Montana state-level public health preparedness and response capacity inventory

82 Pages·2003·3.9 MB·English

by  Moon, Robert W., author

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MontanaState-LevelPublicHealthPreparedness
AndResponseCapacityInventory
MontanaDepartmentofPublicHealthandHumanServices
August,2003
RobertW.Moon,MPH
NorthwestHealthPartners,LLC
[phone]
[email protected]
MontanaStaleLibrary
3 0864 1006 2539 4
Table ofContents
ExecutiveSummary
• Introduction 2
• Methods 3
Results&Recommendations
• FocusAreaA:PreparedPlanningandReadinessAssessment 4
• FocusAreaB:SurveillanceandEpidemiologyCapacity 11
• FocusAreaC:LaboratoryCapacity 14
• FocusAreaE:HealthAlertNetwork(HAN) 17
• FocusAreaF:RiskCommunicationandHealthInformationDissemination...20
• FocusAreaG:EducationandTraining 22
• DemographicInformation 24
AppendixA
• CompletedAssessmentInstrument 28
MontanaState-LevelPublicHealthPreparedness
AndResponseCapacityInventory
August,2003
ExecutiveSummary
Introduction
TheMontanaDepartmentofPublicHealthandHumanServices(DPHHS)contractedthe
servicesofNorthwestHealthPartners,LLCtoconductanassessmentofMontana'sstate
healthagencyemergencypreparednessandresponsecapacities. ThePublicHealth
PreparednessandResponseCapacityInventorydevelopedbytheCentersforDisease
ControlandPreventionwasthetoolusedtoassessprogresstowardmeetingpreparedness
benchmarksandcriticalcapacitiesnecessarytorespondtobioterrorism,outbreaksof
infectiousdiseases,andotherpublichealththreatsandemergencies. DuringApril/May
2003,teamsofstatehealthagencystaffwereselectedbyfocusareaandsubjectmatter
expertiseandwereinterviewedtoprovidetheirperceptions.
Giventhescopeandcomplexityoftheassessment,itisimportanttounderstandhowto
interprettheseresults. Theresultsrepresentaself-assessmentataparticularpoint-in-
time(April/May,2003). Theassessmentprovidesthestatewiththeopportunityto:
1) Evaluatethegapsinkeypublichealthpreparednessandresponsecapacities
2) Prioritizetheorderinwhichthestatewillbegintoaddressthosegaps
3) Determinethestepsnecessarytofurtherenhancethepublichealthsystem
4) Establishabaselineagainstwhichtomeasureprogressindeveloping
preparednessandresponsecapacities
5) Reviewthestrengthsofthepublichealthsystem.
Montana'sPublicHealthEmergencyPreparedness&ResponseProgramisintheearly
stagesofdevelopmentandmanyfacetsoftheprogramarejustbeginningtobe
formalized. Therefore,theexpectationofhavingwrittenplans,agreementsandprotocols
inplaceandexercisedwithparticipationbyallvitalpartners,isunrealistic. Whilemany
capacitiesweredeemedbystatestafftobe"inprogress,"theactivitiesrequiredtofully
meetthebenchmarksdescribedintheCapacityInventoryareinmanycasesmore
accuratelydescribedasbeing"intheearlystagesofdevelopment." Agreatdealof
discussionandnegotiationwillneedtooccurtocreatea"system"ofpublichealth
preparedness. Toeffectivelyrespondinanemergency,informalcommunicationsand
relationshipsmustbetransformedintowrittenplans,protocolsandagreementsamong
publichealthsystemandresponsepartnersandevenamongtheinternalDPHHSfocus
areas,programsandbureaus.
Methods
ThePublicHealthPreparednessandResponseCapacityInventory,Version1.1,
December2002isavoluntaryrapidself-assessment. Thisinventorywascreatedinpart
fromtheUSDepartmentofJusticePublicHealthPerformanceAssessmentfor
EmergencyPreparedness,NationalPublicHealthPerformanceStandardsassessment
instruments,CDCBioterrorismCoreCapacityProject,CouncilofStateandTerritorial
Epidemiologistscapacityassessmenttool,andselectedstatespecificassessment
instruments.
