EM Forum Presentation — August 29, 2012

Building the Bridge to Better Public Health and Emergency Management
Proceedings of the 9th Annual Tribal Public Health Preparedness Conference

Joe Finkbonner
Executive Director, Northwest Portland Area Indian Health Board

John Erickson
Special Assistant, Public Health Emergency Preparedness and Response
Washington State Department of Health

Lynda Zambrano
Executive Director, Northwest Tribal Emergency Management Council

John Scott
President, Center for Public Service Communications

Amy Sebring
EIIP Moderator

This transcript contains references to slides which can be downloaded from http://www.emforum.org/vforum/tribal/conference2012.pdf
A video recording of the live session is available at
An audio podcast is available at

[Welcome / Introduction]

Amy Sebring: Good morning/afternoon everyone and welcome to EMForum.org. I am Amy Sebring and will serve as your Moderator. We would also like to extend a special welcome to any tribal members who are with us today. We are very glad you could join us.

Today we are going to hear about highlights from the 9th Annual Tribal Public Health Preparedness Conference that was held in the Pacific Northwest just a couple of weeks ago. As noted, a primary goal of the conference was to share strategies for improving regional emergency preparedness, response, and recovery.

More than 250 delegates representing 30 tribes and native organizations from Washington, Oregon, Idaho, Montana and Alaska were present along with partners from local, state, and federal agencies. Today we will hear from some of the conference organizers. First, for the benefit our newcomers, we will begin with an overview presentation, and then we will proceed to your questions or comments.

[Slide 1]

Now it is my pleasure to introduce John Scott who will serve as our facilitator today. John founded and directs the Center for Public Service Communications and has worked for many years on disaster risk reduction both here and abroad. He is an enrolled member of the Tlingit and Haida Indian Tribes of Alaska.

I am going to turn it over to John to introduce our other guests today with whom he worked to plan the tribal conference. Please see today’s Background Page for further biographical information on each of our guests and related links.

Welcome John, and thank you very much for taking the time to be with us today. I now turn the floor over to you to start us off please.


John Scott: Thank you, Amy. I am in fact Tlingit with family from Southeast Alaska. I won’t waste time about me, though. We have some excellent guests here today so we’ll just jump right in.

The relations between the U.S. government and federally recognized tribes are prescribed but often challenging. Relationships between states and tribes can also be challenging and complicated. We have with us representatives today who have been involved in and responsible for transcending these challenges, and as pertains to public health emergency preparedness have developed some model programs that will be valuable for you to listen to, particularly those tribal members who might be with us.

Today we have Joe Finkbonner who is Executive Director of the Northwest Portland Area Indian Health Board to represent the tribal perspective, John Erickson, who is Special Assistant to the Secretary to the Washington State Department of Health and Director of Washington State’s Public Health Emergency Preparedness Response Program to represent the state perspective in its relations with tribes in the region.

An outgrowth of this commitment and hard work of these two and others is the Northwest Tribal Emergency Management Council whose Executive Director, Lynda Zambrano is also with us. Lynda is also filling as double duty—she is Interim Director of the National Tribal Emergency Management Council.

What we are talking about is a tribal public health emergency preparedness conference that took place successfully a couple of weeks ago in Washington state. Without further ado I will turn it over to our first speaker, Joe Finkbonner.

Joe Finkbonner: Thanks John. Good afternoon, everyone. I want to start by giving a little bit of an overview of our organization—Northwest Portland Area Indian Health Board and talk about our primary function in the states we serve and to zero in on our model that we have with the state of Washington.

[Slide 2]

The Northwest Portland Area Indian Health Board was formed in 1972 to promote self-determination in order to improve the quality of healthcare delivered to the 43 federally recognized tribes in Idaho, Oregon and Washington. We work in four priority areas for those tribes—legislative and policy analysis, where we will examine different levels of legislative development and assess the impact to the member tribes of our board.

