Overview of Public Health: synopsis of programs and functions [June 2010]

GEORGIA D EPARTMENT OF COMMUN1TY H EALTH
OVERVIEW OF PUBLIC HEALTH
Division of Public Health Georgia Department of Community Health

TABLE OF CONTENTS
DCH Organizational Chart........................................................................... ................... . 1 Public Hea lth Organizational Chart............................................................................... 2 Public Health SFY2011 Base Budget.................................................................. ............ 3
Division of Public Health Program Descriptions
Public Health Administration ......................................................................................... 4 Environmental Health ............ ........................................................................................ 7 Epidemiology... ... ......... .... ......... ...... ...... .......................................................................... 8 Health Promotion Disease Prevention.................................................................. ..... 9 Immunization and Infectious Disease .................................................. ..... .. ..... ......... 10 Public Health Laboratory .......................................................................................... 11 Maternal and Child Health.......................................... .............................................. 12 Vital Records ................................................................................. ............................. 13
Division of Emergency Preparedness and Response Program Description
Emergency Preparedness and Response................................................................ 14

Georgia Department of Community Health

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State Medical Education Board Cheri Tucker
Georgia Composite Medical Board LaSharn Hughes
Georgia Board for Physician Workforce Cheri Tucker

Executive Ass1stant Deborah Bevelle

I_ Brain &Spinal Injury Trust Fund Commission

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Craig Young

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L Georgia Trauma Care Network Commission

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Healthcare Facility Regulation
Doug Colburn

Medicaid Jerry Dubberly

State Health Benefit Plan Nancy Goldsiein

Public Health M. Rony Francois, MD, 1- -
MSPH, PhD

Emergency Preparedness & Response
Patrick O'Neal, MD

Communications Lisa Marie Shekell
0 Program Division
0 Enterprise Function
0 Attached Agencies

General Counsel Vacant

'Acting Chief Information Officer
I Vince Harris

Chief Operating Officer
Debbie Hall

Act:ing Chief Financial Officer
Scott Frederking

Inspector General Robert Finlayson

Legislative & External Affairs
Russell Crutchfield

Office of Health lnfomnation Technology
& Transparency

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Georgia Department of Community Health
Public Health Division
Clyde L. Reese,ll, Esq. Commissioner

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Toni Mills Executive Assistant

M. Rony Francois, MD, MSPH, PhD
Public Health Director & State Health Officer

Public Health Advisory Council

Tom Wade Deputy Director Public Health Administration

Miriam Bell Deputy Director Public Health Programs & Services

Carole Jakeway

Director Field Operations
Districts

Kimberly ReddinQ Program Director Health Promotion &

Scott Uhlich Program Director Environmental Health

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County Health Departments Nursing & Pharmacy Sections

Disease Prevention

Rhonda Page Director
State Operations Grants Mgmt & Evaluation
Strategic Planning and Development
Jamie Howgate Coordinator
OCH Enterprise Coordination Facilities & Support
IT
Communications Legislative Affairs
IG Operations
Finance Legal

Brian Castrucci Program Director Maternal & Child
Health
Anil Mangla Program Director Infectious Disease &
Immunization

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Anil Mangla

Acting Program Director

! Epidemiology

Ken Bramlett Program Director
Vital Records
Elizabeth Franko Program Director
State Health Laboratory

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Division of Public Health State Fiscal Year 2011 Base Budget

Program Structure

Total

State

Tobacco Federal/Other

Environmental Health

4,381,764

2,812,965

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1,568,799

Epidemiology

8,032,651

3,395,650

115,637

4,521,364

Georgia Public Health Laboratory

15,088,818 14,596,086

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492,732

Health Promotion and Disease Prevention -
Infectious Disease & Immunization
Maternal & Child Health

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32,341,206 101,143,243 364,153,771

3,975,478 26,039,045 32,671,213

11,540,177
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16,825,551 75,104,198 331,482,558

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Public Health Formula Grants to Counties

