An assessment of Montana's capacity to respond to a public health emergency : region ... report

78 Pages·2003·4.1 MB·English

by  Northwest Center for Public Health Practice

s
362.1
P30AM
Rl2003
An AssessmentofMontana's Capacityto Respond to
a Public Health Emergency: Region 1 Report
Completedfor:MontanaDepartmentofPublicHealth
andHumanServices; Helena,MT
April14,2003
NorthwestCenterforPublicHealthPractice
1107NE45thStreetNE,Suite400
Box354809
Seattle,WA98195-4809
[phone]•fax[phone]
[email protected]
*Forquestionsaboutthisreport,pleasecall(406)444-9020
MontanaStateLibrary
3 0864 1006 2534 5
Table ofContents
ExecutiveSummary "
Introduction
Methods
ToolDevelopment 2
ToolImplementation
DataAnalysis
InterpretingResults
SurveyLimitations
Results _
DemographicsandPersonnel
FocusAreaA "
FocusAreaB
FocusAreaC
FocusAreaE
FocusAreaF
S_umFmoacruysAreaG 6_,4
Appendices:
AppendixA:MontanaPublicHealthEmergencyPreparednessandResponseCapacity
AssessmentTool
AAppppeennddiixxBC::DPuabtlaiGcrHoeuaplithngEsmUesregdenfcoryAPnraelpyasriesdnessandResponsePlanningRegions
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
Executive Summary
Introduction:
TheMontanaDepartmentofPublicHealthandHumanServices(DPHHS)contractedwiththe
NorthwestCenterforPublicHealthPractice(NWCPHP),attheUniversityofWashington,to
conductanassessmentofMontana'scurrentcapacitytorespondtopublichealthemergencies.
IncooperationwithDPHHSstaff,NWCPHPdevelopedanassessmenttoolusingCDC's"Public
HealthPreparednessandResponseCapacityInventory:AVoluntaryRapidSelf-Assessment,
LocalVersionI"(CDC,August2002)asatemplateandothersurveytoolsandemergency
preparednessdocumentsasasourceofadditionalquestions. TheUniversityofMontana
TechnicalAssistanceCenter(UM)providedtrainingandtechnicalassistancetocountyandtribal
publichealthagenciesinMontanaincompletingtheassessment. Fifty(89%)ofMontana's56
countiesandthree(43%)ofMontana'ssevenreservationscompletedtheassessment(overall
responserate,84%).
Results:
MorethanhalfofthepublichealthagenciesinRegions2,3,4and5,andnearlyhalfofthe
publichealthagenciesinRegion1,havedesignatedapublichealthemergencypreparednessand
responsecoordinator. Mostagenciesexchangeinformation,shareresources,collaboratewith
neighboringjurisdictions,andaremembersofalocalemergencypreparednessgroup.
Agreementswithemergencyresponsepartnersareprimarilyinformalinnature.
Fpatloartchete,helaomncodalsptluebpvlaeirltc.,hpOeuanbleltihtcosheterwavolitcahegseewmnoceiurelgsdeinbnceyeparrceohsvpoiofdneRsdeegbpiyloantnhsse2aC,roe3u,inn4t,tyhaeDnidesaa5rslhtyaersvteaangaedcsEoommfpeldreegtveeendlcopyplmaennmt
Services(DES)orTribalEmergencyResponseCommission(TERC)plansinanemergencyin
NnaeatriloynahlalPfhoarfmtahceeaugteinccailesStionckRpeiglieornes1o.urTcheesfaerewdaigsetnrciibeutsewdiatchroaspslraengiionnds,evaenldoptmweonctotmopmleatneadge
plansareinplaceinRegions1and5. Severalpublichealthagencieshaverespondedtoareal
publichealthemergencyinthepast12months,butwiththeexceptionofagenciesinRegion1,
fewhaveparticipatedinatabletoporfunctionalexercise.
Mostagencieshaveadesignatedepidemiologycontactpersontocoordinateresponsetodisease
outbreakswithinthecommunityandwiththeMontanaDepartmentofPublicHealthandHuman
Services. MostlocalpublichealthagenciesinMontanahaveestablished,orareintheprocessof
establishing,asystemtoreceivenotifiablediseasereports24hoursaday,sevendaysaweek.