We also have some health promotion and disease prevention projects that we administer locally to our tribes but we also do training and technical assistance for health promotion and disease prevention projects as well as operating a tribal epidemiology center where we do data surveillance and research.

Part of that epidemiology center’s wealth is bringing people to demonstrate and instruct them on how to use statistical software like SAS in order to mine the surveillance projects that we hopefully worked with them on so they can better evaluate their programs and their health promotion efforts.

[Slide 3]

Our board has 43 delegates. We have one delegate from each member tribe. We meet quarterly amongst ourselves and with state and other officials in Idaho, Oregon and Washington. We provide guidance to the state, feds and other on how to work with our tribes and also how to integrate some of their policy that is friendly to tribal health programs.

We review issues for HHS and Indian Health Services and assess their impact on tribal operations. Our quarterly meetings include developing positions oftentimes resulting in resolutions where we will give formal feedback to various levels of governments on legislative and budgetary issues.

Each year we provide a budget analysis on the President’s budget. We also give positions on health promotion and disease prevention programs and explain what our projects and programs are doing at some of the tribes that we may not be working with. We also review publication and data research issues that have been impacting Indian health and examine health status of our member tribes either individually or as an aggregate group for the Portland area.

[Slide 4]

This gives you a visual of the Portland area. As I said we serve Idaho, Oregon and Washington. There are 43 tribes. There are nine tribes in Oregon, five in Idaho that we serve, although there are actually six tribes in Idaho and the sixth tribe is on the southern border of Idaho and overlaps in Nevada. They are served by the Phoenix area rather than the Portland area. So we serve only five of the six tribes in Idaho. In Washington there are 29 federally recognized tribes.

[Slide 5]

I’m going to zoom in on and talk a little about the demographics of Washington and how this model of emergency and public health preparedness program began in the Northwest. In Washington there are 29 federally recognized tribes that are small by most standards. They range in size from the smallest being the whole nation out on the peninsula of the Washington coast of about 100 members to the largest being the Yakama nation which is in central Washington near Mount Adams with over 14,000 members.

The 2000 census identified the American Indian and Alaskan Native population in the state of Washington at a little over 112,000. They comprise approximately two percent of the state’s population. To put this in context, nationally there are over 563 tribes and the American Native population as a single race indicator comprised less than one percent of the overall US population. It is slightly higher if you look at multiple race indicators. That transitions me into how we got this program started.

About ten years ago we had a partnership with the University of Washington Northwest Center for Public Health Practice to do two assessments that were contracted to them by the Washington State Department of Health—one to do a capacity assessment for our tribes and look at the infrastructure of our tribal programs and also a workforce development assessment and look at the training topics that our tribes felt that our tribal public health officials felt they needed in order to fully assure public health preparedness.

Out of that we determined a conference was needed not only to address some of the workforce development issues that were in place but also one of the priority issues was identifying and mobilizing community partnerships. That we felt was lacking even though Washington tribes have a strong relationship with the state the local relationships were not as consistent. The state of Washington along with our board decided we wanted to hold and conference and start the networking and partnership discussions before anything catastrophic happens.

In that we put together an agenda, organized our first public health preparedness conference about nine years ago, and the rest is history. I’m going to turn it over to John Erickson and ask him to explain the state of Washington’s role and how that plays into this overall model.

John Erickson: Good morning and afternoon to folks.

[Slide 6]

This morning I am just going to give you a little background about Washington state specifically and talk about this year’s meeting—the ninth annual meeting that we just recently held in the last couple of weeks.

[Slide 7]

That is the state of Washington. It is not a very large state and this is a busy slide—I apologize for that. We have about six and half million people in this state. Like Joe said we have 29 tribes. We have 39 counties. We have 35 local health departments—some of the local health departments are multi-county.

We have informally organized into nine regions. Those are the color groupings that you see there. The reason we did that was for planning for public health emergencies. We thought it is all about neighbor helping neighbor and sharing resources and collaboration. We wanted to try to strengthen the regional aspect of Washington like some of the other states already have a regional model.

