Community Preparedness

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Community Preparedness

• Jim Schwendinger MSN MPH CCRN ANP-C
• Epi-X Clinician Communication Team
• Centers for Disease Control and Prevention (CDC)
• Mollie Melbourne MPH MEP
• National Association of Community Health Centers,
  Inc.

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• Continuing Education Credits
  DISCLAIMERIn compliance with continuing
  education requirements, all presenters must
  disclose any financial or other relationships
  with the manufacturers of commercial products,
  suppliers of commercial services, or commercial
  supporters as well as any use of unlabeled
  product(s) or product(s) under investigational
  use. CDC, our planners, and the presenters for
  this seminar do not have financial or other
  relationships with the manufacturers of
  commercial products, suppliers of commercial
  services, or commercial supporters. This
  presentation does not involve the unlabeled use
  of a product or product under investigational
  use.

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Why take an All Hazards approach ?

• Natural Disaster
• Hurricane, Earthquake, Tornado, Flood, Wildfire,
  Ice Storm
  
• Terrorist Attack
• Conventional, Radiologic, Biologic, Chemical
• Known Infectious Diseases
• Mumps, Norovirus, E.coli, Influenza, VHF
• Unique Infectious Diseases
• SARS, H5N1
• Infrastructure Challenges
• Fire, Staff Issues, Power Outage

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Our Health Protection Preparedness System A
Network of Shared Responsibility !

• Local - tribal - state - federal
• Domestic international
• Public private
• Multi-sector
• Non-partisan
• Health protection homeland security economic
  protection

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Federal Planning Resources

• National Response Framework

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ESFs Roles and Responsibilities

• ESF 1 Transportation (DOT)
• Aviation/airspace management and control
• Transportation safety
• Restoration/recovery of transportation
  infrastructure
  
• Movement restrictions
• Damage and impact assessment
• ESF 2 Communications (DHS-NCS)
• Coordination with telecommunications and
  information technology industries
  
• Restoration and repair of telecommunications
  infrastructure
  
• Protection, restoration, and sustainment of
  national cyber and information technology
  resources
  
• Oversight of communications within the Federal
  incident management and response structures
  
• ESF 3 Public Works and Engineering (DoD)
• Infrastructure protection and emergency repair
• Infrastructure restoration
• Engineering services and construction management
• Emergency contracting support for life-saving and
  life-sustaining services
  
• ESF 4 Firefighting (USDA)
• Coordination of Federal firefighting activities
• Support to wildland, rural, and urban
  firefighting operations

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ESFs (cont.)

• ESF 5 Emergency Management (DHS-FEMA)
• Coordination of incident management and response
  efforts
  
• Issuance of mission assignments
• Resource and human capital
• Incident action planning
• Financial management
• ESF 6 Mass Care, Emergency Assistance,
  Housing, and Human Services (DHS-FEMA)
  
• Mass care
• Emergency assistance
• Disaster housing
• Human services
• ESF 7 Logistics Management and Resource
  Support (DHS-FEMA)
  
• Comprehensive, national incident logistics
  planning, management, and sustainment capability
  
• Resource support (facility space, office
  equipment and supplies, contracting services,
  etc.)
  
• ESF 8 Public Health and Medical Services
  (HHS)
  
• Public health
• Medical
• Mental health services
• Mass fatality management

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ESFs (cont.)

• ESF 9 Search and Rescue (DHS-FEMA)
• Life-saving assistance
• Search and rescue operations
• ESF 10 Oil and Hazardous Materials Response
  (EPA)
  
• Oil and hazardous materials (chemical,
  biological, radiological, etc.) response
  
• Environmental short- and long-term cleanup
• ESF 11 Agriculture and Natural Resources
  (USDA)
  
• Nutrition assistance
• Animal and plant disease and pest response
• Food safety and security
• Natural and cultural resources and historic
  properties protection and restoration
  
• Safety and well-being of household pets
• ESF 12 Energy (DOE)
• Energy infrastructure assessment, repair, and
  restoration
  
• Energy industry utilities coordination
• Energy forecast

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ESFs (cont.)

• ESF 13 Public Safety and Security (DOJ)
• Facility and resource security
• Security planning and technical resource
  assistance
  
• Public safety and security support
• Support to access, traffic, and crowd control
• ESF 14 Long-Term Community Recovery
  (DHS-FEMA)
  
• Social and economic community impact assessment
• Long-term community recovery assistance to
  States, local governments, and the private
  sector
  
• Analysis and review of mitigation program
  implementation
  
• ESF 15 External Affairs (DHS-FEMA)
• Emergency public information and protective
  action guidance
  
• Media and community relations
• Congressional and international affairs
• Tribal and insular affairs

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Federal Resources NIMS more
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Federal Resources NIMS IRIS
http//www.fema.gov/library/viewRecord.do?id2694
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Other Federal Planning Resources All Hazards

• CDC Emergency Preparedness and Response site
  http//emergency.cdc.gov/
  
• The FEMA Plan Ahead site http//www.fema.gov/pl
  an/index.shtm
  
• Ready.gov http//www.ready.gov/america/getakit/in
  dex.html

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Ready.gov Get a Kit

• Water
• One gallon per person per day - at least three
  days (drinking sanitation)
  
