HomeMy WebLinkAbout2019/01/22 - BOH Packet JASON COUV�'
PubliclHealth
Always working for a safer healthier Mason County
PUBLIC
HEALTH
MASON COUNTY BOARD OF HEALTH
REGULAR MEETING
Jan 22, 2019
3:00 PM
Commission Chambers
411 North Fifth Street
Shelton, WA 98584
DRAFT AGENDA
1. Welcome and Introductions Scott Hilburn Chair
2. Approval of Agenda—ACTION Board Members
3. Approval of Minutes of Nov, 27 2018 —ACTION Board Members
4. Selection of 2019 BOH Chair -ACTION Board Members
5. Health Officer Report Dr. Diana Yu
6. Administration Updates Dave Windom
a. Foundational Public Health
b. Health Officer Transition
c. Legislative updates
7. Community Health Update Lydia Bucheit
8. Environmental Health Updates Alex Paysee
9. Other Business and Board Discussion Board Members
10. Public Comments
11. Adjourn
If special accommodations are needed,please contact Melissa Drewry,427-9670,Ext.589. From the Belfair area,please dial
275-4467,Ext.589;from the Elma area please dial 482-5269,Ext.589.
Mason County Public Health
415 N 6th Street, Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 ❖ Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400
FAX (360)427-7787
MASON COUNTY BOARD OF HEALTH PROCEEDINGS
411 North 5th Street,Shelton,WA
November 27,2018
Attendance: Randy Neatherlin,County Commissioner;Kevin Shutty,County Commissioner;Terri Drexler.
County Commissioner;Eileen Branscome,Hospital District#1;Peggy VanBuskirk,Hospital District#2; Gary
Plews,Fire Commissioner; Kathy McDowell,City of Shelton Council Member;Keri Davidson,Shelton School
District.
1. Welcome and Introductions-Chair Scott Hilburn called the meeting to order at 3:00 p.m.
2. Approval of Agenda—Two resolutions were added to the agenda for discussion.The first,0 1-18 was in
regards to the Federal Public Health System while the second,02-18 sets the 2019 meeting dates.
Cmmr.Drexler/Shutty moved and seconded to add resolutions 01-18 and 02-18 to the agenda for
consideration.All in favor. Motion carried unanimously.
A short discussion was had about both resolutions.
Cmmr.Shutty/Gary moved and seconded to approve resolution 01-18.All in favor. Motion carried
unanimously.
Peggy/Gary moved and seconded to approve resolution 02-18 as presented.All in favor. Motion
carried unanimously.
3. Approval of Minutes September 25,2018-Peggy/Cmmr.Drexler moved and seconded to approve the
minutes as written.All in favor. Motion carried unanimously.
4. Health Officer Report-Dr.Yu announced she will be retiring at the end of May,2019.She discussed
options for her replacement noting the need fora public health background.
Scott questioned what the hiring process is to which Dave said they could hire a new officer,or perhaps
share with another county.Dr.Yu spoke to the positives and negatives in sharing a health officer with a
neighboring county.
Opioid use-Dave announced that there are no reported opioid deaths in 2018.Dr.Yu spoke about the
naloxone kits being disbursed and the new opioid response mobile outreach. She noted that she felt positive
about the dent they are making,and will continue to make in this crisis.
5. Administration Report-Dave talked in depth about a recent presentation at the Washington State Public
Health Association Conference. Scott asked if his presentation was recorded;Dave said it was and would
send a link to the group.He said in January he would like to sit down and outline a work plan with BOH,
planning and public health to determine how to build a healthy community.
Dave then spoke about the steering committee for the$295 million ask for public health funding.He said
that due to his position as President of WSALPHO(Washington State Association of Local Public Health
Officials)he may call upon BOH to come testify since he cannot advocate.
It was announced that March 6,2019 is Legislative day on the hill for WSALPHO.
Dave talked about the road construction in Shelton and the difficulties faced by handicapped individuals
with no access to Building 8 at this time.The front entrance of the building is estimated to be complete by
the third week of December.
6. Environmental Health Report-Cody Lund stepped in for Alex Paysee and spoke about the booth hosted by
Public Health at Oysterfest,noting that they were so successful that they ran out of materials.
BOARD OF HEALTH PROCEEDINGS
November 27,2018-PAGE 2
Cody announced that Sean McGuire is leaving the county so a search is currently in place to fill his
position.
Cody then spoke in detail about his position as a food inspector.He said that he is currently trying to get
Mason County enrolled in the FDA Retail Food Standards Program.This program has nine different
standards to help produce an efficient science based food program which is uniform throughout the
country.For training and outreach,Mason County has received$3,000 and another$1,600 is pending for
training in January.
Cmmr.Drexler discussed the septic updates mentioned in the EH report..She said tiere are some significant
updates they're considering and quickly briefed some of thes8'updates.' "
7. Community Health Report-Lydia announced that she and Abe,Gardner spoke at the Washington State
Public Health Association Conference about the opioid program. She noted that they have received several
invitations to speak around the State.
The mobile outreach is now running twice a week in four locations around the County:Comindnity Food
Pantry of Belfair,Skokomish Health Clinic,Skookum Creek Tobacco,and at the Park&ride in Shelton.
Lydia said they have cards being handed out at all needle exchange locations surrounding Mason Comity
for those interested. - r;
Alison Smallwood,a Community Health Education Specialist for Public Health,showed a video regarding
how outreach has helped those struggling with addiction.
She then showed a website currently being worked on by Public Health that communicates data to the
community and also has outreach.The site has a Google calendar showing all of the AA and NA meetings
along with the mobile outreach dates.Lydia explained how data is updated on the page and asked that the
board look at the website and then fill out a survey about the site.Dave added that this website can be done
by staff and is customizable for less cost. 5
8. Other Business and Board Discussion-Peggy and Scott thanked Cmmr.Drexler for all of her involvement
with mental health and health in general during her time with Mason County.Cmmr.Drexler thanked the
entire board and discussed how mental health really called to her and announced that the goal is to have the
treatment and evaluation center open by April,2019.
Gary asked Dave to have a wildfire and public health discussion on the January agenda.
9. Public Comments-None.
10. Adjourn-The meeting adjourned at 4:15 p.m.
BOARD OF HEALTH PROCEEDINGS
November 27,2018-PAGE 3
ATTEST MASON COUNTY,WASHINGTON
BOARD OF HEALTH
MASON COUNTY,WASHINGTON
Melissa Drewry,Clerk of the Board
Scott Hilburn,Hospital District#1
Kathy McDowell,City Commissioner
Kevin Shutty,Commissioner
Randy Neatherlin,Commissioner
Sharon Trask,Commissioner
Peggy Van Buskirk,Hospital District#2
Gary Plews,Fire Commissioner
From the Directors Desk
January 2019 f
It's not too late, get your flu shots!
