Next year’s Public Health Preparedness Summit will be held in Anaheim, California.

1. Visit the webpage: http://www.phprep.org/2011/Agenda.
2. Now, click on “Searchable Schedule” under the “Agenda” tab.
3. Click on the speaker’s name and you’ll find the presentation file (if uploaded).

Who was at the Summit?

If you want to check out who was at the 2011 Public Health Preparedness Summit, click here.

Continuing Education Evaluation Deadline

The deadline for completing the continuing education evaluation is March 28, 2011. Visit the CDC Training and Continuing Education Online website at www.cdc.gov/tceonline to complete the evaluation survey. Additional instructions are available at www.phprep.org/2011/agenda/evaluation.cfm.

2011 Public Health Preparedness Summit Survey Deadline

The Summit survey closes March 28, 2011. Upon completion of the survey, you will be entered into a drawing to win FREE registration, airfare, and three nights hotel accommodations at the 2012 Summit in Anaheim, CA. Visit www.phprep.org/evaluation to access the brief survey.

Facilitator:
Rebecca Gehring, BA, MPH

Presenters:

Paul Epstein, BS
Nancy Carlson, BS

Paul Epstein of the Results That Matter Team, Epstein & Fass Associates and Nancy Carlson of the Minnesota Behavioral Health MRC, Minnesota State Department of Health, held an interactive session to discuss the importance of strategic planning for community resiliency by using the balanced scorecard approach. This approach allows an organization to align their activities to reach unified public health outcomes—community resiliency.

Over 40 people divided into small groups to participate in a basic strategy map tabletop exercise. The goal of the tabletop exercise was to develop a Community Public Health Preparedness Strategy Map. The exercise gave participants opportunities to discuss how community assets, community process and learning, and community implementation allow for  community health outcomes (strategic goals).

After the exercise, Carlson briefly described the functions of her behavioral health MRC unit and her experience with strategic mapping. She presented a real-world event and explained how she used the draft strategic road map during the fall 2010 flooding in Minnesota. This real world event helped validate what really worked when compared to the hypothetical steps and outcomes developed during the planning process. After the event, Carlson reviewed her lessons learned and revised the MRC unit’s strategic map so it actually aligned to her organization’s capabilities.

The revisions have lead to organizational change. Minnesota is now using the revised MRC road map to increase development and implementation of the key elements necessary to respond to a major spring flood. Instead of recruiting volunteers to develop regional strike teams, counties and regions will now be asked to put together their own qualified volunteers with leadership roles.

In conclusion, it is important to understand that a strategic road map is a living document which  can and should be adapted and/or revised to address needs within the local community.  Efforts like these will ultimately lead to developing and improving resiliency.

Rebecca Gehring is a Program Associate on the Public Health Preparedness Team at the National Association of County and City Health Officials.

Presenter:
Keith Hansen, BS

Sharon Medcalf, RN, MEd, and Keith Hansen from the Center for Preparedness Education (CPE) in Omaha, NE, presented a captivating session about after-action conferences on Thursday at the 2011 Public Health Preparedness Summit.  The focus of the session was about how the CPE acted as a third-party facilitator for seven local health departments’ after action conferences (AAC) in response to H1N1.

The CPE staff found that as an impartial third party, they could allow all individuals involved with the response to be active participants in the AAC, and by using a consensus workshop method, the AAC’s could be run more efficiently and effectively.  CPE staff designed a survey which meets HSEEP requirements, and CDC and state requests, and then disseminated it to all individuals involved in the response.

The data from the surveys was shared with each local health department, and served as a framework for discussion points during the AAC.  After facilitating each AAC, the resulting comments on strengths and areas needing improvement were categorized and delivered to each department, essentially giving all of the content needed in order to write a comprehensive after-action report.  Because the CPE is funded entirely by grants, it was able to provide this service free to all interested health departments within the state.

