Public Health Preparedness I

Information Gathering and Dissemination

CDC is mainly responsible for the collection and dissemination of information from/to both local and state health agencies

Health Promotion (1975-Present)

Car safety, restriction on tobacco use, etc. Education and promotion of Public Health

Risk Determination

Compare hazards to vulnerabilites. Assessed through predictability, cascading events, speed of onset, etc. Hierarchy of response priorities in which life, safety, and health of population comes first. Essential facilities and services comes second and critical infrastructure comes third.

ICS Public Health Applications

Designed for emergencies but had implications for public health. Could also be used for disease outbreaks, non-outbreak situations, food-borne illness, and medical emergencies.

Planning

Does the thinking. What's going to be needed in hours/days to come. Determines resources needed, assesses the situation. Gathers and analyzes data through surveillance and data collection. Provides situational information often through GIS, mapping, and graphs. Estimates future probabilities. Prepares alternative strategies.

Operations

Does work based on information. Carries out plan. Participates in the planning process. Operationalizes the strategy of the incident action plan. Accomplishes the incident objectives.

Unified Command

Enables all responsible agencies to manage an incident together by establishing a common set of incident objectives and strategies. Allows incident commanders to make joint decisions by establishing a single command structure. Maintains unity of command. Each employee only reports to one supervisor.

Bacteriology (1880-1910)

Era included Jon Snow who founded epidemiology through his investigation of the water pumps. Era supported science and the invention of microscopes.

Health Resources (1910-1960)

Era where money was flowing into Public Health and there were resources to support Public Health infrastructure.

Risk

Estimated impact that a hazard would have on people, services, facilities, and structures in a community. Refers to the likelihood of a hazard event resulting in an adverse condition that causes injury or damage. Depends on hazard, vulnerability, and exposure.

What does magnitude/severity of impact refer to?

Extent of expected damage, types of expected infrastructure damage

Surveillance

Key function of local public health agency. Important for biologic terrorism events and infectious disease outbreaks.

Shattuck's Report of the Sanitary Commission of Massachusetts

Look at living conditions and created a system for Public Health which resulted in the first health department in Boston. Paul Revere was the first health officer.

Key elements of family communication plan

Make sure everyone knows contact numbers and how to get in touch. Keep a list of emergency numbers near the phone at all times include list of physicians/telephone numbers. Identify an out of state point of contact to call in case of emergency. Establish a family phone tree in advance. Select a safe room in home. Make sure you are personally reachable by health department during emergencies.

Mitigation

Making every effort to minimize the occurrence of an emergency. This includes preparing the public, alerting agencies/communication, and coordination across jurisdictions.

History of PH Preparedness

Many historical events have led to a greater awareness in public health emergency response. Led to Public Health Threats and Emergencies Act of 2000, in fiscal year of 2001 legislation authorized $540 million to improve public health agencies response capabilities and capacities.

What is "shelter in place"?

Means selecting a small, interior room with no or few windows. Sealing the room off to limit air flow into the room. Taking temporary cover there to reduce exposure to potentially dangerous substances in the air.

Transfer of Command Process

Moves the responsibility for incident command from one Incident commander to another. Must include a transfer of command briefing (which may be oral, written, or both).

Should I purchase a gas mask?

No. A gas mask will only protect you if you are wearing it during an attack. Mask must be the right type, fit properly, and requires training to be used effectively.

Should someone stockpile their own antibiotics?

No. No single antibiotic protects against all biological weapon agents. Ineffective against viruses. Limited shelf life. Can have serious side effects. Should only be taken with medical guidance.

Emergency Management

Organized analysis, planning, decision-making, and assignment of available resources to mitigate, prepare for, respond to, and recover from the effects of all hazards. The goals are to save lives, prevent injuries, and protect property and the environment.

Information Officer

Part of the command staff. Needs to have the ability to communicate clearly. Capacity to deal calmly with media. Familiarity with risk communication principles.

Safety Officer

Part of the command staff. Recognized expertise with hazards attendant on particular kinds of incident. Must have a strong personality to stand up to incident commander.

Liaison Officer

Part of the command staff. Serves as the Incident Commander's point of contact for representatives of governmental agencies, non-governmental organizations (NGOs), and private-sector organizations.

Exposure

People, property, systems, or functions that could be lost to a hazard. Generally includes what lies in the area the hazard could affect.

