Enhancing Public Health, Health Care System, and Clinician Preparedness: Strategies to Promote Coordination and Communication

Patrick J. Meehan, M.D.Director

Division of Emergency and Environmental Health Services

National Center for Environmental Health

Centers for Disease Control and Prevention

What is a Disaster?

A disaster is the result of a vast ecological breakdown in the relation between humans and their environment, a serious and sudden event (or slow, as in a drought) on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid (From Noji, Gunn and Lechat)

Disasters, terrorism and other public health emergencies all require rapid mobilization of resources and experts across agencies and across jurisdictional lines

To be Prepared, What Does Public Health Need Incident command and support structure Preparedness and response plans Communications Epidemiology and surveillance Laboratory Environmental/occupational health

Federal Level Response Plans

National Oil and Hazardous Substances Pollution Contingency Plan (NCP)

Federal Radiologic Emergency Response Plan

Federal Response Plan

Federal Response Plan

Supports the Robert T. Stafford Disaster Relief and Emergency Assistance Act (P.L. 99-288)

Signed by 27 Federal agencies and the Red Cross Incident command system approach Primary means for coordinating Federal response

to presidentially declared disaster State/local government overwhelmed

Terrorism

Presidential Decision Directives (PDD) 39 and 63

FBI Lead HHS Support

Emergency Support Function #8 (ESF – 8): Health and Medical

HHS is lead agency Assessment of health/medical needs Surveillance Medical care personnel Health and medical supplies Patient evacuation Hospital care Food/drug/medical device safety Worker health and safety

Goal of the Bioterrorism Cooperative Agreement Program To upgrade State and local public health

jurisdictions’ preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies

Bioterrorism Cooperative Agreement Program

7 Focus areas: State and local preparednessEpidemiology and surveillanceBiologic labChemical labHealth alert networkCommunicationTraining

Response happens at the local level

National Pharmaceutical Stockpile (NPS) Components: a Two-Tiered Response

Eight 12-Hour Push Packages: To reach designated airfield within 12 hours of Federal activation Pre-positioned in environmentally controlled and secured facilities Pre-configured for rapid identification and ease of distribution

Vendor Managed Inventory (VMI) Packages: Are held at several sites Will be shipped to arrive within 24 and 36-hour periods Pharmaceuticals and supplies delivered from one or more VMI

sources “Tailored" to provide specific materiel depending upon suspected

or confirmed agent

NPS Contents Pharmaceuticals:

Antibiotics

Mark I kits, diazepam, atropine, pralidoxime

IV Supplies

Airway Management Supplies

Other Emergency Medications

Bandages and Dressings

Some Lessons Learned

Communication: media, public information, health care community

Operations Issues: how to manage a large event Lack of science Components of response teams Worker health and safety Capacity to deal with environmental health issues

Each NPS 12-hour Push Package:

Weighs over 50 tons

Fills a wide-body aircraft

Occupies over 100 cargo containers

Requires 5000 square feet ground/floor space for proper staging

Public Health Role in Nuclear, Radiologic and Chemical Emergencies Health and medical evaluation and

recommendations Worker health and safety Risk assessment and communication Population monitoring and follow up Exposure assessment

CDC Cooperative Agreement Program Requirements Enhanced Capacities:

Defined as: the additional expertise and infrastructure (i.e., over and above the Critical Capacities) to enable public health systems to have optimal capacities to respond to bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies.

If selected, these must also be addressed in the work plan similar to the Critical Capacities.

Presentations from HHS Preapplication Workshops Review of CDC’s Supplemental Program Announcement

Slide set by CDC

Public Health Preparedness State and Local Component - Technical Assistance Workshops for Fiscal Year 2002 Funding: February–March 2002Slide set by Department of Health and Human Services (HHS)

Metropolitan Medical Response System (MMRS)Slide set by Department of Health and Human Services (HHS)/Office of Emergency Preparedness (OEP)

HRSA Bioterrorism Hospital Preparedness ProgramSlide set by Department of Health and Human Services (HHS)/Health Resources and Services Administration (HRSA)

Working Towards a Coordinated National Preparedness EffortSlide set by Federal Emergency Management Agency (FEMA)/Office of National Preparedness (ONP)

Program Overview of the Office for Domestic Preparedness (ODP)Slide set by U.S. Department of Justice (DOJ)/Office of Justice Programs (OJP)/Office for Domestic Preparedness (ODP)