[Slide 8]

This slide of the state of Washington shows the nine regions and the 29 tribes. You see some of the tribes are rather large on the east part of the state and they also border on multiple regions and multiple counties which should make the collaboration all the more important.

This map is a little bit misleading because these reservations boundaries—there are also treaty rights that significantly expand the areas of tribal influence much beyond the reservation boundaries. That makes again a reason for the collaboration.

[Slide 9]

Like Joe mentioned we have partnered over the years with Joe’s group—the Northwest Portland Area Indian Health Board and in the early years the Northwest Center for Public Health Practice at the University of Washington to begin the thinking around these regional and state meetings on tribal coordination and emergency planning.

We also partnered with Lynda’s group who we will hear from in a few minutes—the Northwest Tribal Emergency Management Council, and the American Indian Health Commission of Washington and a laundry list of organizations such as the State Hospital Association and State Pharmacy Association, all 35 local health jurisdictions, state and local emergency management agencies, and the list goes on.

Many people have joined into this collaboration to move the needle on emergency planning.

[Slide 10]

Specifically this year we had the Ninth Annual Emergency Preparedness Conference. The title is "Continuing to Bridge the Gap between Emergency Management and Public Health". When we started this effort back in 2004 we were just focused on public health. For a number of years we just had a public health emergency management conference.

As time went on we recognized the importance of broadening that to emergency management in general to increase the collaboration. With Lynda’s help and her group we expanded in 2009—I think that was the first collaboration—maybe it was 2010 where we broadened it to public health and emergency management.

We bring together tribal, state, local and federal agencies. Many of the state representatives of governments in Region X—Idaho, Oregon, Washington, Montana, British Columbia and Alaska join us, and many federal partners also.

This year we had it at the Squaxin Island Tribe Conference Center. It is a beautiful facility in Shelton which is near Olympia, which is about 60 miles south of Seattle. It was a wonderful location. This is the second year in a row we had this here. About 300 people were registered this year and about 250 were actually present.

[Slide 11]

I wanted to touch bases on a couple important issues that we discussed this year. One of the biggest issues was the 2012 canoe journey which had just completed at the Squaxin Island Reservation just a week or two before our meeting. For those of you who don’t know about this event, it is a wonderful event that involves tribes from Alaska, British Columbia and Washington in a canoe journey down through Puget Sound.

I think 100 canoe families this year participated. The weather was wonderfully cooperative. It was beautiful weather and the winds were calm which is not always the case in the Pacific Northwest where it rains more often than the sun shines. It was an incredible piece of work and we had Ken Choke and Hanford McCloud from the Nisqually Tribe talk about some of the planning they did for their tribe around this event and some of the after action items.

There are many emergency management issues related to this—safety issues, public health issues—because literally thousands of people watched from the shore of this canoe journey and every evening when they landed there was quite a celebration. There was a weeklong celebration at the Squaxin at the end of this event.

I certainly encourage any of you to come to Washington or British Columbia in the future and participate in this event if you can. Next year it is at the Quinault Indian Reservation in Washington. It is hosted by the Quinault Indian Reservation.

Two other issues we had at this year’s meeting—we had specific breakout sessions for each of the states—Washington, Idaho and Oregon—to talk with the partners that were there about specific state issues—emergency management, public heath, healthcare coalitions, crisis standards of care, emergency plans, regional and tribal coordination.

Each year the discussion gets more and more robust and we have to continue to expand the time. It was a wonderful conversation this year. I hosted the Washington conversation and it was truly and inspiration because each year the conversations get more robust as we move this needle in emergency planning.

The other high point I did want to mention was the fireside chat. Each year over the last several years we have hosted fireside chats between the Secretary of Health, Mary Selecky, the Adjutant General of the National Guard in Washington, General Bret Daugherty and tribal leaders.

The thought is—it is a very small meeting—to have a discussion between leaders to discuss issues, priorities, hopes and dreams of where we are going. Each year that discussion becomes more robust. We continue to look forward to that. The Secretary loves to do those conversations because it helps us in the collaboration effort.

