the changing nature of health security: healthcare ......2019/09/07 · the changing nature of...

Kevin Yeskey, MDPrincipal Deputy Assistant Secretary for Preparedness and

Response

Alaska State Hospital & Nursing Home AssociationSeptember 25, 2019

The Changing Nature of Health Security: Healthcare Preparedness and Response in the

Face of 21st Century Threats

2Saving Lives. Protecting Americans.

ASPR Mission

Save Lives and Protect

Americans from 21st Century

Health Security Threats


ASPR’s Key Priorities

Providing Strong

Leadership

Building a Regional

Disaster Health Response

System

Sustaining Public Health

Security Capacity

Enhancing the Medical

Countermeasures Enterprise


Goals

• Make sure that patients affected by disasters that result in injury or illness are taken care of no matter where they are.

• Support healthcare facilities so that they can provide care for patients who may exceed their surge capacity, domain of expertise, or local resources.

• Help facilities to prepare for, respond to, and recover from disasters impacting the public’s health without asking for federal approval.


Defining the ProblemHistoric and Ongoing Response Environment

2012

Deepwater Horizon

Japan Earthquake Nuclear Event

Hurricanes Katrina, Rita, and Wilma

Re-emerging H5N1

Hurricanes Ike and Gustav

Project BioShieldAct

Pandemic and All-Hazards Preparedness Act Reauthorized

National Health Security Strategy

H1N1 Pandemic

Haiti Earthquake

Hurricane Irene

Hurricanes Isaac and Sandy

Unaccompanied Children

Unaccompanied Children

Ebola West Africa

Ebola DRC

PHEMCE Review

PHEMCE Strategy and Implementation Plan

Pandemic and All-Hazards Preparedness Act

National Health Security Strategy

Hurricanes Florence and Michael

Hurricanes Harvey, Irma, and Maria

Zika

Measles

Flint Water Contamination

WV Chemical Release

Hurricane Matthew

H7N9

National Biodefense Strategy

20152001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013 2014 2016 2017 20182012 2019

Sandy Hook

Shooting

PAHPAI 2019

Typhoons Yutu and Mangkhut

9/11 and Anthrax


Challenges to disaster healthcare in Alaska

• Unique threats: Tsunamis, earthquakes, environmental Proximity to adversaries

• Geographic isolation Remote vulnerable populations Limited supply chain redundancy

• Infrastructure vulnerabilities 40% of population lives in one city Limited road structure


• 25 Hospitals • 174 Community Health

Centers• 18 Long term care facilities• 1 VA hospital• 2 Trauma Centers (Level 2)• 2 Pediatric Trauma Centers• 1 Ebola Assessment Center• 0 Burn Centers• 0 Radiation Injury Treatment

Network Centers


Alaska Seismic Activity

2 weeks of seismic activity• Red = within 24 hours

• Population: 737,438 (Anchorage:40%) 17% of population with a disability

• Most seismically-active state in the country Notable recent earthquakes:

7.1M, November 30, 2018, Anchorage, AK (ongoing recovery)

7.9M, January 23, 2018, Kodiak Island, AK (initial tsunami warnings)

7.1M, January 24, 2016, Homer, AK 7.9M, June 23, 2014, Aleutian Islands ’46 (8.6M), ‘57 (8.6M), ‘58 (7.8M), ‘64

(9.2M), ‘65 (8.7M), ‘75 (7.6M)


Alaska Travel DistancesLargest State in the US Ground Travel Network


Solutions

• Align federal programs Hospital Preparedness Program National Disaster Medical Program Medical Reserve Corps

• Partner with other Federal Agencies (VA & DoD)• Partner with the Private Sector• Innovate

National Pediatric Disaster Initiative Regional Disaster Health Response System Public-Private Partnerships


ASPR’s 2019-2023

Priorities & Programs


Hospital Preparedness Program (HPP)

• 62 HPP Grantees: 50 state health departments, 8 territorial health departments, 4 large metropolitan jurisdictions (Los Angeles, New York City,

Chicago, and the District of Columbia)

• Healthcare Coalitions are the foundation of the HPP• Coalitions consist of many components of healthcare system

15Saving Lives. Protecting Americans. 15

What is a Healthcare Coalition?