With the legislative session underway, both WSALPHO and the Washington State Public Health
Association will be working in Olympia putting forward a large ask of the legislature. In September,
WSALPHO and DOH asked for$296 million which is what our data shows as needed to fund
communicable disease, environmental public health and assessment. In December,the Governor
released his proposed budget which includes 22 million dollars for foundational public health.The good
part of the Governor's budget is that this would be a recurring baseline budget number under the
Department of Health budget.
That budget item breaks down as follows:
$12 million to continue FPHS(Foundational Public Health)work from the previous biennium
$3 million specifically for Seattle King Public Health
$1.2 million for tribal FPHS efforts
That leaves$5.8 million dollars or less than $1 per person of new money in Washington for Foundational
Public Health.WSALPHO and our partners have decided to make a $100 million dollar ask of the
legislature to fund smaller portions of the communicable disease, environmental health and assessment
work.
Our proposal breaks down as follows(per biennium):
$20 million for the continuing work
$40 million for communicable disease
$28 million for environmental health
$12 million for assessment
As the chair of WSALPHO this year, I've asked that every board of health have FPHS on their agenda for
January. In addition to the monetary ask, we're running a policy bill that defines FPHS,that removes
some outdated statues and formalizes the relationship between DOH and the local health jurisdictions.
The bill requires local LH1 concurrence when funding becomes available through DOH.This is a big step
forward in getting a coordinated and properly funded approach to public health.
Here in Mason County we're sticking with "Public Health is Essential" as our slogan.The effort is to keep
awareness of public health in front of the legislature where a monetary ask will be made. March 6th is
our annual legislative education day in Olympia. BOH Members are welcome to attend. Contact me for
details. Breakfast is provided!
FTE's stand at 20.9.
AN ACT Relating to foundational public health services; amending
RCW 43 . 70 . 512; adding a new section to chapter 43 . 70 RCW; creating a
new section and repealing , 43 . 70 . 514, 43 . 70 . 516, 43. 70 . 520,
43 . 70 . 522 and 43 . 70 . 580 . .
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 . RCW 43 . 70 . 512 and 2007 c 259 s 60 are each amended to
read as follows :
(1) Protecting the public' s health across the state is a
fundamental responsibility of the state and this is accomplished
through the governmental public health system. This system is
comprised of the state department of health, state board of health,
local health jurisdictions, sovereign tribal nations, and Indian
health programs .
(2) (a) The legislature intends to define a limited statewide set
of core public health services, called foundational public health
services, which the governmental public health system is responsible
for providing in a consistent and uniform way in every community in
Washington. These services are comprised of foundational programs
and cross-cutting capabilities .
(b) These governmental public health services should be
delivered in ways that maximize the efficiency and effectiveness of
the overall system, make best use of the public health workforce and
evolving technology, and address health equity.
(c) Funding for the governmental public health system must be
restructured to support foundational public health services . In
restructuring, there must be efforts to both reinforce current
governmental public health system capacity and implement service
delivery models allowing for system stabilization and
transformation.
NEW SECTION. Sec. 2 . A new section is added to chapter 43. 70
RCW to read as follows :
(1) With any state funding of foundational public health
services, the state expects that measurable benefits will be
realized to the health of communities in Washington as a result of
the improved capacity of the governmental public health system.
(2) Distributions to fund such foundational public health
services or structural changes to implement such foundation public
health services must be made under allocation plans mutually agreed
to by the department, a statewide association representing local
health jurisdictions, and the state board of health, and in
consultation with tribal nations .
(3) By October 1, 2021, the department, in consultation with
local health jurisdictions, sovereign tribal nations, and the state
board of health, shall report on:
(a) Service delivery models, and a plan for further
implementation of successful models;
(b) Changes in capacity of the governmental public health
system; and
(c) Progress made to improve health outcomes .
(4) For purposes of this section:
(a) "Foundational public health services" means a limited
statewide set of defined public health services within the following
areas :
(i) Control of communicable diseases and other notifiable
conditions;
(ii) Chronic disease and injury prevention;
(iii) Environmental public health;
(iv) Maternal, child, and family health;
(v) Access to and linkage with medical, oral, and behavioral
health services;
(vi) Vital records; and
(vii) Cross-cutting capabilities, including:
(A) Assessing the health of populations;
(B) Public health emergency planning;
(C) Communications;
(D) Policy development and support;
(E) Community partnership development; and
(F) Business competencies .
(b) "Governmental public health system" means the state
department of health, state board of health, local health
jurisdictions, sovereign tribal nations, and Indian health
programs located within Washington.
(c) "Indian health programs" means Tribally operated health
programs, Urban Indian Health Programs, tribal epidemiology
centers, the American Indian Health Commission for Washington
State, and the Northwest Portland Area Indian Health Board.
(d) "Local health jurisdictions" means a public health agency
organized under chapter 70 . 05, 70 . 08, or 70 . 46 RCW.
(f) "Service delivery models" means a systematic sharing of
resources and function among state and local governmental public
health entities, sovereign tribal nations, and Indian health
programs to increase capacity and improve efficiency and
effectiveness .
NEW SECTION. Sec. 3. The following acts or parts of acts are
each repealed:
(1) RCW 43 . 70 . 514 (Public health—Definitions) and 2007 c 259 s
61;
(2) RCW 43 . 70 . 516 (Public health—Department ' s duties) and 2007 c
259 s 62;
(3) RCW 43 . 70 . 520 (Public health services improvement plan—
Performance measures) and 2007 c 259 s 64 & 1993 c 492 s 467;
(4) RCW 43 . 70 . 522 (Public health and performance measures -
Assessing the use of funds - Secretary' s duties) and 2007 c 259 s 65
and
(5) RCW 43 . 70 . 580 (Public health improvement plan - Funds -
Performance-based contracts - Rules - Evaluation and report) and
1995 c 43 s 3 .
