Posts Tagged ‘public health emergency’

What’s the Medical “Standard of Care” in an Emergency?

January 23rd, 2014

Good question.  Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. For example-  hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies, and beds could be in short supply; and alternate care facilities may need to be used. 

You can imagine how difficult it would be to set alternative standards of care in the middle of an emergency- which is why we’ve been working with a statewide Crisis Standards of Care planning group since last January.  Our Public Health Emergency Preparedness team has been working with healthcare, public health, emergency management, and legal experts to develop a plan and a set of standards to guide the delivery of healthcare during the most catastrophic disasters- providing guidance for managing scarce resources (both people and stuff) in an emergency. 

A key resource is a landmark crisis standards of care report developed by the Institute of Medicine- which examines indicators and triggers that guide the implementation of crisis standards of care and provides a toolkit to help stakeholders establish indicators and triggers for their own communities.  The IOM report has toolkits for behavioral health, emergency management, emergency medical services, hospital care and public health.

Strategic National Stockpile Readiness

February 27th, 2013

The CDC’s “Strategic National Stockpile” is a large quantity of medicine and medical supplies that are available to states in case there’s a public health emergency (flu outbreak, asteroid, etc.) severe enough to cause local health supplies to run out.  Once federal and local authorities agree that the stockpile is needed, meds and supplies are delivered to any state in time for them to be effective. Each state is responsible for receiving and distributing the stockpile assets to local communities fast. 

Our Public Health Emergency Preparedness shop is responsible for the overall planning and execution in AZ.  The Plan (which isn’t posted on-line for security reasons) provides a step by step approach to accessing and distributing pharmaceuticals, vaccines and other medical equipment and products stored by the Feds.  Our Plan is evaluated yearly by the CDC.  The review covers every aspect of our plan… including how we communicate with the public, work with our healthcare and Agency partners as well as how we plan to work with vulnerable populations should SNS assets be needed. 

This year we got a score of 93% from the CDC…  and our partner counties (Pinal and Maricopa) received similar scores- demonstrating that the plans work together effectively to serve the public when they need to be activated.  We’ll be testing these plans during a full-scale exercise this week.  Congratulations to our preparedness rock-stars Teresa Ehnert, Marcus Castle, Stacey Cain and the whole emergency preparedness team! 

By the way…  we received and executed stockpile assets (antiviral medications and other healthcare supplies) during the 2009 H1N1 Influenza pandemic.  Our turnaround time from the minute we received the first shipment until everything was at its local destination was less than 36 hours- an impressive testament to our ability to plan and execute during a public health emergency. 


Annual Preparedness “Reportcard”

January 15th, 2013

Every year a group called the Trust for America’s Health puts out a ‘Report Card” regarding what they believe is an assessment of each state’s readiness for a public health emergency.  They use various measurements that they can find and grade each state against each other.  The implication is that states that do poorly won’t be able to execute in a public health emergency and the ones that do well will do fantastic.  The problem is that they usually pick measuring sticks that have little to do with real public health readiness, things that public health systems have little control over, or both.  Sometimes the points are awarded for things that are cosmetic.  I don’t have any objection to outside entities scoring and passing judgment on states’ preparedness…  but I do object when the criteria they use has little to do with the conclusions they draw. 

For example- in this year’s report AZ lost 3 out of a total of 10 possible points because our whooping cough vaccination rates are 86% (rather than 90%), there’s a $5 co-pay for flu shots under the state Medicaid program, and the fact that AZ doesn’t have a comprehensive global warming action plan.  Using those criteria- are you ready to conclude that our state’s public health preparedness network is unable to effectively respond to a public health emergency?  (That’s a rhetorical question). 

Safeguarding the public’s health is more important than ever.  Whether the threat is a disease outbreak, environmental hazard or natural disaster, the public health system works 24 hours a day, 7 days a week to keep Arizonans safe.  Each year, the CDC evaluates state and local public health preparedness programs in a detailed report that measures what really matters.  This year’s installment is entitled 2012 State-by-State Report on Laboratory, Emergency Operations Coordination, and Emergency Public Information and Warning Capabilities.  This document outlines each state’s ability to perform key laboratory functions, engage in emergency operations, and develop and distribute public health messages.  While Arizona wasn’t perfect in this year’s CDC report- we did pretty darn good. 

For example, our Lab tests thousands of biological and chemical samples each year, and is a cornerstone of our public health system.  As a part of the Laboratory Response Network, we’ve consistently demonstrated its ability to detect high-threat biological agents like anthrax. Our lab team works long hours to test samples from suspicious packages and provide accurate results to our first responder community. As the report indicates, one area for improvement is our turn-around-times for pulsed-field gel electrophoresis testing- a technique used to identify organisms that commonly cause food borne illness.  We’re working to improve these turn-around-times by ensuring we have the right staffing and resources needed to meet these bench marks.  

Another capability addressed in this year’s CDC report is Emergency Operations Coordination.  ADHS has participated in dozens of exercises and drills over the past several years to prepare our staff for public health emergencies.  For the 3rd year in a row, our staff met the 60 minute target for Emergency Operations Center activation.  Similarly, our staff successfully demonstrated our ability to develop and distribute public health messages in a timely manner.  These examples illustrate our ability to manage public health emergencies and safeguard the public’s health during a disaster.  

For our employees that work in preparedness throughout Arizona’s public health system- the work is never done.  But I’m proud to say that we’ve achieved all of our emergency preparedness targets, and nearly all of the lab requirements for this year’s report.  Thanks to all of our preparedness staff for their hard work and dedication.  Well done.

Regulatory Relief in a Public Health Emergency

February 17th, 2011

I often write about the benefits and leverage we can achieve for our public health goals by partnering with external organizations and Stakeholders, but sometimes the collaborative initiatives are with ourself.  Our Medical Facility Licensing and Emergency Preparedness teams have been working with our licensed facilities to figure out what they’d need in terms of regulatory relief if there’s a public health emergency.

For example, the question of granting and getting regulatory relief in a public health emergency is more complicated that it sounds right off the bat, because there are a host of federal (Centers for Medicare and Medicaid) and state rules and regulations that apply (here’s info on the H1N1 declaration).  Kathy McCanna and Connie Belden from Licensing put together a terrific PowerPoint on this subject to help providers to incorporate waiver requests into their disaster plans.   They presented at the January Alternate Care System conference for the Central Region (Maricopa, Gila and Pinal Counties) and will be presenting the material next month at the Western Region conference.  Thanks for going above and beyond.

Congratulations Mohave and Yuma Counties!

June 18th, 2010

A big round of applause is due for Patty Mead and Becky Brooks and their teams at Mohave & Yuma Counties for receiving full recognition for Project Public Health Ready (PPHR).  Their teams persevered through the process, didn’t give into frustration when additional documentation was needed and came out on the winning end. ADHS is proud to be a partner in the process and hope that this will provide some encouragement to those going through the process right now.

PPHR is a public health preparedness training and recognition program that helps local health departments to build organizational capacity to respond to public health emergencies. The program is the only national standard for local public health preparedness and includes preparedness planning, workforce capacity development, and demonstration of readiness through exercises or real events and it’s been the primary deliverable under our CDC public health preparedness cooperative agreement.  Nice work getting this done, especially since you did in the middle of an influenza pandemic!