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Vital Records

62,673,116 4,191,247

61,686,565 3,690,567

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986,551

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500,680

Total Public Health Base Budget 592,005,816 148,867,569 11,655,814 431,482,433

DPH & DEPR Administration Emergency Preparedness/Trauma System Improvement

22,437,146 46,121,266

Total Public Health and EPR Budget 660,564,228

15,065,614 3,082,935
167,016,118

131,795 11,787,609

7,239,737 43,038,331 481,760,501

PUBLIC HEALTH ADMINISTRATION

Public Health is a Division of the Georgia Department of Community Hea lth. The Division Director, in addition to leading the organization, is also the State Health Officer, as appointed by the Governor. The division is subdivided into operational and programmatic elements, each headed by a Division Deputy Director.
ADVISORY COUNCIL FOR PUBLIC HEALTH
House Bill 228, which was signed into law during the 2009 legislative session, moved the Division of Public Health from the Department of Human Resources into the Department of Community Health. This bill also created the Advisory Council for Public Health, which is composed of nine members appointed by the Governor in staggered three-year terms. This Advisory Council must meet at least quarterly and is to advise the Division of Public Health on all relevant matters.

Departmental Administrative Functions

Many of the administrative areas of responsibility are maintained at the Departmental level and thus have a reporting structure that is outside of the Division, but their responsibility is with public health business. Below is a list of these services:

Contracts Administration Human Resources Legal Counsel External Affairs & Constituent Services

Budget
Procurement & Purchasing
Financial Services I Accounts Payable
- Communications

The following are descriptions of the administrative and operational functions that report to the Departmental level but have responsibilities within the Division of Public Health.

CONTRACTS ADMINISTRATION

Public Health Contracts Administration is responsible for managing the development, approval, and execution for over 600 contracts for all programs within the Division of Public Health, Division of Emergency Preparedness and Response, and the Trauma Commission. This section also handles amendment s, extensions, renewals, terminations, maintenance of executed agreements, and provides mandatory contract training and tracking tools on all contract activities.

HUMAN RESOURCES

There are over 1,300 full time positions within the Division at the state office. Human Resources is responsible for all aspects of recruitment, hiring, benefits management and training for the division.

OFFICE OF GENERAL COUNSEL

The Georgia Attorney General's office serves as the official attorney for state agencies. The Department's Office of General Counsel provides in-house administrative legal support throughout its various divisions and functions. Currently, three attorneys are assigned to work exclusively with the Division of Public Health. These attorneys provide daily legal support and oversee administrative legal tasks such as responding to open records requests, reviewing policies, and legal research on state and federal laws and regulations affecting the various programs within the Division of Public Health. There is also a staff person within the Office of General Counsel who is assigned to Public Health to coordinate the work of the Institutional Review Board and the Public Health Advisory Council.

EXTERNAL AFFAIRS & CONSTITUENT SERVICES

This Office serves as the Division's primary point of contact for activities related to the Georgia General Assembly. It also serves as a liaison to consumers, families, advocates, and the general public for assistance

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PUBLIC HEALTH ADMINISTRATION
with questions, problems or access to our services. The team tracks and analyzes state and federal legislation that affects public health. BUDGET OFFICE The Division of Public Health budget office manages a budget of $600 million of state and federal public health funds, in 10 appropriated programs divided into 29 sub-programs. In addition, the budget office manages the Division of Emergency Preparedness and Response's $46 million budget. PROCUREMENT AND PURCHASING Procurement and purchasing ensures the acquisition of appropriate goods and services at the best possible total cost to meet the needs of the division. This section ensures that their processes promote fair and open competition. FINANCIAL SERVICES This section is responsible for ensuring that all financial processes are completed and accounted for. Financial Services monitor expenditures, pays bills for goods and services and has accounting oversight for the Department. COMMUNICATIONS This section is responsible for all aspects of marketing for the Department and the Division of Public Health. Communications staff members are the primary point-of-contact with the media and also work directly with program staff on health communications and promotions.
Division Administrative Functions
The following are descriptions of the administrative and operational functions that report to the Deputy Director for Public Health Administration. ENTERPRISE COORDINATION This program was created during the transition of Public Health from the Department of Human Resources to the Department of Community Health. The program is responsible primarily for ensuring that key administrative linkages between the Division of Public Health and the Department are made and maintained at the enterprise level. Areas of responsibility include, Information Technology, Communications, Legislative Affairs, Inspector General, Operations, Finance and Legal. FIELD OPERATIONS Field Operations is a new part of the Division of Public Health created to support a strong emphasis on public health at the local level. This section is headed by the Chief Nurse of Georgia and includes the Offices of Pharmacy and Nursing as well as serving as the primary point of contact with the 18 public health district offices. STATE OPERATIONS The Office of State Operations is responsible for coordinating the development and implementation of grants management and evaluation, strategic planning and partnerships, and systems development for the Georgia Division of Public Health. The structural units are Grants Management and Evaluation and Strategy and Performance Management.
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PUBLIC HEALTH ADMINISTRATION

Division Programmatic Functions

The following programs report t o the Deputy Director of Programs and Services.

