1. Public Health and Disaster Preparedness AcademyHealth June 8, 2004 Kristine M. Gebbie, DrPH, RN Columbia University School of Nursing

2. AcademyHealth, June 8, 2004 Goals zReview some of the major gains in public health infrastructure and emergency response zIdentify areas in which public health systems and services research are essential to provide the evidence base for improvement

3. AcademyHealth, June 8, 2004 Public health infrastructure for response Data and Information: surveillance, partner contacts, laboratory data Prepared Workforce: they have the competencies Systems and Relationships: a practiced plan and ties to other agencies

4. AcademyHealth, June 8, 2004 Data and information: progress zDevelopment of new surveillance sources yambulance usage yOTC pharmacy use yER visits zMore information on care resources zMuch more information routinely distributed or available to clinicians zCapacity of workforce to use unexamined

5. AcademyHealth, June 8, 2004 Systems and relationships: progress zPublic health more visible with policy makers zPublic health leadership is at local, state and national emergency planning table zRegional public health response systems to support rural and small agency capacity zStrengthened ties between public health and medical care organizations zGeneric ICS training of limited use

6. AcademyHealth, June 8, 2004 Prepared workforce: progress zAssessment of general and emergency preparedness competencies zNetwork of Centers for Public Health Preparedness zExpanded use of emergency drills and exercises as developmental opportunities zSpecialty training in emergency preparedness in MPH & other programs

7. AcademyHealth, June 8, 2004 One attempt: Public Health Ready zCertification requires yemergency plan integrated with overall local plan ycompetency training for all staff ydrills/exercises involving other agencies with improvement plan zFirst 10 agencies certified this year zMuch anecdotal information on improvement

8. AcademyHealth, June 8, 2004 What we dont know: data & information zHow much makes a difference? zWhat transmission routes work best? zWhat language(s) facilitate communication across cultural lines ylaboratories ymedical workers yuniformed first responders ypublic health

9. AcademyHealth, June 8, 2004 What we dont know: systems & relationships zWhat general and special legal structures are effective? zHow do formal and informal relationships interact? zHow the cultures of public health and emergency response fit together? zWhat is the minimum size (agency or population) needed to support good emergency response?

10. AcademyHealth, June 8, 2004 What we dont know: prepared workforce zHow much of this knowledge is dual use? zWhat are the leadership differences in emergencies? zWhat is the balance between systems and science? z How do we measure competency? z What degree of specificity is needed by all workers vs. specialists? z What is the length of knowledge/skill retention?

11. AcademyHealth, June 8, 2004 If the answer to some of these is drills & exercises zHow do typical training activities intersect with drills and exercises? zWhat level of exercise? zAt what frequency? zTo what standard? zAt what cost?

12. AcademyHealth, June 8, 2004 Practice makes better zPlanning for emergencies, building formal interagency/inter-jurisdictional agreements and training staff are only part of the picture zRegular reviews, exercises and drills are essential to maintain awareness, identify areas for improvement and develop proficiency in response

13. AcademyHealth, June 8, 2004

14. The biggest questions: zWhat is the total cost, including lost opportunity cost, of emergency preparedness? zHow would we assess the cost effectiveness of any of the activities of preparedness? zWhat does dual use really mean and is it worthwhile as a concept?

15. AcademyHealth, June 8, 2004 We fervently believe zAn effective public health infrastructure can ydeliver essential public health services ywhich means that emergency services are effective and ypeople and communities are protected zBut we lack the evidence to demonstrate and improve upon it!

16. AcademyHealth, June 8, 2004 Columbia University School of Nursing Center for Health Policy www.nursing.hs.columbia.edu