Sincetheresponsetothistoolin2003canserveasabaselineforfutureassessments,this
processdeliberatelyfocusedonprovidingsomenarrativeandinformationthatsupports
theassessment,ratherthanmerelyachecklistofcriticalcapacitiesinayes/nofashion.
Mostquestionsinstructedrespondentsto"checkonlyone"response. Somequestions
instructedtherespondentstouseamulti-answermatrixandprovidean"allthatapply"
response. Ablankboxapproachedquestionswithabasestatementfollowedbyaseries
ofbulleteditemsasthougheachbulleteditemrequiredayes/noresponsewherea"no"
responseisdesignated. AcopyofthecompletedCapacityInventoryisprovidedas
AppendixA.
ThestateofMontanarecentlycontractedwiththeUniversityofWashingtonSchoolof
PublicHealthtoanalyzeresultsofanadaptedinventoryfromCDCforassessmentof
localpublichealthpreparedness. Thefinalreportisentitled"AnAssessmentof
Montana'sCapacitytoRespondtoaPublicHealthEmergency: StatewideReport"and
reflectsastatewideassessmentoflocaljurisdictions'publichealthemergencyresponse
capacities. Thisstatereportwillutilizeselectedfindingsfromthelocalstudyto
emphasizeastateview,contrastedwithlocalinformation.
ResultsandRecommendations
FocusAreaA:PreparedPlanningandReadinessAssessment
CriticalCapacityIA: toestablishaprocessforstrategicleadership,direction,
coordination,andassessmentofactivitiestoensurestateandlocalreadiness,interagency
collaboration,andpreparednessforbioterrorism,otheroutbreaksofinfectiousdisease,
andotherpublichealththreatsandemergencies.
SummaryofStateResponse: TheCapacityInventoryincludesquestionsthatassess
overallstatehealthplanningactivities,aswellasstrategicplanningforpublichealth
emergencypreparedness. Theideaisthatstatehealthplanningeffortscanserveasa
foundationuponwhichtobuildcategoricalplanningefforts,suchasemergency
preparednessplanning. Tosomedegree,datahasbeenutilizedtoidentifyandprioritize
thestate'shealthproblemsandgapsinpublichealthservices. However,anoverallstate
healthplanninginitiativeandanactualplanto"improvehealth"doesnotexist.
Intermsofemergencypreparedness,themajorstakeholdershavebeenidentifiedandare
engagedinplanningactivitiesledbyDPHHS. Theagencyleadershipupdateshigh-level
policymakers,includinganinterimlegislativecommitteeappointedbytheGovernor,on
thestatusofpublichealthpreparednessactivitiesbeingundertakenwiththeCDCand
HRSAg^rants.
ThereisnoformalevaluationprocessforthePublicHealthEmergencyPreparedness&
ResponseProgramtodetermineeffectivenessofactionstepsorrecommendprogram
changes. Evaluation,atthispoint,consistsofreportsandgrantsubmissionstothe
fundingsource,ratherthanperiodicreviewtodeterminetheeffectivenessoftheprogram.
Strengths:
• Thestatehealthagencyhasdesignatedapublichealthemergencypreparedness
andresponseexecutivedirectorandacoordinator.
• Planninginemergencypreparednessisbeingconductedwiththestatehealth
agencyandavarietyofcriticalpartnersthroughaformaladvisorycouncil.
• TheNorthwestCenterforPublicHealthPracticeattheUniversityofWashington
SchoolofPublicHealthhasinstitutedapublichealthleadershipinstitute
annually.
ActionstoConsider:
• Engageincorestatewidepublichealthplanningactivities,providingafoundation
onwhichtobuildcategoricalplanningefforts. Thisshouldincludedevelopment
andregularupdatingofaplanto"improvepublichealth."
• Createasystemtobetterutilizeandsharethesourcesofdataandinformation
availabletomonitorhealthstatusandidentifyhealthproblemsinthestate.