- Epidemiology - Environmental Health - Immunizations and Infectious Diseases - Health Promotion Disease Prevention

- Maternal and Child Health - Public Health Laboratory - Vital Records

The following pages provide detailed descriptions for each program.

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ENVIRONMENTAL HEALTH
PROGRAM DESCRIPTION
The Environmental Health Program promotes and protects the well being of citizens and visitors of Georgia by assuring the environmental conditions in which people live, work and play can be healthy. This is accomplished by providing primary prevention through a combination of surveillance, education, enforcement and assessment programs designed to identify, prevent and abate the biological, chemical and physical conditions that adversely impact human health and thereby reducing morbidity and premature death related to environmental hazards.
CORE SERVICES
Routine inspection of more than 30,000 food service establishments; investigates food-borne related complaints and illnesses; certifies environmental health specialists and educates and trains food service operators. Regulate and inspect new sewage management systems; educate, train and certify environmental health specialists, septic tank contractors, and soil scientists. Regulate and inspect public swimming pools; investigate complaints and water-borne illnesses; provide consultation and inspection of new swimming pool construction and installation; and provide education and training for swimming pool operators. Regulate and inspect tourist accommodations; investigate complaints and illnesses; provide education and training for tourist accommodation employees and managers. Screening, monitoring and education on the causes of lead poisoning; conducts environmental inspections of residential housing and facilities to identify lead hazards; and requires lead hazard abatement of rental residential property and facilities identified with lead hazards. Regulate and inspect tattoo parlors. Conducts animal bite investigations. Requires and monitors quarantine of exposed animals. Recommends management options for rabies control. Conduct health assessments, risk communication, technical assistance, community education and training to reduce and eliminate exposures to hazardous chemicals in the environment. Reduce water-borne illnesses associated with contaminated well water supplies. Under a Memorandum of Agreement approves well water supplies serving food service establishments, tourist accommodations and public swimming pools. Conduct well assessments and well water sampling for individual residences served by individual wells. Provides consultation on indoor air issues associated with mold, mildew, formaldehyde, radon and other pollutants found in an indoor environment. Responsible for shelter inspections, monitoring temporary food service operations and temporary wate r supply, and mass fatality planning under the GA Emergency Response Plan.
FUNDING
State: $2,812,965 Federal/Other: $1,568,799
Total: $4,381,764
NUMBERS SERVED
All citizens and visitors of Georgia
LEGAL AUTHORITY
O.C.G.A. 26-2-373., O.C.G.A. 31-2-12, 31-3-5, O.C.G.A. 31-45, O.C.G.A. 31-28, O.C.G.A. 31-41, Centers for Disease Control {CDC) Grant, O.C.G.A. 31-40, O.C.G.A. 31-19, O.C.G.A. 31-12-1, ATSDR Grant, MOU EPD, O.C.G.A. 31-2-1{6){7}, MOU EPD, CDC Grant, O.C.G.A. 31-12-1.

EPIDEMIOLOGY

PROGRAM DESCRIPTION
The Epidemiology Program improves the health status of Georgians by monitoring the distribution and determinants of health-related states or events in the population. This information is used to control health problems and provide the data for evidence-based practice. Health information is used to guide strategic planning at state and local levels and to improve public health programs and Georgia's he.alth status. Public health agencies, partners within DCH and other partners use the data to determine the health challenges and areas of greatest need across the state. This system helps communities' direct efforts to achieve the greatest possible public health benefit.
CORE SERVICES
Assess and monitor the health status of Georgians. Conduct notifiable disease surveillance through the State Electronic Notifiable Disease Surveillance System (SENDSS). Respond to and investigate disease reports. Conduct disease outbreak investigations. Provide vital records and hospital discharge data for health planning through the Online Analytical Statistical Information System (OASIS). Provide data/analyses to inform Infectious Disease, Immunization, Chronic Disease, MCH, and other DPH Programs. Provide subject matter expertise related to infectious diseases (enteric, vectorborne, healthcareassociated, zoonotic, vaccine-preventable, etc.). Conduct surveys (BRFSS/YRBS) to monitor behavioral risks of Georgians. Produce annual health status report cards. Maintain registries of priority health problems such as stroke, birth defects, violent deaths, and cancer.