Community PartnersAcademic Institutions

Non-profitsVolunteers

Elected OfficialsFire Departments

Police Departments

Long Term CareSkilled Nursing Facilities

Hospice Care

Hospitals

Public Health Departments

Outpatient Facilities

Primary CareSpecialists

Health Care

Coalition (HCC)

Health CentersRural Health CentersCommunity Health Centers

Local Government

Emergency Medical Services

Home Health Agencies

Emergency Management Agencies

Behavioral and Mental Health Centers and Agencies

Physicians

A HCC is a group of individual health care and response organizations in a defined geographic location. HCCs play a critical role in developing health care delivery system preparedness and response capabilities.


Healthcare Preparedness Program - Alaska

• $1,097,949 – Total 2019 HPP Funding • 2015 – Established Statewide HCC • 1 – Full Time HCC Coordinator• 39 – Current HCC Members

8 – Acute Care Hospitals 14 – Critical Access Hospitals 1 – Pediatric Care Center 1 – Special Pathogen Center 1 – EMS Organization 2 – Public Heath Organizations 1 – EM Agency

• Engagement of additional health care provider types in preparedness, response, and recovery planning

• Development and testing of pediatric surge processes

• Strengthening the Trauma and EMS systems to better support medical surge operations

• Increase information sharing and coordination through consistent Essential Elements of Information and common operating picture system

• Maintenance and development of local health care community emergency capabilities with a focus on risk-based planning

HCC PRIORITIESBY THE NUMBERS


Medical Reserve Corps | MRC Locations

• Alaska currently has one registered MRC unit. City of Ketchikan Medical

Reserve Corps established November 2004

• At its peak, Alaska had four active units; first unit registered in 2002.


Regional Treatment Network for Ebola and Other Special Pathogens

• A tiered, regional treatment network across the nation for Ebola and other infectious diseases balances geographic need and differences in institutional capabilities, bringing the health care sector together to prepare for infectious disease threats 10 regional Ebola and other special

pathogen treatment centers 60 state- or jurisdiction-designated Ebola

treatment centers 185 Ebola assessment hospitals

Map produced by Division of Information Management, GIS Branch

State or Jurisdiction Ebola Treatment Center (69)Regional Ebola and Other Special Pathogen Treatment Center (10)Area within 400 miles of Regional Treatment Center


Strategic National StockpileThe nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.


Medical Countermeasures - Alaska• Mature MCM Program, tenured staff, long-term key partners• ANTHC, AKNG and Civil Air Patrol to support remote distribution• Significant closed POD agreements beyond hospitals: JBER, Eielson AFB,

USCG, Ted Stevens Airport and Southcentral Foundation• Anchorage MSA includes 2 CRI planning jurisdictions (50% of state population) • Successfully conducted large scale MCM FSE in April 2019• Recent ORR site visit conducted by CDC/DSLR indicates DHSS on track to be

“established” by 2022. • Going forward - shifting from focused antibiotic response to Pandemic scenarios


National Disaster Pediatric Initiative | Pediatric Centers of Excellence

April 2019: Solicited feedback from pediatric stakeholders on:• Unique needs of children during disasters• FOA for Pediatric Centers of Excellence • Equipment and supplies for the care of pediatric patients

July 2019: Release FOA for Pediatric Centers of Excellence• Two pilot project awards available, totaling $6 million• Designed to complement HPP, EMSC, NDMS• Will serve as a nationally available resource to help other

facilities and providers to plan and coordinate the care of children during large-scale national emergencies, particularly those involving health security threats, such as CBRN incidents and pandemics


RDHRS Pilot Sites

Align plans, policies, procedures related to clinical excellence in disasters

N E B R AS K A M E D I C I N E M AS S A C H U S E T T S G E N E R AL H O S P I TAL

Sites will build systems that exhibit the following 5 capabilities:

Build a partnership for disaster health response

Develop readiness metrics and conduct an exercise to test capabilities

Improve statewide and regional situational awareness

Increase statewide and regional medical surge capacity


Mutual Responsibility for Readiness

Comprehensive Emergency Response

HHS

DHS/FEMA

DoD

VA

DOT

State & Local

EMS

Hospitals

Outpatient Facilities

SupplyChain

Community Partners

Long Term Care

A robust response to 21st-century threats necessitates seamless integration between public and private response. While public sector resources are an essential part of the equation, complementary private sector investments

in readiness are critical to the health care system’s ability to serve patients during a disaster.

Academic Institutions


Questions?

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