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

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

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

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

Supports the Robert T. Stafford Disaster Relief and Emergency Assistance Act (P.L ) 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

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

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

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

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

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

NPS Contents Pharmaceuticals:  Antibiotics  Mark I kits, diazepam, atropine, pralidoxime IV Supplies Airway Management Supplies Other Emergency Medications Bandages and Dressings

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

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

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

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.

Presentations from HHS Preapplication Workshops Review of CDC’s Supplemental Program Announcement Slide set by CDC Public Health Preparedness State and Local Component - Technical Assistance Workshops for Fiscal Year 2002 Funding: February–March 2002 Slide 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 Program Slide set by Department of Health and Human Services (HHS)/Health Resources and Services Administration (HRSA) Working Towards a Coordinated National Preparedness Effort Slide 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)