[Slide 12]

This is a picture of Dr. Evan Adams. You may recognize him. He is quite a famous movie actor. He starred in Smoke Signals—the American Indian film that was done several years ago. He is an aboriginal physician in the Ministry of Health in British Columbia. In 2009 he was one of our guest speakers.

Being in the Pacific Northwest, British Columbia and the aboriginal tribes in Canada are very much a partner in our conversations as we do this emergency planning. Evan was with us in that year. Also in 2009 we talked about a mutual aid agreement that had recently been signed from our Olympic Peninsula Tribes and local health jurisdictions—that is on the Western and Pacific Ocean end of Washington.

In that agreement seven tribes and three local health jurisdictions had come together to sign a mutual aid agreement that covered emergency preparedness activities and how to respond to emergencies but more than that it was broader into public health services and how everybody was going to be sharing resources. Those were a couple of the other top priorities in the last few years in meetings. Lynda is going to talk about her group’s role in 2010 when we joined with emergency management and significantly increased the participation by that group.

[Slide 13]

I think we all know the funding continues to decline in this effort. We are committed here in Washington. I know the other state health departments in the region are also committed to continuing this very important effort into the future as long as the funding continues and allows us to do that.

This year Lynda was able to bring in more resources externally—some private resources—maybe she can talk a little about that. Maybe she can talk a little about that. That will help us move the conference along.

[Slide 14]

That’s all I have to say. Here is some contact information for myself and for Gina Yarbrough, our Tribal Emergency Response Coordinator.

John Scott: John, before we move on to Lynda could you mention a little about the Centennial Accord which is unique in Washington and could be of interest to state representatives that might be online?

John Erickson: In Washington we have a Centennial Accord between the tribes and state government. It is signed and led by our current governor, Christine Gregoire, and all the tribes in Washington. It is a formal coming together and agreement between the tribes and state government about the priorities and importance of working together.

Each year the governor hosts a meeting to help develop a work plan for the Centennial Accord. Much of what we do in the area of emergency preparedness and public health is under the umbrella of this Centennial agreement. It is truly a landmark agreement. I know most jurisdictions don’t have such an agreement but it has really helped us improve the collaboration among all of us.

[Slide 15]

Lynda Zambrano: Thank you for inviting us to be part of this call today. We are honored. Our first slide is a slide that demonstrates building systems through partnerships. I wanted to make mention of that particular phrase because when we started our emergency management program we recognized very early on that much of our staff turns over through the course of time.

One of the things we did not want to see happen was for us to start down the road of creating emergency management and the homeland security program and have those go away because they weren’t institutionalized. Much of what my partners on the call have been talking about, both John and Joe, have been the collaborative work that has occurred over the last few years in regards to not just building those relationships but building systems—systems that will carry us through into the future and continue to be able to enhance and better prepare our Tribal Nations for these events that we face.

[Slide 16]

With this slide you’ll see a similar slide to some of those you have already seen earlier. The important thing about this particular slide is that in John’s slide as he was talking about the regions and how the public health regions are set up, the emergency management regions in the state of Washington are also set up similar. That is important because we haven’t had to recreate boundaries or define separate areas by which we are working within. I used that slide to demonstrate that.

[Slide 17]

We put this poll question into our PowerPoint because we like to emphasize for those people who are new to our emergency management programs in the state of Washington that it was just a few years ago that there were no emergency management programs in the state of Washington. Over the course of the last eight years we have been able to help stand up 27 or our 29 Tribal Nations to establish points of contact clear through to full blown offices of emergency management that are now formally recognized by the state of Washington.

[Slide 18]

A brief history in regards to NWTEMC and how we began—we started out in Region One. We were a collaborative effort of eight tribes. Originally there were seven tribal chiefs of police with myself as the emergency manager of the Tulalip Tribe. We came together to take a look at creating emergency management and what would need to be done in order to do that.

