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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Public Health Preparedness as Part of Emergency Management

I’ve written in the past on the need for emergency managers, in the broadest definition, to become more familiar with public health preparedness.  As emergency management continues to integrate, by necessity, into and with other professions, this understanding is imperative.  We need to stop considering EMS as our only public health interface.  Public health incidents, of which this nation has yet to be truly and severely struck by in decades, require more than public health capabilities to be successfully managed – so we can’t just write off such an incident as being someone else’s responsibility.  We’ve also seen non-public health-oriented disasters take on a heavy public health role as concerns for communicable diseases, biological agents, or chemical agents become suspect.  If you are an emergency manager and you aren’t meeting regularly with public health preparedness officials for your jurisdiction, you are doing it wrong.

Aside from meeting with public health preparedness staff, you should also be reading up on the topic and gaining familiarity with their priorities, requirements, and capabilities.  (don’t skip either of those links… seriously.  They each contain more info on public health preparedness).  One of the best resources available is TRACIE.  TRACIE is a resource provided by the US Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR).  TRACIE stands for the Technical Resources, Assistance Center, and Information Exchange.  I’ve been digging around in ASPR TRACIE for the past several years and also receive their monthly newsletter.  I get a lot of newsletters from different sources… some daily, some weekly, some monthly.  I’ve recently unsubscribed to a bunch which seem to have information that has diminished in value, doesn’t seem to be timely, or are poorly written.  TRACIE is one of those that stays.  It has tremendous value, even if you aren’t directly involved in public health preparedness and response.  The information and resources provided here come from public health preparedness experts – these are emergency managers.

Recently, ASPR did a webinar on Healthcare Response to a No-Notice Incident, highlighting the Las Vegas shootings. Check it out.

But public health speaks a different language!  True.  So do cops, firefighters, and highway departments.  So what’s your point?  While public health certainly does have certain terminology that covers their areas of responsibility, such as epidemiology, med-surge, and others, that doesn’t mean their language is totally different.  In fact, most of the terminology is the same.  They still use the incident command system (ICS) and homeland security exercise and evaluation program (HSEEP), and can talk the talk of emergency management – they are just applying it to their areas of responsibility.  Are there some things they might not know about your job?  Sure.  Just like there are things you don’t know about theirs.  Take the time to learn, and make yourself a better emergency manager.

What have you learned from public health preparedness?  How do you interface with them?

© 2018 – Timothy Riecker, CEDP

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Awareness of Public Health Preparedness Requirements – CMS

Emergency management and homeland security are collaborative spaces.  Think of these areas a Venn diagram, with overlapping rings.  Some of the related professions overlap with each other separately, but all of them overlap in the center.  This overlap represents the emergency management and homeland security space.  What’s important in this representation is the recognition that emergency managers and homeland security professionals, regardless of what specific agency they may work for, need to have awareness of that shared space and the areas of responsibility of each contributing profession.  One of the biggest players in this shared space is public health.Presentation1

For nearly a year, public health professionals have been talking about new requirements from CMS, which stands for The Centers for Medicare and Medicaid Services.  How does Medicare and Medicaid impact emergency management?  CMS, part of the Department of Health and Human Services (HHS) covers over 100 million people across the US – far more than any private insurer.  As an arm of HHS and a significant funding stream within public health, they set standards.

The most relevant standard to us is the Final Rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.  The rule establishes consistent emergency preparedness requirements across healthcare providers participating in Medicare and Medicaid with the goal of increasing patient safety during emergencies and establishing a more coordinated response to disasters.

The CMS rule incorporates a number of requirements, which include:

  • Emergency planning
  • Policies and procedures
  • Communications planning with external partners
  • Training and exercises

These are all things we would expect from any emergency management standard.  Given the different types of facilities and providers, however, the implementation of the CMS rule can be complex.  A new publication released by the HHS ASPR (Office of the Assistant Secretary for Preparedness and Response) through their TRACIE program (Technical Resources, Assistance Center, and Information Exchange), provides some streamlined references to the CMS rule.  It’s a good document to study up on and keep on hand to help keep you aware of the requirements of one of our biggest partners.

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

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