CDC Releases New Public Health Emergency Preparedness and Response Capabilities

The CDC recently released its updated Public Health Emergency Preparedness and Response Capabilities.  While this is certainly important for public health preparedness personnel, these are something that most emergency management professionals should also be aware of.  Public Health is an incredibly integral partner in emergency management and homeland security.  Last year I did a review of the new HHS ASPR Health Care Preparedness and Response Capabilities and also included the previous version of the CDC Public Health capabilities in my discussion.

The new CDC standards, at a glance, are the same as the previous version.  All 15 capabilities have been continued.  Upon closer examination, there has certainly been some refinement across these capabilities, including some adjustments in the functions, or primary activities, associated with each capability; as well as a better look at preparedness measures for each.  As with the previous version, they front load some guidance on integrating the capabilities into preparedness and response activities.

For those keeping track from the previous version, each capability narrative includes a summary of changes which were adopted from lessons learned over the past several years.  Similar to the previous version, each capability is broken into functions and tasks, with suggested performance measures.  For those of you who remember the old Target Capabilities List and Universal Task List, it’s a similar, although more utilitarian, concept.

So what do emergency managers need to know?  Fundamentally, be aware that these capabilities are what public health will be primarily focused on rather than the National Preparedness Goal’s 32 Core Capabilities.  These aren’t mutually exclusive to each other, though.  In fact, the new CDC document references the National Preparedness Goal.  There are some public health capabilities that cross walk pretty easily, such as Fatality Management.  The public health capability, however, has a strong focus on the public health aspects of this activity.  Some public health capabilities don’t necessarily have a direct analog, as many of them would be considered to be part of the Public Health, Healthcare, and Emergency Medical Services Core Capability.

My recommendation is to have a copy of this document handy.  Review it to become familiar with it, and, depending on how heavy your involvement is with public health, you may be making some notes on how these capabilities compare with and interact with the 32 Core Capabilities.

© 2018 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC℠

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2017 Health Security Index

The 2017 National Health Security Preparedness Index has been released by the Robert Wood Johnson Foundation.  The Index provides measures of data nationally and for each state in the US across six public health domains, which include:

  1. Health security surveillance
  2. Community planning and engagement
  3. Information and incident management
  4. Healthcare delivery
  5. Countermeasure management
  6. Environmental and occupational health

The documents found on the website indicate a continued trend of improvement across the nation, but progress is slow, with some states lagging behind significantly according to the study, particularly in the deep south and mountain west regions.

The report identifies the following factors as having the greatest influence on the increase and intensity of US and global health threats:

  • Newly emerging and resurgent infectious diseases like Zika, MERS, and Ebola.
  • Growing antibiotic resistance among infectious agents.
  • Incomplete vaccination coverage.
  • Globalization in travel and trade patterns.
  • Political instability, violence and terrorism risks.
  • Aging infrastructure for transportation, housing, food, water, and energy systems.
  • Extreme weather events including storms, fires, floods, droughts, and temperature extremes.
  • Cyber-security vulnerabilities.

I think it’s important to note that while some of the factors listed above are distinctly within the public health realm, others are more universal in nature.  So not only are the findings of this study relevant to everyone, because public health is relevant to everyone, but many of the factors that influence the threats fall within areas of responsibility of broader emergency management and homeland security.

Public health matters are near the top of my list of greatest concern.  This report clearly shows that while we have made great strides in public health preparedness, we have a long way to go.  There is also no end game.  We don’t get to say we won after playing four quarters, three periods, or nine innings.  These are efforts in which we must persist, and not only with today’s tools and capabilities, but we must constantly look toward new tools.  However, as we do this, new threats will emerge.  It may seem intimidating, but it’s essential.

What are you doing to further public health preparedness capabilities?

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

Reviewing Health Care and Public Health Capabilities

Most in emergency management and homeland security are aware of the National Preparedness Goal’s 32 Core Capabilities, but are you aware of the Health Care and Public Health capabilities promulgated and published by the HHS/ASPR and the CDC?

