Regionalization in local public health systems: public health preparedness in the Washington metropolitan area

The Washington metropolitan area was closely examined to understand how these regional preparedness structures have been organized, implemented, and governed, as well as to assess the likely impact of such regional structures on public health preparedness and public health systems more generally. It was found that no single formal regional structure for the public health system exists in the Washington metropolitan area, although the region is designated by the Department of Homeland Security as the National Capital Region (NCR). In fact, the vast majority of preparedness planning and response activities in this area are the result of voluntary self-organization through both governmental and nongovernmental organizations. Some interviewed felt that this was an optimal arrangement, as personal relationships prove crucial in responding to a public health emergency and an informal response is often more timely than a formal response. The biggest challenge for public health preparedness in the NCR is incorporating all federal government agencies in the area in NCR preparedness planning.     

Using social network analysis to understand Missouri's system of public health emergency planners

OBJECTIVES: Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006. METHODS: The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri. RESULTS: Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/ clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks. CONCLUSIONS: While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.     

我国CDC突发公共卫生事件应急处置能力与现状分析

目的：分析我国CDC突发公共卫生事件应急处置能力与现状。方法：对2010年全国CDC突发公共卫生事件应急处置工作相关数据进行统计分析。结果：应急基础保障方面,全国CDC领导小组设置率和应急队伍设置率分别为96.2%和94.9%,而专家库设置率和本部门专门应急机构设置率仅为58.9%和60.9%;应急人员数量地区差异较大;应急物品储备齐全率仅为37.5%。应急能力建设方面,应急人员流行病学、应急检验和应急管理培训平均每人为1.78天、0.73天和0.67天;应急能力落实方面,应急处置职能完成度平均为54.1%。多因素回归分析显示,应急处置基础保障工作、应急能力建设均对应急处置结果产生影响。结论：现阶段我国CDC突发应急组织架构良好,突发事件信息报告和应急处置逐步规范,但仍需进一步加强专门应急机构和专家库建设、完善应急队伍结构、加强应急物品储备工作、提高应急培训和演练效果、落实突发事件应急处置职能。     

Partnering for preparedness: the project public health ready experience

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The project's pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.     

Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness

ABSTRACT: BACKGROUND: Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as "exercises", for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. METHODS: We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1) the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2) the major challenges to inter-organizational communications and information management. RESULTS: Thirty-five local health departments (LHDs), 24 local emergency medical services (EMS) agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC) responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents' comments were related to the complete or partial failure of communications equipment or systems. CONCLUSIONS: Using the 2010 Statewide Exercise in California as an opportunity to develop our research framework, we characterized several aspects of the public health and medical system's response to a standardized emergency scenario. From a research perspective, this study provides a potential new framework for conducting exercise-based research. From a practitioner's perspective, our results provide a starting point for preparedness professionals' dialogue about expected and actual organizational roles, responsibilities, and resource capacities within the public health system. Additionally, the identification of specific challenges to inter-organizational communications and information management offer specific areas for intervention.     

A preliminary framework to measure public health emergency response capacity

To provide a scientific guide for most countries in the world to build a complete public health emergency management system. Capacity assessment theory and emergency management theory were reviewed respectively and linked together to construct a preliminary, two-dimensional public health emergency response capacity framework. A preliminary framework for public health emergency response capacity was obtained, which consists of three levels: the systems level, the organizational level, and the individual level. A two-dimensional matrix or a set of two-dimensional matrixes that comprise capacity, dimension, and emergency function dimension formed the preliminary framework in three levels, respectively. This preliminary framework can act as a theoretical guide for a country or a region to set up their own public health emergency response systems.     

Determinants of implementing heart health: promotion activities in Ontario public health units: a social ecological perspective

This paper reports the results of a study undertaken to explain levels of implementation of heart health promotion activities observed in Ontario public health agencies in 1997. Organizational-level data were collected by surveying all 42 health departments in 1994, 1996 and 1997 as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, the model examines relationships between implementation and four sets of possible determinants of activity: (1) the predisposition of agencies to undertake heart health promotion activities, (2) their capacity to undertake these activities, (3) internal organizational factors and (4) external system factors. A small set of five variables explains almost half of the variance in implementation (R2 = 0.46): organizational capacity (beta = 0.40), priority given to heart health (beta = 0.36), coordination of programs (beta = 0.19), use of resource centers (beta = 0.12) and participation in networks (beta = 0.09). The results suggest that models integrating organizational and socio-ecological theories can help us understand the implementation of community-based heart health promotion activities by public health agencies. Implications for future research, policy and practice are discussed.     