[Slide 19]

As we came together and started learning you can imagine that we faced an extremely large learning curve. There were a lot of different components to emergency management, different components to homeland security. We are going to flip through the next couple of slides to demonstrate the law enforcement component, the equipment, the training, the exercise and the critical infrastructure.

[Slide 20]

I like this slide—NIMS alphabet soup—because we had an entire new language to learn. Not only did we have a new language within emergency management to learn but our public health partners had a separate language. As we started to bring our partners together we learned there was a whole new language we all needed to learn to be speaking with one another so we could be better communicating.

[Slide 21]

The mission of NWTEMC has been to build partnerships and develop comprehensive emergency planning documents, to work together to share resources, knowledge, skills and to assist in coordinating exercises. We try to provide a network of expertise culturally relevant as it pertains to emergency management and Homeland Security.

[Slide 22]

This slide demonstrates early on within the first few years of development of NWTEMC we had added 17 new tribes just within the first couple of years as our program developed and grew. As you heard John and Joe talk about we started out as a Washington based program but since then we have expanded our charter and bylaws to include Oregon, Idaho and Alaska.

[Slide 23]

Here are our tribal emergency management council partners include both state and federal partners. We have a list of different partners that routinely attend our NWTEMC meetings and provide input so we can continue to expand on those partnerships and hopefully be able to institutionalize the importance of emergency management and homeland security in tribal country.

[Slide 24]

We also have many regional partners because as we all know our emergency management programs are important to be implemented at the local level. We need to be working with our local and regional partners even sometimes more importantly than our state and federal partners when we have incidents that are occurring on our lands. We strongly encourage the building of relationships with both our local and our regional partners.

[Slide 25]

Our organization is non-profit. We have a unique ability to go out and solicit funding that can help us expand on our efforts. Our efforts are really about building infrastructure and capacity within our Tribal Nations.

We have a unique ability to assist our tribes in writing grants and bringing dollars into the individual Tribal Nations as well as for the conference’s purposes being able to go out and solicit vendors and be able to raise some additional funding and pay for some of the additional items we like to bring forth in the conferences.

[Slide 26]

What we do—I included a few more slides that I would typically include but I wanted at least for the purpose of the presentation and the people who are listening to have a full list of the services we are able to provide. We can move through a couple of these slides quickly but I will mention a few of them.

One of them is assisting in the development of the emergency management plans and grants writing. We literally help bring millions of dollars into the state of Washington in our grants writing and most of those dollars have gone directly to the individual Tribal Nations to help them develop that infrastructure and capacity.

We also assist one another in raising awareness of homeland security issues and mandates. We educate our communities through our CERT programs and Medical Reserve Corps programs.

[Slide 27]

We also provide a link to regional, state and federal homeland security and emergency management programs. As all of us are aware even as we sit here and speak Hurricane Isaac is coming ashore of our land. Here even in the Pacific Northwest we are maintaining levels of communication with our tribes that are in Louisiana as well as with our state and federal partners monitoring the situation and ready to assist in any way that we can in continuing to promote the lines of communication throughout our partners.

We provide templates for many of our different plans and we maintain essential databases as well. Our databases are comprised of tribal members that have taken training so we are able to take that training and add that culturally sensitive and relevant component to it and bring that back out to tribal country.

[Slide 28, 29]

We also maintain a website that is a conduit for sharing information. We provide resources for our tribal clinics. This is where we really tie our public health piece in because we help educate our local partners on issues that are very unique to tribal country such a quarantine, isolation, jurisdiction and sovereignty.

Our conference has become a really great forum in which we are able to take these conversations and discussions and from that we have been able, I think for all of us, to better define what public health and preparedness truly means, who needs to be doing what and how we need to continue to collaborate in times of need.

[Slide 30]

Some of our Washington state tribal programs specific to Washington—we have stood up a statewide CERT program, and statewide Medical Reserve Corps program, a statewide communications project, also our critical infrastructure protection project and we have developed a cadre of NWTEMC trainers.