FiftypercentormoreoftheagenciesinRegions2,3,4,and5assessboththecompletenessand
timelinessofsurveillancesystemreporting,andassessandaddressbarrierstoreporting. Most
agencieshaveaccesstotheinformationneededforday-to-dayepidemiologicsurveillanceand
response;butfewhaveinformationontheCDC-defmed"criticalagents,"andtheexercisingof
legalauthoritiesinapublichealthemergency. Ingeneral,diseaseandoutbreakinvestigation
protocolsandpost-eventevaluationsareunwritten,informalactivitiesinMontana'slocalpublic
healthagencies,andprotocolstoenhancesurveillancewhennecessaryareintheearlystagesof
development.
RNeorgtihowne1stReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
ThhaevirnegaraeccLeesvsetloAaLlaebvselinAealcahbirnegtihoeni,rjhuorwisedviecrtioonnloyrhcallofseoftothtehepiurbjluircishdeiaclttihona.geTnhceireesraerpeofrtew
microbiologylabsstatewide;howeverthereisatleastonemicrobiologylabineveryregion.
Fewofthemicrobiologylabscanruleoutthepresenceofanthrax,brucellosis,tularemia,and
plasue. Region3canonlyruleoutanthrax. Almostallpublichealthagenciesinallregions
knowtheycancontactthestatelaboratoryiftheirlocallabcannotprovidethelevelofservice
thattheyneed. Abouthalfofpublichealthagencieswithintheregionsengageinactivitiesto
buildrelationshipswiththeirLevelAlabs. Mostagencies(35outof53responses)haveakey
contactinlawenforcementtowhomtheycancommunicatelabresults. Areasneedingattention
throughoutallregionsarethecreationofprotocolsandformalizedagreementsbetweenpublic
healthagenciesandlocallabsandothercommunitypartnersto:a)assureaccesstolaboratories,
b)timelyandaccuratereporting,c)properhandlingofspecimens,andd)propercommunication
ofresults.
MostagenciesinRegions3,4,and5haveahealthalertsystem,althoughfewofthesecurrently
operate24hoursaday,sevendaysaweek. HighspeedInternetconnectivityispresenttosome
extentinmostjurisdictionsandiscompletelyabsentinonly15counties,representingnearlyhalf
oftheagenciesinRegions1,2,and4. Mostagencieshaveinitiatedthetransitionofprogramsto
electronicdataandmessagingsystemsandhaveredundantcommunicationwithe-mail,
primarilyintheformoffaxmachines. Fewagencies,however,haveformallytestedtheability
toreachresponsepartnersusingthesecommunicationsystems. Thepercentofstaffmembers
proficientincomputersoftwareapplicationsvarieswidely(0-100%ofstaffperapplication,per
respondingagency);thereforetrainingshouldbetargetedtotheparticularneedsofeachagency.
Mostpublichealthagencieswithintheregionshaveaccesstoapublicinformationofficer.
Throughouttheregionstherearefewemergencycontactdirectoriesandcontactlists,an
emergencyresponse/crisiscommunicationplan,oremergencycommunicationprotocols. Public
healthagenciesthroughouttheregionsprimarilydisseminateinformationaboutpublichealth
idsissuseesmitnhartoeugihnfmoerdmiaaticohnatnhnreolusg(hstucohwnashpalrlinmteoertiTnVg)saannddlee-tmtearisl.lRisetg-iseornvses3.aTnhde5maolsstocommon
informationalmaterialsproducedintheregionsareforsmallpox(Regions1and3)andanthrax
(Regions2,4,and5). Mostagenciesinallregionshavesomepre-crisistopicspecific
informationalmaterialsonreportableconditions. Mostpublichealthagencieswithintheregions
stillneedtoaccessinformationalmaterialsoncriticalbiologicalagents,chemicalagents,and
otherpublichealththreats.
