CMH Public Health Emergency Preparedness and Response Report

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Review the Public Health Preparedness Capabilities. Pay specific attention to the Public Health Preparedness Capabilities Planning Model. Your report should identify and plan for a state of your choosing with an emphasis on the three defined phases:

  • Assess current state: Assess organizational roles and responsibilities, resource elements, and performance.
  • Determine goals: Review jurisdictional inputs, prioritize capabilities and functions, and develop short- and long-term goals.
  • Develop plans: Plan organizational initiatives, capability building/sustain activities, and capability evaluations/demonstrations.


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Public Health Preparedness Capabilities: National Standards for State and Local Planning March 2011 Centers for Disease Control and Prevention Table of Contents Public Health Preparedness Capabilities: National Standards for State and Local Planning Page Executive Summary ..................................................................................................................................................................... 2 Using this Document for Strategic Planning ...................................................................................................................... 6 At-A-Glance: Capability Definitions, Functions, and Associated Performance Measures ............................... 10 Capabilities (in alphabetical order) 1. Community Preparedness ................................................................................................................................. 16 2. Community Recovery .......................................................................................................................................... 22 3. Emergency Operations Coordination ........................................................................................................... 27 4. Emergency Public Information and Warning ............................................................................................. 36 5. Fatality Management .......................................................................................................................................... 45 6. Information Sharing ............................................................................................................................................. 55 7. Mass Care ................................................................................................................................................................. 62 8. Medical Countermeasure Dispensing ........................................................................................................... 71 9. Medical Materiel Management and Distribution ...................................................................................... 81 10. Medical Surge ........................................................................................................................................................ 92 11. Non-Pharmaceutical Interventions .............................................................................................................. 102 12. Public Health Laboratory Testing ................................................................................................................. 109 13. Public Health Surveillance and Epidemiological Investigation ......................................................... 119 14. Responder Safety and Health ........................................................................................................................ 127 15. Volunteer Management ................................................................................................................................... 133 Endnotes .................................................................................................................................................................................... 140 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 1 EXECUTIVE SUMMARY Public health threats are always present. Whether caused by natural, accidental, or intentional means, these threats can lead to the onset of public health incidents. Being prepared to prevent, respond to, and rapidly recover from public health threats is critical for protecting and securing our nation’s public health. The 2009 H1N1 influenza pandemic underscored the importance of communities being prepared for potential threats. Because of its unique abilities to respond to infectious, occupational, or environmental incidents, the Centers for Disease Control and Prevention (CDC) plays a pivotal role in ensuring that state and local public health systems are prepared for these and other public health incidents. CDC provides funding and technical assistance for state, local, and territorial public health departments through the Public Health Emergency Preparedness (PHEP) cooperative agreement. PHEP cooperative agreement funding provides approximately $700 million annually to 50 states, four localities, and eight U.S. territories and freely associated states for building and strengthening their abilities to respond to public health incidents. Evolving Threats and Strengthening the Public Health System Public health departments have made progress since 2001, as demonstrated in CDC’s state preparedness reports (http://www.cdc.gov/phpr/reportingonreadiness.htm). However, state and local public health departments continue to face multiple challenges, including an ever-evolving list of public health threats. Regardless of the threat, an effective public health response begins with an effective public health system with robust systems in place to conduct routine public health activities. In other words, strong state and local public health systems are the cornerstone of an effective public health response. Today, public health systems and their respective preparedness programs face many challenges. Federal funds for preparedness have been declining, causing state and local planners to express concerns over their ability to sustain the real and measurable advances made in public health preparedness since September 11, 2001, when Congress appropriated funding to CDC to expand its support nationwide of state and local public health preparedness. State and local planners likely will need to make difficult choices about how to prioritize and ensure that federal dollars are directed to priority areas within their jurisdictions. Defining National Standards for State and Local Planning In response to these challenges and in preparation for a new five-year PHEP cooperative agreement that takes effect in August 2011, CDC implemented a systematic process for defining a set of public health preparedness capabilities to assist state and local health departments with their strategic planning. The resulting body of work, Public Health Preparedness Capabilities: National Standards for State and Local Planning, hereafter referred to as public health preparedness capabilities, creates national standards for public health preparedness capability-based planning and will assist state and local planners in identifying gaps in preparedness, determining the specific jurisdictional priorities, and developing plans for building and sustaining capabilities. These standards are designed to accelerate state and local preparedness planning, provide guidance and recommendations for preparedness planning, and, ultimately, assure safer, more resilient, and better prepared communities. Public health preparedness capabilities. CDC identified the following 15 public health preparedness capabilities (shown in their corresponding domains) as the basis for state and local public health preparedness: Biosurveillance Incident Management - Public Health Laboratory Testing - Emergency Operations Coordination - Public Health Surveillance and Information Management Epidemiological Investigation - Emergency Public Information and Warning Community Resilience - Information Sharing - Community Preparedness Surge Management - Community Recovery - Fatality Management Countermeasures and Mitigation - Mass Care - Medical Countermeasure Dispensing - Medical Surge - Medical Materiel Management and Distribution - Volunteer Management - Non-Pharmaceutical Interventions - Responder Safety and Health U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 2 EXECUTIVE SUMMARY These domains highlight significant dependencies between certain capabilities. A jurisdiction should choose the order of the capabilities it decides to pursue based upon their jurisdictional risk assessment (see Capability 1: Community Preparedness for additional or supporting detail on the requirements for this risk assessment) but are strongly advised to ensure that they first are able to demonstrate capabilities within the following domains: • • • • • Biosurveillance Community resilience Countermeasures and mitigation Incident management Information management To identify the public health aspects for each capability, CDC used the names and definitions from the U.S. Department of Homeland Security (DHS) Target Capabilities List, content from the Pandemic and All-Hazards Preparedness Act (PAHPA), and capabilities from the National Health Security Strategy (NHSS) as a baseline. As part of this process, the biosurveillance aspects of animal disease and emergency support, food and agriculture safety and defense, and environmental health were incorporated into the public health surveillance and epidemiological investigation capability. In addition, the detection of chemical, biological, radiological, nuclear, and explosive agents were incorporated into the laboratory testing capability. Important cross-cutting preparedness topics such as legal preparedness, vulnerable or at-risk populations, and radiological/ nuclear preparedness are addressed in several of the 15 capabilities. Aligning across national programs. The Pandemic and All-Hazards Preparedness Act (PAHPA) specifies the need to maintain consistency with certain other national programs, specifically the NHSS preparedness goals. PAHPA also directs that the NHSS be consistent with the DHS National Preparedness Guidelines, a major component of which is the Target Capabilities List. The National Preparedness Guidelines represent a standard for preparedness based on establishing national priorities through a capabilities-based planning process. In addition to aligning with the National Preparedness Guidelines, CDC determined that the public health preparedness capabilities should be aligned with the 10 Essential Public Health Services model developed by the U.S. Department of Health and Human Services (HHS). CDC conducted a mapping process which determined that several of the public health preparedness capabilities aligned with multiple essential public health services. Thus, the state and local preparedness capabilities align with both the DHS target capabilities and the HHS 10 Essential Public Health Services, with a focus on public health capabilities critical to preparedness (see figure at right). The public health preparedness capabilities defined by CDC also directly align with 21 of the NHSS capabilities. Everyday use. The public health preparedness capabilities now represent a national public health standard for state and local preparedness that better prepares state and local health