From NHSS Objectives to PPHR Criteria—Too Many Requirements, Not Enough Resources: How the Advanced Practice Centers Can Help

New this year from the Centers for Disease Control and Prevention Public Health Emergency Preparedness Program (PHEP), is the introduction of the 15 Target Capabilities.  Change is never easy, but the National Association of County and City Health Officials’ Advanced Practice Centers (APCs) products can make it much easier!  The national APCs have created a myriad of tools to help you as you begin to implement the new Target Capabilities. The APC tools are developed by local health departments (LHDs) specifically for LHDs, and  should make implementation of the new Target Capabilities a lot less painful.

Examples of APC tools that correlate include (1) TCL—Community Preparedness-APC Child Care Partnerships; (2) TCL—Emergency Public Information and Warning–APC Call Center Surge; and (3) TCL—Fatality Management – APC Toolkit for Mass Fatality Planning.  We live in an alphabet soup of acronyms—TCL, PHEP, CDC, HHS, ASPR, NACCHO, APC, NHSS, and so on.  The acronym you are going to want to remember is NACCHO-APC.  So before you even begin to implement the new 15 PHEP Target Capabilities, please check out the NACCHO APC tools that will make life easier—you’ll be happy you did!

For additional information, visit  www.naccho.org/topics/emergency/APC/index.cfm.

Ann Steeves, Founder and President of HC-EMI and a former HPP Regional Coordinator, has extensive experience in the emergency preparedness arena working with public health, health care, emergency management, EMS, Tribes, and businesses.  Ann is an Incident Command System (ICS), Homeland Security Exercise and Evaluation Program (HSEEP), and Continuity of Operations (COOP) Instructor and has facilitated strategic planning and exercise development for large groups. Contact Ann at asteeves@hc-emi.us or visit www.hc-emi.us for more information.

Public Health and Community Pharmacy Collaborating for All-Hazard Preparedness and Response

In Wednesday’s session, “Public Health and Community Pharmacy Collaborating for All-Hazard Preparedness and Response,” the presenters discussed how establishing relationships between community pharmacies and public health can be a beneficial approach to emergency preparedness and response. The panel included the following participants: Lisa A. Rosenfeld, Palm Beach County Health Department; Mitchel Rothholz, American Pharmacists Association; Rachel Abbey, Montgomery County Advanced Practice Center; and Lisa Koonin, Centers for Disease Control.

Rothholz explained that the pharmacists’ collaboration with public health builds three positive underlining principles: access, proximity, and hours.

“Pharmacies are in a unique position where they can reach mass numbers of people,” said Rothholz, “since 93 percent of Americans live within 5 miles of a community pharmacy.” Not only do pharmacists reach and communicate with many people, they are also viewed as highly trustworthy in the public eye.

Ninety-six percent of pharmacies are computerized, with databases of health information that could facilitate the targeting of messages to at-risk patients. Yet, these resources are not being optimized for emergency preparedness. However, this type of accessibility with pharmacies could meet the modern needs of public health care.

Vaccinations are one way in which pharmacies are helping to relieve some of the pressure felt by public health departments and physicians. Right now, 50 states allow pharmacists to administer immunizations, though certain restrictions vary by state. Approximately 147,000 pharmacists nationwide are trained to give vaccines. But despite the rising numbers of pharmacists qualified to give vaccines, some public health issues will require more than increased training. Patient age limitations have been an obstacle in some states.

One of the most recent examples was during H1N1, when pharmacists were not allowed to give vaccines to individuals under the age of 18. This caused public health officials and pharmacists to attempt legislative change on age restrictions. Changing such laws would enhance the value of pharmacists, especially considering the ease of access they provide to this portion of the population.

Vaccines are just the tip of the iceberg when it comes to the possibilities provided by pharmacy collaboration with public health. However, many more prospective partnerships such as product distribution, diabetes management, and cholesterol management, could spring from such partnerships.