[Slide 31]

We have continued to build a statewide network of CERT teams that are now involving our tribal youth. We are very proud of our tribal youth that are taking our classes and we will continue that message into our future generations.

[Slide 32]

Here I would like to share a very unique incident of a story. This was a training we conducted a few years back. It was training between the Sauk-Suiattle Tribe and the city of Darrington. This was a training in which the chairperson of Sauk-Suiattle and the mayor of Darrington came together and took the class together.

The scenario was a mock flooding incident. The important thing to know about this training is we brought 250 people together from 37 different agencies and we conducted the mock training. Three weeks later the reservation did flood and three weeks later the chairperson from the Sauk-Suiattle and the mayor of Darrington were able to sit down at a table and share resources and personnel and much better be able to manage that incident.

[Slide 33]

The Medical Reserve Corps really ties back to our public health programs here in the sate of Washington. It was very critical for us to have our own Medical Reserve Corps people because we needed people that were familiar with the tribal culture.

When we first started working with our county personnel we felt everybody out in regards to what their level of understanding of the culture was. It became very apparent that it would be beneficial for us to bridge that gap as well so we have continued to work on our statewide Medical Reserve Corps.

[Slide 34]

This is a great van that was donated by the American Red Cross. It is fully outfitted for us to be able to access if we need a distance with communications.

[Slide 35]

We have also done a great deal of work in emergency backbone communications. We have quite a few people in Washington, and a much more extensive list than this, and tribal members that have obtained their ham radio licenses and are able to communicate in times of need.

[Slide 36]

The important thing to know about the critical infrastructure in Washington is that the tribes own nearly ten percent of the landmass although the tribes will argue that they own 100 percent. The state of Washington has a figure out there that says close to ten percent.

With that nearly the entire Washington critical infrastructure is located within or within close proximity of our Tribal Nations. That includes our international borders and shipping lanes, our ferry system, naval bases, oil refineries, the Grand Coulee dam that is pictured here over at the Colville nation.

Our tribes are providing security for our critical infrastructure on a daily basis demonstrating the importance of us working together with Tribal Nations to bridge the gaps and make sure we are doing the best job we can to provide Homeland Security for the homeland.

[Slide 37]

This is a photo of some of our NWTEMC trainers emphasizing the importance of having that cadre of trainers in Indian country.

[Slide 38]

I apologize for this last slide because it was an announcement for a previous conference. It has not been updated yet. I’d like to thank John and Joe for conducting this call and Amy for flipping the slides.

John Scott: Lynda, maybe I could ask one more question of you and that is a little bit about the expansion to the national effort.

Lynda Zambrano: Absolutely. As we have continued to grow in the Pacific Northwest and do a great deal more outreach with our Alaska partners we learned there are other groups in the nation that are formed similar to the NWTEMC but have not gone quite to the extent we have in regards to formalizing the relationship, creating those charters and bylaws or even going as far as obtaining their 501c3 like NWTEMC has done.

Becoming more aware of those groups that are out there, we have done some outreach and we have started working with some of those consortiums to provide information, even a model by which we have been able to move this program a little further down the road. What we have found is that the return is ten-fold in terms of the information sharing and the things we have been able to learn from one another.

We have currently outreached to the Montana working group. We are working with the Michigan group. We are working with tribes in California, Arizona and Texas. We have done some outreach to Louisiana and are maintaining lines of communication there. What our group has chosen to do is pay the executive board of directors for the purpose of defining what that road will look like in the future as the group creates the National Tribal Emergency Management Council.

The formal executive board of directors was announced at our conference this year. Those representatives will be defining and creating and moving forward with the national effort by which it creates a forum. It will be a forum by which all these different organizations throughout the nation will be able to continue to share information and best practices.

John Scott: If all this was a show-and-tell I think it was a good one but I think there is far more to it. I scan the names of the participants of this morning’s call and I recognize some of you but not all. I don’t know what connection you might have with tribal governments in your community.

