1. Readiness: Where Are We? Where Do We Need to Be? CDC-AMA 1 st National Congress on Public Health Readiness July 22, 2004 Charles A. Schable, MS Director Office of Terrorism Preparedness and Emergency Response Centers for Disease Control and Prevention

2. Objectives Summarize key findings gathered during Conference discussion sessions Review several success strategies for ensuring preparedness in public health and medicine Identify unresolved needs and recommended action for moving closer to a state of readiness

3. 1 st National Congress on Public Health Readiness - Who Participated? Approximately 800 registered 58% Public Health 47% Clinical Medicine/Healthcare 5% Other

4. Public Health Preparedness “The continuous process of improving the Health System’s capacity to detect, respond to, recover from, and mitigate the consequences of terrorism and other health emergencies”

5. Detection

6. Detection and Surveillance Findings Clinician and public health approaches to early detection are complementary rather than competitive Numerous methods for improving bi-directional exchange of information are being explored in communities Sharing electronic syndrome data from health care systems is feasible and promising (BioSense offers opportunity for shared operational system), BUT usefulness has not been widely established

8. New Detection Methods Detection technologies are rapidly developing but beware; LRN is the gold standard Critically important that relationships and communication between clinical labs and the LRN is firmly established, ongoing, continually in development. Without, there is no connectivity.

9. Response and Containment

11. Legal Preparedness for Response and Containment Legal authorities must be established prior to response and containment --- capacity to implement Isolation / quarantine Legal representation for detainees Pre-response education for public health, medical providers, law enforcement Major legal barriers to emergency response care: Healthcare liability issues Credentialing issues

12. Emergency Communications: Key Findings and Recommendations Significant progress has been made in planning for communication during crisis Most jurisdictions report ability to send rapid emergency messages to many critical health providers However, a single effective National emergency communication system still lacking and needed In developing risk communication messages, do not focus only on messages that public health officials want to get out; consider information NEEDS of the public

16. Key Findings and Recommendations from Other Response and Containment Sessions Delay in response is costly both in terms of lives lost and other economics --- mathematical modeling a tool for planning response activities Need coordination of volunteer health professionals --- 1 registry of all --- available locally --- address participation barriers (e.g. credentialing, liability) Avoid “federalizing” local responses --- Ensure capability at local level to assume Incident Command of the emergency situation Not well-prepared for response and containment at borders and ports of entry

17. Key Findings and Recommendations from Response and Containment Sessions - continued Need for collaboration between public health and emergency management for containment and receipt of Strategic National Stockpile (SNS) well- understood; Inclusion of medical community / clinicians in SNS distribution plans is critical but may be under-appreciated Surge capacity planning is ongoing in communities, but a number of unresolved issues (e.g. transport, materials management, “worried well,” etc)

18. Although the critical partnership recognized, session not well-attended by Clinical / Healthcare colleagues (17%)

20. Idea for improving clinician participation in community response efforts

23. Under new National Response Plan (NRP)

24. Recovery

25. Recovery: Findings and Recommendations Recovery primarily the responsibility of local / state government Important lessons learned from Oklahoma City --- collaboration among medical community, public health, academia, mental health professionals critical to recovery Consider also including the business community Unanswered question: When or how does recovery end?

27. Minimizing Consequences: Planning for Preparedness

28. Mental and Psychosocial Preparedness  Ensure that mental health is integrated into public health and health care planning and response activities  Separating physical from mental health is artificial, especially in emergency situations  Include mental health professionals and diverse professionals in table-top exercises Clarify public reactions in emergency --- Distinction between public panic and the health system’s inability to handle public’s concerns during an emergency

29. Emergency Preparedness Education / Training Investments in training by the federal government (CDC, HRSA) have resulted in more training efforts targeting both clinicians and public health providers, and bridging practice and academic communities Evidence-base is needed to demonstrate effectiveness of training methods There remains redundancy and duplication Bilingual and cultural competency training needed to better facilitate work with health professionals across borders

35. Addressing Workforce Shortages Workforce shortages are pervasive across multiple disciplines in public health and health care Reasons for shortages similar --- wages, working conditions, limited training programs Rural settings particularly vulnerable and lack ability to recruit qualified workers Suggested solutions consistent: –Begin active recruiting starting in high school –Develop stronger, more innovative academic- practice links –Integrate approaches to “pipeline” development and readiness training

36. Measuring Preparedness

37. CDC’s Health Protection Goals Health Promotion & Prevention of Disease, Injury, and Disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life. Preparedness: People in all communities will be protected from infectious, environmental, and terrorist threats.

38. CDC Evidence-Based Performance Goals for Public Health Disaster Preparedness Charge: To develop goals and measures for public health preparedness, applicable to State and Local Public Health Preparedness needs Measures developed that can be evidenced by internal or multi-agency exercises Developed by examining current literature in fields of Disaster Response, Emergency Management, Public Health, Emergency Medicine, others --- Interviews of thought leaders where gaps existed 35 Performance Goals with 45 Measures Available for review - August 31, 2004

39. Clinicians & Laboratorians & Veterinarians Public Health Healthcare Organizations Strong Links: Frontlines of Defense

40. Preparedness Current Emphasis Hospitals Environmental (BioWatch) Laboratory Law Enforcement ACTION POINT Intersection of Information & Analysis PUBLIC HEALTH Media Clinicians Public Quarantine Stations Border States

41. Preparedness Desired State DoD & VA Vital Records Environmental (BioWatch) Pharmacy Data Veterinary Cargo/ Imports Immigration International Schools Business Law Enforcement ACTION POINT Intersection of Information & Analysis PUBLIC HEALTH Media Public First Responders Border States Laboratory Quarantine Stations Hospitals Clinicians

42. “The function of protecting and developing health must rank even above that of restoring it when it is impaired.” ~ Hippocrates www.cdc.gov

43. Slides of Sessions and Attendance Roster will be posted on Conference webpage in next 2-3 weeks. www.CDC-AMA-ReadinessConference.org See you in 2006 for the 2 nd National Congress on Public Health Readiness…? www.CDC-AMA-ReadinessConference.org