Recently updated, the 2017-2022 Health Care Preparedness and Response Capabilities are assembled by the US Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR).  According to ASPR, these capabilities are intended to ‘describe what the health care delivery system must do to effectively prepare for and respond to emergencies that impact the public’s health’.  The health care delivery system includes health care coalitions (HCCs), hospitals, and EMS.  These consist of four capabilities:

  1. Foundation for Health Care and Medical Readiness
  2. Health Care and Medical Response Coordination
  3. Continuity of Health Care Service Delivery
  4. Medical Surge

The Centers for Disease Control and Prevention (CDC) (also part of HHS) publishes the Public Health Preparedness Capabilities.  The current version of the Public Health capabilities is dated 2011, with the CDC being anticipated to begin updating the document in late summer of 2017.  The CDC’s Public Health Preparedness Capabilities help to establish standards for state and local public health preparedness through 15 capabilities, which are:

  1. Community Preparedness
  2. Community Recovery
  3. Emergency Operations Coordination
  4. Emergency Public Information and Warning
  5. Fatality Management
  6. Information Sharing
  7. Mass Care
  8. Medical Countermeasure Dispensing
  9. Medical Material Management and Distribution
  10. Medical Surge
  11. Non-Pharmaceutical Interventions
  12. Public Health Laboratory Testing
  13. Public Health Surveillance and Epidemiological Investigation
  14. Responder Safety and Health
  15. Volunteer Management

Similar to the use of the Core Capabilities in emergency management and homeland security broadly, I see the ASPR and CDC sets of capabilities as providing an opportunity to identify capabilities which are functionally focused.  Aside from the three common Core Capabilities (Planning, Public Information and Warning, and Operational Coordination), there is only one public health/health care-specific Core Capability: Public Health, Health Care, and Emergency Medical Services.  It makes sense for these areas to need to further identify and refine their own capabilities.  It might be interesting to see other sub-sets of public safety, such as fire and law enforcement do the same relative to the Core Capabilities they each heavily participate in.  Or it might send us down a rabbit hole we don’t need to jump down…

That said, I always champion opportunities for synergy and streamlining of existing systems and doctrine, and I’m rather disappointed that has not been done.  There is clearly overlap between the ASPR and CDC capabilities as compared to the Core Capabilities; that being apparent in even the titles of some of these capabilities addressing topics such as operational coordination, mass care, and public information and warning.

Corresponding to the recent release of ASPR’s updated Health Care Preparedness and Response Capabilities, I sat through a webinar that reviewed the update.  The webinar gave an opportunity for me to ask if there was any consideration given to structuring these more similarly to the National Preparedness Goal’s Core Capabilities.  In response, ASPR representatives stated they are working with the Emergency Preparedness Grant Coordination Working Group, which consists of ASPR, CDC, Health Resources and Services Administration, DHS/FEMA, US DOT, and the National Highway Traffic Safety Administration.  This working group has developed an interim crosswalk, applicable to the current documents, and expected to be updated with the CDC’s update to the Public Health Preparedness Capabilities.  While a crosswalk helps, it still acknowledges that each are operating within their own silos instead of fully coordinating and aligning with the National Preparedness Goal.  The world of preparedness is dynamic and made even more complex when efforts aren’t aligned.

Regardless of the lack of alignment, these are great tools.  Even if you aren’t in public health and health care, you should become familiar with these documents, as they represent important standards in these fields.  Similar to the Core Capabilities, grants and preparedness activities are structured around them.  If you interface with public health and health care, you have even more reason to become familiar with these – as they are likely referenced in multi-agency discussions and you should be aware of the similarities and differences between these and the Core Capabilities.

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

National Firefighter Cancer Registry – Show Support!

Last week US Representatives Bill Pascrell (D-NJ) and Richard Hanna (R-NY) introduced a bi-partisan bill to create a national cancer registry for firefighters (paid and volunteer).  This bill, HR 4625, is known as the Firefighter Cancer Registry Act.  It calls for the registry to be established and managed by the Centers for Disease Control and Prevention (CDC).  The site for the bill is here, although as of the time of my post, little information is available.

According to Rep Pascrell’s website, the national cancer registry would:

  • Store and consolidate epidemiological information submitted by healthcare professionals related to cancer incidence among firefighters.
  • Make anonymous data available to public health researchers to provide them with robust and comprehensive datasets to expand groundbreaking research.
  • Improve our understanding of cancer incidence as the registry grows, which could potentially lead to the development of advanced safety protocols and safeguards.
  • Increase collaboration between the CDC and epidemiologists, public health experts, clinicians and firefighters through regular and consistent consultations to improve the effectiveness and accuracy of the registry.