FUNDING

State: Federal/Other:
Tobacco: Total:

$3,395,650 $4,521,364 $115,637 $8,032,651

NUMBERS SERVED
All citizens and visitors of Georgia

LEGAl AUTHORITY OCGA 31-12-1 to 31-12-4, OCGA 31-12-8, OCGA 31-12-10.

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HEALTH PROMOTION DISEASE PREVENTION

PROGRAM DESCRIPTION
Health Promotion and Disease Prevention implements popu latio,n based programs and services aimed at reducing disease risks, promoting healthy youth development, targeting unhealthy behaviors, providing access to early detection and treatment services, and improving management of chronic diseases. Targeted risk behaviors include smoking, physica~ inactivity, unhealthy eating, lack of preventive healthcare, sex:ual violence, and reducing risky behaviors in youth. There are five key action areas for the work of health promotion: 1) build healthy public policy; 2) create environments that support and promote health; 3) strengthen community action for health; 4) develop personal skil ls; 5} re-orient health services toward prevention and health promotion. Program activities are developed and imp~emented using evidence-based best practices. Health promotion strategies used to address the five key action areas include: health communication; health education; self help/mutual aid; organizational change; community development and mobilization; advocacy; and policy development. It is the combination of multiple strategies applied across the five action areas that makes health promotion effective.

CORE SERVICES
Breast and cervical cancer screening for eligible women through the Georgia Breast and Cervical Cancer Program (BCCP}. Cancer treatment for low income, eligible Georgians through the Cancer State Aid (CSA) Program Breast and cervical cancer treatment for eligible women through the Women's Health Medicaid Program (WHMP). Comprehensive tobacco use prevention activities including tobacco cessation services through the Georgia Tobacco Quit Line (GTQL). Implementation of population-based strategies that address chronic disease prevention and management. Primary sexual violence prevention. Health communication and education. Implementation of primary prevention strategies to address obesity in children, adolescents, and adults Technical assistance to worksites on the development and implementation of evidence-based worksite wellness policies and practices. Community capacity building through the provision of technical assistance to community based organizations to address chronic disease prevention, risk factor reduction, and positive youth development.

FUNDING

State: Federal/Other: Tobacco Master Settlement:
Total:

$3,975,478 $16,825,551 $11,540,177 $32,341,206

NUMBERS SERVED All citizens and visitors of Georgia

LEGAL AUTHORITY OCGA 31-2-(3} -Public Law 101-354; OCGA 31-15-1, Public Law 106-354, CGS 31-12A-1-13