--- END ---
}
SESSION
2019 LEGISLATIVE
WASHINGTON
STATE ASSOCIATION Public Health Services
0
1COUNTIES -
Foundational Public Health Services (FPHS)
The Problem Government Public Health System
Washington's governmental public health system has a critical and
unique public safety role that is focused on protecting and improving
the health of families and communities. Demand for public health
services has increased with the changing nature of preventable
diseases, the resurgence of"historical" diseases,and the surge of new
public health threats; but there is also inequitable funding for services State Board Department
across the 35 local health jurisdictions. of Health
of Health
The Solution
In 2015,the Washington State Department of Health and representatives
of local health jurisdictions(LHJs),the Washington State Association of
Counties,and other public health partners initiated work to develop a �OTCbal Health
set of public health programs and services that every citizen should have
Jurisdictions I and other
access to-the Foundational Public Health Services(FPHS). The goal is
departments
to have a responsive and sustainable public health system and ensure
healthy and economically vital communities across Washington. In
2018,local health jurisdictions,the State Department of Health,and the
State Board of Health completed an assessment that produced a cost-
estimate for fully funding FPHS.That estimate is$450 million a biennium.
The Request Stabilizing LHJs to adapt and be nimble to changing public health issues such as
The FPHS budget decision package Hepatitis C,wildfire smoke,and childhood lead poisoning.
for the 2019-2021 legislative Innovative approaches to service delivery, like the Washington State Tuberculosis
session focuses on critical work Collaborative Network,making best use of public health technical experts.
in communicable disease control, . Keeping kids safe by testing more at-risk kids for lead exposure and partnering
environmental public health,and with state and local agencies to find and replace fixtures leaching leads into
assessment and seeks to fund the
governmental public health system. school drinking water.
This package,for$100 million/ Helping growing counties across the state keep up with communicable disease
biennium,includes efforts such as: cases by streamlining disease investigations and improving follow-up times.
Why This Helps Counties
Local governments and communities highly value public health. Often, local revenue is used to fund state
required programs and services. With fully funded FPHS, local governments are empowered to use local
revenue to implement public health services that address local contexts and health needs unique to
their health jurisdiction. FPHS funding also provides stability for LHJs in funding services that are easily
impacted by unpredictable events such as outbreaks, economic changes, and natural disasters.
• • LEGISLATIVE SESSION
WASHINGTON Public
STAT[ASSOCIATION
of COUNTIES
Our Work Continues
Awarded in the 2017 Biennium Budget, an initial
one-time investment of$12 million was allocated to
the governmental public health system. Local health Piloted Shared Service Projects
jurisdictions(LHJs) used a $10 million allocation to
reinforce their local needs in communicable disease
investigation, surveillance, and control as well as �°l?
pilot three shared service projects that emphasized
multi-jurisdictional sharing.
$12 Million Initial Investment:
Spending Detail Year 1 ($6M)
Disease Investigation,55%
Other capabilities,18%
Immunization,10%
V�16m ® Communicable disease data
and planning,9% Health • Statewide TB •Shared
Information Resource Center Epidemiology
Community health for Providers Lead:Public Services
assessment,7% Lead:Tacoma- Health Seattle Lead:Spokane
Pierce County King County Regional Health
Emergency prep,1% Health District District
Currently, statewide work includes developing the public health system implementation plan, assigning
accountability measures, honing new and existing service delivery models, and aligning FPHS work to other
statewide health initiatives including opiates, suicide prevention, and homelessness. Locally, FPHS funding has
supported improvements in local health jurisdictions including:
• Kitsap County: Improved response to communicable disease by streamlining disease tracking and
assessment. This has helped staff improve client access to disease treatment and have faster disease
follow-up to mitigate the severity of disease outbreaks.
• Adams County: Provided essential training to new staff, enabling a swift and local response to communicable
disease investigation in foodborne illness, tuberculosis, and STDs.
Pierce County: Working with local and state healthcare partners, the State Department of Health and the
Centers for Disease Control and Prevention, the health department investigated a Hepatitis C outbreak. In
total, the department notified 2,800 people,facilitated testing of exposed individuals, and identified 13 cases
of confirmed disease.
Benton and Franklin Counties: Improved response for all infectious disease reports and eliminated a backlog
of case reports, increased local tuberculosis response, and developed a food safety priority system to
improve food safety efforts for over 1,300 permitted establishments.
Jaime Bodden, Managing Director,Washington State Association of Local Public Health Officials(WSALPHO)
Q 206 Tenth AveOlympia, WA 98501Q (360) 785-1886 8 www.wsac.org
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Funding Priorities
PUBLIC
Foundational Public Health Services
WSALPHO's top priority is the full and sustainable funding of Foundational
Public Health Services (FPHS) for the governmental public health system. is
Protecting public health is a fundamental responsibility of the state. A strong
governmental public health system is essential to keep Washington healthy and safe. In partnership with
the Department of Health, State Board of Health, and Tribal governments WSALPHO requests FPHS
funding prioritization of environmental public health, communicable disease prevention and
control, and assessment. To fully fund all aspects of the public health system, FPHS will be a multi-year
request. General Fund State: $148,421,000 in FY 20 and$147,580,000 in FY 21.
In addition, WSALPHO supports FPHS legislation which defines the FPHS framework of the
governmental public health system, including concurrence language which ensures funding and
system changes are agreed by both state and local health jurisdictions.
Model Toxics Control Act (MTCA)
WSALPHO supports the following Department of Ecology MTCA funding requests:
• Local Solid Waste Financial Assistance Fund: includes enforcement grants 0 O
to ensure solid waste facilities protect human health and the environment, °
reducing human exposure to toxins. MTCA: $28,200,000
• Chemical Action Plans: Funding to implement plan development and implementation
monitoring to reduce human exposure to specific toxins. State Toxics Control Account: $4,482,000
• Local Source Control Programs: local government assistance to small businesses to manage
chemicals and hazardous waste to prevent spills and stormwater pollution. Local Toxics Control
Account: $3,000,000
• Litter Control Account: Restore and create recycling programs to reduce contamination and improve
waste reduction. Waste Reduction Recycling and Litter Control Account: $6,000,000
Monitor Group B Water Systems
Local Group B programs provide citizens with greater opportunity to pursue their economic
interests and enables local government to better satisfy their communities' needs while
protecting health and safety. WSALPHO supports the Department of Health request to
♦ work with local public health to ensure the approximately 13,400 Group B public water
systems comply with statewide rules and are providing safe and reliable drinking
water. General Fund State: $506,000 in FY 20 and ongoing.
WSALPHO206 Tenth Avenue SE Olympia, WA .: , . . . . .