departments for responding to public health emergencies and incidents and supports the accomplishment of the10 Essential Public Health Services. Each of the public health preparedness capabilities identifies priority resource elements that are relevant to both routine public health activities and essential public health services. While demonstrations of capabilities can be achieved through different means (e.g., exercises, planned events, and real incidents), jurisdictions are encouraged to use routine public health activities to demonstrate and evaluate their public health preparedness capabilities. A systematic approach. The content of each public health preparedness capability is based on evidence-informed documents, applicable preparedness literature, and subject matter expertise gathered from across the federal government and the state and local practice community. In developing this document, CDC reviewed key legislative and executive directives to identify state and local public health preparedness priorities. These include the following: • Pandemic and All-Hazards Preparedness Act (PAHPA), which authorizes state and local preparedness funding • U.S. Department of Homeland Security (DHS) Homeland Security Presidential Directives 5, 8, and 21 • National Health Security Strategy (NHSS) U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 3 EXECUTIVE SUMMARY CDC also reviewed relevant preparedness documents from national partners such as the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO), and third-party organizations including Trust for America’s Health and RAND Corporation. The methodology for selecting the capabilities was peer reviewed by the Board of Scientific Counselors for CDC’s Office of Public Health Preparedness and Response. The Board deemed that the methodological approach and the capabilities as presented were within the scope of state and local preparedness. Engaging stakeholders. Numerous stakeholders were involved in developing the 15 public health preparedness capabilities. Stakeholders included approximately 200 subject matter experts from CDC and other federal agencies and professional organizations. Federal agencies actively involved in the process included the HHS Office of the Assistant Secretary for Preparedness and Response, DHS Federal Emergency Management Agency and Office of Health Affairs, and the U.S. Department of Transportation’s National Highway Traffic Safety Administration. CDC also worked with national associations including the American Hospital Association, the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, the National Emergency Management Association, and the National Public Health Information Coalition. In addition, CDC collaborated with national partners such as the ASTHO and NACCHO to engage the state and local practice community. This collaborative process began in January 2010 when CDC representatives and other subject matter experts began working together to develop the public health preparedness capabilities. Over the next year, CDC held weekly subject matter expert capability working groups to develop recommendations for the scope of the selected capabilities, capability functions, and resource elements for each capability. Their work was extensively vetted with many key stakeholders throughout the process. Moving Forward State and local public health departments are first responders for public health incidents, and CDC remains committed to strengthening their preparedness. CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning will assist public health departments in developing annual and long-term preparedness plans to guide their preparedness strategies and investments. These standards will be refined over time as emerging evidence becomes available to advance our preparedness knowledge. About this Document: How the Public Health Preparedness Capabilities Are Organized The public health preparedness capabilities are numbered and presented alphabetically in this document. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Community Preparedness Community Recovery Emergency Operations Coordination Emergency Public Information and Warning Fatality Management Information Sharing Mass Care Medical Countermeasure Dispensing Medical Materiel Management and Distribution Medical Surge Non-Pharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Responder Safety and Health Volunteer Management U.S. Department of Health and Human Services Centers for Disease Control and Prevention A Guide for Strategic Planning The 15 capability sections in this document are intended to serve as national standards that state and local public health departments can use to advance their preparedness planning. Public Health Preparedness Capabilities: National Standards for State and Local Planning 4 EXECUTIVE SUMMARY Each capability includes a definition of the capability and list of the associated functions, performance measures, tasks, and resource considerations. • The Capability Definition defines the capability as it applies to state, local, tribal, and territorial public health. • The Function describes the critical elements that need to occur to achieve the capability. • The Performance Measure(s) lists the CDC-defined performance measures (if any) associated with a function. • The Tasks describes the steps that need to occur to complete the functions. • The Resource Elements section lists the resources a jurisdiction needs to have or have access to (via an arrangement with a partner organization, memoranda of understanding, etc.) to successfully perform a function and the associated tasks. CDC categorizes the Resources into three categories: 1. Planning, 2. Skills and Training, and 3. Equipment and Technology. CDC further defines some Resources Elements as “Priority.” Priority elements are considered to be the most critical of the Resource Elements and as “minimum standards” for state and local preparedness. The remaining Resource Elements are recommended or suggested activities for consideration by jurisdictions. Resource Elements: Planning: Elements that should be included in existing operational plans, standard operating procedures and/or emergency operations plans. This may include language on suggested legal authorities and at-risk populations. Skills and Training: The baseline competencies and skills necessary for personnel and teams to possess to competently deliver a capability. Equipment and Technology: The equipment that a jurisdiction should have in their possession (or have access to), and the equipment should be in sufficient quantities to adequately achieve the capability within the jurisdiction. Note: As a first step, jurisdictions are encouraged to self-assess their ability to address the prioritized planning resource elements of each capability followed by an assessment of their ability to demonstrate the functions and tasks within each capability. CDC has defined successful accomplishment of prioritized resource elements as the following: a public health agency has either the ability to have (within their own existing plans or other written documents) or has access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element. Jurisdictions are not required to submit plans to CDC but should have plans available for review upon request. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 5 USING THIS DOCUMENT FOR STRATEGIC PLANNING CDC’s National Standards for State and Local Planning provides a description of the capabilities needed for achieving state and local public health preparedness. The content is intended to serve as a planning resource that state and local public health preparedness staff can use to assess their jurisdictional preparedness. CDC is making these national standards for public health preparedness available to the nation’s public health system to support their planning efforts. Jurisdictions also are encouraged to use other tools and local-level input in their planning processes, such as existing jurisdictional strategic plans, data from current hazard and vulnerability assessments, and results from After Action Reports/Improvement Plans. Public Health Preparedness Capabilities Planning Model To assist jurisdictions in using the capabilities for planning, CDC has developed a Public Health Preparedness Capabilities Planning Model. The model describes a high-level planning process that state and local public health departments may wish to follow to help determine their preparedness priorities and plan their preparedness activities. This planning model fits into the planning phase of the U.S. Department of Homeland Security Preparedness Cycle. The Public Health Preparedness Capabilities Planning Model is not intended to be a prescriptive methodology, but rather it is intended to describe a series of suggested activities for preparedness planning. The diagram below depicts the model’s three main phases and associated steps. The following are descriptions for the suggested steps to complete each of the three phases. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 6 USING THIS DOCUMENT FOR STRATEGIC PLANNING Phase 1: Assess Current State Step 1a: Assess Organizational Roles and Responsibilities The first step in the assessment phase is to determine which organizational entities within the jurisdiction are responsible for each capability and function. These entities may include state agencies, partner organizations, local and tribal health departments, and others. For instance, in some jurisdictions the coroner/medical examiner traditionally takes a lead role in fatality management activities; public health should, therefore, seek this partner when identifying what role public health contributes to this capability. Step 1b: Assess Resource Elements Each function within the capabilities includes a list of priority and recommended resource elements, divided into three categories: Planning, Skills and Training, and Equipment and Technology. These are the resources that CDC and subject matter experts have determined are the most critical for being able to build and maintain the associated capabilities. To assess public health’s current capability, it is necessary to review the resource elements (particularly the priority resource elements) to determine the extent that these elements exist in the jurisdiction. Not all public health agencies are expected to own each resource element; jurisdictions are encouraged to partner with both internal and external jurisdictional partners to assure access to resources as needed. Jurisdictions are encouraged to first self-assess their ability to address the prioritized resource elements of each capability followed by their ability to demonstrate the functions and tasks within each capability. Successfully addressing prioritized resource elements is defined as a public health agency either has the ability to demonstrate that they have (within their own existing plans or other written documents) or have access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element. For each resource element, if not fully present as described in the capability definitions, any challenges or barriers to the full attainment of that resource element should be noted. In addition, CDC has crosswalked the resource element content with the Project Public Health Ready (PPHR) 2011 criteria and the Public Health Accreditation Board (PHAB) measures (July 2009 beta test version) – these appear in the Endnotes section where applicable. Jurisdictions which have or are pursuing PPHR or PHAB certification may be able to use this information to further facilitate their assessments. The resource elements described for each function are not intended to be an exhaustive list of all possible types of resources required; nor do they give any indication of quantity of resources required (e.g., number of staff ). Therefore, it is critical that in addition to assessing the defined resource elements, each jurisdiction notes the presence or absence of any other critical resources needed to meet its needs and any challenges or barriers. Step 1c: Assess Performance After completing the resource element assessment, the next suggested step is to assess the performance of each capability and function, and whether or not it meets the jurisdiction’s needs. Performance demonstration and evaluation may be collected via activities to address CDC-defined performance measures or documented exercises or real incident activities. