Readiness: Where Are We? Where Do We Need to Be?

CDC-AMA 1st National Congress on Public Health ReadinessJuly 22, 2004

Charles A. Schable, MSDirector

Office of Terrorism Preparedness and Emergency ResponseCenters for Disease Control and Prevention

Objectives

• Summarize key findings gathered during Conference discussion sessions

• Review several success strategies for ensuring preparedness in public health and medicine

• Identify unresolved needs and recommended action for moving closer to a state of readiness

1st National Congress on Public Health Readiness -Who Participated?

Approximately 800 registered• 58% Public Health• 47% Clinical Medicine/Healthcare• 5% Other

Public Health Preparedness

“The continuous process of improving the Health System’s capacity to detect, respond to, recover from, and mitigate the consequences of terrorism and other health emergencies”

Detection

Detection and Surveillance Findings

• Clinician and public health approaches to early detection are complementary rather than competitive

• Numerous methods for improving bi-directional exchange of information are being explored in communities

• Sharing electronic syndrome data from health care systems is feasible and promising (BioSense offers opportunity for shared operational system), BUT usefulness has not been widely established

New Detection Methods

• Detection technologies are rapidly developing but beware; LRN is the gold standard

• Critically important that relationships and communication between clinical labs and the LRN is firmly established, ongoing, continually in development. Without, there is no connectivity.

Response and Containment

Legal Preparedness for Response and Containment

• Legal authorities must be established prior to response and containment --- capacity to implement

Isolation / quarantineLegal representation for detainees

• Pre-response education for public health, medical providers, law enforcement

• Major legal barriers to emergency response care: Healthcare liability issuesCredentialing issues

Emergency Communications: Key Findings and Recommendations

• Significant progress has been made in planning for communication during crisis

• Most jurisdictions report ability to send rapid emergency messages to many critical health providers

• However, a single effective National emergency communication system still lacking and needed

• In developing risk communication messages, do not focus only on messages that public health officials want to get out; consider information NEEDS of the public

Key Findings and Recommendationsfrom Other Response and Containment Sessions

• Delay in response is costly both in terms of lives lost and other economics --- mathematical modeling a tool for planning response activities

• Need coordination of volunteer health professionals --- 1 registry of all --- available locally --- address participation barriers (e.g. credentialing, liability)

• Avoid “federalizing” local responses --- Ensure capability at local level to assume Incident Command of the emergency situation

• Not well-prepared for response and containment at borders and ports of entry

Key Findings and Recommendationsfrom Response and Containment Sessions - continued

• Need for collaboration between public health and emergency management for containment and receipt of Strategic National Stockpile (SNS) well-understood; Inclusion of medical community / clinicians in SNS distribution plans is critical but may be under-appreciated

• Surge capacity planning is ongoing in communities, but a number of unresolved issues (e.g. transport, materials management, “worried well,” etc)

Although the critical partnership recognized, session not well-attended by Clinical / Healthcare colleagues (17%)

Idea for improving clinician participation in community response efforts

Under new National Response Plan (NRP)

Recovery

Recovery: Findings and Recommendations

• Recovery primarily the responsibility of local / state government

• Important lessons learned from Oklahoma City --- collaboration among medical community, public health, academia, mental health professionals critical to recovery

• Consider also including the business community

• Unanswered question: When or how does recovery end?

Minimizing Consequences: Planning for Preparedness

Mental and Psychosocial Preparedness

Ensure that mental health is integrated into public health and health care planning and response activities

Separating physical from mental health is artificial, especially in emergency situations

Include mental health professionals and diverse professionals in table-top exercises

• Clarify public reactions in emergency --- Distinction between public panic and the health system’s inability to handle public’s concerns during an emergency

Emergency Preparedness Education / Training

• Investments in training by the federal government (CDC, HRSA) have resulted in more training efforts targeting both clinicians and public health providers, and bridging practice and academic communities

• Evidence-base is needed to demonstrate effectiveness of training methods

• There remains redundancy and duplication

• Bilingual and cultural competency training needed to better facilitate work with health professionals across borders

Addressing Workforce Shortages• Workforce shortages are pervasive across multiple

disciplines in public health and health care

• Reasons for shortages similar --- wages, working conditions, limited training programs

• Rural settings particularly vulnerable and lack ability to recruit qualified workers

• Suggested solutions consistent:– Begin active recruiting starting in high school– Develop stronger, more innovative academic-

practice links– Integrate approaches to “pipeline” development

and readiness training

Measuring Preparedness

CDC’s Health Protection Goals

• Health Promotion & Prevention of Disease, Injury, and Disability:

All people will achieve their optimal lifespan with the best possible quality of health in every stage of life.

• Preparedness:

People in all communities will be protected from infectious, environmental, and terrorist threats.

CDC Evidence-Based Performance Goals for Public Health Disaster Preparedness

• Charge: To develop goals and measures for public health preparedness, applicable to State and Local Public Health Preparedness needs

• Measures developed that can be evidenced by internal or multi-agency exercises

• Developed by examining current literature in fields of Disaster Response, Emergency Management, Public Health, Emergency Medicine, others --- Interviews of thought leaders where gaps existed

• 35 Performance Goals with 45 Measures

Available for review - August 31, 2004

Clinicians & Laboratorians &

Veterinarians

Public Health

Healthcare Organizations

Strong Links: Frontlines of Defense

Preparedness

Current Emphasis

Hospitals

Environmental(BioWatch)

Laboratory

Law Enforcement

ACTION POINTIntersection of Information &

Analysis

PUBLIC HEALTH

Media

Clinicians

Public

Quarantine Stations

Border States

PreparednessDesired State

DoD& VA

Vital Records

Environmental(BioWatch)

PharmacyData

Veterinary

Cargo/Imports

Immigration

International

Schools

Business

Law Enforcement

ACTION POINTIntersection of Information &

Analysis

PUBLIC HEALTH

MediaPublic

First Responders

Border States

Laboratory

Quarantine Stations Hospitals

Clinicians

“The function of protecting and developing health must rank even above that of restoring it when it is impaired.” ~ Hippocrates

www.cdc.gov

Slides of Sessions and Attendance Roster will be posted on Conference webpage in next 2-3 weeks.

www.CDC-AMA-ReadinessConference.org

See you in 2006 for the2nd National Congress on Public Health Readiness…?