According to an email received from Rep Hanna’s office, the bill has the support of the National Volunteer Fire Council, the International Association of Fire Chiefs, the International Association of Fire Fighters, the New York State Association of Fire Chiefs, the Congressional Fire Services Institute, the National Fallen Firefighters Foundation, and the International Fire Services Training Association.

Firefighters are exposed to a variety of harmful chemicals on a regular basis.  Fairly routine fires, such as car fires and room and contents fires contain a variety of toxins due to the quantity of synthetics used in manufacturing common materials.  More advanced incidents, such as full structure fires, industrial, and hazardous materials incidents contain even more dangerous chemicals that, despite protections, firefighters are still exposed to.

I urge everyone to keep an eye on this bill and contact your representatives to express support for it. 

– TR

Ebola Reflection Measures our Preparedness

NBC News recently posted an article citing a report published by the Presidential Commission for the Study of Bioethical Issues.  The link provided to the report in the NBC News article doesn’t seem to work, but I’ve found what I believe to be the report here.  The focus of the report is on the ethical challenges faced by the US in responding to this issue.  The report summarizes a variety of ethics related concerns and considerations in this ongoing response and paints a fairly accurate picture of our failures and what needs to be addressed – at least within the topics it discusses.

Photo credit: Forbes.com

Photo credit: Forbes.com

As you might expect from a report on bioethics, it is very public health focused.  While they do make mention of very public health centered topics such as clinical drug trials, they do cover topics which are much more broadly rooted in emergency management and homeland security, such as community and responder education, and ethics associated with quarantine.  This report, while fairly focused, opens a virtual Pandora’s box of issues related to our domestic response to Ebola.

Needless to say, our collective response to this matter was horrible.  Public health policy and guidance was a moving target for weeks; responders were ill prepared to handle potentially infected persons; and the collective of society, politicians, and public safety were largely reluctant to deal with matters of quarantine much less prepared for it.  Was this our first consideration of something like Ebola?  Of course not.  Didn’t we have preparations in place?  Kind of.

Back in the late 90s, pushed mostly by the Nunn-Lugar-Domenici act of 1996, preparedness efforts for state and local responders were funded to enhance our capabilities in dealing with WMD incidents.  Several years later, after 9/11 and the anthrax attacks, another surge of funding was pushed down to state and local governments from HHS/CDC for the purpose of bolstering public health preparedness including preparedness for WMD/weaponized biologicals and naturally occurring pandemic incidents.  These two programs alone, not including other related funding, fostered the creation of plans and organizations to support them, purchased entire stockpiles of equipment and supplies, trained tens of thousands of responders and public health workers, and encouraged exercises across the nation to test capabilities (it was actually these exercises which largely influenced the creation of what we now know as HSEEP).  A lot of good came from these programs, but when suddenly tested with the reality of implementation we seemed to fall apart.  Why?

First of all, many of these preparedness efforts occurred between 10 and nearly 20 years ago.  Many of the people initially trained in these programs have since retired from public service with their organizations losing a great deal of institutional knowledge.  While training programs have continued and still exist, there have been systemic gaps in tying this type of training to other preparedness efforts (planning, policy, equipment, etc.).  Some equipment purchased near the beginning of these programs has likely been retired as well.  Much of it still exists, but has been brought into the fold of other applications, such as HazMat – which is certainly appropriate, but yet again we see gaps, this time our ability to readily utilize equipment specifically for public health threats.

In my opinion many of the planning efforts we saw after 9/11 were misguided.  This started with the people who were doing the planning.  Many health organizations emphasized health care experience for these positions instead of EM or planning experience – which was their main function.  Certainly health care knowledge had some importance, but that could be supplemented through a good advisory committee (EM after all is a team effort).  Exacerbating poor hiring decisions was a lack of investing in the people that were hired.  Many organizations expected them to churn out pandemic influenza plans in short order, with little/no training on the planning process or integral systems that must be considered.  Further, much of the planning had been done in a vacuum – that is, it had been performed with little/no input from other stakeholders.  I had reviewed many of these plans, finding things such as inappropriate applications of ICS and wild assumptions of resource availability.  In no way were these plans realistic or applicable.

There were many exercises performed and most of them had great value.  The problem is that there were a lot of assumptions in these exercises and policy decisions made in the exercises were rarely challenged as they would be in reality.  The US Ebola response brought this all to light as decisions such as quarantine were being handled at the governor level and under significant controversy.  So in this recent response I ask why were decisions delayed and deferred to higher authorities?  Why were adequate local/regional plans not in place to address the care and handling of potentially infected persons?  Why did procedural issues take weeks to resolve?  The simple answer is that there was a lack of proper preparedness.

