1. Nora O’Brien, MPA California Primary Care Association
Innovations in Primary Care Emergency Management: Planning, GIS Mapping, and Public Health Response Emergency Management Higher Education Conference June 4, 2009
Nora O’Brien, MPA California Primary Care Association

2. Presentation Overview
Review of California Community Clinics and Health Centers (CCHC) and emergency response roles
Current H1N1 Influenza Outbreak and CPCA response
CPCA Clinic Emergency Preparedness Resources
Application of Emergency Management Education to current work
Questions
Emergency Management Higher Education Conference
June

3. CPCA Community Clinic and Health Centers
822 community clinics and health centers (CCHCs)
CPCA’s more than 740 members include:
Federally Qualified Health Centers (FQHCs and FQHC Look-a-likes)
Rural Health Clinics
Community Clinics
Free Clinics
Planned Parenthood Clinics
17 Regional Clinic Consortia
Emergency Management Higher Education Conference
June

4. Who CA CCHCs Serve Patients 4 million patients
49% of whom are limited English proficient
Visits
12.5 million patient visits provided
1 mil uninsured and 1.4 mil Medi-Cal
3.6 million patients under 200% of the FPL
All information compiled by Jeanita Harris, CPCA Data Analyst. Numbers are based on 2007 OSHPD data.
Emergency Management Higher Education Conference
June

5. CA CCHC Characteristics
CCHCs serve the most vulnerable patients- regardless of their ability to pay, insurance, or immigration status.
Health care safety net for many communities, counties and regions.
Provide multitude of services to uninsured/underinsured where hospitals and other medical providers may not exist.
Emergency Management Higher Education Conference
June

6. Potential CCHC Emergency Response Roles
Medical surge capacity for hospitals and public health departments
Triage
Disease surveillance
Mental health services
Alternate Care Sites
Medical response staging
Deploy mobile units and CCHC staff
Ethnic community outreach
Serve as Points of Distribution (POD) sites
Translation services
Shelter residents
Social Services access
CCHCs can respond effectively to emergencies when given resources, training, and equipment
Emergency Management Higher Education Conference
June

7. H1N1 Influenza Outbreak Why public health officials are alarmed
Novel virus- no one has immunity to it
Likely to kill more healthy adults than young and old
Cases identified in outpatient settings like CCHCs
One of earliest 107 confirmed cases was a member
1918 pandemic followed similar pattern of mild cases then deadly outbreaks during fall and winter
Today we have greater syndromic surveillance capability, anti-viral meds, and instant communication
Emergency Management Higher Education Conference
June

8. CPCA H1N1Influenza Outbreak Response
Situational awareness of local clinic and regional consortia response needs
Coordinate medical response with local, state, and national partners
Promote credible medical guidance from state and federal sources via CPCA website and snapblast
Advocate CCHC interests on state and federal calls
CCG testified H1N1 Influenza legislative hearing
Respond to media requests- LA Times, SF Chronicle
Emergency Management Higher Education Conference
June

9. CCHC Emergency Response Efforts
Hurricane Katrina (2005)
Deployed mobile medical assets
Triaged to hospitals
Provided Rx & primary care
Wildfires (2003, 07, 08)
Used Clinic practice management systems to ID patients at risk
Provided mental health services
Treated First responders and community
Provided translation services
Evacuation and shelter assistance
Emergency Management Higher Education Conference
June

10. Challenges to CCHC Emergency Response
No consistent patient tracking system
Limited reimbursement for services rendered
Not all CCHCs integrated into local response plans
CCHCs at varying levels of preparedness
CCHC leadership buy-in for preparedness efforts
Emergency Management Higher Education Conference
June

11. Clinic Emergency Preparedness Efforts…Meeting the Challenges
No consistent patient tracking system!
Few CCHCs have Electronic Health Record systems
Limited reimbursement for services rendered:
CPCA Policy Team involved in tracking, monitoring, and influencing legislation that can positively impact reimbursement to clinics.
Not all CCHCs integrated into local response plans:
CAHAN
CPCA EOP Template
Emergency Management Higher Education Conference
June