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IMMUNIZATION AND INFECTIOUS DISEASE
PROGRAM DESCRIPTION
Immunization and Infectious Disease (IDI) programs provide Georgia's statewide HIV, STD, TB, Refugee Health and Immunization services. IDI services cover a wide array of critical prevention, treatment and ongoing care services for Georgians who are either infected with communicable diseases .and/or are at risk of acquiring communicable or vaccine preventable diseases. The Immunization program provides vaccines to all uninsured or underinsured chi ldren in Georgia 0-18 years of age. In addition, adult vaccination services are offered to uninsured and underinsured adults and adults that require vaccinations not covered by Medicaid. The immunization program assesses need and coordinates the distribution of vaccines in response to pandemic influenza emergencies. The Infectious Disease program provides critical infectious disease prevention and control services through statewide screening, treatment and care services of Georgians infected or at risk of acquiring communicable diseases in individuals at high risk of acquiring communicable diseases and/or the medically under-insured or uninsured.
CORE SERVICES
Vaccines for Children (VFC), adult vaccinations, vaccine distribution. GRITS (Georgia Registry of Immunization Transactions and Services). HIV Prevention Education, Counseling &Testing/Partner Services, Care Quality Management. Medication distribution for approved HIV positive clients/ AIDS Drug Assistance Program (ADAP). Health Insurance Contin uation Program (HICP)/ Health insurance continuity of care program. Screening of newly arriving refugees, parolees, asylees and victims of human trafficking. TB Prevention education, screening, treatment and control and medical consultation. STD Prevention education, screening, treatment and control and medical consultation.
FUNDING
State: $26,039,045 Federal/Other: $75,104,198
Total: $101,143,243
NUMBERS SERVED
1.45 million 0-18 VFC eligible children in Georgia. HIV care services provided to approximately 10,000 Georgians in 2008 and 12,000 in 2009 respectively. Over 4,000 eligible Georgians enrolled in the ADAP in 2008 over 5,000 in 2009. HIV Prevention- Over 110,000 Georgians received HIV counseling, testing and referral services in 2008. That number climbed to over 120,000 in 2009 STD- In 2007, Georgia ranked 3rd in the nation for infectious syphilis cases, with 680 cases; 51h for Gonorrhea cases with 17,835 cases and 6th for Chlamydia cases with 42,913 cases. In 2008, Georgia ranked 3rd in the nation for infectious syphilis cases, with 914 cases; 6th for Gonorrhea cases with 16,272 cases; 13th for Chlamydia cases with 42,629 cases. In 2007, 473 TB cases were reported; 4,265 contacts evaluated, of those evaluated 50 (1%} had TB. There were 932 cases of LTBI (20%). In 2008, 478 cases were reported; 4,895 contacts evaluated, of those 79 had TB (2%). There were 1,082 cases of LTBI (22%}. In 2007, the TB staff provided prevention education to 7,710 clients and staff. In 2008, 10, 550 clients and staff were educated. Refugee Health- In 2007, 1,667 (89%} of all refugees entering the state of Georgia were provided health assessments within 90 days of arrival.
LEGAL AUTHORITY
OCGA 31-17-1, OCGA 31-17-2, OCGA 31-17-4, OCGA 31-17A-2, OCGA 31-14-1-14, OCGA 31-14-2:31-14-3, Refugee Act, 412(b)(5), OCGA 31-2-2
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PUBLIC HEALTH LABORATORY
PROGRAM DESCRIPTION Established by the Georgia Legislature in 1905, the Georgia Public Health laboratory (GPHl) provides screening, diagnostic and reference testing services to residents of Georgia through county health departments, public health clinics, private physicians, hospitals, other clinical laboratories, and state agencies. GPHL is comprised of three facilities including the Central Facility/Decatur, t he Albany Regional PH Laboratory and the Waycross PH Laboratory. All three GPHL facilities are licensed by the State of Georgia and certified by Centers for Medicare and Medicaid Services (CMS). Additionally, the Central Facility and Waycr oss PH Laboratory are certified by the Centers for Disease Control and Prevention and the US Department of Justice as a testing sites for bioterrorism Select Agents.
CORE SERVICES GPHL supports public health programs, assists in control ling infectious (bacteriology, immunology, mycobacteriology, mycology, parasitology, virology) diseases as well as identifying conditions such as metabolic diseases and hemoglobinopathies in newborns, and lead poisoning in children.
- A critical function of GPHL is to support state and national security by standing ready and capable of providing testing for both biologic and chemical threats.
- All GPHL facilities perform rabies testing. Regional Labs perform water testing for fluoride proficiency for all water systems within the State.
FUNDING State: $14,596,086
Federal/Other: $492,732 Total: $15,088,818
NUMBERS SERVED The GPHL serves Georgia residents across the state. FY2009 Specimens Received: 700,490 FY2009 Laboratory Tests Performed: 8,514,483 FY2008 Specimens Received: 699,136 FY2008 Laboratory Tests Performed: 8,931,135
LEGAL AUTHORITY 31-2-1. legislative intent; grant of authority
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MATERNAL AND CHILD HEALTH
PROGRAM DESCRIPTION The Maternal and Child Health program provides direct services (family planning, children with special health care needs, early intervention, and WIC), population-based interventions (newborn screening), and su pports the public health infrastructure through the administration of Title V Block Grant funds to improve the health of mothers, children and their families through education.
CORE SERVICES
Universal newborn hearing screening initiative. Newborn Metabolic and Hemoblobinopathy Screening. Early intervention. Coordinated care for children with special health care needs. Women, Infants, and Chi ldren (WIC). Family plarnning. Regional Perinatal Centers. Coordinated care and outreach for all children. Prenatal care. Health education including breastfeeding support, nutrition, SIDS prevention. Oral health preventive services. Children and Youth with Special Needs, Children Medical Services. Quality Management.
FUNDING State: $32,671,213
Federa l/Other: $331A82,558 Total: $364,153,771
NUMBERS SERVED
Population-based services for all deliveries of live births ("'150,000). WIC serves approximately 350,000 annually. Early Intervention serves approximately 6,000 annually. More than 200,000 dental treatments annually. Family planning serves approximately 150,000.
LEGAL AUTHORITY
O.C.G.A 31-12-6; 31-12-7; 31-1-3.2, O.C.G.A 31-12-6; 31- 12-7; 31-1-3.2, Title V Social Security Act, Tit le XIX, Title V Social Sewrity Act, O.C.G.A 31-2-2, O.C.G.A 49~7~3
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VITAL RECORDS