Back in October of last year, when Ebola was emerging in the US, I posted an article titled Preparing for Ebola – and Whatever Else May Come.  The article still has a great deal of relevancy since I’ve seen very little preparedness for future occurrences – only a harried response to the most recent incident.  There have certainly been a great deal of policies and procedures assembled for the current Ebola issue, but these have a feeling of being temporary, throwaway, or single-use documents, applied only for this instance instead of durable and lasting plans.  Many will keep them ‘on the books’, only to find that their hasty assembly wasn’t comprehensive enough for the next occurrence.  Emergency management and homeland security professionals, public health leaders, and elected and appointed officials need to take a step back and re-look at out preparedness efforts – especially in regard to public health issues.  While we should learn from what we have experienced, we also need to think comprehensively about what is needed.  Well considered policies need to be put in place, supported by our laws and responsibilities to protect the public while also considering protection of civil liberties.  Other preparedness efforts such as planning, training, and exercising need to continue to occur but must have their connections strengthened and intentional.  Exercises need to test plans and policies and challenge decision makers who are certainly making difficult decisions that may include ethics and moral issues in the consideration of caring for few while protecting the greater society.

These are not easy things to be done – which supports the need to work on them now, when we aren’t facing an imminent disaster.  While Ebola certainly wasn’t a health care crisis and there were a lot of things done right, there is always room for improvement – especially when the next biological occurrence could be a crisis.

What have you and your organization learned from the Ebola response?  What gaps have you addressed?  What do you feel still needs to be addressed?

© 2015 – Timothy Riecker

Preparing for Ebola – and Whatever Else May Come

Unless you’ve been living under a rock lately, you should be quite aware of the headlining threat in public health and public safety – Ebola hemorrhagic fever.  Ebola has been in existence for quite a while, but the current outbreak of this deadly virus in western Africa has garnered much attention.  Thus far, beyond western Africa, infected persons have been identified in Spain and the United States.  The ease and frequency of air travel, combined with the virulence of Ebola have led to a frenzied reaction by politicians, the media, and our health care system.  While we are at a stage in the US where only a handful of infected persons have been identified, this virus is quite dangerous and could easily and rapidly spread.

While I’m not a public health expert, preparedness is universal.  Public health is at the tip of the spear for this fight and must be supported by other professions within public safety and beyond – that’s what emergency management is all about.  That said, this is proving to be quite a test for our public health partners.  The consequences of failure could be devastating.

Considering the five mission areas, we are most strongly functioning within Prevention, Protection, and Response for Ebola.  Certainly the three common Core Capabilities of Planning, Operational Coordination, and Public Information and Warning are all fully engaged across the three mission areas.  Additionally, we are seeing a great deal of work within in the Intelligence and Information Sharing; Screening, Search, and Detection; Public Health and Medical; and Situational Assessment Core Capabilities; along with some work in other capabilities to a lesser degree.  Why is it important to recognize the mission areas and Core Capabilities?  It helps to keep us focused and prompts us to examine the critical activities for each.

In which mission areas and Core Capabilities does your agency fit in?

What are you responsible for?

Are you doing it?

Do you have all the information you need to do it safely and effectively or are you waiting for public health to call and tell you what to do?  I’m betting you haven’t gotten that phone call.

In a situation like this, we are seeing a lot of activity and emphasis at the Federal level through US Health and Human Services and the Centers for Disease Control.  Their focus is on solving the problem in front of them.  While they have people engaged in getting messages out and engaging partners, they have a lot to accomplish and likely haven’t gotten to all the stakeholders.  We will hopefully see some more aggressive messaging given the circumstances that have been described at the Texas hospital where Ebola patients have been treated.  So what should you do?  Hopefully your agency is already in contact with your local health department to discuss both your role in the public safety system and the potential exposures and vulnerabilities you may have to Ebola.  If your local health department doesn’t seem to have much information, reach up to your state health department.  Don’t wait to get a call… by then it could be too late.