12. Clinic Emergency Preparedness Efforts…Meeting the Challenges
CCHCs at varying levels of preparedness:
Exercise participation
GIS mapping
CCHC leadership buy-in for preparedness efforts:
Ongoing meetings/discussions with leadership by key CPCA team members
Emergency Management Higher Education Conference
June

13. CPCA CCHC Emergency Management Tools and Resources
A robust CCHC-specific Emergency Operations Plan
Clinic Emergency Preparedness Help Desk
Emergency Flipchart
Clinic Emergency Preparedness Task Force
ACS, POD and Mobile Medical Asset GIS Mapping
CPCA Emergency Preparedness Training Modules
Clinic ICS/NIMS Training
Pandemic Influenza Planning Toolkit
Redundant Communication Training Module
Emergency Management Higher Education Conference
June

14. ACS, POD & Mobile Medical Asset GIS Tracking
Why GIS is Important to Emergency Preparedness
9/11 Story
Integral to any comprehensive disaster management plan
Bottom line: “This stuff saves lives.”
Identification of Clinic Alternate Care Sites
ACS Survey Tool
ACS Outreach
ACS Data Collection
GIS Mapping
Knowing what is in your community so that you can protect it
A spatial display and analysis tool that can answer key questions
Emergency Management Higher Education Conference
June

15. CPCA Regional Outreach
Increased visits to CPCA Clinics/Increased interaction with CPCA field operations
Statewide Tabletops and expanded emergency preparedness exercises
Provision of expanded information, training and additional resources to CPCA members
Expanded CPCA Help Desk information and FAQs
Establishment of a CPCA Emergency Preparedness Quarterly Newsletter
Expanded opportunities for webinars, new training content, & additional live seminars as needed
Emergency Management Higher Education Conference
June

16. CCHC NIMS Expectations
Bureau of Primary Health Care (BPHC) Emergency Management Expectations expect FQHCs and Look-Alikes to “move toward NIMS compliance and implement ICS in their EMPs”- not required
ASPR’s Hospital Preparedness Program (HPP) requires only hospital staff to meet the 14 NIMS elements
CCHCs likely required to implement some of the NIMS elements in future HPP guidance
Emergency Management Higher Education Conference
June

17. Clinic Incident Command System NIMS Training
Modeled after the Hospital Incident Command System training and tailored to the CCHC setting
Developed with input from 40 CCHC medical and operational staff
Designed for three CCHC audiences
Command Module (4 hour)
ICS H 100, ICS H 200, and 700A CalEMA certified
Executive Module (1.5 hour)
General Staff Module (1 hour)
Emergency Management Higher Education Conference
June

18. Clinic ICS/NIMS Training Next Steps
Final versions of the Command, Executive, and General staff module will be available on demand via CPCA’s web-based Learning Management System- June 2009
CPCA will host a General Staff WebEx training- June 2009
CPCA will offer the Executive Module via videoconference- August 2009
Emergency Management Higher Education Conference
June

19. Emergency Management Education
Masters of Public Affairs, Disaster and Emergency Management Program- Park University, KC, MO
“Rationality, responsibility, and responsiveness in their organizations within a framework of the highest ethical values”
Both Online and in-person classes
Experienced emergency management faculty- IAEM and IACP past presidents
Undergraduate and certificate DEM programs also available
Emergency Management Higher Education Conference
June

20. Application of Emergency Management Education to Current Work
Provided an academic framework to emergency management work largely focused on preparedness rather than response
Firmer knowledge of in-depth emergency management concepts such as mitigation, business continuity, disaster resiliency, and vulnerable population response
Modified work to reflect larger emergency management context, i.e., public safety, private sector, government, EMS
Emergency Management Higher Education Conference
June

21. Emergency Management Academic Research Challenges
Paucity of emergency management research regarding vulnerable population preparedness and response
LEP populations, resource poor individuals, disabled, seniors, children, etc.
Service providers of vulnerable populations need EM tools and resources to plan but lack infrastructure to implement
Disconnect between response to public health emergencies and other disasters/emergencies
Public health departments are often not integrated into local emergency management agencies
Emergency Management Higher Education Conference
June

22. Questions?
Nora O’Brien, MPA Associate Director of Program Planning and Development California Primary Care Association 1215 K Street, Suite 700, Sacramento, CA (F)
Emergency Management Higher Education Conference
June