• Continuetoexpandandstrengthenthepartnershipsandorganizationsinvolvedin
thepublichealthemergencypreparednessplanningeffort. Commitadequate
time,effort,resourcesandpersonneltothestate'spublichealthemergency
preparednessandplanningprocess.
Participateindevelopinga "strategicplan"foremergencypreparednessand
responsesystemdevelopment,incoordinationwithDES/ODP(asopposedtoa
responseplan).
DevelopandimplementanoverallevaluationsystemforthePublicHealth
EmergencyPreparedness&ResponseProgram.
Createanoveralltrainingplanaddressingneedsandresourcesforcorepublic
healthandemergencypreparednessskilldevelopment.
Encouragestatehealthagencyleadershiptoattendpublichealthleadership
trainingsatalllevels.
CriticalCapacityIB:toconductintegratedassessmentsofpublichealthsystem
capacitiesrelatedtobioterrorism,otherinfectiousdiseaseoutbreaks,andotherpublic
healththreatsandemergenciestoaidandimproveplanning,coordination,and
implementation.
CriticalCapacityIIA:torespondtoemergenciescausedbybioterrorism,other
infectiousdiseaseoutbreaks,andotherpublichealththreatsandemergenciesthroughthe
developmentandexerciseofacomprehensivepublichealthemergencypreparednessand
responseplan.
CriticalCapacityIIB: toensurethatstate,local,andregionalpreparednessforand
responsetobioterrorism,otherinfectiousdiseaseoutbreaks,andotherpublichealth
threatsandemergenciesareeffectivelycoordinatedwithfederalresponseassets.
SummaryofStateResponse: Thestatehascompletedassessmentsofstateandlocal
publichealth,hospitalandlaboratoryemergencypreparednesscapacities. Statestatutes
andadministrativerulearebeingassessedtodetermineifstateemergencyhealthpowers
existtosupportpublichealthemergencypreparednessandresponse.
TheDivisionofDisasterandEmergencyServices(DES),DepartmentofMilitaryAffairs,
hasanoverallEmergencyCoordinationPlan(EOP)thatlinkswithissue-specificannexes
thatdelineatetheresponsibilitiesofthemajorstateagenciesinanemergencyevent.
DPHHShasacompiledahealth/medicalannextotheDESEOPthatisintheearlystages
ofdevelopment. Localhealthdepartmentshavecompletedinitialdraftsofparallel
health/medicalannexestotheirlocalDESplans.
TheCapacityInventoryprovidesachecklistofsuggestedcomponentsthatcouldbe
includedintheDPHHShealth/medicalannextotheDESEOP. Thischecklistshouldbe
reviewedtoassuretheDPHHSannexisascompleteandcomprehensiveaspossibleinits
finalform. InadditiontothoseelementsthatarecurrentlyincludedintheDPHHS
annex,decontaminationofmasscasualtiesisaddressedintheDESEOPthroughlinkages
toleveragefederalresources. Personalprotectiveequipmentforbiological,chemicaland
radiologicagentsaresomewhatdependentondevelopingindustrystandardstoensure
moreuniversalusage. Theprotectionandrecoveryoftheenvironmentisaresponsibility
oftheDepartmentofEnvironmentalQuality. Themanagementofdonationsandthe
designationofsheltersisajointcollaborationbetweenDES,RedCrossandthestate
healthagency. Publichealthandmedicalcoordinationneedsagreatdealofattentionto
assureeffectivecollaborationofstateandlocalpreparednessassets. Effortsare
underwaytoaddressverificationofprovisionalcredentialsandprofessionalliability
coverageforout-of-stateclinicianstoexpediteavailabilityduringthedeliveryofpublic
healthservices.
Afieldoperationsmanualisnotfullyinplaceintermsofupdatesandaddressinglinks
withtheEmergencyOperationsCenter(EOC). Thefieldoperationsmanualneedstobe
furtherdevelopedandupdatedperiodicallyandshouldsummarizecriticalproceduresand
contactinformation.