Each of these three presentations represents a unique and excellent model that should be looked at for other regions and communities. As most of you know these EM Forums are recorded and will be available online. I encourage you to share what you have heard today with your colleagues particularly encouraging some of the tribal communities that might not be on the call today to check in and listen.

The contact information for John, Joe and Lynda is available. I am available to but I would encourage you to contact the three principles. I’ll turn it over to Amy Sebring thanking the EM Forum and EIIP for this marvelous opportunity and work with Amy to respond to some questions you might have.

Amy Sebring: Thank you very much to all of you. We are going to take some questions, and then time permitting we will demo some more of these resources.

[Audience Questions & Answers]

Isabel McCurdy: Being from British Columbia, how many tribes from here attended your conference?

Lynda Zambrano: I don’t have an answer to that because I am in the middle of doing our final report and just acquired the sign-in sheets on Friday. I can’t give you an exact number although I do know we had some partners here from Canada. On the website we have a list of all of those parties that originally registered. It is on a link under the Ninth Annual Tribal Conference.

John Scott: All three of the principles are working on a continuing cross-border consultation that is coming up in 2013. It will involve provinces and first nation communities in Canada as well as tribes and state and federal institutions in the U.S.

Amy Sebring: You mentioned you are putting together a report of the conference. When will that be available?

Lynda Zambrano: I hope to have it done by the end of this week. The final report will include the sign-in sheets, a full overlay of expenses, funding sources, and vendors we will be thanking for helping to support a tremendously successful conference between all our partners.

Avagene Moore: Thanks to all for a fine presentation. Lynda, you mentioned training tribal youth. How do you structure or offer emergency management or CERT training? Is it through the schools?

Lynda Zambrano: We have been doing it through the Tribal Summer Youth Programs. Many of our tribes employ our summer youth and we have been working with the coordinators of some of those programs. They have been very easily able to slip in a full-blown CERT class and be able to provide credit to those students for taking the classes.

I’m very proud to inform everyone that even at our annual conferences we even have a cadre of tribal youth that attend from the Colville nation. They are able to acquire credits for school for coming to the conference and assisting us with registration and logistics.

Dennis White: For Lynda, have you run a functional or tabletop exercise with your MRC members yet to a point where they were staged at a rally point, and if so, were tribal members well represented there? May contact you later.

Lynda Zambrano: Yes, when I indicated the exercise we conducted in Darrington with the 250 people from 37 different agencies we actually activated a Medical Reserve Corps and contacted 4 separate reservations to send their Medical Reserve Corps personnel. In some of the photos of the exercise you can see the Medical Reserve Corps personnel onsite.

John Erickson: In addition to that the State Department of Health sponsors annual exercises and each year more and more tribes connect to those public health exercises—infectious disease type exercises that we invite all in the region to participate in.

Amy Sebring: I know you have a long history of tsunami preparation but I was wondering if you were focusing some renewed efforts on that with those tribes on the coast?

John Erickson: During that event in Japan there were very routine collaborations between local, state, federal government and coastal tribes in Alaska, B.C., Washington and Oregon. It was probably the first time we had to kick into action this recent collaboration we’ve built over the last few years.

There was a lot of discussion about what the radiation readings mean and what are the levels on the coast versus inland and things like that. That was during the response. The debris issue continues to be discussed at all levels of government. It is pretty well set up in the coastal states all the way down to California and Hawaii is connected to the conversation, too. Folks from the tribes and local, and state and federal government that are participating and watching for debris or cleaning up debris—I think all the states have websites now and they have 800 numbers for folks to report debris also as it hits the coast.

It hasn’t really impacted much of the coast yet. Some big items like a barge in Oregon and a ship off British Columbia came across pretty quickly but the vast majority of debris has yet to come. It will probably be here over the winter and into next spring.

Amy Sebring: Joe can you tell us some of the challenges you have faced in developing the public health emergency preparedness side of it vis-a-vis the daily ongoing needs of these communities? How do you get them interested when they may feel they have more pressing concerns?