Unity of Command

Personnel report only to one supervisor and receive work assignments from their supervisors.

What is part of the response?

Personnel, supplies, security, evacuation, first aid, counseling, food, shelter

Span of Control

Pertains to the number of individuals or resources that one supervisor can manage effectively during an incident. Is key to effective and efficient incident management. Is usually between 3 to 7 subordinates. Optimally does not exceed 5 subordinates.

Six major roles of federal government in public health

Policy, finance, public health protection, information gathering and dissemination, capacity building, direct patient healthcare services

What should the hazard profile consider?

Predictability, magnitude or severity of impact, speed of onset, potential for cascading events

In addition to the government, what other sectors contribute important functions?

Private sector, non-governmental organizations, civilian populations

Capacity Building

Process begins with individual providers and extends to hospitals and entire communities. Many influential persons are in political positions with limited tenures. Capacity building limited by annual funding from Congress.

Hazard Identification

Process of identifying hazards that threaten a given area. Usually based on historical events.

Logistics

Provides support often in the form of resources. Acquires resources (personnel, equipment, services, and support). Get's what is needed. Obtains supplies. Manages internal communications equipment. Maintains equipment.

Vulnerability assessment

Provides the extent of injury and damages that may result from a hazard event of a given intensity in a given area

Centralized State Authority

State has direct oversight over local Public Health agencies. An example is Florida.

Decentralized State Authority

State has loose oversight. Jurisdiction relies mainly with local agencies. An example is New Jersey.

Consequence management

Steps taken to limit any negative consequences

Emergency

Sudden occurrence demanding immediate action (ex. motor vehicle accidents)

Vulnerability

Susceptibility to physical injury, harm, damage or economical loss. Depends on an asset's construction, contents, and economic value of it's functions.

History of ICS

System was made for fire service. Recognized that there was no common communication which led to lack of accountability. Also saw that there was a lack of planning process which overloaded incident commanders. There was also no method to integrate inter agency requirements. The identification of these weaknesses lead to development of ICS.

Public Health Security Framework

The combination of resilience and systematization will lead to public health security for a population. Public Health security entails all hazards, not just infectious diseases and bioterriosm

Direct Patient Healthcare Services

The federal government has limited involvement. Healthcare delivery is primarily regulated by the jurisdiction of states and local public health authorities.

Risk Assessment

The process of measuring the potential loss of life, personal injury, economic injury, and property damage resulting from hazards.

Food and Water supplies

Three to seven day supply recommended. Store in sealed, unbreakable containers, note storage date and replace every 6 months. Food should be non-perishable, three to seven day supply. Maintain caloric intake, minimize preparation, manual can opener.

Three Key Elements of Personal Preparedness

-Assembling an emergency kit -Making a family communication plan -Learning more about readiness

Three Core Functions of Public Health

-Assessment (Evaluate, Monitor Health, Diagnose and Investigate) -Policy Development (Inform, Educate, Empower, Mobilize Community Partnerships, Develop Policies) -Assurance (enforce laws, link to/provide to care, assure competent workforce)

Challenges that ICS addresses

-Clarifies decision making and using resources efficiently -Minimize number of people you have to talk to -Effective and concise communication

Steps of Risk Assessment

-Identify hazards -Profile hazards -Inventory assets -Estimate losses

Reasons to use ICS

-Mandated by Office of Homeland Security -Creates a safer work environment for response personnel -Establishes a clear focus on objectives and lines of authority -Removes emotion from the decision making process

Why must Emergency Public Health take into consideration?

-Multiple sectors -Public Health tools applied during emergencies -Resilience analysis -Systematization of efforts -Communities must maintain a level of preparedness

Factors affecting community health

-Physical Factors (ex. environment, geography, infrastructure, transport, etc.) -Social/Cultural Factors(ex. social influences, economy, politics, religion, etc.) -Community Organization: ways in which communities organize their resources -Individual Behaviors

"All Hazards Way" Approach

-Preparing for anything without preparing for everything -Recognizing that PH events are unpredictable -Always have available a continuous and minimum level of resources and personnel with adequate training -Have the basic level to ability to respond initially to any disaster -Learn from prior experiences to decrease risks from future events

Key System Components of Preparedness

-Unified planning: plan together prior to an actual event -Coordination: Necessary to achieve effective results -Communications: Vital for both knowledge sharing and surveillance

Elements of ICS

-Unity and chain of command -Management by objectives -Organizational flexibility -Span of control -Common terminology -Personal accountability -Integrated communication -Resource management

Objectives

What can be accomplished during an operational period

Area Command

Activated when necessary. Could be due to complexity of incident (similar incidents in different areas) or for span of control considerations. Oversees multiple incidents being handled by separate ICS organizations or a very large incident.

