Attempts by one local health department to provide only essential public health services: a 10-year retrospective case study.

BACKGROUND: Because of local political circumstances, in 1996, the local public health department in Amarillo, Texas, divested itself of almost all personal health services and chose to retain only essential population-based public health services. METHODS: We analyzed function, funding, and staffing for various health department activities in FY 1997 and again in FY 2007. The figures were adjusted for inflation and population growth. We interviewed key personnel about the motivation and effects of the changes that occurred with this 10-year period. RESULTS: The local health department both transferred and reassumed some personal health services during this period. This was primarily in the area of immunization services and care for special population such as refugees. Public health preparedness also became a significant new area of activity. Most personal health services provided by the health department before 1996 remained the function of other health care entities in the community. When adjusted for inflation and population growth, most of the growth in the health department's personnel and budget was the result of state and federally mandated program changes. CONCLUSIONS: Growth in this local health department, which was committed to provide only essential health services, was driven primarily by state and federally mandated programs. Real growth for essential public health services did not occur over a 10-year period.

Top ten list of long-term care facility preparations for the upcoming influenza season.

A novel influenza A partly of virus of swine origin (2009 H1N1) emerged this spring, resulting in an influenza pandemic. This pandemic is anticipated to continue into the next influenza season. Given that the 2009 H1N1 and seasonal influenza A appear to be somewhat different in the human populations affected and that two influenza vaccines will be recommended this fall, those who manage long-term care facilities and treat patients in them will be faced with many uncertainties as they approach the 2009/10 influenza season. Ten specific suggestions are offered to those responsible for the care of patients in long-term care facilities regarding the upcoming influenza season. These practical suggestions are the clinical opinions of the authors and do not represent official recommendations of the American Geriatrics Society or any agency.

Tularemia outbreak at a metropolitan airport, Texas.

A jackrabbit die-off near a metropolitan airport was observed by an airport contractor. Further investigation determined that this die-off was probably due to epizootic tularemia. Because of proximity to areas of heavy human traffic and fears of transmission of tularemia to humans, the local health district and department of emergency management organized a multiagency response involving local animal control, environmental health, public health, law enforcement, and airport personnel, in addition to state and federal agencies. The tularemia epizootic subsequently ended, and no cases of human tularemia occurred. In our after-action analysis, we identified several lessons learned: the importance of animal illness surveillance, which can serve as a warning for potential human illness and epidemic; the usefulness of pre-event planning, training, and exercises in facilitating a coordinated response; the usefulness of an effective communication system with the healthcare community; the importance of responders being familiar with Centers for Disease Control and Prevention (CDC) Category A bioterrorism agents when considering a rapid response; and the fact that attempts at environmental control may result in perturbations in animal populations with unintended consequences.

Medical response to hurricanes Katrina and Rita: local public health preparedness in action.

Like more than 150 communities in Texas, our community participated in disaster response for Gulf coast citizens evacuated from hurricanes Katrina and Rita. We implemented and adjusted emergency operations plans that were designed to respond to a local disaster. Lessons learned will strengthen our disaster preparedness in the future, including the importance of a robust medical presence at evacuation shelters; the value of an accurate and timely database of medical needs for shelter occupants; the usefulness of brief paperwork; the need for a preidentified and pretrained group of healthcare workers; the necessity of timely and accurate communications with medical partners in the community; the requirement that our local city government plan, open, and operate disaster shelters in our community; and the impact of ease of travel, frequent and honest communication, and sincere appreciation on maintaining morale in our volunteers.