Local Response
The Peoria City/County Health Department and other local health departments throughout Illinois have prepared for the possibility of large-scale emergency responses for many years. The events of 9/11 and the Hurricane Katrina disaster prompted states, counties and communities to review their emergency response plans.

Through funding from the U.S. Centers for Disease Control and Prevention (CDC) and the Illinois Department of Public Health (IDPH), Peoria City/County Health Department prepared by way of drills, table-top exercises, policy writing and workforce competency. In addition, the department developed community partnerships with police, fire, county and city emergency managers; the American Red Cross; local hospitals; Caterpillar Inc.; Bradley University; special-needs populations; the news media; and a multitude of community agencies in the event that a man-made or natural disaster were to impact Peoria.

The development of the Strategic National Stockpile (SNS) through CDC funds allowed local health departments to prepare to dispense medication to the public. Through surveillance mechanisms, federal, state and local emergency responders will determine when there are a large number of people affected with similar signs and symptoms of an illness, such as the H1N1 influenza (swine flu), to warrant distribution of the SNS. The task for Peoria was to have a system in place to distribute the appropriate medications in pre-designated sites to the 184,000 people living in Peoria County.

Staff trained and drilled repeatedly to handle SNS distribution. The health departments counted the number of people to whom they can distribute medication and how long it would take. Establishing partnerships, contact information and developing relationships prior to an event are keys to a successful response.

Peoria demonstrated its ability to respond during Hurricane Katrina when the city was selected to receive evacuees from Louisiana. The city's emergency planners were notified and quickly brought together over that Labor Day weekend. A reverse 911 system was used to contact and convene those identified as decision makers to prepare Peoria as a site for dislocated families.

Peoria has two emergency operation centers, but neither was capable of housing the necessary emergency operations center for this type of situation, so the Peoria Civic Center was utilized. There were a number of challenges associated with using the Civic Center, such as the need for multiple phone lines, information and technology setup, and communications.

Regional Response
Peoria, Tazewell and Woodford counties have long-standing partnerships and, in the area of emergency preparedness, they have a mutual aid relationship. In addition, Illinois local health departments have a premier mutual aid system called IPHMAS (Illinois Pubic Health Mutual Aid System), which has been recognized by the CDC.

The CDC funds an emergency planning program throughout multiple states, called the Cities Readiness Initiative (CRI). There are three CRI Metropolitan Statistical Areas (MSAs) in Illinois-Chicago, East St. Louis and Peoria. The Peoria MSA consists of Peoria, Woodford, Tazewell, Marshall and Stark counties. The CDC provided funding to these counties to prepare for a large-scale emergency situation that may require a regional response rather than a local response.

The Peoria MSA recently held its first regional emergency exercise using Kewanee High School as its SNS dispensing site. Emergency planners from all five counties participated in the exercise, as well as residents and agencies within Stark and Henry counties. This type of exercise allows for all partners to test communication capabilities, distribution site logistics and staff ability to handle a high volume of recipients or victims. Evaluators observed every aspect of the distribution process from the time a client entered the distribution center until they exited the building. Each exercise concludes with a hotwash, a debriefing of the drill activities. Critical issues are addressed and plans and practices that may need to be revamped are reviewed. The entire process is evaluated in order to strive for better practices.

State Response
The Illinois Department of Public Health (IDPH) is a critical partner to local health departments in terms of resources, support and guidance. The Department is led by Director Dr. Damon T. Arnold, and he is assisted in the area of preparedness and response by Deputy Director Winfred Rawls.

Scenario
With the news that H1N1 influenza had been identified in the United States and was being transmitted from person-to-person, the CDC declared a public health emergency and ordered the distribution of the SNS to the states. IDPH immediately began preparations to receive the SNS and push the supplies out to local health departments. Once the SNS arrived in Illinois, IDPH worked with members of the Illinois National Guard at a receiving and distribution center to prepare pallets of supplies for each of the state's 95 certified local health departments. After the packing and labeling was complete, the pallets were transported by drivers from the Illinois Department of Transportation and escorted by the Illinois State Police to pre-designated local health department drop sites.

Within 24 hours, SNS supplies had been successfully distributed to all local health departments. The antiviral medications and other supplies were in Peoria and ready to be distributed to hospitals, physician practices and federally qualified health centers. None of the points of distribution (PODS) for the local health departments in Illinois were "stood up." The case numbers were not unusual for an influenza outbreak, but there were school closures and intense news media interest.

For Peoria, there are predetermined, confidential "drop sites" that have been evaluated and designated as receiving and distribution sites, as well as sites identified as PODS to which the public would have been directed to go had the situation called for distribution of pharmaceuticals. The local news media would have played an important role in helping to inform and educate the public when this type of response was necessary.

The Illinois Department of Public Health continues to report weekly numbers of H1N1 influenza probable and confirmed cases and encourage the public to use precautions to keep from becoming sick and spreading illness, including washing your hands; covering your mouth when you cough or sneeze; staying at home if you have respiratory illness; and taking additional precautions when taking care of the very young, the elderly and those with chronic diseases and weakened immune systems. iBi