Public Health and Disaster Preparedness

AcademyHealthJune 8, 2004

Kristine M. Gebbie, DrPH, RNColumbia University School of Nursing

AcademyHealth, June 8, 2004

Goals

Review some of the major gains in public health infrastructure and emergency response

Identify areas in which public health systems and services research are essential to provide the evidence base for improvement

AcademyHealth, June 8, 2004

Public health infrastructure for response

Data and Information: surveillance, partner contacts, laboratory data

Prepared Workforce: they have the competencies

Systems and Relationships: a practiced plan and ties to other agencies

AcademyHealth, June 8, 2004

Data and information: progress

Development of new surveillance sources ambulance usage OTC pharmacy use ER visits

More information on care resourcesMuch more information routinely

distributed or available to cliniciansCapacity of workforce to use unexamined

AcademyHealth, June 8, 2004

Systems and relationships: progress

Public health more visible with policy makers

Public health leadership is at local, state and national emergency planning table

Regional public health response systems to support rural and small agency capacity

Strengthened ties between public health and medical care organizations

Generic ICS training of limited use

AcademyHealth, June 8, 2004

Prepared workforce: progress

Assessment of general and emergency preparedness competencies

Network of Centers for Public Health Preparedness

Expanded use of emergency drills and exercises as developmental opportunities

Specialty training in emergency preparedness in MPH & other programs

AcademyHealth, June 8, 2004

One attempt: Public Health Ready

Certification requires emergency plan integrated with overall

local plan competency training for all staff drills/exercises involving other agencies

with improvement planFirst 10 agencies certified this yearMuch anecdotal information on

improvement

AcademyHealth, June 8, 2004

What we don’t know: data & information

How much makes a difference?What transmission routes work best?What language(s) facilitate

communication across cultural lines laboratories medical workers uniformed first responders public health

AcademyHealth, June 8, 2004

What we don’t know: systems & relationships

What general and special legal structures are effective?

How do formal and informal relationships interact?

How the cultures of public health and emergency response fit together?

What is the minimum size (agency or population) needed to support good emergency response?

AcademyHealth, June 8, 2004

What we don’t know: prepared workforce

How much of this knowledge is ‘dual use’?

What are the leadership differences in emergencies?

What is the balance between ‘systems’ and ‘science’?

How do we measure competency?

What degree of specificity is needed by all workers vs. specialists?

What is the length of knowledge/skill retention?

AcademyHealth, June 8, 2004

If the answer to some of these is “drills & exercises”

How do typical training activities intersect with drills and exercises?

What level of exercise?At what frequency?To what standard?At what cost?

AcademyHealth, June 8, 2004

Practice makes better

Planning for emergencies, building formal interagency/inter-jurisdictional agreements and training staff are only part of the picture

Regular reviews, exercises and drills are essential to maintain awareness, identify areas for improvement and develop proficiency in response

AcademyHealth, June 8, 2004

AcademyHealth, June 8, 2004

The biggest questions:

What is the total cost, including lost opportunity cost, of emergency preparedness?

How would we assess the cost effectiveness of any of the activities of preparedness?

What does ‘dual use’ really mean and is it worthwhile as a concept?

AcademyHealth, June 8, 2004

We fervently believe

An effective public health infrastructure can deliver essential public health services which means that emergency services

are effective and people and communities are protected

But we lack the evidence to demonstrate and improve upon it!

AcademyHealth, June 8, 2004

Columbia University School of Nursing

Center for Health Policy

www.nursing.hs.columbia.edu