• Food
• At least a three-day supply of non-perishable
  food
  
• Battery-powered or hand crank a NOAA Weather
  Radio with tone alert
  
• Extra batteries for both
• Flashlight and extra batteries
• First aid kit
• Whistle to signal for help
• Dust mask
• To help filter contaminated air
• Plastic sheeting and duct tape to
  shelter-in-place
  
• Moist towelettes, garbage bags and plastic ties
  for personal sanitation
  
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food)
  
  
• Local maps

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Get a Kit Things to Consider

• Prescription medications, glasses medical
  information
  
• KIWY - http//emergency.cdc.gov/disasters/hurrican
  es/katrina/pdf/kiwy.pdf
  
• Infant formula and diapers
• Pet food and extra water for your pet
• Important family documents - insurance policies,
  ID, bank records
  
• In a waterproof, portable container
• Cash or traveler's checks and change
• Emergency reference material - first aid book
• Sleeping bag or warm blanket for each person.
• Complete change of clothing sturdy shoes.
• Household chlorine bleach a measuring device
• Fire Extinguisher
• Matches in a waterproof container
• Feminine supplies and personal hygiene items
• Mess kits, paper cups, plates and plastic
  utensils, paper towels
  
• Paper and pencil
• Books, games, puzzles or other activities for
  children
  

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CDC Resources COCA

• The Clinician Outreach Communication Activity
  (COCA)
  
• Weekly informational and monthly training
  updates
  
• COCA Conference Calls
• Email question and answer service regarding
  emergency preparedness and response topics -
  coca_at_cdc.gov
  
• COCA website http//emergency.cdc.gov/coca/

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CDC Resources Epi-X

• To provide secure, moderated communications for
  public health officials to report and discuss
  disease outbreaks and other acute health events
  including terrorism.
• Epi-X roles
• State/Territorial Epidemiologist
• State/Territorial Public Health Laboratory
  Director
  
• State/Territorial Public Health Officer
• State/Territorial Public Health Veterinarian
• State/Territorial Terrorism Response Coordinator
• Poison Control Center Director
• HAN Coordinator
• City, County, or Regional Health Officer
• Epi-X Help Desk - epixhelp_at_cdc.gov and
  877-438-3749

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1-800-CDC-INFO

• CDC-INFO 1-800-232-4636
• Toll-free
• 24/7/365
• Direct connection to the CDC DEOC
• Flexible Staffing
• Information provided by CDC SMEs
• Email cdcinfo_at_cdc.gov

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Other Federal Planning Resources Pandemic
Influenza

• US Department of Health and Human Services (HHS)
• Pandemicflu.gov
• - National and HHS Pandemic Influenza Plans
• - Checklists
• - Links to WHO and other US government agency
  websites such as FDA, USDA, etc.
  

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PandemicFlu.gov
Pandemic influenza Preparedness Checklists

• State and Local
• Business
• Preschool
• Schools (K-12)
• Colleges Universities
• Faith-based Community Organizations

• Physician Offices and Ambulatory Care
• Home Health
• Emergency Medical Services
• Future Checklists

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Preparedness Challenges

• Disruption of services (police, fire, EMS)
• Interruption of utilities
• Decreased or eliminated health infrastructure
• Communication
• Transportation
• Supplies (non-retail)
• Community infrastructure
• Schools
• Retail services

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Disruption of services

• Police
• Fire
• EMS
• Government services
• US Mail
• Entitlements
• Resource agencies

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Utilities

• Water
• Electricity
• Gas
• Telephone service
• Cable and other TV service
• Sewer
• Sanitation services

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Health Infrastructure

• Decreased or non-existent healthcare services
• Local clinics
• Individual provider offices
• ERs
• Hospitals
• Long Term Care facilities

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Communication

• Telephone
• Internet
• Radio
• Other

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Transportation

• Mass transit
• Emergency vehicles
• Personal vehicles
• Physical infrastructure
• Roads, bridges, tunnels
• Resources
• Gas, maintenance items

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Supplies

• Needed for organizational function
• Wholesale suppliers
• Long-term function

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Community Infrastructure

• Schools
• Businesses
• Retail services
• Food
• Medicine
• Supplies
• Shelter-related

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Preparation and Response

• Individuals and Families
• Businesses
• Communities
• Faith-based Organizations
• Health Care Providers
• Governments
• International Organizations

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Issues Specific to Selected Populations

• Planning must take into account the special
  circumstances of any number of select diverse
  groups
  
• Elderly
• Homebound Individuals
• Disabled Persons
• Single Parents
• People with Chronic Illnesses
• Others

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Special Populations

• The Public Health Workbook to Define, Locate and
  Reach Special, Vulnerable and At-Risk Populations
  in an Emergency (DRAFT)
  
• Provides a process that can support state, local,
  and tribal planners as they advance in their
  efforts to reach all populationsand
  specifically, special populationsin day-today
  communication and during crisis or emergency
  situations.
• www.emergency.cdc.gov/workbook/