ThecapacityofMontanapublichealthagencieswithintheregionstotrainandeducatestaffis
mixed. Thenumberofstaffinlocalpublichealthagenciesisgenerallysmallandtherearemany
barrierstoobtainingeducation. Despitethesebarriers,agenciesreportagreatdealofsupportfor
employeeeducation,includingincentivesforin-personanddistancelearning(inRegions3and5
inparticular). Mostpublichealthagenciesregion-widetraintheirownstafforparticipatein
trainingwithstatepublichealthagencies,LEPCsorTERCs. MostoftheagenciesinRegion1,
3,5collaboratewithotheragenciesintheareatoprovidedistancelearning. Almostallpublic
healthagencieshaveaccesstosomedistancelearningtechnologiesalthough24/7satelliteaccess
needstobedevelopedinallregions. Barrierstodistancelearningmentionedbyallregions
RNoergtihowne1stReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington u
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
includedlackoftimeforstafftodevotetodistancelearning,slowinternetconnectivity,andlack
ofsatellitereceivers. Trainingsneededbytheregionsare:
• Specificprocedurestofollowduringbiologicalandchemicalincidents(allRegions).
• Basiceducationregardingbiologicalandchemicalincidents(Region2,3,4,5).
• Howtoidentifyandrecognizeaterroristact(Region1,2,3).
• IncidentCommand/UnifiedCommand(Region2,3,5).
• Surveillance(Region2).
• Infections/syndromesrelatedtocriticalagentlist(Region4).
• Riskcommunicationandworkingwiththemedia(Region5).
• Howthepublichealthsystemworksinyourstate(Region3).
Fewagencieswithintheregionsconductaninternaltrainingneedsassessmentorevaluatethe
trainingstheyoffer.
Summary:
TheresultsofthisassessmentofMontana'scapacitytorespondtoapublichealthemergency
highlightseveralstrengthsandareasforincreaseddevelopment. Overallrecommendationsfor
thestateinmeetingcriticalcapacitiesdonotdifferwhenviewingdataattheregionallevel.
Actionstoconsiderincludeexpandingandformalizingcollaborativerelationshipswithpublic
healthemergencyresponsepartners,providingtrainingintheresponsetoapublichealth
emergency,anddevelopinglocalandregionalemergencyresponseplans. Basicpublichealth
systemscreateafoundationuponwhichmoresophisticatedsystemsaredeveloped.
Recommendednextstepsthatrelatetoevery-daypublichealthshouldbeinitiatedpriortothose
relatedtobioterrorismandotherpublichealthemergencies. Publichealthofficialsatthestate,
local,andregionallevelsareencouragedtoassesstheresourcesoftheiragencyandregionas
theydeterminetheprioritiesforactionandnextstepsforaddressingcriticalcapacityneeds.
RNoergtihownes1tReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington U1
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
Introduction
InFebruaryof2002,theCentersforDiseaseControlandPrevention(CDC)announcedthe
availabilityoffiscalyear(FY)2002fundsforthecooperativeagreementprogramtoupgrade
stateandlocalpublichealthjurisdictions'preparednessforandresponsetobioterrorism,other
outbreaksofinfectiousdisease,andotherpublichealththreatsandemergencies(Announcement
Number99051—EmergencySupplemental). Statesapplyingforthesefundswereableto
requestsupportforactivitiesunderseveral"focusareas":
• FocusAreaA:Preparednessplanningandreadinessassessment
• FocusAreaB:Surveillanceandepidemiologycapacity
• FocusAreaC:Laboratorycapacity-biologicalagents
• FocusAreaE:Healthalertnetwork/communicationsandinformationtechnology
• FocusAreaF:Healthriskcommunicationandhealthinformationdissemination
• FocusAreaG:Educationandtraining
Montanaappliedandreceivedfundingintheamountof$7,008,529forpreparednessofitspublic
healthsystem. Recognizingthattheeffectofanyeventwillbeexperiencedatthelocallevel,the
MontanaDepartmentofHealthandHumanServices(DPHHS)decidedthatamajorityofthis
fundingwouldbeprovidedeitherdirectlytolocalhealthdepartmentsinMontanaorindirect
supportoflocalefforts. DPHHScontractedwiththeNorthwestCenterforPublicHealth
Practice(NWCPHP),attheUniversityofWashington,toconductanassessmentofMontana's
currentcapacitytorespondtopublichealthemergencies. Theresultsofthatassessmentare
presentedhere.