Evaluation of public health response to hurricanes finds North Carolina better prepared for public health emergencies

Reviews of state public health preparedness improvements have been primarily limited to measuring funds expenditures and achievement of cooperative agreement benchmarks. Such reviews fail to assess states' actual capacity for meeting the challenges they may face during an emergency, as evidenced by activities undertaken during the various phases of a disaster. This article examines North Carolina's public health preparedness and response performance during two hurricanes, Hurricane Floyd in 1999 and Hurricane Isabel in 2003, as well as capacity building activities in the intervening years. North Carolina created new infrastructures, enhanced laboratory capacity, and strengthened communications after Hurricane Floyd. These activities facilitated implementation of functional capabilities through effective centralized communication, command and control incident management, and a rapid needs assessment and medical surveillance during Hurricane Isabel. North Carolina continues to implement these capabilities in public health emergencies. Measuring and implementing functional capabilities during exercises or real events facilitates achievement of preparedness performance standards, goals, and objectives.     

Integrating pharmacies into public health program planning for pandemic influenza vaccine response

BackgroundDuring an influenza pandemic, to achieve early and rapid vaccination coverage and maximize the benefit of an immunization campaign, partnerships between public health agencies and vaccine providers are essential. Immunizing pharmacists represent an important group for expanding access to pandemic vaccination. However, little is known about nationwide coordination between public health programs and pharmacies for pandemic vaccine response planning.MethodsTo assess relationships and planning activities between public health programs and pharmacies, we analyzed data from Centers for Disease Control and Prevention assessments of jurisdictions that received immunization and emergency preparedness funding from 2012 to 2015.ResultsForty-seven (88.7%) of 53 jurisdictions reported including pharmacies in pandemic vaccine distribution plans, 24 (45.3%) had processes to recruit pharmacists to vaccinate, and 16 (30.8%) of 52 established formal relationships with pharmacies. Most jurisdictions plan to allocate less than 10% of pandemic vaccine supply to pharmacies.DiscussionWhile most jurisdictions plan to include pharmacies as pandemic vaccine providers, work is needed to establish formalized agreements between public health departments and pharmacies to improve pandemic preparedness coordination and ensure that vaccinating pharmacists are fully utilized during a pandemic.     

Regional public health emergency preparedness: the experience of Massachusetts Region 4b

Historically, local public health in Massachusetts has been largely decentralized, with each town responsible for providing local public health services. After 9/11, the Massachusetts Department of Public Health (MDPH) began to plan for bioterrorism and other possible public health emergencies and found that having 351 separate departments made emergency planning difficult and dispersing of funds a challenge. To facilitate this process, MDPH created seven emergency preparedness regions and asked local public health departments to engage in joint planning. This article describes the formation of Region 4b and how the region came together to work on emergency preparedness issues. It also examines the organizational, financial, and planning challenges associated with organizing these towns as a unified entity.     

Public health preparedness: a systems-level approach

Public health and emergency preparedness have become central concepts in the current restructuring of various regional-, national- and global-level public health and emergency management agencies and systems. In this article, a glossary of the most important terms and concepts currently pertaining to public health preparedness is provided with a focus on systems-level and organisational issues.     

The case for transforming governmental public health

Changing threats to the public's health necessitate a profound transformation of the public health enterprise. Despite recent attention to the biodefense role of public health, policymakers have not developed a clear, realistic vision for the structure and functionality of the governmental public health system. Lack of leadership and organizational disconnects across levels of government have prevented strategic alignment of resources and undermined momentum for meaningful change. A transformed public health system is needed to address the demands of emergency preparedness and health protection. Such transformation should include focused, risk-based resource allocation; regional planning; technological upgrades; workforce restructuring; improved integration of private-sector assets; and better performance monitoring.     

Building human resilience: the role of public health preparedness and response as an adaptation to climate change

Global climate change will increase the probability of extreme weather events, including heatwaves, drought, wildfire, cyclones, and heavy precipitation that could cause floods and landslides. Such events create significant public health needs that can exceed local capacity to respond, resulting in excess morbidity or mortality and in the declaration of disasters. Human vulnerability to any disaster is a complex phenomenon with social, economic, health, and cultural dimensions. Vulnerability to natural disasters has two sides: the degree of exposure to dangerous hazards (susceptibility) and the capacity to cope with or recover from disaster consequences (resilience). Vulnerability reduction programs reduce susceptibility and increase resilience. Susceptibility to disasters is reduced largely by prevention and mitigation of emergencies. Emergency preparedness and response and recovery activities--including those that address climate change--increase disaster resilience. Because adaptation must occur at the community level, local public health agencies are uniquely placed to build human resilience to climate-related disasters. This article discusses the role of public health in reducing human vulnerability to climate change within the context of select examples for emergency preparedness and response.     

Self-assessment in the measurement of public health workforce preparedness for bioterrorism or other public health disasters

OBJECTIVE: The purpose of this study was to examine effective ways to evaluate public health workers' competence for preparedness. METHODS: The Public Health Ready project, developed by the National Association of County and City Public Health Officials and the Centers for Disease Control and Prevention, is a pilot program designed to prepare local public health agencies to respond to emergency events. Workers at a Public Health Ready site (N=265) rated their need for training and their competence in meeting generic emergency response goals. Cluster analysis of cases was conducted on the self-assessed need for training. RESULTS: Three groups of workers emerged, differing in their overall ratings of need for training. A given worker tended to report similar needs for training across all training goals. CONCLUSIONS: In this study, workers' ratings of need for training may reflect an overall interest in training rather than need for training in a particular area. Caution should be exercised in interpretation when generic goals and self-assessment are used to measure need for training. Future assessments of training needs may be more effective if they use objective measures of specific local plans.     