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Americas Voice for Community Health Care
The NACHC Mission The National Association of Com
munity Health Centers (NACHC) represents
Community, Migrant, and Homeless Health Centers,
as well as Public Housing Primary Care Programs
and other community-based health centers.
Founded in 1970, NACHC is a nonprofit
organization providing advocacy, education,
training and technical assistance to health
centers in support of their mission to provide
quality health care to underserved populations.
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Health Centers at a Glance

• Located in or serve a high need community
• Provide comprehensive primary care and supportive
  services
  
• Serve all who seek care, regardless of ability to
  pay
  
• Governed by community board with majority of
  members HC patients
  
• Meet performance and accountability requirements
• Design services to meet the needs of their
  community
  

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Health Centers at a Glance

• 1,150 community, migrant, homeless, and public
  housing health center organizations with more
  than 6,300 sites
  
• Over 112,000 FTEs
• Provide quality care for 1.47 per patient per
  day (538 annually)
  

Data source Uniform Data System 2006 National
Association of Community Health Centers - 2007
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Health Center Services Include

• 12-step programs
• AIDS family social services
• Breast-feeding classes
• Cancer, health screenings
• Case management
• Childbirth classes
• Dental care
• Diabetes management
• Domestic Violence prevention
• Early education supports
• Family planning
• Flu clinics
• HIV education/prevention

• Homeless support services
• Immunizations
• Mental health counseling
• Migrant healthcare
• Neonatal home visits
• Nutrition counseling
• Nutritional assessment
• Pharmacological screening
• Prenatal care
• Primary care
• School based clinics
• Senior abuse screening
• Substance abuse counseling
• Substance abuse referrals

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About Our Patients

• As of November 2007, 17 million patients with 68
  million patient visits
  
• 91.9 of patients fall below 200 FPL
• Racial and ethnic minorities comprise almost 2/3
  of our patient population
  
• 39.8 are uninsured 37.4 have Medicaid or
  another public insurance coverage
  
• 28.9 of patients report being best served in a
  language other than English

Data sources Uniform Data System 2006
National Association of Community Health Centers
2007 www.bphc.hrsa.gov
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The Impact of Health Centers

• Improve access to primary and preventative care
• Cost effective care
• High quality care
• Reduction in Health Disparities
• Effective management of chronic illness
• Improve birth outcomes
• Create jobs and stimulate economy

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Importance of Planning for Health Centers

• Serve as advocates for medically underserved
• Mission driven organizations serve their
  communities
  
• Closely linked with hospitals and health
  departments
  
• Financially lean need fast recovery
• Historical roles in emergencies patients WILL
  seek care from their health center
  
• Accreditation requirements
• HRSA Expectations

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Potential Roles in Emergency Management

• Provide services to CHC patients
• Increase ER Surge Capacity on off site
• Triage patients
• Provide mental health services
• Disease or syndromic surveillance
• Serve as conduit of information to patients and
  community
  
• Outreach to hard to reach populations
• Mobile clinics
• Provide culturally competent, linguistically able
  provider/support staff
  
• Distribute medications or vaccines to patients,
  staff, community members (PODs)
  
• Provide medical/dental/MH staff for alternate
  care sites
  

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Past Experience in Emergencies

• Treatment of respiratory and eye irritation in
  New York, New Jersey, and Washington DC following
  Sept. 11 attacks
  
• Diagnosis and treatment of first monkeypox
  victims in Wisconsin and Illinois
  
• Treating storm related injuries and administering
  tetanus and hepatitis after Hurricane Katrina
  
• Treating patients at community shelters and
  dispatching mobile clinics in CA during wildfires
  in 2003 2007
  
• Augment staff in ER and Medical Care Shelters in
  KY following tornados in 2008

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Engaging Health Centers

• REACH OUT!!
• Assess resources, capacity, capabilities
• Determine role(s) for Health Center
• Include in exercises and drills
• Involve in ESF-8 and/or other planning meetings
• Provide funding and access to other resources

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How to Find Health Centers in Your Area

• Contact the PCA in your state (http//www.nachc.co
  m/nachc-pca-listing.cfm)
  
• Visit http//ask.hrsa.gov/pc/

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Questions?

• Mollie Melbourne
• Director of Emergency Management
• National Association of Community Health Centers
• coca_at_cdc.gov

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Summary

• All hazards preparedness efforts make sense !
• Natural Disaster
• Terrorist Attack
• Known Infectious Diseases
• Unique Infectious Diseases
• Infrastructure Challenge
• Know the current plans planning resources
• Federal
• State
• Local community
• Businesses

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Summary

• Determine the needs of your area, organizations
  and community.
  
• Develop preparedness plans.
• Share resources!
• Exercise and evaluate.
• Preparedness actions must be taken BEFORE an
  actual event !

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Acknowledgments

• CDC COCA
• CDC Epi-X
• CDC Emergency Communications System
• CDC INFO
• CDC DEOC

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Thank you!

• The findings and conclusions in this
  presentation have not been formally disseminated
  by CDC and should not be construed to represent
  any agency determination or policy.

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Complacency is the enemy of health protection!
www.pandemicflu.gov
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Further questions?

• Please email us at coca_at_cdc.gov

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