RNoergtihownes1tReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
Methods
ToolDevelopment
TheNorthwestCenterforPublicHealthPractice(NWCPHP)reviewedthetools,methods,and
resultsofpreviousassessmentsofMontana'spublichealthsystememergencypreparednessand
responsecapacities,interviewedkeycontactsineachCDC-identified"focusarea,"andidentified
gapsindataneededtodescribe,improve,andcontinuouslyassessandevaluatethose
preparednessandresponsecapacities. NWCPHPdraftedanassessmenttoolusingCDC's
"APsusbelsiscmeHneta,ltLhocParlepVaerresdinoenssI"an(dCDRCe,spAoungsuestCa2p0a0c2i)tyasInavetnetmoprlya:teA.VNoWluCnPtaHrPyR'sapdriadftSealsfs-essment
toolincorporatedtheresultsofthereviewofpreviousMontanaassessmentsandincluded
additionalquestionsfromseveralotherdocumentsandsurveyinstrumentspertainingtopublic
healthemergencypreparednessandresponse. Alistofthepreviousassessmentsandother
surveyinstrumentsreviewedisincludedintheattachedassessmenttool,AppendixA. Multiple
draftsoftheassessmenttoolwerereviewedbyDPHHSstaff,aswellasotherexperts,fortheir
feedback.
ToolImplementation
NfoWrCthPeHUnPivceornsdiutyctoefdMtornaitnainnagoTnecthhneicdaelsiAgsnsiasntdanccoempCleenttieorn(oUfMt)heoanssOecstsombeenrt3t1o,ol20i0n2M.onUtMana
trainedrepresentativesfromthecountyandtribalpublichealthagenciesinMontanaand
distributedtheassessmenttoolduringNovember2002. Allcountiesandreservationsin
Montanaweregiven12weekstocompletetheassessment. Thedeadlineforreturning
completedsurveystotheMontanaDepartmentofPublicHealthandHumanServiceswas
January15,2003,howevercompletedsurveyswerereceived,andresultsincludedinthisreport,
throughFebruary7,2003.
DataAnalysis
DatawereanalyzedwithSPSSversion11.5forWindowsanddescribedascounts,frequencies,
andmeans. Partnerorganizationswithwhompublichealthagencieshadagreementsfor
emergencyresponse(FocusAreaA),healthalertreceiptanddistribution(FocusAreaE)and
emergencyresponseplancomponents(FocusAreaA)wereeachgroupedintoeightcategoriesto
simplifythepresentationofresults. AppendixBcontainsadetaileddescriptionoftheeight
categories. Commentsandresponsesto"fill-in-the-blank"oropen-endedquestionswereentered
intoaMicrosoft®Accessdatabaseandanalyzedqualitatively.
NWCPHPcreatedreportsforthreelevelsofanalysis:statewide(aggregate),regional,and
jurisdictional(county/reservation). Thisreportcontainsresultsoftheregionalanalysis. Reports
arealsoavailableforthestatewideandjurisdictionalanalyses. Experiencesuggeststhat
Montanacountieswithalargepopulationoftenhavemoreresources(e.g.,budget,equipment,
personsemployed)thancountieswithasmallpopulation. Therefore,datainthestatewide
analysiswerestratifiedbycountypopulationsize(>20,000persons,10,000-20,000persons,
<10,000persons). Datafromreservationswereincludedintheoverallcounts(i.e.,the"all"
columnoftablesinthestatewideanalysis),butwerenotpresentedseparately,duetothelimited
RNeorgtihowne1stReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington 2
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
responserateandpotentialconfidentialityissues. FiveregionswerecreatedbyMontanastate
andlocalpublichealthagenciesforpreparationofregionalresponseplans. Countiesand
reservationsnotincludedinthisreportarenotedinthestateandappropriateregionalreports.
Mostofthecompletedassessmentscontainedsomemissingdata-notanuncommonfindingin
anassessmentofthislength. Therearemanypossiblereasonswhyaquestionmaynotbe
answeredbyarespondent-therespondentmaynothaveunderstoodthequestion,thequestion
mayhavebeenoverlooked,orthequestionmaynothaveappliedtothatparticularrespondent.