Very simply, we are looking at preparations for your agency’s role.  These preparations, although slightly different based on the agency, apply to all agencies; from first responder agencies, to local government, K-12 and higher education schools, hospitals, private sector, and not for profits.  Let’s break this down with the Preparedness Cycle:

The Preparedness Cycle - FEMA

The Preparedness Cycle – FEMA

Plans, policies, procedures – do you have them in place and up to date?  Depending on the role and function of your agency you can have several of the following – emergency operations plan, emergency procedures, infection control plan and procedures, public health plan, communicable disease or pandemic influenza plan.  You should engage with public health experts to ensure that your plans, policies, and procedures address everything known about Ebola.  You may need to create some procedures specifically addressing issues pertaining to Ebola and your agency’s role.  Do your plans, policies, and procedures link up to your agency’s critical activities for each Core Capability you are engaged in?  What agencies do you need to coordinate with to be effective?

Organizing – depending on your agency’s role, you may need to make some internal changes or designations within your organization to better streamline your activities.

Training – train everyone who has anything to do with any component of the plan in what they need to do.  This is a great opportunity to ensure that everyone is trained up in their role of the emergency operations plan.  If your agency has physical contact with the public, training in personal protective equipment (PPE), identification of signs and symptoms, and patient care are extremely important.  Given the detail of the activities and the just-in-time training, job aids will be a great help to your staff to ensure that they follow the procedures you provide for them.  Don’t get caught short… communicate to your staff in what is going on, what your agency is or may be responsible for, and what they will be called upon to do.

Equipping – your staff need the right equipment for the job.  Not only PPE, but the forms and databases used to record information, decontamination equipment, etc.  It is extremely important that staff are trained not only in how to use equipment but to prevent contamination of equipment and prevention of cross contamination.  Do you have all the equipment you need?  If not, who does?

Exercising – Conduct table top exercises to talk through policies and higher levels plans to validate and become familiar with them.  Identify shortfalls and correct them immediately.  Conduct drills to test the skills of staff for specific activities and larger exercises – functional or full scale – to test multiple functions and plans.

Evaluating – Evaluation is a constant throughout all of the preparedness cycle.  We need to evaluate every step within the preparedness cycle and make adjustments and improvements as needed.  Embrace best practices and fix shortfalls.  This leads directly to the next step…

Taking Corrective Action – Some corrective actions are quick and easy fixes while others can take a while or cost money above budget to address.  A corrective action plan (aka improvement plan) will help you keep track of what needs to be fixed, the priority it holds, who is responsible for making it happen, and a strategy to make it happen – it’s a living document.

The preparedness cycle can be applied to any hazard, be it Ebola or a flood.  With all this attention on Ebola, it’s a great opportunity to pull plans off the shelf and have discussions with internal and external stakeholders on these preparedness steps.

© 2014 – Timothy Riecker

Marketing the Preparedness Message

There are some great ideas in Jim McKay’s article – The Preparedness Message Isn’t Reaching the Public, featured in Emergency Management Magazine.  Just like any good marketing campaign, we have to push with multiple strategies.  Billboards and television campaigns are great but they aren’t going to hit home with everyone.  We need to be more creative in our approach.  Our methods will resonate differently with various people.  The CDC’s zombie campaign got a lot of attention (see my blog post on it!).  Why?  Because they not only used something trendy, they considered their audiences.  Not all audiences respond to the zombie campaign; some think it’s ridiculous – but they were able to engage a lot of people.  Different people require different methods.  Once you reach an audience, then you can convey a message.  Preparedness is boring, let’s face it.  We need creative and diverse solutions to reach and engage audiences.

The CDC’s Zombie Banner

 

 

 

There are four major challenges we’re facing when it comes to preparedness that I speak about in presentations.  These are many of the thoughts of many folks when it comes to disasters:

1) It’s not going to happen here.

2) It’s not going to be that bad.

3) There is nothing I can do about it.

4) Government will take care of me.

These aren’t rocket science, but they can be tough nuts to crack – especially when we don’t want to be the ‘doom and gloom’ people.

Let’s look at what has worked.  McKay’s article mentions coupons to Target for preparedness kits.  This is an effective methodology that has worked well for years in California and other places around the country.  In Central New York, where I’m from, a county health department capitalized creatively on a point of distribution exercise to get the beginnings of preparedness kits in the hands of residents.  The 300 slots they had available filled very quickly.  The event got great press and all positive comments from those who participated.  Good or bad economy, people like free or discounted things.  The lesson learned here is to get preparedness underwritten.  Be it by grant funds or corporate sponsors.  If Pepsi wants to put out a preparedness kit, so be it.