Rosenfeld also discussed practical ways to engage public health and community pharmacies. She used the example of flu information cards created for pharmacy counters, which includes items you should have in your medicine cabinet at home.

To help aid public health officials in engaging pharmacists, suggestions include the following: attending adult and childhood immunizations coalitions, speaking with your local community pharmacy supervisors, and contacting your local/state pharmacy association.

Finally, public health and community pharmacies need a centralized place where information, resources, and conversation can be shared. A website was developed by the Montgomery County, Maryland Advanced Practice Center called “A Prescription for Preparedness.”  This is an online environment for pharmacists and local health departments to connect on the issue of public health emergency preparedness. The sites tools are free of charge, adaptable, and can be customized to your own logo. For more information, visit www.rx4prep.org.

Jessika Boedeker is a graduate student at the University of Georgia pursuing Health and Medical Journalism.

Help Ready America for Emergencies

Sick of searching for quality tools and resources on community partnerships with pharmacies? Montgomery County APC has the cure. Attend “A Prescription for Preparedness: An Online Community for Local Health Departments and Pharmacists to Help Ready America for Emergencies” session.

When: Thursday, Feb. 24 at 3:30 PM
Where: International 10 Room
Who: Montgomery County APC and Palm Beach County Health Department
What: “A Prescription for Preparedness: An Online Community for Local Health Departments and Pharmacists to Help Ready America for Emergencies”

On Thursday, Feb. 24, the Montgomery County Advanced Practice Center and Palm Beach County Health Department will present a sharing session titled “A Prescription for Preparedness: An Online Community for Local Health Departments and Pharmacists to Help Ready America for Emergencies.”

Please visit International 10 Room at 3:30 PM to see a demonstration of the virtual toolkit that has been created to help local health departments reach out to pharmacists and pharmacies to better prepare for emergencies. More important, share your thoughts and ideas about the virtual toolkit. The toolkit is dynamic—case studies, resources and tools are continually updated—so it can best serve to help ready America for emergencies. Add your name to the list of survey participants to keep in contact and help us continue to improve this virtual toolkit. Visit www.rx4prep.org.

If you are not able to attend the roundtable session but would like to comment on the virtual toolkit, please contact  MontgomeryAPC@montgomerycountymd.gov.

Jeanine Gould-Kostka serves as a project coordinator with the Montgomery County, Maryland, Advanced Practice Center for Public Health Preparedness and Response. She worked in research for nine years at the Food and Drug Administration and the National Cancer Institute. Ms. Gould-Kostka has been employed by the Montgomery County Department of Health and Human Services since 2004.

Priority Setting and Staffing During Emergencies: A Delicate Balancing Act

There’s no doubt about it. Effectively managing the multiple activities a local health department (LHD) coordinates during an emergency can be complex. The situation becomes even more difficult with finite resources and when response priorities are torn between two major activities: public health investigations and mass prophylaxis operations (hint: think H1N1).

We’ve all experienced it: budget cuts, layoffs, restructuring, and funding rejections. The list goes on and on, and there doesn’t appear to be an end in sight in the near future. With fewer human resources at our disposal for use on the front lines of a public health response, agencies must make tough decisions concerning where to place personnel in order to adequately execute operational objectives while mitigating the effect of an emergency.

The Advanced Practice Center (APC) at Multnomah County Health Department (Portland, OR) has developed a resource to assist LHDs with doing just this. The Staff Allocation Decision Guide allows an experienced administrator, preparedness leader, or incident commander to make tough decisions related to the placement of personnel both in advance of and during a public health emergency, to the following public health interventions:

•    Public health investigation (e.g., the process of disease investigation, surveillance, contact tracing and case management) of a naturally occurring disease, food-borne outbreak, or a chemical/biological/radiological/nuclear event; and

•    Mass prophylaxis operation (e.g., the process of dispensing or distributing medicines and/or vaccines) to mitigate the health impact of a public health threat.