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 7 USING THIS DOCUMENT FOR STRATEGIC PLANNING Phase 2: Determine Goals Step 2a: Review Jurisdictional Inputs After assessing the jurisdiction’s current level resource elements and performance, the next step is to identify needs and gaps. In addition to the resource element assessment from the previous phase, there are a number of additional inputs which can be used, including (but not limited to) the following: • • • • • • • • Existing data from jurisdictional hazards and vulnerability analyses Emergency management plans Funding considerations (e.g., guidance or funding requirements from related federal preparedness programs) Previous strategic plans or planning efforts Previous state and local accreditation efforts CDC’s Strategic National Stockpile Technical Assistance Review results After Action Reports/Improvement Plans Previous performance measure results See Capability 1: Community Preparedness priority resource element requirements for additional detail on this topic. Step 2b: Prioritize Capabilities and Functions The capability definitions are broad; no jurisdiction is expected to be able to address all issues, gaps, and needs across all capabilities in the immediate short term. Therefore, jurisdictions should choose the order of the capabilities they decide to pursue based upon their jurisdictional risk assessments (see Capability 1: Community Preparedness for additional or supporting detail on the requirements for this risk assessment), but are strongly advised to ensure that they first are able to demonstrate capabilities within the following domains: • • • • • Biosurveillance Community resilience Countermeasures and mitigation Incident management Information management Other prioritization criteria may include the following: • • • • • Missing/incomplete priority resource elements Performance/ability is substantially lower than needed Risks and threats to the public health, medical, and mental/behavioral health system Ability to close gaps and develop capability is greatest Evidence-based practice Step 2c: Develop Short-term and Long-term Goals This planning model defines short-term goals: one year, and long-term goals: two years to five years. Jurisdictions should review the various inputs described in step 2a, analyze their priorities based on the prioritization criteria described in step 2b, and determine a set of short-term (one year) and long-term (two years to five years) goals. For the purposes of this model, all goals should refer to the capabilities, functions, and resource elements. For example, a short-term goal may be to fully build a particular function within a capability, including ensuring the presence of all priority resource elements. Long-term goals would be to build (individually or via partnerships), demonstrate performance, and, ultimately, sustain all capabilities and functions. Phase 3: Develop Plans U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 8 USING THIS DOCUMENT FOR STRATEGIC PLANNING Step 3a: Plan Organizational Initiatives After determining the short-term and long-term goals, the next step is to engage in concrete initiatives and activity planning, particularly for the short-term goals. While in practice jurisdictions may group together related activities to address multiple functions or capabilities within the scope of one project or initiative, for the purposes of this planning model all activities are viewed as related to individual capabilities, functions, and resource elements. Step 3b: Plan Capacity Building/Sustain Activities For each capability and function, jurisdictions generally will be either building, sustaining, or, perhaps, scaling back the capability and/or function, depending on the needs, gaps, priorities, and goals that have been identified. For build and sustain scenarios, jurisdictions are encouraged to pursue partnerships and memoranda of understanding with other agencies, partners, and jurisdictions. For scale-back scenarios, jurisdictions should identify the challenges and barriers causing them to scale back their efforts. States should consider what types of support are required by their local and tribal health departments and plan assistance or contracts accordingly. Support provided to local health departments should ideally describe which capabilities and functions are intended to be addressed. Jurisdictions should also determine any technical assistance needs they might have, whether from CDC or other sources. Technical assistance may be needed to address challenges, barriers, or other needs. For the purposes of this planning model, activities and technical assistance needs will, in general, relate to specific functions and resource elements (i.e., developing or modifying plans or processes, training staff, or building/buying equipment and technology). Step 3c: Plan Capability Evaluations/Demonstrations The final step in the planning process is to develop plans for demonstrating and evaluating the capabilities and functions, especially those that have been newly developed. Demonstrations of capabilities can be through many different means such as exercises, planned events, and real incidents. Jurisdictions are strongly encouraged to use routine public health activities to demonstrate and evaluate their capabilities. Documentation of the exercise, event, or incident, and the use of quality improvement-focused After Action Reports/Improvement Plans is a vital part of this process. For those capabilities and functions where CDC-defined performance measures have been developed, jurisdictions are encouraged to collect data for those measures. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 9 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Capability 1: Community Preparedness Definition: Community preparedness is the ability of communities to prepare for, withstand, and recover — in both the short and long terms — from public health incidents. By engaging and coordinating with emergency management, healthcare organizations (private and community-based), mental/behavioral health providers, community and faith-based partners, state, local, and territorial, public health’s role in community preparedness is to do the following: • • • • • • Support the development of public health, medical, and mental/behavioral health systems that support recovery Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents Promote awareness of and access to medical and mental/behavioral health resources that help protect the community’s health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation) of at-risk individuals Engage public and private organizations in preparedness activities that represent the functional needs of at-risk individuals as well as the cultural and socio-economic, demographic components of the community Identify those populations that may be at higher risk for adverse health outcomes Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities (e.g., improvised nuclear device or hurricane) Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Determine risks to the health of the jurisdiction Build community partnerships to support health preparedness Engage with community organizations to foster public health, medical, and mental/behavioral health social networks Coordinate training or guidance to ensure community engagement in preparedness efforts Capability 2: Community Recovery Definition: Community recovery is the ability to collaborate with community partners, (e.g., healthcare organizations, business, education, and emergency management) to plan and advocate for the rebuilding of public health, medical, and mental/ behavioral health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where possible. This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident Health Recovery into Planning and Response. Post-incident recovery of the public health, medical, and mental/behavioral health services and systems within a jurisdiction is critical for health security and requires collaboration and advocacy by the public health agency for the restoration of services, providers, facilities, and infrastructure within the public health, medical, and human services sectors. Monitoring the public health, medical and mental/behavioral health infrastructure is an essential public health service. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations Function 3: Implement corrective actions to mitigate damages from future incidents Capability 3: Emergency Operations Coordination Definition: Emergency operations coordination is the ability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable system of oversight, organization, and supervision consistent with jurisdictional standards and practices and with the National Incident Management System. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 10 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Conduct preliminary assessment to determine need for public activation Function 2: Activate public health emergency operations Measure 1: Time for pre-identified staff covering activated public health agency incident management lead roles (or equivalent lead roles) to report for immediate duty. Performance Target: 60 minutes or less Function 3: Develop incident response strategy Measure 1: Production of the approved Incident Action Plan before the start of the second operational period Function 4: Manage and sustain the public health response Function 5: Demobilize and evaluate public health emergency operations Measure 1: Time to complete a draft of an After Action Report and Improvement Plan Capability 4: Emergency Public Information and Warning Definition: Emergency public information and warning is the ability to develop, coordinate, and disseminate information, alerts, warnings, and notifications to the public and incident management responders. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Function 2: Function 3: Function 4: Function 5: Activate the emergency public information system Determine the need for a joint public information system Establish and participate in information system operations Establish avenues for public interaction and information exchange Issue public information, alerts, warnings, and notifications Measure 1: Time to issue a risk communication message for dissemination to the public Capability 5: Fatality Management Definition: Fatality management is the ability to coordinate with other organizations (e.g., law enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the proper recovery, handling, identification, transportation, tracking, storage, and disposal of human remains and personal effects; certify cause of death; and facilitate access to mental/ behavioral health services to the family members, responders, and survivors of an incident. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Function 5: Determine role for public health in fatality management Activate public health fatality management operations Assist in the collection and dissemination of antemortem data Participate in survivor mental/behavioral health services Participate in fatality processing and storage operations Capability 6: Information Sharing Definition: Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of health-related information and situational awareness data among federal, state, local, territorial, and tribal levels of government, and the private sector. This capability includes the routine sharing of information as well as issuing of public health alerts to federal, state, local, territorial, and tribal levels of government and the private sector in preparation for, and in response to, events or incidents of public health significance. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 11 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Identify stakeholders to be incorporated into information flow Function 2: Identify and develop rules and data elements for sharing Function 3: Exchange information to determine a common operating picture Capability 7: Mass Care Definition: Mass care is the ability to coordinate with partner agencies to address the public health, medical, and mental/ behavioral health needs of those impacted by an incident at a congregate location. This capability includes the coordination of ongoing surveillance and assessment to ensure that health needs continue to be met as the incident evolves. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Determine public health role in mass care operations Determine mass care needs of the impacted population Coordinate public health, medical, and mental/behavioral health services Monitor mass care population health Capability 8: Medical Countermeasure Dispensing Definition: Medical countermeasure dispensing is the ability to provide medical countermeasures (including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment or prophylaxis (oral or vaccination) to the identified population in accordance with public health guidelines and/or recommendations. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Identify and initiate medical countermeasure dispensing strategies Function 2: Receive medical countermeasures Function 3: Activate dispensing modalities Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 4: Dispense medical countermeasures to identified population Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 5: Report adverse events Capability 9: Medical Materiel Management and Distribution Definition: Medical materiel management and distribution is the ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) during an incident and to recover and account for unused medical materiel, as necessary, after an incident. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 12 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Direct and activate medical materiel management and distribution Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 2: Acquire medical materiel Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 3: Maintain updated inventory management and reporting system Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 4: Establish and maintain security Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 5: Distribute medical materiel Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Function 6: Recover medical materiel and demobilize distribution operations Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC’s Office of Public Health Preparedness and Response Capability 10: Medical Surge Definition: Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. It encompasses the ability of the healthcare system to survive a hazard impact and maintain or rapidly recover operations that were compromised. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Assess the nature and scope of the incident Support activation of medical surge Support jurisdictional medical surge operations Support demobilization of medical surge operations Capability 11: Non-Pharmaceutical Interventions Definition: Non-pharmaceutical interventions are the ability to recommend to the applicable lead agency (if not public health) and implement, if applicable, strategies for disease, injury, and exposure control. Strategies include the following: • • • • • • Isolation and quarantine Restrictions on movement and travel advisory/warnings Social distancing External decontamination Hygiene Precautionary protective behaviors U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 13 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Engage partners and identify factors that impact non-pharmaceutical interventions Determine non-pharmaceutical interventions Implement non-pharmaceutical interventions Monitor non-pharmaceutical interventions Capability 12: Public Health Laboratory Testing Definition: Public health laboratory testing is the ability to conduct rapid and conventional detection, characterization, confirmatory testing, data reporting, investigative support, and laboratory networking to address actual or potential exposure to all-hazards. Hazards include chemical, radiological, and biological agents in multiple matrices that may include clinical samples, food, and environmental samples (e.g., water, air, and soil). This capability supports routine surveillance, including pre-event or pre-incident and post-exposure activities. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Manage laboratory activities Measure 1: Time for sentinel clinical laboratories to acknowledge receipt of an urgent message from the CDC Public Health Emergency Preparedness (PHEP)-funded Laboratory Response Network biological (LRN-B) laboratory Measure 2: Time for initial laboratorian to report for duty at the CDC PHEP-funded laboratory Function 2: Perform sample management Measure 1: Percentage of Laboratory Response Network (LRN) clinical specimens without any adverse quality assurance events received at the CDC PHEP-funded LRN-B laboratory for confirmation or rule-out testing from sentinel clinical laboratories Measure 2: Percentage of LRN non-clinical samples without any adverse quality assurance events received at the CDC PHEP-funded LRN-B laboratory for confirmation or rule-out testing from first responders Measure 3: Ability of the CDC PHEP-funded Laboratory Response Network chemical (LRN-C) laboratories to collect relevant samples for clinical chemical analysis, package, and ship those samples Function 3: Conduct testing and analysis for routine and surge capacity Measure 1: Proportion of LRN-C proficiency tests (core methods) successfully passed by CDC PHEP-funded laboratories Measure 2: Proportion of LRN-C proficiency tests (additional methods) successfully passed by CDC PHEP-funded laboratories Measure 3: Proportion of LRN-B proficiency tests successfully passed by CDC PHEP-funded laboratories Function 4: Support public health investigations Measure 1: Time to complete notification between CDC, on-call laboratorian, and on-call epidemiologist Measure 2: Time to complete notification between CDC, on-call epidemiologist, and on-call laboratorian Function 5: Report results Measure 1: Percentage of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli O157:H7 submitted to the PulseNet national database within four working days of receiving isolate at the PFGE laboratory Measure 2: Percentage of PFGE subtyping data results for Listeria monocytogenes submitted to the PulseNet national database within four working days of receiving isolate at the PFGE laboratory Measure 3: Time to submit PFGE subtyping data results for Salmonella to the PulseNet national database upon receipt of isolate at the PFGE laboratory Measure 4: Time for CDC PHEP-funded laboratory to notify public health partners of significant laboratory results U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 14 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Capability 13: Public Health Surveillance and Epidemiological Investigation Definition: Public health surveillance and epidemiological investigation is the ability to create, maintain, support, and strengthen routine surveillance and detection systems and epidemiological investigation processes, as well as to expand these systems and processes in response to incidents of public health significance. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Conduct public health surveillance and detection Measure 1: Proportion of reports of selected reportable diseases received by a public health agency within the jurisdiction-required time frame Function 2: Conduct public health and epidemiological investigations Measure 1: Percentage of infectious disease outbreak investigations that generate reports Measure 2: Percentage of infectious disease outbreak investigation reports that contain all minimal elements Measure 3: Percentage of acute environmental exposure investigations that generate reports Measure 4: Percentage of acute environmental exposure reports that contain all minimal elements Function 3: Recommend, monitor, and analyze mitigation actions Measure 1: Proportion of reports of selected reportable diseases for which initial public health control measure(s) were initiated within the appropriate time frame Function 4: Improve public health surveillance and epidemiological investigation systems Capability 14: Responder Safety and Health Definition: The responder safety and health capability describes the ability to protect public health agency staff responding to an incident and the ability to support the health and safety needs of hospital and medical facility personnel, if requested. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Identify responder safety and health risks Identify safety and personal protective needs Coordinate with partners to facilitate risk-specific safety and health training Monitor responder safety and health actions Capability 15: Volunteer Management Definition: Volunteer management is the ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of volunteers to support the jurisdictional public health agency’s response to incidents of public health significance. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Coordinate volunteers Notify volunteers Organize, assemble, and dispatch volunteers Demobilize volunteers U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 15 CAPABILITY 1: Community Preparedness Community preparedness is the ability of communities to prepare for, withstand, and recover — in both the short and long terms — from public health incidents.1 By engaging and coordinating with emergency management, healthcare organizations (private and community-based), mental/behavioral health providers, community and faith-based partners, state, local, and territorial, public health’s role in community preparedness is to do the following: • Support the development of public health, medical, and mental/behavioral health systems that support • • • • • recovery Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents Promote awareness of and access to medical and mental/behavioral health 2 resources that help protect the community’s health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation) of at-risk individuals Engage public and private organizations in preparedness activities that represent the functional needs of at-risk individuals as well as the cultural and socio-economic, demographic components of the community Identify those populations that may be at higher risk for adverse health outcomes Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities (e.g., improvised nuclear device or hurricane) This capability consists of the ability to perform the following functions: Function 1: Determine risks to the health of the jurisdiction Function 2: Build community partnerships to support health preparedness Function 3: Engage with community organizations to foster public health, medical, and mental/behavioral health social networks Function 4: Coordinate training or guidance to ensure community engagement in preparedness efforts Function 1: Determine risks to the health of the jurisdiction Identify the potential hazards, vulnerabilities, and risks in the community that relate to the jurisdiction’s public health, medical, and mental/behavioral health systems, the relationship of those risks to human impact,3 interruption of public health, medical, and mental/behavioral health services, and the impact of those risks on the jurisdiction’s public health, medical, and mental/ behavioral health infrastructure. Tasks This function consists of the ability to perform the following tasks: Task 1: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners, the public health, medical, and mental/behavioral health services for which the jurisdiction needs to have access to mitigate identified disaster health risks. Task 2: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners, the public health, medical, and mental/behavioral health services within the jurisdiction that currently support the mitigation of identified disaster health risks. Performance Measure(s) At present there are no CDC-defined performance measures for this function. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 16 CAPABILITY 1: Community Preparedness Function 1: Determine risks to the health of the jurisdiction Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: (Priority) Written plans should include policies and procedures to identify populations with the following: – – – – – Health vulnerabilities such as poor health status Limited access to neighborhood health resources (e.g., disabled, elderly, pregnant women and infants, individuals with other acute medical conditions, individuals with chronic diseases, underinsured persons, persons without health insurance) Reduced ability to hear, speak, understand, or remember Reduced ability to move or walk independently or respond quickly to directions during an emergency Populations with health vulnerabilities that may be caused or exacerbated by chemical, biological, or radiological exposure These procedures and plans should include the identification of these groups through the following elements: – – – – Review/access to existing health department data sets Existing chronic disease programs/maternal child health programs, community profiles Utilizing the efforts of the jurisdiction strategic advisory council Community coalitions to assist in determining the community’s risks4, 5 P2: (Priority) Written plans should include a jurisdictional risk assessment, utilizing an all-hazards approach with the input and assistance of the following elements: PLANNING (P) – – Public health and non–public health subject matter experts (e.g., emergency management, state radiation control programs/radiological subject matter experts (http://www.crcpd.org/Map/RCPmap.htm)) Existing inputs from emergency management risk assessment data, health department programs, community engagements, and other applicable sources, that identify and prioritize jurisdictional hazards and health vulnerabilities This jurisdictional risk assessment should identify the following elements: – – – Potential hazards, vulnerabilities, and risks in the community related to the public health, medical, and mental/ behavioral health systems The relationship of these risks to human impact, interruption of public health, medical, and mental/behavioral health services The impact of those risks on public health, medical, and mental/behavioral health infrastructure6 Jurisdictional risk assessment must include at a minimum the following elements: – – – – A definition of risk Use of Geospatial Informational System or other mechanism to map locations of at-risk populations Evidence of community involvement in determining areas for risk assessment or hazard mitigation Assessment of potential loss or disruption of essential services such as clean water, sanitation, or the interruption of healthcare services, public health agency infrastructure Suggested resource – Hazard Risk Assessment Instrument, University of California, Los Angeles, Center for Public Health and Disaster: http://www.cphd.ucla.edu/hrai.html P3: Written plans, as a stand-alone plan, annex, or via other documentation, developed with input from jurisdictional partners7, 8 should indicate how the health department will assist with the following elements: –– Assurance of community public health, medical, mental/behavioral health services in an incident, with particular – attention to assure access to health services to populations and areas of low economic resources and displaced populations9,10 Addressing the concerns and needs of populations not directly impacted by a particular incident but concerned about the possibility of adverse health effects U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 17 CAPABILITY 1: Community Preparedness Function 1: Determine risks to the health of the jurisdiction Resource Elements (continued) – – – – – Family reunification assistance and patient tracking for family members impacted by the incident Providing for the functional needs of at-risk individuals for adverse health outcomes with social services or other lead agencies (e.g., disabled persons, low-income populations needing medication assistance, medical transportation, or assistance in accessing sub-specialty medical technology and medical care) Child care Pet services and pet care Psychological first aid and other relevant mental/behavioral health services11 PLANNING (P) Suggested resources –– – – – CDC Radiation Emergencies website: http://emergency.cdc.gov/radiation/ Planning Guidance for Responding to a Nuclear Detonation, Second Edition, June 2010: http://hps.org/hsc/documents/Planning_Guidance_for_Response_to_a_Nuclear_Detonation-2nd_Edition_ FINAL.pdf Listening Session on At-Risk Individuals in Pandemic Influenza and Other Scenarios: After Action Report, U.S. Health and Human Services, Assistant Secretary for Preparedness and Response Office for At-Risk Individuals, Behavioral Health, and Human Services Coordination: http://www.phe.gov/Preparedness/planning/abc/Documents/abc_listening_session.pdf Preparedness Tools and Resources for Disabled Populations: http://www.disability.gov/emergency_preparedness SKILLS AND TRAINING (S) P4: Written plans should include memoranda of understanding or other letters of agreement with community health centers, non-profit community agencies, hospitals, and private providers within the jurisdiction or with neighboring jurisdictions, if applicable, who are willing to or who can provide access to medical and mental/behavioral health services during and after an incident.12,13 S1: Have or have access to services of persons with expertise in Geospatial Informational Systems to assist in locating/ mapping locations of at-risk populations. These Geospatial Informational System services may be found within other governmental agencies (e.g., emergency management) or within academic settings (e.g., schools of public health). Function 2: Build community partnerships to support health preparedness Identify and engage with public and private community partners who can do the following: • Assist with the mitigation of identified health risks • Be integrated into the jurisdiction’s all-hazards emergency plans with defined community roles and responsibilities related to the provision of public health, medical, and mental/behavioral health as directed under the Emergency Support Function #8 definition at the state or local level Tasks This function consists of the ability to perform the following tasks: Task 1: Identify community sector groups to be engaged for partnership based upon the jurisdictional risk assessment. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 18 CAPABILITY 1: Community Preparedness Function 2: Build community partnerships to support health preparedness Tasks (continued) Task 2: Create and implement strategies for ongoing engagement with community partners who may be able to provide services to mitigate identified public health threats or incidents (concept of “strategic advisory council” or joint collaborative). Task 3: Utilize community and faith-based partnerships as well as collaborations with any agencies primarily responsible for providing direct health-related services to help assure the community’s ability to deliver public health, medical, and mental/behavioral health services in both short and long term settings during and after an incident. Task 4: Utilize a continuous quality improvement process to incorporate feedback from community and faith-based partners into jurisdictional emergency operations plans. Task 5: Identify community leaders that can act as trusted spokespersons to deliver public health messages. Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. PLANNING (P) P1: (Priority) Written plans should include a policy and process to participate in existing (e.g., led by emergency management) or new partnerships representing at least the following 11 community sectors:14 business; community leadership; cultural and faith-based groups and organizations; emergency management; healthcare; social services; housing and sheltering; media; mental/behavioral health; state office of aging or its equivalent; education and childcare settings.15 ,16 P2: (Priority) Written plans should include a protocol to encourage or promote medical personnel (e.g., physicians, nurses, allied health professionals) from community and faith-based organizations and professional organizations to register and participate with community Medical Reserve Corps or state Emergency Systems for Advance Registration of Volunteer Health Professionals programs to support health services during and after an incident.17,18,19 (For additional or supporting detail, see Capability 15: Volunteer Management) P3: Written plans should include documentation of community and faith-based partners’ roles and responsibilities for each phase of the health threat. P4: Written plans should include a process to provide mechanisms (e.g., town hall meetings, websites) to discuss public health hazard policies and plans of action with community partners.20 P5: Written plans should include strategies to support the provision of community health services during multiple types of hazard scenarios (also known as robustness) in order to support the identified risks in the jurisdiction.21 SKILLS AND TRAINING (S) P6: Written plans should include a process to provide guidance to community and faith-based partners to support development of these groups’ emergency operations