Cross-training for Epidemiology Surge Capacity: Lessons and Tools from Delaware General Health District

Whether monitoring travelers for Ebola, managing a large-scale foodborne outbreak, investigating environmental exposures, or identifying the unknown cause of an illness, during an outbreak or event, epidemiology and infectious disease staff at local health departments (LHDs) can be stretched thin. LHDs have lost 23% of their workforce since 2008, shedding over 40,000 jobs across the country. This deficiency is compounded by the much older age of the local health department workforce – 55% are over age 45 and almost a quarter of health department staff are eligible for retirement.

Still, there is an opportunity for public health departments to move the field forward, but they need staff with diverse skillsets to help lead this work. Having cross-trained public health staff who can support an investigation is a critical component of developing surge capacity to manage ongoing work and respond to emerging issues. Proactively working with staff ahead of time to develop a baseline knowledge can save time and resources and better prepare local health departments to be flexible when faced with an emergency or new challenge. NACCHO spoke with Travis Irvan from the Delaware General Health District in Ohio about their efforts to work with staff across the organization to prepare for this scenario.

What prompted you to initiate this type of cross-training? How did you identify the need?

In July of 2018, we investigated a large foodborne outbreak that involved over 600 ill persons.  During this investigation, we had to utilize staff to conduct foodborne illness interviews who do not routinely work on communicable disease investigations. Of our approximately 75 staff members, 31 assisted in foodborne illness interviews.  We were able to provide Just-In-Time training to our staff who participated in these interviews, and while they performed tremendously, we did identify a need to have annual training for epidemiology surge capacity.

How was this training established?

After our large foodborne outbreak, we did a hot wash and it was evident that additional training was needed.  As I stated earlier, our staff did a great job filling in and conducting these interviews, but we decided that additional training in this area was definitely needed.  Not only did the staff who filled in for foodborne interviews identify this training as a need, but our epidemiology staff also felt this training would be beneficial to improve data accuracy and analysis.  When we discussed our lessons learned and improvements needed for the after-action report, this training was identified as a priority and leadership was on board.  We decided that all staff needed this training, which means everyone from our plumbing inspectors to our WIC staff take this annual training.

What sort of training do you do now? Did the materials exist, or did you have to develop new materials?

Starting in 2019 we include outbreak interview training as part of our annual all-staff required trainings.  The training takes around thirty minutes to complete and involves watching a YouTube video created by the Integrated Food Safety Centers of Excellence and reviewing a form we created with some tips on how to conduct a foodborne disease investigation.  After these have been completed, staff has to complete a quick survey to measure their foodborne disease investigation knowledge.  We modeled our training after Oregon Public Health’s Disaster Epidemiology Interviewing Training Guide.

What has been the outcome? Have there been other events during which you called upon these cross-trained staff to support an investigation?

Even though we have not had to test epidemiology surge capacity since this training was implemented, we feel it has been a very worthwhile investment.  Staff who do not conduct interviews on a daily basis may not realize there are right and wrong ways to ask questions to get an accurate answer.  And with this new training, our staff will already have a building block of knowledge to rely on to go along with any Just in Time training we do when the next event arises.

About Christina Baum

Christina Baum serves as a Senior Program Analyst for infectious disease at NACCHO. Her work includes projects on emerging infectious diseases, epidemiology, healthcare-associated infections, and antibiotic resistance.

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