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

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 4. 2009

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. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

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 4. 2009

Questions? Nora O’Brien, MPA Associate Director of Program Planning and Development California Primary Care Association 1215 K Street, Suite 700, Sacramento, CA 95814 916 440-8170 (F) 916 440-8172 nobrien@cpca.org www.cpca.org/resources/cepp Emergency Management Higher Education Conference June 4. 2009