The courts, public health, and legal preparedness

The judicial branch's key roles, as guardian of civil liberties and protector of the rule of law, can be acutely relevant during public health emergencies when courts may need to issue orders authorizing actions to protect public health or restraining public health actions that are determined to unduly interfere with civil rights. Legal preparedness for public health emergencies, therefore, necessitates an understanding of the court system and how courts are involved in public health issues. In this article we briefly describe the court system and then focus on what public health practitioners need to know about the judicial system in a public health emergency, including the courts' roles and the consequent need to keep courts open during emergencies.     

Systems modeling in support of evidence-based disaster planning for rural areas

The objective of this communication is to introduce a conceptual framework for a study that applies a rigorous systems approach to rural disaster preparedness and planning. System Dynamics is a well-established computer-based simulation modeling methodology for analyzing complex social systems that are difficult to change and predict. This approach has been applied for decades to a wide variety of issues of healthcare and other types of service capacity and delivery, and more recently, to some issues of disaster planning and mitigation. The study will use the System Dynamics approach to create computer simulation models as "what-if" tools for disaster preparedness planners. We have recently applied the approach to the issue of hospital surge capacity, and have reached some preliminary conclusions--for example, on the question of where in the hospital to place supplementary nursing staff during a severe infectious disease outbreak--some of which we had not expected. Other hospital disaster preparedness issues well suited to System Dynamics analysis include sustaining employee competence and reducing turnover, coordination of medical care and public health resources, and hospital coordination with the wider community to address mass casualties. The approach may also be applied to preparedness issues for agencies other than hospitals, and could help to improve the interactions among all agencies represented in a community's local emergency planning committee. The simulation models will support an evidence-based approach to rural disaster planning, helping to tie empirical data to decision-making. Disaster planners will be able to simulate a wide variety of scenarios, learn responses to each and develop principles or best practices that apply to a broad spectrum of disaster scenarios. These skills and insights would improve public health practice and be of particular use in the promotion of injury and disease prevention programs and practices.     

State of emergency preparedness of Kentucky's rural public health workforce: assessing its ability to identify community health problems

OBJECTIVE: The author examined the emergency preparedness readiness of all workgroups within Kentucky's rural public health departments as it related to the 10 Essential Public Health Services. This article describes the results related to the three emergency preparedness competencies for the first Essential Public Health Service: the ability to monitor health status to identify community health problems. METHODS: Onsite surveys were conducted in one urban and 93 rural Kentucky public health agencies during 2005 and 2006. Categorical data were analyzed using univariate and multivariate analysis techniques. The author compared responses to the level of confidence (LOC) and need for training (NFT) among the seven workgroup classifications. RESULTS: One thousand nine hundred ninety-four public health workers completed the surveys. Of these, 1,813 workers represented 55% of the state's rural local public health workforce. Kentucky's rural public health workforce can be described as predominantly Caucasian, female, and not planning to retire within the next five years. There were significant differences among workgroups for LOC and NFT for each competency examined. Across all workgroups, there was a mean LOC (58%) in the ability to describe the actions to take and procedures to follow in an emergency. There was a correspondingly higher mean perceived NFT (73%) for this competency. CONCLUSION: This study raises the question of whether we are adequately prepared to monitor our communities' health status. Further research that minimizes the limitations of self-reports and, instead, requires the worker to demonstrate the competency may provide a more accurate assessment of emergency preparedness.     

Currently employed public health administrators: are they prepared?

Challenges to the public health system come from shifting expectations of government, economic cycles, and demographic changes. Public health administrators, charged with the responsibility of both leading and managing their agencies, those who are recognized as having significant management responsibility and influence over programs and hold positions of leadership, must be prepared. The skills needed by administrators were identified using a focus group approach. The critical skills identified include public health values, epidemiology and advocacy, organizational management, cultural competency, coalition building, communications, managing change, strategic thinking and planning, Informatics, and team building. Potential action steps were also identified.     

哈尔滨市疾病预防控制机构突发公共卫生事件应对能力现况与评价

目的了解哈尔滨市基层疾病预防控制体系中突发公共卫生事件应对能力的现况,并评估其机构和人员应对能力的强弱,找出应急体系建设的相关问题,针对问题提出改善措施。方法采用统一的调查问卷对哈尔滨市18所区（县）疾控机构及相关应急管理人员进行调查,并对每项调查结果赋分,最终汇总计算的分值,作为每个疾控中心的最终结果。结果各疾控机构学历、职称分布不均衡;应急准备和响应能力整体情况较好;各辖区疾控部门协作较少;各疾控部门检验能力、演练频次、业务培训内容有待提高。结论通过对区（县）级疾控机构应对突发公共卫生事件能力进行全面评价,找出其特点和薄弱环节,进而采取有针对性的改进措施,以提高突发公共卫生事件应对能力,完善基层疾控机构完善应急体系。