Electronicandpaperdirectoriesofagencypersonnelandemergencyresponsepartners
areavailableandseveralcall-downsystemsarecurrentlyinplace. However,thestate
healthagencyhasnotbeendiligentintestingitsabilitytoreachitsownpersonneland
keyexternalpartnersinanemergency.
Regionalplanningforpublichealthemergencyresponseisintheearlystagesof
development. Emergencymedical/traumaserviceregions(3)areinplaceandfunction
throughhospitalsandemergencymedicalserviceunits.Currently,therearepublichealth
serviceregionsinplaceforavarietyofcategoricalprograms,however,therearemany
configurationsbeingusedandnoconsensusastowhichareworkableforpublichealth
servicedelivery. Publichealthemergencypreparednessplanningregions(5)havebeen
identifiedandregionalplanningactivitiesarejustbeginning. EMS/traumaandpublic
healthemergencypreparednessregionsdonotalign. Regionalizationinanyform
denoteschangeandthereisconsiderableresistancetotheidea,especiallywhenmonetary
andeconomicissuescrosslocaljurisdictionalborders.
Hospitalreadinessforemergencyresponseisintheearlystagesofdevelopment. The
hospitalshavebeensurveyedandassessedforemergencyreadiness. HRSA,CDC,and
IndianHealthServicehavecollaboratedinthiseffort. Surgecapacityofhospitalsand
othermedicalfacilitiesneedtoaddressthepossibilityofamultipleincreaseintheir
identifiedmaximumcapacitytohandleemergencies.
Strengths:
• Theagency'splanningforemergencypreparednesshasincludedthelocaland
statepublichealthsystem,laboratoryandhospitalassessments,aswellasa
reviewofthelegalinfrastructureforemergencyresponse.
• TheDPHHShasadraftpublichealthemergencypreparednessandresponseplan
(health/medicalannextothestateEOP)andfieldoperationsmanualthatlinkwith
theDES. TheEmergencyResponseCoordinator,incoordinationwiththe
EmergencyOperationsCenter,hasfacilitatedactivationofthepublichealth
emergencypreparednessandresponseplan.
• TheDPHHShasparticipatedinlimitedtabletopandfunctionalexercises
(earthquake,anthrax)andadditionalexercisesareplannedincoordinationwith
criticalpartners.
• Localandregionalpublichealthemergencypreparednessandresponseplanning
activitiesareunderway.
• TheEMSserviceregionsarefunctionalandoperating,incollaborationwiththe
hospitals.
ActionstoConsider:
• Continuetoassessandstrengthenthestate'slegalinfrastructuretorespondto
publichealthemergenciesandthreats.
• Furtherdevelop,refineandexercisethepublichealthemergencypreparedness
andresponseplan(health/medicalannextostateEOP)andthefieldoperations
manual. Considermakingitascomprehensiveaspossiblebyreviewing
suggestedplanelementsintheCapacityInventory.
• Explorepublichealthplanningregionsdesignedtoincreasecapacityforpublic
healthemergencyresponse. Theregionalplanningprocessshouldbediscussed
openlyandcoordinatedwithlocaljurisdictions.
• Ensureandformalizeinwriting,thecoordinationofthestate'spublichealth
emergencyresponsewithDisasterandEmergencyServicesandtheDepartment
ofEnvironmentalQuality.
• Establishasystemtoensureregularupdatingandtestingofelectronicandpaper
directoriesofagencypersonnelandemergencyresponsepartners,preferably
meetingITstandards. Considerintegrationofcall-downsystemsordevelopment
ofanon-callstructuretoensureatimelyandappropriateresponsebytheDPHHS.
• Planandcoordinateunannounceddrillsandexercisesforcriticalfirstresponders
andincidentcommandatthestatelevel.
• Assurehospitalandmedicalsurgecapacityisaddressedinlocalandregional
planningandcoordinatedwithHRSAguidelines.