plans/response operations. S1: Mid-level public health staff participating in community preparedness activities should be able to demonstrate the “Plan For and Improve Practice” domain within the core competencies in Public Health Preparedness and Response Core Competency Model. Suggested resource – Association of Schools of Public Health Preparedness Competencies: http://www.asph.org/userfiles/PreparednessCompetencyModelWorkforce-Version1.0.pdf For further information on competency content and locations offering this training, see: http://emergency.cdc.gov/cdcpreparedness/training/ U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 19 CAPABILITY 1: Community Preparedness Function 3: Engage with community organizations to foster public health, medical, and mental/behavioral health social networks Engage with community organizations to foster social connections22 that assure public health, medical and mental/behavioral health services in a community before, during, and after an incident. Tasks This function consists of the ability to perform the following tasks: Task 1: Ensure that community constituency groups understand how to connect to public health to participate in public health and community partner preparedness efforts. Task 2: Ensure that public health, medical, and mental/behavioral health service agencies that provide essential health services to the community are connected to jurisdictional public health preparedness plans and efforts.23 Task 3: Create jurisdictional networks (e.g., local businesses, community and faith-based organizations, ethnic radio/media, and, if used by the jurisdiction, social networking sites) for public health, medical, and mental/behavioral health information dissemination before, during, and after the incident. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning) Note: Tasks 1 through 3 apply to all jurisdictions; states are expected to ensure attainment by their local communities. Performance Measure(s) At present there are no CDC-defined performance measures for this function. PLANNING (P) Resource Elements P1: Written plans should include a process for community engagement in problem solving strategy sessions to identify how the short-term or permanent relocation of health-related supplies and other services can support the direct restoration of a sense of community and social connectedness in terms of public health, medical, and mental/behavioral health services.24 P2: Written plans should include a protocol to identify health services needed to support identified disaster risks and ensure these services are culturally and socially competent.25 Function 4: Coordinate training or guidance to ensure community engagement in preparedness efforts Coordinate with emergency management, community organizations, businesses, and other partners to provide public health preparedness and response training or guidance to community partners for the specific risks identified in the jurisdictional risk assessment. Tasks This function consists of the ability to perform the following tasks: Task 1: Integrate information on resilience, specifically the need for community-derived approaches to support the provision of public health, medical, and mental/behavioral health services during and after an incident, into existing training and educational programs related to crisis and disaster preparedness and response. Task 2: Promote training to community partners that may have a supporting role to public health, medical, and mental/ behavioral health sectors (e.g., education, child care, juvenile justice, child welfare, and congregate childcare settings). U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 20 CAPABILITY 1: Community Preparedness Function 4: Coordinate training or guidance to ensure community engagement in preparedness efforts Tasks (continued) Task 3: Provide guidance to community partners, particularly groups representing the functional needs of at-risk populations, to assist them in educating their own constituency groups regarding plans for addressing preparedness for and recovery from the jurisdiction’s identified risks and for access to health services that may apply to the incident. Note: Tasks 1 through 3 apply to all jurisdictions; states are expected to ensure attainment by their local communities. Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: (Priority) Written plans should include documentation that public health has participated in jurisdictional approaches to address how children’s medical and mental/behavioral healthcare will be addressed in all-hazard situations, including but not limited to the following elements: PLANNING (P) – – – – – Approaches to support family reunification Care for children whose caregivers may be killed, ill, injured, missing, quarantined, or otherwise incapacitated for lengthy periods of time Increasing parents’ and caregivers’ coping skills Supporting positive mental/behavioral health outcomes in children affected by the incident Providing the opportunity to understand the incident26 Suggested resources – – – Kids Dealing with Disasters: http://www.oumedicine.com/body.cfm?id=3745 National Commission on Children and Disasters: 2010 Report to the President and Congress: http://www.ahrq.gov/prep/nccdreport/nccdreport.pdf Post-Katrina Emergency Management Reform Act of 2006: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_bills&docid=f:s3721is.txt.pdf SKILLS AND TRAINING (S) P2: (Priority) Written plans should include a process and procedures to build and sustain volunteer opportunities for residents to participate with local emergency responders and community safety efforts year round (e.g., Medical Reserve Corps). (For additional or supporting detail, see Capability 15: Volunteer Management) S1: Identify, recommend, or develop standardized and competency-based disaster education and training programs (such as the National Disaster Life Support Program, the American Academy of Pediatrics disaster medicine curriculum, National and State Voluntary Organizations Active in Disaster planning documents) for emergency responders, citizen volunteers, and other community residents. S2: Have or have access to at least one Medical Reserve Corps and coordinate with existing Community Emergency Response Teams/Citizen Corps. (For additional or supporting detail, see Capability 15: Volunteer Management) U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 21 CAPABILITY 2: Community Recovery Community recovery is the ability to collaborate with community partners, (e.g., healthcare organizations, business, education, and emergency management) to plan and advocate for the rebuilding of public health, medical, and mental/behavioral health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where possible. This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident Health Recovery into Planning and Response. Post-incident recovery of the public health, medical, and mental/behavioral health services and systems within a jurisdiction is critical for health security and requires collaboration and advocacy by the public health agency for the restoration of services, providers, facilities, and infrastructure within the public health, medical, and human services sectors. Monitoring the public health, medical and mental/behavioral health infrastructure is an essential public health service.27,28,29,30 This capability consists of the ability to perform the following functions: Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations Function 3: Implement corrective actions to mitigate damages from future incidents Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Assess the impact of an incident on the public health system31 in collaboration with the jurisdictional government and community and faith-based partners, in order to determine and prioritize the public health, medical, or mental/behavioral health system recovery needs. This function addresses the intent of National Health Security Strategy Outcome 8 that there should be a collaborative effort within a jurisdiction that results in the identification of public health, medical, and mental/behavioral assets, facilities, and other resources which either need to be rebuilt after an incident or which can be used to guide post-incident reconstitution activities. Tasks This function consists of the ability to perform the following tasks: Task 1: In collaboration with jurisdictional partners, document short-term and long-term health service delivery priorities and goals. Task 2: Identify the services that can be provided by the public health agency and by community and faith-based partners that were identified prior to the incident as well as by new community partners that may arise during the incident response. (For additional or supporting detail, see Capability 1: Community Preparedness, Capability 7: Mass Care, and Capability 10: Medical Surge) Task 3: Activate plans previously created with neighboring jurisdictions to provide identified services that the jurisdiction does not have the ability to provide during and after an incident. Task 4: In conjunction with healthcare organizations (e.g., healthcare facilities and public and private community providers) and based upon recovery operations, determine the community’s health service priorities and goals that are the responsibility of public health. (For additional or supporting detail, see Capability 10: Medical Surge) Performance Measure(s) At present there are no CDC-defined performance measures for this function. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 22 CAPABILITY 2: Community Recovery Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: (Priority) Written plans should include processes for collaborating with community organizations, emergency management, and healthcare organizations to identify the public health, medical, and mental/behavioral health system recovery needs for the jurisdiction’s identified hazards. Suggested resource – National Disaster Recovery Framework (draft February 2010): http://disasterrecoveryworkinggroup.gov/ndrf.pdf P2: (Priority) Written plans should include how the health agency and other partners will conduct a community assessment and follow-up monitoring of public health, medical, and mental/behavioral health system needs after an incident. Suggested resource for environmental incidents – Community Assessment for Public Health Emergency Response Toolkit http://www.emergency.cdc.gov/disasters/surveillance/pdf/CASPER_toolkit_508%20COMPLIANT.pdf Suggested resource for radiation incidents PLANNING (P) – State Radiation Control Programs: http://www.crcpd.org/Map/RCPmap.htm (For additional or supporting detail, see Capability 1: Community Preparedness) P3: (Priority) Written plans should include the following elements (either as a stand-alone Public Health Continuity of Operations Plan or as a component of another plan): – – – – – – – – – – Definitions and identification of essential services needed to sustain agency mission and operations Plans to sustain essential services regardless of the nature of the incident (e.g., all-hazards planning) Scalable work force reduction Limited access to facilities (social distancing, staffing or security concerns) Broad-based implementation of social distancing policies if indicated Positions, skills and personnel needed to continue essential services and functions (Human Capital Management) Identification of agency vital records (legal documents, payroll, staff