For more information about the CPE process, and how to use it in your jurisdiction, contact Sharon Medcalf and Keith Hansen at the Center for Domestic Preparedness at Center@preped.org.

Connor Scott is a Program Associate on the Public Health Preparedness Team at the National Association of County and City Health Officials.

If you complete the survey, you will be entered into a drawing to win FREE registration, airfare, and three nights hotel accommodations at the 2012 Summit in Anaheim, CA. The survey closes Monday, March 28, 2011. To take the survey, visit www.phprep.org/evaluation .

Continuing Education Credit
The deadline for completing the continuing education evaluation is March 28, 2011. Visit the CDC Training and Continuing Education Online website at www.cdc.gov/tceonline to complete the evaluation survey. Additional instructions are available at www.phprep.org/2011/agenda/evaluation.cfm.

Thank you and we look forward to receiving your feedback.

James Blumenstock, MA

Presenters:

William Stephens, MS
Michael Heumann, MPH, MA
Adela Salame-Alfie, PhD

What is the National Alliance for Radiation Readiness (NARR)? It’s the voice of health in radiological preparedness! It’s a new and growing coalition, striving to improve the nation’s ability to prepare for, respond to, and recover from a radiological event. Wednesday’s session about the NARR was an energetic discussion of the past, present, and future.

Adela Salame-Alfie, PhD, New York Department of Health, presented the evolution of the NARR. It grew with recognition by the Centers for Disease Control and Prevention’s (CDC) need for better coordination following the 2006 Polonium-210 Russian spy poisoning incident to the 2008–2009 discussions among public health association members about priorities and gaps in t he field and the need for a coalition.

Jim Blumenstock, MA, Association of State and Territorial Health Officials (ASTHO), focused on the present—how the organizations that currently make-up the NARR (American Medical Association, American Public Health Association, Association of Public Health Laboratories, ASTHO, Conference of Radiation Control Program Directors, Council of State and Territorial Epidemiologists, Health Physics Society, National Association of County and City Health Officials, National Disaster Life Support Foundation, National Emergency Management Association) are working together. The NARR is developing tools, improving communication, and raising awareness of radiological issues.

Focused on the present, but with an eye toward the future, Michael Heumann, MPH, MA, Oregon Public Health Division, gave the crowd a sobering assessment of the current state of radiological preparedness. Results of the 2010 CSTE  membership survey indicated that in nearly every measure of public health capacity and capability, the nation is poorly prepared to respond to a major radiation event. For example, a fundamental step of preparedness, the development of response plans, has not occurred in 45 percent of responding states.

Not all is bleak, however. Response was better related to those who have exercised a dirty bomb scenario, for on-call coverage and other communications, and having mutual aid agreements in place.

Finally, Bill Stephens, MS, Tarrant County Public Health (TX), aimed squarely on the future and challenged the audience to join the NARR in becoming the community of practice around radiological preparedness.

The conversation covered the waterfront—from talking about the need to improve preparedness for the very type of substance that was used against the Russian spy in 2006 (alpha-emitters) to a comment about new FBI trainings for investigating criminal activities related to radiation. States, especially those without nuclear power plants, need to know what the real threats are in order to prioritize and plan for likely scenarios.

Following an event, messaging may need to be ahead of the signs and symptoms exhibited by the exposed. Like the community in Goiania, Brazil in 1985 (where 130,000 people flooded emergency rooms after an exposure, but only 20 had signs and symptoms of radiation sickness), the public may not wait for leaders to “be sure” about what the situation is. They’ll take immediate action and we need to be ready for that! How can radiation be integrated with current surveillance systems so as to minimize burden on local public health? How can we encourage continuity planning for businesses and families?  These are some of the questions that will guide the NARR’s work moving forward.

The NARR kick-off meeting is March 24-25, 2011 following the “Bridging the Gaps: Public Health and Radiation Emergency Preparedness” conference in Atlanta, GA. Look for the NARR website to launch in June 2011 with information and tools to help us become a more protected, resilient nation. For more information, contact Sterling Elliott at selliott@astho.org.