• Clarifyrolesandresponsibilitiesregardingtriageofvictims,decontaminationof
masscasualties,isolationwithinahealthfacility,andinfectioncontrolmeasures.
• Provideaplantoaddresstheresponsetomassmortuaryneeds.
• Developrecommendationsforpersonalprotectiveequipmentforstateand
localemergencyresponders.
• Continuetoprovideadditionalemergencymanagementtrainingopportunitiesfor
stateresponsestaff.
• DevelopstatepolicieswiththeRedCrossandDESformanagementofdonations
anddesignationofshelters.
CriticalCapacityIIIA: toeffectivelymanagetheCDCStrategicNationalStockpile
(SNS),shoulditbedeployed-translatingSNSplansintofirmpreparations,periodic
testingofSNSpreparedness,andperiodictrainingforentitiesandindividualsthatare
partofSNSpreparedness.Toensuretheavailabilityandrapiddeploymentoflife-saving
pharmaceuticals,antidotes,othermedicalsupplies,andequipmentnecessarytocounter
theeffectsofnerveagents,biologicalpathogens,andchemicalagents;readinessfor
immediatedeploymenttoanylocationintheeventofaterroristattackusingabiological
toxinorchemicalagentdirectedagainstacivilianpopulation.
SummaryofStateResponse: ThemanagementoftheStrategicNationalStockpileis
generally"inplace"andtiedintotheDPHHShealth/medicalannexandtheDESEOP.
TheUSInspectorGeneral,basedinAtlanta,GA,hasconductedtwositevisitstoassess
Montana'spreparednessfortheStrategicNationalStockpile,withalocalassessmentin
LewisandClark,aswellasYellowstoneCounties(March2002,January2003). Reports
areonfilewiththeSNSCoordinator. Overall,Montanascoredhigherthanthesample
averageinallfunctionalareas. Thestatehealthagencyisworkingcloselywiththelocal
jurisdictionstodeveloplocalSNSplansandcreateaninfrastructuretomanagetheSNS
assets. Thelocalemergencypreparednessplansareintheearlystagesofdevelopinga
plantointegratefederalresponses. IfthelocalplansactivelyaddressthefederalSNS
response,thestateresponsesystemwillbeenhancedconsiderably. However,mostofthe
localplanswillbedependentontheassetsmadeavailableintheregionorlocalarea.The
SNSdistributionsystemisintheearlystageofdevelopment.
Strengths:
• TheDPHHShashiredanSNScoordinator.
• GubernatorialpowersfortheSNSareagreeduponandavailable.
• State/localSNSmanagementinfrastructurereliesheavilyonlocaljurisdictionsto
assurecriticalcomponentsareinplace.
• DecisionmakershaveadoptedanSNSpreparednessstrategythatwillattemptto
giveallcitizensequalaccesstoSNSassets.
• AirportandgroundtransportforinitialSNSdeliveryhasbeensecured.
• ThedistributionsystemforSNSoncereceivedfromthefederalgovernmentis
mostlyinplace,exceptthedesignationofdrivers.
• AcontactlistforSNSisavailableandupdatedforallkeymembersofoverall
SNSresponseteam.
Actionstoconsider:
• DescribetherolesandresponsibilitiesofSNSpartnersthroughformalwritten
agreementstosupportcriticalfunctions.
• ReviewlocalplanstoassuredispensingoftheSNSisbeingaddressedasalocal
responsibility,incoordinationwiththestateplan.
• Incollaborationwiththepublicinformationofficerandriskcommunications
staff,developacommunicationplanthatsupportsthedispensingandstockpiling
functionofSNSandthatreadiesthepopulacefortheSNScriticalfunctions.
• Createformalcommitmentsbywrittenagreementstoprovidetheeffective
executionatboththestateandlocallevelsforSNS.
• Ensurethetimeandeffortisbeinggiventoplanningforcommunication,
dispensingandtreatmentatboththestateandlocallevelstoensureacoordinated
networkofemergencyresponse.
• Assureareliable24/7singlepointofcoveragefortheSNSteamtoassurecritical
corefunctionscanbedeployed.