^th and October 13^th, the Health district hosted meetings of the Galveston County Emergency Response Collaborative. In the September 8^th meeting, members discussed Hurricane Katrina and how response agencies can be better prepared to respond to emergencies in the future. Members also discussed the use of Web EOC, a web based system to track emergency response efforts, to improve communications. On October 13^th, Eliot Jennings, Galveston County Emergency Management Coordinator, shared with the group about the use of incident command structure to manage emergencies. Lessons learned from Hurricane Rita were also discussed.

Laboratory Response Network Training - On September 15^th, the Health District hosted training about the Laboratory Response Network. The Laboratory Response Network (LRN) is a network of 140 laboratories affiliated with federal agencies, military installations, international partners, and state/local public health departments to provide the laboratory infrastructure and capacity to respond to biological and chemical terrorism, and other public health emergencies.> About 30 people from UTMB, Mainland Medical, and the Health District attended the training where they learned about the role of the LRN and how environmental and clinical samples should be submitted for testing.