BecauseNWCPHPanalystscouldnotdeterminethereasonquestionswereunansweredwithout
additionalinformation,allunansweredquestionsweretreatedasmissingdata. Thenumberof
countiesandreservationsrespondingtoeachofthequestionsisindicatedineachtable(i.e.,n=).
Whenthenumberofmissingresponsesvariesbyiteminatable,thisisnotedinthetable
footnotes.
Schoemcekeqduemsutlitoinpsleinisttermusc.teTdhreessepoqnudeesnttisontsom"ocshtecckoomnmloynolnye"asrkeesdpornessepointdeemnbtusttosoimndeicraetsepotondwehntosm
thelocalhealthofficerreports,describethecommunicationamongmembersofthelocal
emergencypreparednessgroup,andindicatetheform(i.e.,paperorelectronic)ofagency
personnelandemergencypartnercontactinformation. Inthesecases,onlythefirstorhighest
rankinganswerselectedwasrecorded.
InterpretingResults
Giventhescopeandcomplexityofthisassessment,itisimportanttounderstandhowtointerpret
theresults. PopulationstratawereselectedtobeconsistentwithpreviousMontanaassessments,
resultinginanunevendistributionofcountiesinthedifferentpopulationstratifications. There
were33countiesincludedinthe"counties<10,000"populationstrata,eightinthe"counties
10,000-20,000"strata,andninecountiesincludedinthe"counties>20,000"strata. Becauseof
theunevendistribution,acknowledgingdifferencesisappropriate,butcomparisonsbetweenthe
strata(e.g.,countiesinonestrataaremore/lesspreparedthancountiesinanotherstrata)arenot
valid. Mostcompletedassessmentscontainedmissingdata;thereforeitisimportanttopay
attentiontothenumberrespondingwhenevaluatingtheimportanceofparticularresults.
Strengthsandactionstoconsiderarepresentedbasedontheresultsreportedbyresponding
agencies;however,theresourcesofspecificagenciesandregionsshouldalsobetakeninto
considerationwhendeterminingpriorityactionsandthemostappropriatemeansofaddressing
nextsteps. Inmanycases,itmaybemostappropriatetoaddresscapacitiesonaregionallevel.
Forexample,agencieswithaverysmallstaffmayagreetoshareapublichealthemergency
preparednessandresponsecoordinatororotherjobtitlewithaneighboringagency,and
collaboratewithotheragenciesinresponseefforts.
RNoergtihownes1tReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington
MontanaPublicHealthEmergencyPreparednessandResponseCapacityAssessment
SurveyLimitations
Ideally,asurveyofthislengthistestedonasmallsubsetofrespondentsbeforeadministeringit
totheentiregroupofrespondents("pilottesting"),inordertoidentifyanyconfusingordifficult
questions. Sectionsofthissurveywerereviewedforoverallcontentandstructurebylocalpublic
healthworkersandmembersoftheBioterrorismAdvisoryCouncil. Deadlinesassociatedwith
thegrantfundingforthisproject,however,didnotallowsufficienttimeforacomplete"pilot
tdeisftf"eroefnttlhyetahsasneswsamsenitntteonold.edAbsyathreesNulWt,CrPesHpPondceonntssulmtaanytshwavheoidnetevreplroepteeddsthoemseurqvueeys.tioWnhsen
resultsappearinconsistentwithwhatisknownfromactualexperienceatthestate,regionalor
locallevels,publichealthofficialsareencouragedtoseekoutadditionalinformation.
Respondentsansweredquestionsregardingfull-timeequivalentstaffing(FTEs)inconsistently.
ResultsforTableE.9(informationtechnologyexpertiseavailable)arethereforereportedinterms
ofcounts(i.e.,agencieswithaccesstothelistedexpertise)insteadofaverageFTEs. Inother
cases,whentherewasaquestionabouttheexactnumberofFTEsenteredforaparticular
question,thesmallestofthepossibleanswerswasused. Datamaythereforeerronthesideof
under-reportingavailableFTEs.
RNoergtihownes1tReCpeonrtte;rAfporrilPu2b0l0i3cHealthPractice,UniversityofWashington