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Policy Legislation
Vital Records Modernization
Vital records serve as documentary proof of a life event, which the public uses to prove
® 1 identity, citizenship, and relationship in order to get official documents, enroll a child in
school, obtain Social Security, or other benefits and services. The Department of Health and
WSALPHO have worked to update and modernize current vital statistics law (chapter 70.58
- RCW) because current law does not provide adequate protections against identity theft and
fraud. Many parts of the statute have not been updated since 1907, making the law outdated, confusing,
and inconsistent to current best practices. WSALPHO supports modernizing vital statistics law to
better protect the public against identify theft, provide consistent practices across Washington,
and support program self-sustainability through a certification fee increase. General Fund State.-
$95,000
tate.$95,000 in FY 20 and$304,000 in FY 21.
Tobacco 21
Tobacco continues to be the leading cause of preventable death and disease. Proposed
legislation focuses on holding retailers accountable for responsible sales practices in addition
to raising the legal age for tobacco products from 18 to 21 for; (1) persons to whom retailers
can sell or give tobacco and vapor products; (2) persons who vapor product retailers can allow
to taste product samples; and (3) where self-service displays and vending machines that
contain the products can be located. WSALPHO supports strategies to prevent marketing, sales, and
use of tobacco, e-cigarettes, smokeless tobacco, and marijuana to youth including raising the
legal sales age from 18 to 21.
Local Public Health Authority
Local boards of health and health officers have the responsibility and authority to: enforce
public health statutes and rules of the state, control contagious or infectious disease, and
maintain the health and sanitation of the community. WSALPHO supports legislation that
respects the public health authority of local health
Contact: officers, boards of health, and state health agencies.
Jaime Bodden Fiscal sustainability for county operations
Managing Director Virtually all programs and services that counties deliver are
jbodden@wsac.org /
required by state constitution, laws, or rules. Counties need
Brynn Brady the tools to be able to adequately fund state mandated
Contract Lobbyist programs. WSALPHO supports the Washington State
brynn@ciebaconsulting.com Association of Counties (WSAC) legislative priorities that ensure
fiscal sustainability for all county operations.
WSALPHO206 Tenth Avenue SE Olympia, WA .. , ::. 1 www.wsalpho.org
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November-December 2018
Communicable Disease& Notifiable Conditions (3 programs-CD, TB, STD) Staff:Audrey O'Connor,
Back up: Elizabeth Custis& Lydia Buchheit
November-December, our communicable disease(CD)program nurse received 58 reports requiring data entry
into the State database,and/or investigation and follow-up. * Reporting of Chronic Hepatitis cases began to be
handled directly by the State Department of Health in 2018.
Disease Nov-Dec Total to date
Campylobacteriosis 2 39
Cryptosporidiosis 0 2
Giardiasis 1 6
Shiga Toxin 2 1 1
Shigellosis 1 1
Hepatitis B-Acute 1 1
Hepatitis B-Chronic 0 2
Hepatitis C-Chronic
Hepatitis C-Acute 0 1
Hepatitis D 1 1
Lyme 0 1
Pertussis 0 2
Salmonellosis 0 2
Coccidiodmycosis 0 1
Anthrax—Ruled out 0 2
Hepatitis A—Ruled out 0 1
Meningitis-Ruled out 0 1
1
Vibrio-Ruled out 0 1
Listeriosis 1 1
Q fever 1 1
Mumps-Ruled Out 1 1
Tuberculosis-Ruled out 1 12
Tuberculosis-Latent 0 3
Tuberculosis-Active/open cases 0 1
Vibriosis(non-cholera) 0 3
Yersiniosis 0 1
Chlamydia 34 264
Gonorrhea 9 60
Syphilis 1 6
Herpes 3 13
HIV 0 3
�otals 58 434
Maternal-Child Health Programs: Staff: Elizabeth Custis
Maternal Child Health Parenting
Our Staff RN was trained in evidence-based parenting and prevention curriculum called Incredible Years. Funding
is provided by Division of Behavioral Health and Recovery(DBHR)grant for substance use prevention work. Staff
will be providing education to parents in Mason County through classes and home visits.
Adult-Baby-Child Dental (ABCD):
Staff attended annual state-wide ABCD update and training. Sent reminders to 10%of families(randomized)in
Mason County whose children are on Medicaid, reminding them of children's dental coverage and encouraging 2
visits per year.These are requirements of the ABCD grant contract. Our rates of untreated decay in children under
the age of 5 are higher than average in our state.We receive calls weekly from residents asking for help in finding
Medicaid dental providers.
Breastfeeding Collaborative:
Our staff is facilitating a group of Mason County providers in providing support for breastfeeding health. This
group collaborated with Mason General Hospital and Clinics to provide required education for the hospital to begin
the application for Breastfeeding Friendly designation.
2
Early Learning Coalition:
This coalition provides collaboration with community agencies and leaders to focus on the importance of early
learning. Staff participated in Early Learning Family Fun Fair in Shelton in November and planning for the same in
Belfair in February. The focus has been on sharing early learning information with our community.
Housing Programs: (Consolidated Homeless Grant and Local Document Recording Fees)
Staff:Todd Parker
Results are from FY19 YTD(July—November) unless otherwise noted
Crossroads Housing
1. Housing Crisis Support Center(Coordinated Entry):
a. 157 households(377 individuals including 162 children and 28 veterans)requested housing
assistance
i. 126 households were literally homeless
ii. 31 households were for prevention service to maintain current housing.