Sterling Elliott is a Senior Analyst of Public Health Preparedness at the Association of State and Territorial Health Officials. She provides staff support to the National Alliance for Radiation Readiness (NARR).

The session was particularly interesting because Athar showed participants how GIS software was used to correct and improve items noted in the flooding after-action report. She presented multiple capabilities of the program and how she used them to improve decision-making, organize data management, and control resource allocation. Athar also shared insight on how local health departments can obtain training and pursue purchasing GIS software.

Connor Scott is a Program Associate on the Public Health Preparedness Team at the National Association of County and City Health Officials

Christa-Marie Singleton, MD, MPH, Centers for Disease Control and Prevention (CDC) Associate Director of Science, and Shakir McLean, a pre-medical student at the University of Delaware, presented and facilitated the discussion. McLean and Singleton shared their considerations in choosing the PHEP awardees, who are charged with identifying risks for human health threats in their communities.

“A key piece of PHEP begins with that risk assessment,” said Singleton. Not only should risk be assessed, the CDC now encourages PHEP awardees to define risk as it pertains to their communities.

For instance, a public health planner can call upon mathematical formulas to help define (and prioritize) risks, such as “Risk = Hazard x Vulnerability – Absorptive Capability of Jurisdiction.”

“When you don’t have a definition of risk, it’s very hard to prioritize what needs prioritizing,” said McLean.

During the summer of 2010, McLean assessed the plans awardees already had in place, assigning a rating from 0 to 4, ranging from preliminary plans to well-developed plans. While no awardee received a score of 4, McLean noted that the best plans identified vulnerable populations. Some called upon Geographic Information System (GIS) technology, such as ESRI mapping, to locate persons requiring extra care.

“You will adjust your mass care planning based upon that risk assessment,” said Singleton.

As for the risks themselves, the CDC now encourages communities to identify and plan for the most salient hazards. For instance, it is no longer considered crucial for Great Plains communities to create scenarios for a hurricane. “We’re not focusing as much on those planning scenarios anymore, because they don’t fit,” said Singleton.

The presenters called attention to the exemplary plan put forth by the University of California, Los Angeles (UCLA), which they deemed amenable for local use or by small states.

Kimberly Shoaf, Assistant Director for the UCLA Center for Public Health and Disasters said, “There are pieces that are very objective, and then the part that’s really important in community engagement…when, not if, this happens to us, who do you turn to? How do you want us to work for you?”

Singleton and McLean also advocated for community involvement in PHEP planning, but they acknowledged the difficulties in garnering participation. “The key piece that we did not see in our plans,is that community has to have a voice in your project,” said Singleton.

In focusing on the needs of community members, Singleton and McLean hope that plans will be better suited to communities and, thus, better executed. “The community’s expectations have to be met. Once you do that you’ll have greater adherence to the policy you’re setting forth,” said McLean.

For more information

View UCLA’s Public Health Incident Command System at www.cphd.ucla.edu.

See GIS in action at http://proceedings.esri.com/library/userconf/proc96/TO50/PAP028/P28.HTM

Chelsea Toledo is a graduate student at the University of Georgia pursuing her master’s degree in Health and Medical Journalism.

Creating and implementing preparedness messages for cultural or religious-specific groups is more difficult than meets the eye. Differences in belief, distrust of government, and media coverage can all affect how well a message is received. For local and state health departments, messages encouraging actions in the event of an emergency may do exactly the opposite of what they are meant to do.

What it all comes down to, explained Reeves, is not what message is delivered, but who delivers it. In times of fear and anxiety, people seek guidance from one or more sources. Some look to the government, others look to the news or media, some turn to perceived experts on the subject, and others turn to leadership from the community or faith-based groups. In turn, the suggestions from each of these sources vary and often contradict each other.

