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

1
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

2
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

3
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

4
Federal Level Response Plans

• National Oil and Hazardous Substances Pollution
  Contingency Plan (NCP)
• Federal Radiologic Emergency Response Plan
• Federal Response Plan

5
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

6
Terrorism

• Presidential Decision Directives (PDD) 39 and 63
• FBI Lead
• HHS Support

7
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

8
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

9
Bioterrorism Cooperative Agreement Program

• 7 Focus areas State and local preparedness
• Epidemiology and surveillance
• Biologic lab
• Chemical lab
• Health alert network
• Communication
• Training
• Response happens at the local level

10
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

11
NPS Contents

• Pharmaceuticals
• Antibiotics
• Mark I kits, diazepam, atropine, pralidoxime
• IV Supplies
• Airway Management Supplies
• Other Emergency Medications
• Bandages and Dressings

12
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

13
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

14
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

15
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.

16
Presentations from HHS Preapplication Workshops

• Review of CDCs Supplemental Program
  AnnouncementSlide set by CDC
• Public Health Preparedness State and Local
  Component - Technical Assistance Workshops for
  Fiscal Year 2002 Funding FebruaryMarch
  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)