2. 7-unit Family Emergency Shelter: 100%capacity;60 referrals were made
a. At this referral rate, in one year 140 families will need shelter and we only have 7 units available
3. Transitional Housing: 5 units are at 100%capacity
4. Rapid Rehousing(Rental Assistance):
a. 126 Households literally homeless and 15 households housed=12%conversion
b. 31 households qualified for prevention and 9 received prevention assistance=29%conversion
c. 43 households assisted into recovery housing(Treatment Sales Tax)=100%of requests were
housed
Community Lifeline:
• Case Management(year-round): 27 adults are currently receiving housing case management services
• Adult Seasonal Emergency Shelter: Open November 1 through April 30
o 63 unduplicated male and female adults have stayed in the shelter through November 2018
Community Action Council: Housing and Essential Needs Program$231,421 paid out for rent and housing costs as
follows:
• Rapid Re-housing: 47 households receiving rental assistance
• Prevention: 38 households receiving rental assistance
Turning Pointe: (Local Recording Fees fund one Advocate position)
1. Domestic Violence Shelter: From July 1,2017—June 30, 2018
a. Total number of requests to stay in the shelter: 701
b. Total number of unduplicated households that stayed in the shelter: 287
c. Total number of children that stayed in the shelter: 211
2. Advocate: 15 households currently receiving case management services
North Mason Resources:
1. Coordinated Entry: 39 households requested services (97 individuals, 28 children and 19 veterans)
a. 10 households qualified for prevention
b. 29 households literally homeless
c. Outcome: 0 have been funded with the Rapid Rehousing funds
2. Case Management: 5 households are receiving case management services
3
Mental Health and Substance Use Disorder Treatment Services-Treatment Sales Tax
Staff:Todd Parker
Results are from FY19 YTD(July–November)unless otherwise noted
Therapeutic Courts(January–December 2018)
Court Program 2017 Grads 2018 Grads
Felony Drug 11 7
Family Recovery 3 8
Veteran 4 2
Mental Health 0 2
Total 18 19
Northwest Resources II: Care Coordination Services
1. New enrollments into care coordination: 84
2. Total Served: 191
3. Number entered in Detox: 10
4. Number entered in Inpatient SUD Treatment: 45
5. Number enrolled into MAT treatment: 7
6. Number enrolled into Mental Health Treatment: 66
7. Assisted with rental assistance into recovery housing: 38
Behavioral Health Resources: North Mason School District School-based Therapist
School Enrolled Students Gender
Belfair Elementary School 11 3 female/8 male
Sand Hill Elementary School 19 5 female/14 male
Hawkins Middle School 14 10 female/4 male
James A.Taylor High School 7 4 female/3 male
North Mason High School 7 4 female/3 male
Consejo Counseling: Mental Health and Client Services for up to 10 individuals that do not have medical coverage
or gaps in coverage. Medication assistance program to provide mental health medication for those that cannot
afford it.
• 27 households enrolled with 13 on active case load
Peninsula Community Health Services: 2 Peer Navigators are funded
• 59 households are currently enrolled and assisted with 27 on active case load
Mason County Opioid Response (3 programs) Staff:Abe Gardner,Christina Miller-Shinn,Audrey
O'Connor
Prescription Drug Overdose Program(PDO) Funded by Department of Health Grant through 08/30/19
2018 was a very successful year for the Department of Health's Overdose Prevention Project,funded by the State's
Prescription Drug Overdose prevention grant from the Department of Health.There have been zero reported
deaths due to opioid overdose—a big change from the 4`h highest death rate in the State from 2012-2016.
However,there were two reported overdoses that led to death in Mason County from amphetamine or multi-drug
use.
4
Our success has stemmed from the 481 individuals that were trained on opioid overdose prevention and response,
including the use of naloxone. 107 of those individuals were inmates at Mason County's jail. Public community
workshops were held in both Shelton and North Mason, and we were present at the Transit Center with an
informational table and naloxone 41 weeks out the year. Many referrals were made to substance abuse and
mental health treatment, including medically assisted treatment(MAT),and several individuals had successful
warm handoffs to partnering treatment providers.We have also trained staff at 10 agencies,including:public
institutions,treatment providers,crisis response teams,tribal institutions,and jail staff.
DEPARTMENT OF HEALTH OVERDOSE PREVENTION PROJECT
Year Reported Fatal opioid Number of Number of Number of Resource
non-fatal overdoses individuals Naloxone kits community Guides
opioid trained in OD distributed workshops distributed
overdoses response
2017 16 5 143 246 8 2100
2018 24 0 481 535 12(+41 table Approx. 1700
events)
Substance Use Mobile Outreach of Mason County
Mason County debuted the Substance Use Mobile Outreach in November 2018.Traveling to 4 different locations
in the county throughout the week(Belfair,Shelton,Squaxin and Skokomish Indian Reservations)in an RV,we
have served 8 individuals and exchanged 3,280 syringes as of Jan 7,2019.
Comprehensive Opioid Abuse Program (COAP)Funded by Bureau of Justice Assistance through(BJA) 10/30/20
We made tremendous headway on our collaborative efforts in 2018 and a significant number of those can be
attributed to the COAP project as well as the ongoing efforts of Mason County's Opioid Stakeholder group
meeting. Mason County has over 60 agencies of all disciplines at the discussion table and has Memorandum of
Understanding(MOU)supported collaboration among agencies(20 MOU's and 6 letters of support/participation).
Mason County Public Health and community partners have secured over$1 million dollars in new grant funding to
work in the community's opioid response.
Our CORP project is involved in intense data collection and reporting,to gain important information about how
well the network to assist those needing substance use recovery services is operating. Working with agencies
throughout the region and the state,and we are also having conversations in between our stakeholder group
meetings that continually build and strengthen the framework for opioid response in Mason County.
Substance Use Prevention (3 programs) Staff: Ben Johnson &Alison Smallwood
Community Prevention&Wellness Initiative(CPWI) Ben Johnson
In 2011,the Division of Behavioral Health and Recovery launched the Community Prevention and Wellness
Initiative(CPWI)to provide substance abuse prevention services and strategies through local coalitions in high-
need communities.Communities have proven to be an effective organizing force for bringing evidence-based
policies and programs to scale, improving public health. Mason County Public Health and School districts work
together to implement programing in local communities. Mason County has two projects,one in Shelton and a
new program just starting in North Mason Community.
5
Tobacco&Vaping Prevention Program Alison Smallwood
As of 2017, 25%of Mason County adults reported being a current smoker(BRFSS,2017 WA State DOH).With a
rate of 1 in every 4 residents currently smoking,there is still work to be done in tobacco cessation in our county.
This program is funded as part of a regional project as the region works together to identify Policy,Systems and
Environmental (PSE)change strategies and activities to impact this health issue.The regional work group is also in
collaboration with chronic disease programs.
Youth Marijuana Prevention Project Alison Smallwood
The purpose of the Regional Strategic planning group is to prevent initiation and use of marijuana by youth ages
12-20 throughout Washington State. Staff will be attending a national marijuana science, policy and best practices
conference in Los Angeles at the end of January.We look forward to gathering the most up-to-date information
and sharing it with the board as well as with our regional partners.
Community Health Assessment and Data Staff:Alison Smallwood, Lydia Buchheit
We will be submitting a request for proposal, in January,to Cascade Pacific Action Alliance(our regional
accountable community of health agency)for funding to support a local forum to address community health
improvement needs in Mason County.We are partnering with Mason General Hospital&Clinics, Peninsula
Community Health Services, Public Hospital District#1 and Public Hospital District#2 and will be inviting other
community sector stakeholders to join. This group will carry on work that was previously done by Mason Matters.