From the perspective of public health, it is important to recognize limitations in knowledge of a community’s values and needs; local leaders are often trusted, authorities on ritual or tradition, and in a position to reach more people. “We can’t be all things to all people,” said Reeves. Furthermore, the factors deciding hope, health, and healing vary with each community.

Building relationships with local community and religious groups and leaders is an effective way to ensure that community members will listen and take the suggested actions of public health departments. Community leaders can offer direction when the public is confused, divided between loyalties, or afraid of the consequences of not adhering to tradition during such events.

Reeves offered several tactics for effectively reaching community leaders, which is sometimes a difficult process. First, it is crucial to explain to local leaders that they and public health officials have a shared goal: healthy outcomes for the community. Emphasizing that this goal can be reached while honoring the community’s values, is also an important precursor to establishing such bonds.

A second productive way to reach community leaders is to educate using specific disaster scenarios. What if people are unable to leave their homes? Or buildings of worship were damaged? In instances like these, beliefs and tradition may come before government-suggested protocol. One session participant used the example of attempting to vaccinate a Somali community during H1N1. Members of the community were torn between what their doctors advised and what their spiritual leaders demanded— to not get vaccinated.

The key to collaboration, however, is to avoid the urge to tell communities what is or is not good for them. “The implementation of these strategies is instead derived from asset-based community development,” said Reeves. Rather than being the authoritative voice in the partnership, public health should give communities the chance to empower themselves and establish what works best for them by looking at existing assets and abilities.

Finally, collaboration and emergency preparedness cannot be maintained without consistent guidance and the appropriate tools. Reeves suggests collaborative workshops, surveys of community members, customizable disaster planning templates, information about other organizations, and ongoing communication.

In a nation with so many diverse communities, understanding the value of faith-based or community organizations can help public health preparedness messages reach more people and improve health outcomes.

Laura Smith is a first-year master’s student in Health and Medical Journalism at the University of Georgia.

During Wednesday’s session, “Incorporating Ethics into Emergency Planning and Response to Ensure Health Equity,” health officers and emergency planners from the Multnomah County Health Department in Oregon, discussed how they successfully created a program that allowed underinsured individuals to access vaccination and emergency care services during the H1N1 influenza pandemic. They based their community outreach program on the Department of Health and Human Services’ National Health Security Strategy that says, “information disseminated to the public must account for language and cultural differences…”

Likewise, the presenters hosted focus groups for specific ethnic and cultural groups to promote influenza healthcare services. For example, health officials organized “African-American Community Dialogues,” or sessions that provided vaccination information and addressed ongoing racial health care inequities in the African-American community. Shortly after the public information seminar, vaccinations were provided to interested individuals.

Additionally, planners organized free clinics to provide vaccination and flu-care services, and set up a hotline so concerned individuals could ask questions.  The presenters hoped that providing accessible services would minimize the economic and health-related impacts of community members. However, throughout the presentation, the speakers emphasized that services were not organized around political motivations, but rather ethical and moral principles.  Presenters said that effectively implementing a free public health service was dependent upon following a specific set of established ethical guidelines prior to organization planning, such as drafting specific ethical frameworks ahead of time. This made the task of deciding who and where the majority of the services would go to first, less complicated.

Acknowledging that children and older individuals were more vulnerable to the illness helped health officials make swift decisions on who should get an antiviral treatment first in case of a shortage.

Lastly, the presenters said they based their ethics framework on four key elements: common good, protecting the well-being of the entire population; justice, providing equal treatment to all community members insured or not; prudence, using expert advice to guide the response strategy; and respect, maintaining the dignity of the individual being treated. Organizers said that adequately accounting for all four key elements yielded a smooth, influenza prevention and control program.

To access Wednesday’s full presentation, please visit www.phprep.org/2011/Agenda/upload/B-09-Incorporating-Ethics-into-Emergency-Planning-and-Response-to-Ensure-Health-Equity.pdf.

Robyn Abree is a graduate student at the University of Georgia pursuing her master’s degree in Health and Medical Journalism.