While the tool applies to any incident calling for both investigation and prophylaxis operations, it is aimed at larger-scale emergency operations requiring rapid decision-making to obtain and allocate surge staff beyond the capacity of the LHD—decisions that may have to be justified to or approved by authorities (e.g., Board of Health) within or outside of the LHD.

Emergencies are stressful—the response doesn’t have to be. Come learn more about how this tool can help you better manage your emergency operations at our sharing session and the national APC booth.

Below is information about the sharing session and APC booth:

•    Sharing Session: Wednesday at 1:30 PM, session B-02,  “Modeling Before, During, and After Disease Outbreaks to Improve Outcomes”
Location: A 703/704

•    APC booth (#1726):  Tuesday evening, Wednesday, and Thursday
Location: Vendor hall

Contact Beth McGinnis at beth.mcginnis@multco.us or 503-793-5765 to set up a chat, or stop by our session to learn more!

Beth is the Program Supervisor for the Advanced Practice Center at Multnomah County Health Department in Portland, OR. She has worked in various public health arenas in the Pacific NW for nine years, following her graduation from Oregon State University with an MPH in 2002.

A New Model for Just-in-Time Training—Just in Time for More Budget Cuts?

How do local health departments (LHDs) respond to public health threats with less people and less money to invest in emergency preparedness infrastructure?  According to recent research from the National Association of County and City Health Officials (NACCHO) on the state of LHD funding, “From January 2008 to December 2009, LHDs lost a cumulative 23,000 jobs due to layoffs or attrition—approximately 15 percent of the LHD workforce.”  While this is not news to LHD staff working in the trenches, it highlights an ongoing significant issue in public health preparedness.

In order to create a robust operational structure during an event, LHDs will rely on community partners, volunteers and existing staff to execute operational objectives.  Many of these new partners may not regularly perform certain tasks undertaken in an emergency as part of their daily operations. With a lack of funding to support the ongoing training of these persons, LHDs are left to train persons with limited exposure to emergency operations at the moment of operational need via Just in Time Training (JITT).

The Advanced Practice Center (APC) at Multnomah County Health Department (Portland, OR) has developed a promising practice to assist LHDs with conducting  JITT. Pulling from adult learning theory concepts, this new inclusive training model is a deliberate effort to meet responders’ needs (i.e., intellectual, behavioral, emotional) and learning styles (i.e., auditory, visual, applied), as well as recognizing the cultural context (i.e., individuals, groups, organizations) of presenting during an operation.

By combining and integrating these approaches in the JITT setting, LHDs will benefit from greater information uptake and retention among emergency responders. Thus, preparedness planners will get the most bang for their training buck, which most will agree is critical in declining resource environments. Ultimately, a well informed, supported, and aware workforce leads to strong emergency operations and will allow LHDs to better serve their communities.

The Multnomah County APC will be sharing more on this model at during the Summit. You can find us at:

• The APC pre-conference workshop on Tuesday, session number WS-15, titled: “Innovative Solutions: Advance Practice Centers Leading the Way in Public Health Preparedness”.  (Location A 706/707; 8:30 AM–5:30 PM)
• In the poster hall on Wednesday, Thursday, and Friday—poster number 269 titled:“Enhancing training during public health emergencies: An Inclusive Just-in-Time (I-JITT) Approach.”
• At an interactive session on Wednesday at 3:30 PM, session number C-03, titled:“Americas Top Model and Training Day All in One: Improving Mass Prophylaxis Operations with Just in Time Training and Computer Models.” (Location: International 8/9)
• At the national APC booth in the vendor hall on Tuesday evening, Wednesday, and Thursday.

Interested in connecting with us? Stop by our sessions to learn more or contact Beth McGinnis at beth.mcginnis@multco.us or call ( 503) 793-5765 to set up a chat.

Beth is the Program Supervisor for the Advanced Practice Center at Multnomah County Health Department in Portland, OR. She has worked in various public health arenas in the Pacific NW for nine years, following her graduation from Oregon State University with an MPH in 2002.