Public Health's updated Community Health Assessment is available on our website or you can click on the
following link: htto://www.co.mason.wa.us/forms/Health/CHA-2018.pdf.The new Mason County Health
Coalition will be working on the Community Health Improvement Plan.
Our new Health Improvement platform through LiveStories is now available for sharing and tracking community
work to improve health outcomes.You can access it from our Public Health Page directly above the picture of our
building at www.healthymasoncounty.org or directly through this link:insight.livestories.com/s/v2/mason-county-
homepage/48 b8750d-70ef-4589-84c5-0df 131766a6a/
Public Health Emergency Preparedness Staff: Lydia Buchheit Assist:Sunni Evans,Alex Paysse
Locally, Mason County has a monthly emergency management planning meeting at the department of emergency
management the second Wednesday at 8:30 AM monthly.Attendees include,emergency management, hospital,
schools,tribes, PUD, Law Enforcement, Fire, Department of Corrections, Red Cross,Washington Ecology,and MC
Planning. Public Health participates in these meetings as well as a monthly communication drill using our digital
radios in the event of the loss of internet or phone communications.
Our contract with the State Department of Health has 14 deliverables for the 2018-2019 contract year.We will be
participating in the State Exercise called T-REX(Transportation Relay Exercise).T-REX 2019 is a full-scale medical
countermeasures(MCM)distribution and recovery exercise.
Bi-monthly West District Healthcare Response Network meetings continue around our region. These meetings
include all regional healthcare partners, hospitals,emergency medical services, medical clinics, public health,
county emergency management, long-term care,and dialysis care to work together to prepare for a coordinated
response to an incident or emergency. In the past two months,our region experienced the wind storms and the
loss of 911 communications. We train on multiple communication platforms,WASecures,WATrac,Alert Sense and
Web EOC to gather and disseminate public health emergency information.
6
From the Desk of the Environmental Health Manager
December 2018 and January 2019
For Board of Health January 221,2019—by Alex Paysse
December Activities:
December 51. Staff hosted a quarterly meeting for the Oakland Bay Clean Water District Advisory Committee.
December 61. Mason Co.was notified of a commercial shellfish growing area downgrade in Oakland Bay. This is a
result of the on-going work in the Oakland Bay/Hammersly inlet in response to the norovirus outbreak that occurred in
2017. DOH completed its Shelton sewer dye study and found a change(expansion)in boundaries to the prohibited
area was necessary to reduce risk of contamination. A conditional area is also being added to Hammersly inlet.
December 141. Linsey Fields was officially re-hired into Sean McGuires previous position.
December 191. Attended the Hammersly/OB shellfish growers meeting held by DOH. DOH presented their findings
from the dye study and reasoning behind the change in classifications.
January Activities:
January 21. Mason County Community Services went Live on their new permitting software"SmartGov". This new
software will bring modem permitting capabilities to the environmental health programs,including online submittals.
January 2nd. Environmental Health fees were adjusted per resolution 70-13,by the July-July CPN(3.6%).
January Ids. Rhonda Elliott j oins the Mason Co.EH team as an Environmental Health Specialist. Rhonda was hired
into a 6-month temporary position to cover the grant projects previously worked on by Linsey Fields.
January 81. Mason County was notified from DOH they would be re-opening some parcel closures on Hammersly
Inlet for commercial shellfish harvesting. WQ staff has been working hard on this area to identify and correct sources
of pollution. We are working on a letter that thanks homeowners for their participation.
January 10'x. Cody Lund attended a quad-county food safety meeting. This includes Jefferson,Clallam,Mason and
Kitsap counties.
January 131. Cody Lund and Wendy Jonas attends a 2-day Temporary Event training in California. Travel expenses
were covered under a FDA grant awarded to Mason County. Wendy Jonas will be assisting with temp event food
inspections during the busier summer season of 2019.
January 251. Dave Windom,Jeff Wilmoth,and Alex Paysse will be attending the annual WOSSA(Washington Onsite
Sewage Association)conference in Tacoma.
-
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WILDFIRE SMOKE
Washington State Departmentof HEALTH RESOURCES
11iHealth
Julie Fox, Cristina Labra & Nancy Bernard
August 2018
Washington State
Comprehensive Emergency. ESF 8: Public Health,
Management Plan Medical and Mortuary
hi
m
Services
F?�-
Appendix 5: Air Quality
r
Wti Response
Attach 1 : Wildfire
Response Severe Smoke
Basic Plan _ EpisodeS
June 2016
W"NoUtan 0411Mary LYvart►►►srt
IEn►er9sncy Wan'��u+snnl Gfvlswn
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WASHINGTON
' AIR �WAiLITY
ADVISORY
Check air quality conditions at ecology.wa.gov/WAQA
GOOD ' SENSITIVE
Air pollution is so low so there is little health risk.
GROUPS
It's a great day for everyone to enjoy the outdoors!
MODERATE People
with health
j People with health conditions should limit conditions such as:
spending any time outdoors&avoid strenuous Asthma,COPD,
J outdoor activities.
diabetes, ; other heart/
They may begin to have worsened symptoms. lungdiseases
-Respiratory illnesses
UNHEALTHY ' colds
Stroke survivors
FOR SENSITIVE GROUPS Children •_
r 18
A• All of the above&: &adults over 65
irQualityAll sensitive groups should limit spending any time •outdoors.People with health conditions may have '•••p- who smoke worsened symptoms.Healthy people may start to
have symptoms.
KNOW THE
Hazard UNHEALTHYSYMPTOMS:
FOR EVERYONE Watery or duy eyes
Everyone,especially sensitive groups,should - Coughing/wheezing
u d e l i n e s limit time spent outdoors,avoid strenuous - Throat&sinus irritation
activities outdoors,&choose light indoor activities.
- Shortness of breath
VERY UNHEALTHY - Headaches
FOR EVERYONE - Irregular heartbeat
Everyone should stay indoors,avoid all strenuous - Chest pain
activity,close windows&doors if it's notr'y
too hot,set your AC to recirculate, , If you are I.Z.
&use a HEPA air filter if possible. experiencing serious
symptoms,seek
HAZARDOUS '"'mediate medical
40 FOR EVERYONE attention.
All of the above&:
People with heart or lung disease,or those who have had a stroke,should consult
their healthcare provider about leaving the area&wearing a properly-fitted
respiratory mask'if they must go outdoors.Follow burn bans and evacuation orders.