assignments) that support essential functions and/or that must be preserved in an incident Alternate worksites Devolution of uninterruptible services for scaled down operations Reconstitution of uninterruptible services32,33,34 P4: Written plans should include pre-defined statements, or message templates, that address likely questions and concerns in an emergency. Message maps should be used by public health spokespersons to use with community media and community organizations. (For additional or supporting detail, see Capability 1: Community Preparedness and Capability 4: Emergency Public Information and Warning) P5: Written plans should include recovery strategies for the timely repair or rebuilding of public health services (e.g., wastewater treatment and potable water supply). P6: Written plans should include procedures that guide the provision of public health, medical, and mental/behavioral healthcare beyond initial life-sustaining care. This includes processes to assure that short- and long-term programs and services are available (pre- and post-incident) to meet the needs of responders and the general public in terms of assuaging stress, grief, fear, panic, and anxiety, as well as to address other medical and mental/behavioral health issues. (For additional or supporting detail, see Capability 1: Community Preparedness and Capability 14: Responder Safety and Health) U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 23 CAPABILITY 2: Community Recovery Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Resource Elements (continued) P7: Written plans should include protocols to identify jurisdictional legal authorities to permit non-jurisdictional clinicians to be credentialed to work in emergency situations. – Suggested template: “Menu of Suggested Provisions for Public Health Mutual Aid Agreements” and especially the section “Licenses and Permits” accessible at http://www2a.cdc.gov/phlp/mutualaid/mutualpermits.asp P8: Written plans should include documentation that addresses the identification of the sectors (e.g., business, nongovernmental organizations, community and faith-based organizations, education, social services) that can provide support to the recovery effort. PLANNING (P) – For examples of potential sectors, see: Building Community Resilience for Children and Families, Terrorism and Disaster Center at the University of Oklahoma Health Sciences Center35 Plan or annex should also include the process to facilitate or assist these organizations with developing their own continuity of operations plans that detail how they will perform these functions in all-hazards recovery situations. Recommended components include the following elements: – – What community stakeholder operations are necessary to sustain public health operations/functions What health support operations do/can they provide (e.g., shelter, day care, spiritual guidance, food, medication support, and transportation) Planning process should document the inclusion of regularly scheduled meetings prior to an incident at which representatives from the different community sectors can meet to do the following: – Establish and maintain interpersonal relationships – Share promising practices/approaches to recovery from similar incidents – Learn about relevant response and recovery processes and policies within the jurisdiction – Ask questions and exchange information (For additional or supporting detail, see Capability 1: Community Preparedness) Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations Facilitate interaction among community and faith-based organizations (e.g., businesses and non-governmental organizations) to build a network of support services which will minimize any negative public health effects of the incident. This function addresses the National Health Security Strategy Objective 8 outcome recommendation that jurisdictions should have an integrated plan as to how post-incident public health, medical, and mental/behavioral services can be coordinated with organizations responsible for community restoration. Tasks This function consists of the ability to perform the following tasks: Task 1: Participate with the recovery lead jurisdictional agencies (e.g., emergency management and social service) to ensure that the jurisdiction can provide health services needed to recover from a physical or mental/behavioral injury, illness, or exposure sustained as a result of the incident, with particular attention to the functional needs of at-risk persons (e.g., those displaced from their usual residence). (For additional or supporting detail, see Capability 3: Emergency Operations Coordination) U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 24 CAPABILITY 2: Community Recovery Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations Tasks (continued) Task 2: In conjunction with jurisdictional government and community partners, inform the community of the availability of mental/behavioral, psychological first aid, and medical services within the community, with particular attention to how these services affect the functional needs of at-risk persons36 (including but not limited to children, elderly, their care givers, the disabled, or individuals with limited economic resources) (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning) Task 3: Notify the community via community partners of the health agency’s plans for restoration of impacted public health, medical, and mental/behavioral health services. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning) Task 4: Solicit community input via community partners regarding health service recovery needs during and after the acute phase of the incident. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning and Capability 8: Medical Countermeasure Dispensing) Task 5: Partner with public health, medical, and mental/behavioral health professionals and other social networks (e.g., faith-based, volunteer organizations, support groups, and professional organizations) from within and outside the jurisdiction, as applicable to the incident, to educate their constituents regarding applicable health interventions being recommended by public health. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning, Capability 6: Information Sharing, and Capability 11: Non-Pharmaceutical Interventions) Task 6: In conjunction with jurisdictional government and community partners, inform the community of the availability of any disaster or community case management services being offered that provide assistance for community members impacted by the incident. (For additional or supporting detail, see Capability 4: Emergency Public Information and Warning) Performance Measure(s) At present there are no CDC-defined performance measures for this function. SKILLS AND TRAINING (S) Resource Elements S1: Incorporate mental/behavioral health training into Medical Reserve Corps, volunteer (e.g., Emergency Systems for Advance Registration of Volunteer Health Professionals) training programs (e.g., grief counseling services). (For additional or supporting detail, see Capability 15: Volunteer Management) Function 3: Implement corrective actions to mitigate damages from future incidents Incorporate observations from the current incident to describe actions needed to return to a level of public health, medical, and mental/behavioral health system function at least comparable to pre-incident levels or improved levels where appropriate. Document these items in a written after action report and improvement plan, and implement those corrective actions that are within the purview of public health. This function addresses the intent of the National Health Security Strategy Outcome 8 recommendation that jurisdictions should have a monitoring and evaluation plan for recovery efforts. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 25 CAPABILITY 2: Community Recovery Function 3: Implement corrective actions to mitigate damages from future incidents Tasks This function consists of the ability to perform the following tasks: Task 1: In conjunction with jurisdictional government and community partners, conduct post-incident assessment and planning as part of the after action report process that affects short and long-term recovery for those corrective actions that are within the control and purview of jurisdictional public health, including the mitigation of damages from future incidents. Task 2: Collaborate with sector leaders37 to facilitate collection of community feedback to determine corrective actions. Task 3: Implement corrective actions for items that are within the scope or control of public health to affect short and long-term recovery, including the mitigation of damages from future incidents. Task 4: Facilitate and advocate for collaborations among government agencies and community partners so that these agencies can fulfill their respective roles in completing the corrective actions to protect the health of the public. Performance Measure(s) At present there are no CDC-defined performance measures for this function. PLANNING (P) Resource Elements P1: Written plans should include a process to engage with jurisdictional business, educational, and social service sectors to support the restoration of access to public health, medical and mental/behavioral health services. P2: Written plans should include a process for how the public health agency will solicit feedback and recommendations from the following sectors, at a minimum, for improved community access to health services: – Education, medical, public health, mental/behavioral health, and environmental health U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 26 CAPABILITY 3: Emergency Operations Coordination Emergency operations coordination is the ability to direct and support an event38 or incident39 with public health or medical implications by establishing a standardized, scalable system of oversight, organization, and supervision consistent with jurisdictional standards and practices and with the National Incident Management System.40 This capability consists of the ability to perform the following functions: Function 1: Function 2: Function 3: Function 4: Function 5: Conduct preliminary assessment to determine need for public activation Activate public health emergency operations Develop incident response strategy Manage and sustain the public health response Demobilize41 and evaluate public health emergency operations Function 1: Conduct preliminary assessment to determine need for public activation Define the public health impact of an event or incident and gather subject matter experts to make recommendations on the need for, and scale of, incident command operations. Tasks This function consists of the ability to perform the following tasks: Task 1: At the time of an incident and as applicable during an incident, work with jurisdictional officials (e.g., other agency representatives; elected or appointed leadership officials; epidemiology, laboratory, surveillance, medical, and chemical, biological, and radiological subject matter experts; and emergency operations leadership) to analyze data, assess emergency conditions and determine the activation levels based on the complexity of the event or incident. Activation levels should be consistent with jurisdictional standards and practices (e.g., jurisdictional Emergency Operations Plans and applicable annexes). (For additional or supporting detail, see Capability 13: Public Health Surveillance and Epidemiological Investigation) Task 2: At the time of an incident and as applicable during an incident, determine whether public health has the lead role, a supporting role, or no role. These roles are defined as follows: –– –– –– Lead role: public health has primary responsibility to establish event or incident objectives and response strategies and to task other supporting agencies (e.g., outbreaks of meningitis, measles, seasonal influenza) Supporting role: public health may be tasked by lead agency (e.g., oil spills, earthquakes, wild fires, hurricanes) No role: there is no public health implication Task 3: Define incident command and emergency management structure for the public health event or incident according to one of the Federal Emergency Management Agency (FEMA) types.42 FEMA incident type may have an impact on training and accreditation requirements and may help determine what level of resources are needed and how to request more resources using standardized language for emergency response.43,44 Performance Measure(s) At present there are no CDC-defined performance measures for this function. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 27 CAPABILITY 3: Emergency Operations Coordination Function 1: Conduct preliminary assessment to determine need for public activation Resource Elements PLANNING (P) Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: Written plans should include a matrix indicating public health involvement in potential incidents based on items identified in the jurisdictional risk assessment. Development of these plans should also include subject matter experts (e.g., epidemiology, laboratory, surveillance, medical, and chemical, biological, and radiological subject matter experts and emergency operations leadership) to help determine public health involvement in an incident that differs from those identified in the jurisdictional risk assessment. 45,46 (For additional or supporting detail, see Capability 1: Community Preparedness) SKILLS AND TRAINING (S) S1: At least one representative (either the Incident Commander or someone who can help to coordinate the public health response to the incident) trained at a minimum to the CDC definition of Responder Training level Tier 4 which includes completion of the following National Incident Management System courses: EQUIPMENT AND TECHNOLOGY (E) P2: Written plans should include processes and protocols for acting upon information that indicates there may be an incident with public health implications that requires an agency-level response. E1: Have or have access to communications equipment that includes a primary and a backup system which may consist of (but not limited to) any of the following: telephones, fax, dedicated telephone line, cellular telephones with chargers, radios (walkie talkies), television, high frequency radios, internet, and satellite communication. – – – – – – Introduction to Incident Command System (IS-100.b) Incident Command System for Single Resources and Initial Action Incidents (IS-200.b) Intermediate Incident Command System (ICS-300) Advanced Incident Command System (ICS-400) National Incident Management System, An Introduction (IS-700a) National Response Framework, An Introduction (IS-800.b) Function 2: Activate public health emergency operations In preparation for an event, or in response to an incident of public health significance, engage resources (e.g., human, technical, physical space, and physical assets) to address the incident or event in accordance with the National Incident Management System and consistent with jurisdictional standards and practices. Tasks This function consists of the ability to perform the following tasks: Task 1: Prior to an event or incident, identify incident command and emergency management functions for which public health is responsible. Task 2: Prior to an event or incident, identify a pool of staff who have the skills necessary to fulfill required incident command and emergency management roles deemed necessary for a response. The pool should include public health subject matter experts, Incident Commander, Section Chiefs, Command Staff, and support positions (e.g., Informational Technology Specialist). U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 28 CAPABILITY 3: Emergency Operations Coordination Function 2: Activate public health emergency operations Tasks (continued) Task 3: Prior to an event or incident, identify staff to serve in the required incident command and emergency management roles for multiple operational periods to ensure continuous staffing during activation. Task 4: Prior to an event or incident, identify primary and alternate physical locations or a virtual structure47 (owned by public health or have access to through a memorandum of understanding or other written agreements) that will serve as the public health emergency operations center. Task 5: At the time of an event or incident, notify designated incident command staff of public health response. Task 6: In preparation for or at the time of an event or incident, assemble designated staff at the appropriate emergency operations center(s) (i.e., public health emergency operations center or jurisdictional emergency operations center). Performance Measure(s) This function is associated with the following CDC-defined performance measure: Measure 1: Time for pre-identified staff covering activated public health agency incident management lead roles (or equivalent lead roles) to report for immediate duty. Performance Target: 60 minutes or less – – Start time: Date and time that a designated official began notifying staff to report for immediate duty to cover activated incident management lead roles Stop time: Date and time that the last staff person notified to cover an activated incident management lead role reported for immediate duty Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: (Priority) Written plans should include standard operating procedures that provide guidance for the management, operation, and staffing of the public health emergency operations center or public health functions within another emergency operations center. The following should be considered for inclusion in the standard operating procedures: PLANNING (P) – – Activation procedures and levels, including who is authorized to activate the plan and under what circumstances Notification procedures; procedures recalling and/or assembling required incident command/management personnel and for ensuring facilities are available and operationally ready for assembled staff Suggested resource – Federal Emergency Management Agency Incident Command System Forms: http://training.fema.gov/EMIWeb/IS/ICSResource/ICSResCntr_Forms.htm P2: Written plans should include job action sheets or equivalent documentation for incident command positions and others with roles in a public health emergency. – For guidance on developing job action sheets, refer to the tool provided by the National Association of County and City Health Officials: http://www.naccho.org/toolbox/tool.cfm?id=5 P3: Written plans should include a list of staff that has been selected in advance of an incident that could fill the incident management roles adequate to a given response, including public health responses and cross-agency responses. Health departments must be prepared to staff multiple emergency operations centers at the agency, local, and state levels as necessary. P4: Written plans should include a list that ensures personnel and equipment arriving at the incident can check in and check out at various incident locations. – The use of Incident Command System Form 211 – “Check-In List” or equivalent documentation is recommended. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 29 CAPABILITY 3: Emergency Operations Coordination Function 2: Activate public health emergency operations PLANNING (P) Resource Elements (continued) P5: Written plans should include mutual aid or other written agreements between public health agencies and response partners at the state, tribe, territorial and local levels to support Emergency Support Function #8 related activities across jurisdictions. These agreements facilitate the sharing of resources, facilities, services, and other potential support required during an incident: – – – – – – – – – Procedures for coordinating investigation and response operations across agencies Procedures for requesting and providing assistance Procedures, authorities, and rules for payment, reimbursement, and allocation of...
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REPORT ON PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE
CAPABILITIES IN GEORGIA STATE AND LOCAL PUBLIC HEALTH
August 02, 2021

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EXECUTIVE SUMMARY
Evolving Threats and Strengthening the Public Health System - Since the year 2001 the
public health branches have made some advancements as tinted in the CDC’S state alertness
report (http://www.cdc.gov/phpr/reportingonreadiness.htm).


Defining National Standards for Georgia State and Local Planning – In reaction to these
encounters and in grounding for a fresh 5-year PHEP cooperative agreement that started
its functioning in August 2011, CDS executed a systematic process crucial for a set of
public health readiness capabilities to support state and home-grown branches with their
premeditated planning.



Public health preparedness capabilities – The following three public health readiness
capabilities that were celebrated by CDC as the Foundation for the state and home-grown
public health readiness highlighted other fifteen useful public health preparedness
capabilities i.e., Biosurveillance Incident Management, Community Resilience,
Countermeasures and Mitigation



Aligning across national programs- All-Hazards Preparedness and Pandemic Act
(PAHPA) postulates the need to uphold consistency with several other domestic
programs, especially the NHSS preparedness goals.



Everyday use – the public health readiness capabilities nowadays signify domestic public
health as a reference point for state and home-grown preparedness that well makes state
and home-grown health branches for retorting to public health predicaments and
incidences.



A systematic approach – The information regarding individual public health readiness
capabilities is grounded on evidence-informed papers, valid readiness literature, and

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subject matter proficiency collected from amid federal government, the state, and homegrown practice community.


Engaging stakeholders- Copious stakeholders were entangled in creating the fifteen
public health readiness capabilities.



How the Public Health Preparedness Capabilities Are Organized- The Public Health
Readiness Capabilities Are Structured either sequentially or alphabetically in this
document.
INTRODUCTION
The threats in the public health sector are constantly existing, whether triggered by

international means, coincidences or by nature, these threats may mark the commencement of
public health threats frequencies. Therefore, it is precarious for shielding our nation’s public
health by preparing to respond, prevent, and speedily recuperate from public health threats.
The H1N1 influenza disease highlighted the prominence of communities being equipped
for possible threats. Because of its exceptional capacity to retort to infectious, environmenta...


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