Public Health System Preparedness

SESSION AUDIO:
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MODERATORS:
Mildred Williams-Johnson Ph.D., DABT & Shoukat Qari, D.V.M., M.V.Sc.

PANELISTS:

Mildred Williams-Johnson, Ph.D., DABT
Preparedness and Emergency Response Research Centers: A Public Health System Approach
Co-Investigators: S. Qari, D.V.M., Ph.D., C. Singleton, M.D., M.P.H., V. Kokor, M.P.H., M. Leinhos, Ph.D.

CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) helps the nation prepare for and respond to urgent threats to the public's health from natural, biological, chemical, nuclear, and radiological events.  In September 2008, COTPER awarded over $11 million to seven accredited schools of public health establishing the Preparedness and Emergency Response Research Centers (PERRCs) to address the Pandemic and All-Hazards Preparedness Act (2006). These centers were funded to conduct studies to address the following research priorities for preparedness and response recommended by the Institute of Medicine: enhancing the usefulness of training; improving timely emergency communications; creating and maintaining sustainable response systems; and generating criteria and metrics for the effectiveness of preparedness and response activities.  Results from studies conducted by the PERRCs will help to strengthen the structure, capabilities, and performance of the public health systems (PHS) for preparedness and emergency response activities at the national, state, local, and tribal levels. Two new centers were funded in 2009 with more than $14 million awarded to all nine PERRCs.  Centers conducted real-time research during the spring 2009 H1N1 outbreak and findings have informed the continued response effort.  Studies included an examination of the public’s willingness to take a vaccine or drug during the H1N1 outbreak, and factors related to health workers willingness to respond during H1N1.  Numerous collaborations with key partners, public health agencies, and private organizations have been developed to conduct these studies.  This session will provide examples of ongoing studies from the PERRCs, descriptions of their engagement with the public health practice community, and discussions of some immediate and anticipated impacts on the public health system for preparedness and response.  Presentations will highlight the partnerships established with state and local health officials to facilitate this research and disseminate research findings to foster the translation of results into public health practice for national preparedness and response.

Margaret Potter, J.D., M.S.

Computational Modeling of Public Health System Preparedness: School Closure as a Pandemic Mitigation Survey

Co-Investigators: S.T. Brown, Ph.D., B.Y. Lee, M.D., M.B.A., P. Sweeney, J.D., RN, M.P.H., C.J. Lin, Ph.D., J. Epstein, Ph.D., T. Hershey, J.D., X. Zhou, M.S.

This study inquires whether a computer model is sensitive to a state-specific index for preparedness. We tested this index in a model of influenza pandemic using school closure as a mitigation strategy. Three data sets represented critical aspects of public health system (PHS) preparedness:  statutes designating officials with school-closure authority represented legal capacity; costs of school closure represented economic constraints; and pandemic preparedness plans represented operational capability. Data yielded legal, economic, and operational indicators for each U.S. state; and the compiled state indicators produced a state-specific preparedness index. The legal indicator was based on a 7-point scale representing relative delay in issuing an official school-closure order. The economic indicator was the dollar-cost of school closure by state, assuming that higher expected costs would inhibit the ordering of school closure. The operational indicator was based on a 3-point scale representing the specificity of school closure planning. The index was a metric for each state, scaled to the timing of school closure and introduced to an agent-based model simulating a U.S. influenza pandemic. We found that this model was sensitive to the preparedness index, both at the national level and the individual state level, by producing differences in peak case incidence, peak epidemic day, and total case incidence.  This study has implications for PHS preparedness. Researchers and decision makers need evidence to determine the most potent predictors of outcome in public health emergencies such as pandemics. But controlled studies are inappropriate for such research, since each outbreaks are unique within each PHS state or locality. And generalizations based on other study methods – field observations, after-action reports, tabletop exercises, and expert opinion panels – are difficult. Computational modeling, used with those methods, can improve the evidence base for preparedness by generating hypotheses, testing sensitivity, providing unusual insights, and assisting in the design of observational studies.

Michael A. Stoto, Ph.D.