Air pollution from dust,vehicles,woodstoves,wildfires,
&industries can seriously impact your heatth ''•""""'"n1`"'"''' ECOLOGY
'For more health information&how to choose the proper H2Ql t�1
respiratory mask,visit doh.wa.eov/smokefromtires.
�m�
DOH Smoke from Fires Website
www. doh .wa . gov/Smoke Fro Fires
Primary Audience
Smoke from fires can be dangerous, especially for sensitive
populations. People who are sensitive to wildfire smoke
include:
People with health conditions (people with heart and lung
diseases, stroke survivors, people with respiratory infections,
people with diabetes, and colds)
Babies and children
Pregnant people
People over 65
Key Health Messages
O Stay informed. Smoke levels can change quickly during wildfires. Check for updates about
wildfires and smoke levels in your area.
O Avoid smoky air. Take steps to reduce exposures when smoke levels are unhealthy. Stay
indoors and keep indoor air clean by closing windows and doors, setting AC on
recirculate, and using an air cleaner with a HEPA filter.
O Keep indoor air clean. Don't contribute to indoor air pollution. Avoid activities like burning
candles or running a vacuum cleaner.
O Know the symptoms. Common health effects of smoke include runny nose, itchy eyes and
headaches. Sensitive populations are at risk for serious effects that can be life-threatening,
such as triggered asthma attacks. Always contact 911 if you're having breathing difficulty
or other serious health problems.
Toolkits
Smokei Exposure to smoke frorn fires can cause or worsen
from fires can be _
healthproblems. •W THE SYMPTOMS
dangerous foreveryone
Ifyou have a hec*h condrfion,smoke from fres may worsen Take these steps to protect your health
your symptoms.When smoke levels are high,even healthy Health conditions
people can have symptoms or health problems. can include:
Symptoms can range from minor imitations to ife•ftreating Asthma Stay Ht}ortned on air quality
co-plications.kicki[ling: • COPD Visit WA Smoke Bbg(www.wasmoke.blogspot.com)for current air quality
Diabetes '1 conditions and smoke forecasts,
' 'HeOrtor lunB Pay attention to local news for health warnings and air quality reports in
y, diseases your area_
�1
f 7a~ /:r.-. !. ?C Respiratory
X� -Ilr
>~ ,;) j alnesses
j� •Mr cads Avoid smoky air
v�D , Strokes survivors People with health conGlifions,such as lung or head diseases,diabetes,drake
s'' survivors or have a cold,should fimit their time outside,avoid intense physical
lose fbe� heatoches
gem activities and keep indoor air dean when smoke levels are"moderate"
flares,children,people over 65,and pregnant women should follow this
_ .&l+�;•, ,-�•�, ar
.y� advice when smoke levels e"unhealthy for sensifive groups."
Y� ,.�. Everyone else should do this when smoke levels are"unheaHhy for everyone."
y; ji; ', rj Keep indoor air clean
ry , :
Close windows and doors.pay attention to the heat,and stay hydrated-
wheezing
ydratedwheezing shortness of chest pain use fans or air conditioner(AC)when it's hot•and set your AC to recirculate.If
breath AffiNs, you don't have an AC and if's too hot to stay home,go to a place with AC hike
If you have any minor irritations take steps to a mal or library.
protect your health.Limit your time spent outdoors, Don't smoke,use candles,or vacuum_
avoid strenuous activities and keep indoor airclean the an air cleaner with a HEPA filter.
Wal 911 for emergency assistance if symptoms
; �i y are serious Eke shortness of breath or chest pato,
4,Jl Contact your healthcare provider
r f3 For more information on how to stay healthy If the have heart or lung diseases and they
y g symptoms get worse around smoke,
and safe,visit the Washington State Department contact your healthcare provider_Call 911 it you or someone else has serious
of Health Smoke From Foes page: symptoms—like trouble breafFing-
www.doh.wa.gov/SmokeFromFires
www.doh.wo.••v/S mokeFro m Fires
DOH i ear--tea b P.,k irlg fN,d..--W3h halms ane r bficaEor¢111 opplapfidw at.-*fa.l ft �Ly.• ••
ocqunsis ca+l oe nsaoe oy camp•fe Cs 079 ar oV enrol aravi:yl6YJoh..a.go..7:s•avers etas n 1. rf�HL't1�f)t DoH is cornn*tea ro providing oustomea wine kens and pw(corioni'n oppiweare ofenwte lemim r ft t�
6'" fequem can 0 mace of can -0
caning aw-sz la may email at ch-Ugrhh•doh—qov.m urea da 711. ;:hA f�gju h.
Source: WA Dept of Health;
httpss://www.doh.wa.gov/CommunityandEnvironment/AirQuality/Smol<eFromFires/Smokefrorn RresTooIkits
Air Pollution and
School
Air luality Conditions*
check Racal air ecrodibons ar. and",hen use this&kart
Good Moderne Unhealthy for Selisltive Groups
Recess Nti-'r striciiors, Adved szLh eats wt" as"-ma Ke- studerr�s with a5l wma,respr3baryr
MMLI esa respirator infection,lung or irfecten, ar+d lLng or heart disease irwccrz ,n 14eerp aabitq levels light::, +
hen, disease to s ay indocds.
P.E. Ai-+--1 Monlorsiudencs wih aznma, beep students with a�rna,resoratory +3rriauc P.E. inamm_.Limit
rt hauri respir.-n infection,lung or irg ectaon, lung or Neat-at disease,and diabetes sbucl F7-z-.o light :,dc*r
heart disease. Increase res,,, inac.m.Limit these sbrdents moderaw sd,.ft._a.
penoasor substlutions'or acttlities.
these sbidenL as nee eJ For others.limit to limit au%1oor actiairies.Alo>,w
arto s.udent tc stay ird lam if"dont want to ,
Athletic
M.rastriv^ions. htann�orgtud=-nts tia+7h aSS-.,ma, Students wth ais} i,resprarloryr it ticn, *•1� _, d�rs�. r'rtti-��� _ * _ •
res iratrarM infection,lungor lung .
and hears:disc ,or condibons tame vis-its-a an are.: with
Events andhe-�disease. Increase es., diabetes shou&'t playauldoars. 3Wd`ii-gLAiry+
Practices e•-•ds a^+c subsG7.�ioF s x
�
�. p Consider n1o41ng events indoors. ff events are --r rt:.-�`e"AaitrloS.T
"
+.Igarrjas acttruiri these sbidens as neecE-d rntoh tale sperr: n mar � . .
n&.cancelled, ncreast nd st periods and
Z-2..,aursf substiUiores,o a9imoafcr 6oMierbreathing rites. t'roj!ah ares;
Source: WA Dept of Health; www.doh.wa.jzov/Portals/1/Documents/Pubs/334-332.pdf
EPA ' s Smoke Ready Toolbox
z,otect4
Enviroamental Topics Laws&Regulations About E'' Search EPAgov
Related Topics: Air Research CONTACT US SHARE O O ® ,J
Smoke Ready Toolbox for Wildfires
Wildland fires produce air pollution that impacts people's health and other aspects of daily life.The increased frequency and intensity of
wildfires in the United States are adversely affecting air quality and putting more people at a health risk from exposure to smoke.Public
health officials can use the resources in the Smoke Ready Toolbox to help educate the public about the risks of smoke exposure and
actions people can take to protect their health.