Joe Finkbonner: That is a good question. Challenges are the obvious ones, like resources, as John has mentioned that is constantly declining every year. Some of the recent events that have happened in the last couple of years have certainly peaked interest in terms of people dusting off their plans. H1N1 certainly heightened people’s awareness about the necessity for public health preparedness and making sure immunizations are up to date.

John can talk more specifically about this year’s communicable disease—that is the pertussis outbreak or pertussis epidemic that has hit Washington state. Those certainly are right on the tabletops or desktops of all health programs of the tribes in the Northwest. That sort of invigorates interest and preparedness on how to mitigate these types of issues that approach our jurisdictions.

John Scott: One of the interesting anecdotes relative to H1N1 issue and tribal involvement is the whole idea of the development of culturally and linguistically appropriate information for not just tribes but for many communities. In the CDC guidance for H1N1 the vaccinations were not to be given to young children and elderly people.

In most native communities the elders are a respected force. To ignore providing service to the elder, even if in other communities it might be a reasonable thing to do, it is frequently not the best practice in native communities. The idea of over time looking at what the national models are and making sure they recognize various cultures within the U.S.

John Erickson: We have many discussions, as you might imagine, in Washington and all the states about CDC priority groups. In the end there appeared to be enough flexibility to allow groups to vaccinate who they wanted to. Further work with federal agencies and specifically CDC will help that for any future outbreak to make that flexibility clear enough. It was certainly a topic of discussion during the event.

Lynda Zambrano: I think my esteemed colleagues have addressed the question very well but I would like to add that through our annual conference—we heard John mention the fireside chat. Last year the fireside chat provided a really beautiful informal forum by which the Secretary of the Department of Health and our tribal leaders were able to sit down at a table and discuss these very issues. I think really productive things have come from the conference that we collectively hold as a group on a annual basis.

John Scott: If I could add to that one of the things I will say about the state of Washington and tribes is that sometimes the dialog gets very challenging when they disagree on things but the relationship that Washington and the tribes have is longstanding and very good. It has really led to that conversation where we get to the meat of things and try to develop real solutions.

I’ll use H1N1. It didn’t work as well in terms of the vaccine distribution in Washington as we had hoped and we thought it would. But yet in our fireside discussion we were able to have that frank and open conversation with Secretary Selecky and her commitment to try to renew and reinvest in that relationship with the tribes has really gone a long way and really is a model more so of not everything always going right but always being able to have that conversation and consistently work on systems. So it is a QI project in the making.

Kelli Merrit: How do you approach training/workshops when you connect with tribes on islands, such as the San Juan Islands? Is it harder for these tribes to participate with state level exercises?

John Erickson: It is harder for any of the groups, government or tribal groups that are on islands or in remote areas, to participate in our annual meeting or any of the exercises. We continue to look for funding to enable and empower folks that want to participate to fund travel wherever we can so they can participate.

We also have a pretty robust video conference network in Washington between local health and the tribes and state health. As time goes on we are using this more and more to have virtual tabletop exercises and things like that so people do not have to travel.

Elysa Jones: I attended the NWTEMC on behalf of MyStateUSA. It was our first time at that conference but we are no stranger to regional WA/ID/OR alerting projects. It was great to meet Lynda and see the fantastic work she and her team are doing.

Avagene Moore: I would think your success and models used in the northwest would be of interest broadly across the country. Have you thought about sharing this through some national organizations such as IAEM, NEMA and public health related conferences?

Lynda Zambrano: We are. We will be in attendance at the International Association this year. 0I believe that is going to be in Florida in October. We have also stood up the National Tribal Emergency Management Council website. That can be found at http://www.NTEMC.org.


Amy Sebring: Time to wrap for today. On behalf of Avagene, myself, and all our participants today, and those who will use your material in the future, thank you very much to all of you for sharing this information with us, and a special thanks to John Scott for helping us arrange the program. We hope you have an even bigger and better conference next year!

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Thanks to everyone for participating today. Have a great afternoon and a great Labor Day Weekend holiday! Until next time, we are adjourned.