“Real Time” After Action Report for the Massachusetts Public Health System to 2009 H1N1

Co-Investigators: E. Savoia, M.D., M.P.H., S. Short, M.P.H., M. Higdon,

During the 2009-2010 H1N1 outbreak, many Massachusetts Department of Public Health (MDPH) bureaus, local health departments, and outside partners are actively engaged in a variety of public health responses.  Rather than waiting until the “event” is over and producing a standard After Action Report, the Harvard School of Public Health Center for Public Health Preparedness (HSPH-CPHP) is collaborating with MDPH to observe and critically analyze the public health response as it unfolds, and will use the results of this research to inform the preparation of a formal After Action Report/Improvement Plan following HSEEP standards. Specifically, since the Fall of 2009, HSPH-CPHP researchers have been using validated methods developed to evaluate public health agencies’ and systems’ performance during exercises to systematically observe actions occurring in a variety of venues related to response strategies such as vaccination, communications, public education, laboratory testing and so on through observations of events, conference calls, e-mail and web-based communications, review of newspapers and other media, and key informant interviews.  Through the Fall, two issues have dominated public health communications:  (1) vaccine distribution, including allocation of vaccine to locations and sites within the state, and the implications of production delays and resulting shortages; and (2) vaccine priority issues, including priorities based on age and employment (e.g. healthcare providers, emergency responders), who should receive (or not receive) certain vaccine formulations. Subsequently, in the Winter and Spring of 2010, HSPH-CPHP will collaborate with MDPH to organize, conduct, and facilitate a series of “facilitated look back” meetings to capture additional information relative to the effectiveness of the response to the 2009-2010 H1N1 outbreak, including the perspectives of MDPH Bureaus that were involved as well as outside partners such as local public health agencies, hospitals and health care and EMS providers, schools, community health centers and others as appropriate.   In addition to providing information needed by MDPH, this research will provide an opportunity to test the utility of and further develop the “Facilitated Look Back” format proposed by the RAND Corporation (Aledort, et al. 2006, RAND TR-320) as a public health systems research approach to examining public health systems’ emergency response capabilities.  Through the use of neutral facilitators and a no-fault approach, a facilitated look back systematically probes dimensions of decisions and nuances in past decision-making explored.  In each of two to three meetings focusing on different aspects of the response, a brief chronology of the events that occurred in response to 2009 H1N1 in the jurisdiction in question will be reviewed. A facilitator will guide the discussion and ask probing questions surrounding key issues about what was happening during points in the chronology that is presented, and lessons learned will be elicited. 

David Howard, Ph.D.

San Diego’s Area Coordinator System: A Disaster Preparedness Model for U.S. Nursing Homes

Co-Investigator: S. Blake, M.A., Ph.D. (candidate)

In October 2007, southern California experienced a series of wildfires that caused the evacuation of fourteen nursing homes and nearly 1,200 residents in San Diego County. As a result of this experience, nursing home administrators in San Diego collaborated with emergency management personnel to develop a unique disaster preparedness communications model. This model, known as the Area Coordinator System, provides a framework for coordinating mass long-term care evacuations between nursing home providers in San Diego County. The purpose of this research is to describe the Area Coordinator System and assess its potential to be replicated in other areas around the country. Key informant interviews were held with nursing home administrators and key long term care and emergency preparedness officials in San Diego. These interviews centered on nursing homes’ disaster preparedness activities, as well as the development of the Area Coordinator System. The San Diego Task Force Area Coordinator system is a network of seven volunteers who serve as emergency preparedness coordinators with nursing homes in their designated areas. These Area Coordinators are responsible for maintaining communication with their nursing homes about emergency preparedness and disaster planning. Area Coordinators also work closely with county emergency management personnel. Nursing homes that participate in the Area Coordinator system are asked to sign an Memorandum of Understanding (MOU), which augments a nursing home’s existing disaster plan and supplements the rules and procedures that are in place which govern the nursing home’s interactions with other organizations during a disaster. This Area Coordinator system reflects a unique communications model for emergency/disaster preparedness that has never been employed among the nursing home community. The main benefit of the Area Coordinator system is that it facilities communication and builds personal relationships and contacts between nursing home administrators.