PROGRAM DESCRIPTION
The Office of Vital Records is responsible for the recording and pr eservation of all vital events including births, deaths, marriages, divorces, fetal deaths and induced terminations of pregnancy (ITOP) occurring in Georgia and in GA residents out of state. Vital Records is also responsible for providing data to state and federal heath and human service agencies, law enforcement, the courts, and the military.

CORE SERVICES
Register and record all vital events within the State of GA and those occurring in GA residents out of state. Upon request, provide certified copies of vital event certificates to registrant, family member, or other authorized parties. Provide custodial birth and death certificates to counties. Correct, amend, or establish delayed registrations. Provide data to state and federal stakeholders under MOU's. Maintain putative father registry under OCGA 19-11-9.

FUNDING
State: $3,690,567 Federal/Other: $500,680
Total: $4,191,247

NUMBERS SERVED

Requests for certified copies increased in 2009, while the total of registered events held steady.

On-line: Mail in: Walk in:
Total:

38,048 96,235 84,771 219,054

LEGAL AUTHORITY
Georgia Code Section 31-10 requires these events be recorded and the State Vital Records Office be the custodian of these records.

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EMERGENCY PREPAREDNESS & RESPONSE

PROGRAM DESCRIPTION
Emergency Preparedness and Response (EPR) is a separate Division within the Department of Community health, but has an inextricable relationship with Public Health. EPR has the primary responsibly of anticipating, preparing for and responding to emergencies of public health significance. These include severe weather events, explosive events, biological, chemical and radiological releases whether accidental or intentional, and pandemics such as the recent H1N1 outbreak. The Division's approach to preparedness and response is to ensure that Georgia's communities are effectively prepared and robust enough to respond and recover from both man made and natural public hea lth disasters.
CORE SERVICES
Public Health Emergency Preparedness- assures the health and well being of the individuals and communities in the State of Georgia by prepa ring for, responding to and recovering from events of public health significance.
Hospital Preparedness - provides support and training that will ready hospitals and supporting health care systems to deliver coordinated and effect ive care to victims of terrorism and other public health emergencies.
EMS- Georgia's regulatory agency for certifying (licensing) of EMS personnel ;and ambulances. Develops standards for pre-hospital triage and transport of patients and emergency preparedness planning of medical responses to disasters.
Trauma- oversees the designation and monitoring of 16 trauma centers within the state, tracks trauma center performance improvement, injury prevention and compliance, monitors performance based upon a data-driven system utilizing Trauma Registry data which also feeds into the National Trauma Databank. Tracks center performance improvement and compliance to the ACS standards.
Injury Prevention- Empowers state and local coalitions through the provision of data, training, and leadership, and the leveraging of resources for injury prevention programs.
Workforce Training- Educates and develops the workforce to improve preparedness in areas such as the following: Integrated Incident Management, Public Health, Food Supply Defense, Forensic Epidemiology, Public Health Emergency Law, Special Needs Populations Shelters and Health Emergency Coordinator Training and Certification.

FUNDING

State: $3,082,935 Federal: $43,038,331
Total: $46,121,266

NUMBERS SERVED EPR serves all individuals and communities in the State of Georgia

LEGAL AUTHORITY
These Rules and Regulations are entitled Public Health Emergency Powers and Procedures and published under the provisions of O.C.G.A. Sections 31-2-1; 31-3-2.1; 31-3-4; 31-12-3 & 4; and 38-3-51.

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