Smoke and Your Health Air Quality Conditions and
Forecasts
• Miclfire Smoke F=UpntlyAsked QNstinnc
• How Smoke from Fires Can Affect Your Health • AIlNQtt
• Particle Pollution and Your Patients'Health Course AirNow current fire conditions
• More Information More Informatton
Guides, Fact Sheets, and Wildfire Smoke Guide
Other Resources
Source: US EPA; https://www.epa.gov/air-research/smoke-ready-toolbox-wildfires
Wildfire Smoke Response Guidance
Wildfire Smoke
A Guide for Public Health Officials
Revised May 2016
U.S.Fmzoom®C ihoacmanA '•U.S_Feet Senice"U-S.Cazin fr Bumse Co=ot
amd Ptevmmam•GSIi ArResvmces Hoa[d
Source: US EPA;
https://www3.epa.gov/airnow/wildfire may2016.pdf
Particle Filter Face Masks
O NIOSH-Approved Respirator Masks
o N95 or P100 commonly sold
o N, P, R with 95% efficiency or greater are all appropriate
0 2 straps
o Note: these filter fine particulates, but not CO or gases
E P95+ nuisance level organic vapor relief masks are available
Y
- o Surgical masks not effective—do not use
O ...
Close fit required for tight seal
o Requires correct size and sometimes brand
o Requires clean shave
O Not currently approved for children
O Consult physician before use if have chronic condition
N95 respirators can help protect
The right face mask can provide some protection for some people your lungs from wildfire smoke.
for a limited time when not possible to stay indoors. Straps must go above and below
the ears.
DOH Wildfire Smoke&Face Masks: https://www.doh.wa.gov/Portals/1/Documents/Pubs/334-353.pdf
L&I Wildfire Smoke&Dust Masks at Work:http://www.Ini.wa.gov/Safety/Topics/AToZ/WildlandFireFighting/PDFs/WildfireSmokeAndDustMasksAtWork pdf
NIOSH Science Blog: Non-occupational Uses of Respiratory Protection:https://blogs.cdc.gov/niosh-science-blog/2018/01/04/respirators-public-use/
NIOSH Guidance on particulate respirators:https://www.cdc.gov/niosh/nppti/topics/respirators/disp part/default.html
Low- Cost Air Sensors
Increasing public use
Potentially helpful in areas without nearby monitors, but issues with
reliability and accuracy
o Testing indicates results differ from agency monitors by 2X
Issues to consider in use:
o EPA: https://www.epa.gov/air-sensor-toolbox
Comparison of analytical capability
o South Coast AQMD: http://www.aqmd.aovZaci-spec
Purple Air Monitoring Data in WA:
https://www.purpleair.com/map
Image Source: EPA,https://www.epa.gov/air-sensor-toolbox
Julie •
julie.fox(gdoh.wa.gov
��iHealtl� Stay healthy during .,
WILDFIRE .
` � SEASON
r. If your area is affected by wildfire SMOKE
Nancy • • Stay informed on air quality Follow your doctor's directions
• • • • • • • • • • If you have a heart or lung
condition,smoke might make
your symptoms worse.
Cristin
Check local air Listen to the radio Dial 911 for emergency
assistance if symptoms
quality reports. for health warnings. are serious.
Avoid outdoor physical Keep windows 8 doors closed
activities
Especially when Run AC,set it to re-circulate
g the air quality is and close the fresh-atr intake.
in the"Unhealthy,
Very Unhealthy, P
�� �'� or Hazardous" windows and doors closed,
�+' categones and you don't have AC,
consider leaving the area.
• Labra
Visit www.doh.wa.gov/smokefromfires for more information
o�
fi
G
��J
--
�+C..
Cf)
-�
by
t
`\
1 WASHINGTON
' AIR QUALITY
I
,JAADVISORY
Check air quality conditions at ecology.wa.gov/WAQA
� GOOD SENSITIVE
' Air pollution is so low so there is little health risk.
It's a great day for everyone to enjoy the outdoors! GROUPS
MODERATE People
II People with health conditions should limit conditions
spending any time outdoors & avoid strenuous Asthma, • '
outdoor activities. diabetes, other
They may begin to have worsened symptoms. lung diseases
Respiratory
UNHEALTHY ` colds
Stroke survivors
FOR SENSITIVE GROUPSChildren under
1 All of the above &: & adults over 65
"I," All sensitive groups should limit spending any time Pregnant women
. outdoors. People with health conditions may have People who smoke
worsened symptoms. Healthy people may start to
have symptoms. IIII
KNOW THE
UNHEALTHYSYMPTOMS:
FOR EVERYONEWatery or dry eyes
Everyone, especially sensitive groups, shouldCoughing/wheezing
limit time spent outdoors, avoid strenuous Throat
activities outdoors, & choose light indoor activities. Phlegm
Shortness of breath
VERY
-
VERY UNHEALTHY Headaches
FOR EVERYONE Irregular heartbeat
' Everyone should stay indoors, avoid all strenuous Chest pain
activity, close windows&doors if it's not
too hot, set your AC to recirculate, If Z. _
& use a HEPA air filter if possibleexperiencing are
serious
Symptoms, seek
HAZARDOUS immediate
medical
FOR EVERYONE attention.
All of the above &:
People with heart or lung disease, or those who have had a stroke, should consult
their healthcare provider about leaving the area & wearing a properly-fitted
respiratory mask* if they must go outdoors. Follow burn bans and evacuation orders.
Air pollution from dust,vehicles,woodstoves,wildfires,
&industries can seriously impact your health. ivzState of Washingtonhm AmSw,DT rhra�of �; l DEPARTMENT of
proper*For more health information&how to choose the ro er Health ECOLOGY
respiratory mask,visit doh.wa.gov/smokefromfires.
January2018