Overall Priorities for Incident Objectives

1. Life Safety 2. Incident Stabilization 3. Property Preservation

Hazard

Act or phenomenon having the potential to produce harm or other undesirable consequences to a person or thing. Exist with or without the presence of people and land development.

Response

Actions taken during event to minimize impact and facilitate quick recovery

Disaster

Any occurrence that warrants an extraordinary response. Requires more than the use of local resources and collaboration among many jurisdictions (ex. hurricanes, wildfires)

What is an Incident?

Anything out of the ordinary day-to-day activities that necessitates a response. This includes emergencies and disasters, outbreaks, vaccination programs, and important meetings/conferences.

Public Health role in Preparedness

Assessment, Policy Development, Assurance

Recovery

Continuing to assist those directly affected. Assuring additional damage does not occur. Implementing lessons learned to benefit the future.

How does Globalization lead to an increase in Public Health emergencies?

Contributes to the increase in Public Health emergencies. Increased number of people in urban areas, increased population, increased travel which leads to an increase in the spread of communicable diseases, and change from rural suburban living to rural urban.

Advance Response Planning

Coordinating with other agencies to develop a plan

Local Preparedness

Day to day operations. Responsible for response and recovery. They are also responsible for surveillance.

What does predictability refer to?

Frequency, likelihood of occurrence, seasonal pattern

HSPD-8

Goes beyond a coordinated response. All agencies follow a similar template.

Incident Commander

Has overall incident responsibility. Individual with the most experience with the particular incident. Determines the Public Health incident objectives and strategy. Develops an organizational structure that can effectively manage the incident.

Command

Has overall responsibilities and makes decisions

Things you should do for advance planning

Have all prescriptions, keep 3 days of prescriptions on hand at all times, have your insurance information available, have immunizations records available, know style and serial number of medical devices, list known food and drug allergies, write down the health conditions of your immediate family

Public Health 3.0

Improvement of health departments and their structures. Chief (community) health strategists engage with stakeholders and form partnerships within communities. Still the need to analyze and generate more data. Need for more resources and people

What is Public Health?

Influence and protect and promote healthy behaviors. Science and art of preventing disease, prolonging life, and promoting physical and mental health through organized community efforts.

Joint Information Systems

Interagency coordination and integration. Develop and deliver coordinated messages. Support decision makers. Most include representatives from each jurisdiction and each agency. May also include representatives from the private sector or public sector. Single JIC location is preferred.

What is the best choice for a safe room?

Interior room above ground with few windows and doors

HSPD-5

Resulted from 9/11 and enacted in 2003. Responded to the need for a coordinated response.

What is part of mitigation?

Return to normal activity, design improvements

Emergency Operation Center (EOC)

The physical location for coordination of information and resources. On activation, communication and coordination must be established between EOC and the incident commander and the unified command. Want close to scene but not too close.

What is resilience?

The population's capacity to withstand adversity and recover quickly

Preparedness

The state of having been made ready or prepared for use or action (readiness). Those activities, programs, and systems that exist before an emergency and that are used to support and enhance response to an emergency or disaster (FEMA). This could be having timely access to info, well organized and exercised plans, knowing roles and responsibilities, and communication within and across disciplines

Miasma Era (1850-1880)

Theory that bad air causes illness

Finance/Administration

Tracking cost and procurement. Provides financial management and accountability. Authorizes expenditures. Maintains reimbursement records. Maintains injury, death, and damage documentation. Negotiates contracts with vendors. Tracks costs associated with mutual aid agreements with other agencies.

What does preparedness include?

Training, plans, drills, surveillance, information backup. Preparedness and planning can happen long before response

Social Engineering (1960-1975)

Vietnam war along with social movements and societal changes led to the ability to talk and educate more on Public Health

Strategy

What needs to be done (activities) to accomplish the objectives

Hazard Analysis

Which public health emergencies are most likely to occur