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2014 Preparedness Summit: Disasters Don’t Take a Break for a Preparedness Summit

Apr 3, 2014, 11:53 AM

At the start of the 2014 Preparedness Summit meeting this week in Atlanta, Summit chair Jack Herrmann took a moment to remember the lives lost in the mudslide in Washington State last week and took note of the many public health workers who left their communities to help in the rescue and recovery. Since then, two more major disasters have occurred—the earthquake and tsunami waves in Chile and the shooting yesterday at Fort Hood. Conversations about those events, and other events back home that need the attention of public health staff even while they are on travel at a preparedness conference, can be heard in the hallways during breaks in the sessions as people who train for such disasters mourn the losses and offer their assistance.

Tom Hipper, Public Health Planner at the Center for Public Health Readiness and Communication at Drexel University in Philadelphia, had some advice for communications by public health departments not involved in a disaster earlier this week. Hipper advises delaying planned, non-urgent communication and sending out empathetic messages about the disasters which can help build community and resilience and give people a chance to become involved by expressing and sharing their sentiments. Hipper says empathetic communication can be a bonding experience and lets people know that others will be thinking about and trying to help them in the event of an emergency in their community.

In addition, says Hipper, while previously people outside a disaster area could often only help by donating money, they can now also be “digital volunteers” by posting and retweeting accurate information from credible sources about a disaster to let people impacted by an emergency know they’re not alone.

The Center maintains and updates a list of important preparedness resources.

>> Bonus Content: Read a previous NewPublicHealth Q&A with Jonathan Woodson on the U.S. Department of Defense’s overall approach to wellness and prevention for military, veterans and their families as part of our National Prevention Strategy series. 

This commentary originally appeared on the RWJF New Public Health blog.

Preparedness Summit: Effective Use of Social Media During a Disaster

Apr 2, 2014, 2:12 PM

“Two or three years ago we were urging you to ask your health directors for social media tools, and now we’re talking about how it’s making a difference,” said Tom Hipper, MSPH, MA, Public Health Planner at the Center for Public Health Readiness and Communication at Drexel University, who helped lead a session on social media and public health response at the Preparedness Summit on Tuesday. He was joined by Jim Garrow, MPH, Operations and Logistics Manager at the Philadelphia Department of Public Health.

While many in the audience of a couple of hundred attendees are still in the early days of using social media, the benefit of adding social media to communications channels for routine and emergency communication is clear said the presenters.

Examples included the use of Twitter by public health officials in Edmonton, Alberta last year after flooding covered the downtown area. So many users accessed the feed that it looked like spam and Twitter shut down the feed, forcing the health department to move to the police Twitter account and then to a private constable’s account when the second feed was also shut down. Despite the switches, a survey after the flooding showed that 98 percent of responders were satisfied with the health department’s responsiveness on social media.

There is also the Verification Handbook for digital content to help verify digital images on social media. One example of an altered report was a shark moving alongside a car in New Jersey just after Hurricane Sandy hit.

Hipper had strong advice for both novice and seasoned health department social media users:

  • During disasters, retweet important information from credible agencies, such as street closings from the Office of Emergency Management
  • Use Twitter message libraries when available. Drexel is creating one that includes messaging for all sorts of public health emergencies such, as an active shooting or a ricin attack. The value of the messages includes faster response in an emergency even if some tweaking is needed, and many of the preset messages are based on feedback to messaging used previously.
  • Engage your audience before an emergency so they will turn to your social media platforms if an emergency strikes. Hipper gave the examples of Chicago, which held an immunization Twitter chat last fall and had 180,000 followers, as well as the Boston Police Department, which already had 40,000 followers before the Marathon bombing last year and saw that number rise to 300,000 as the search for the bombers unfolded.

Hipper and Garrow also advised repeating information during a disaster because people join the conversation at different points; to announce when to expect next updates and what hashtags are being use; to point to other credible agencies for information; and to ask users to send questions which can help improve the information they provide.

This commentary originally appeared on the RWJF New Public Health blog.

2014 Preparedness Summit: Looking at the Past to Improve the Future

Apr 2, 2014, 11:19 AM

“Disasters pose questions of who [is helped] first and who...last,” said Sheri Fink, MD, PhD, a correspondent for The New York Times and Pulitzer Prize-winning author, to more than 1,000 attendees of the 2014 Preparedness Summit  in Atlanta this week. Fink is the author of Five Days at Memorial: Life and Death in a Storm Ravaged Hospital, about the response by health providers, first responders, volunteers, patients and family members who rode out the storm in a hospital that lost power in the early hours of the hurricane. Fink was the headline speaker for the first plenary session of the Summit.

Fink’s book—which Umair Shah, deputy director of Harris County Public Health and Environmental Health Services in Texas and a panelist for the plenary discussion, urged the audience to read even if they only had time to skim—takes a close up look at the response from what may have been mercy killings to heroics by family members who commandeered boats to help evacuate patients.

Questions posed during the emergency in New Orleans, said Fink, included whether the hospital should be taking in new patients during the storm at a time when it was trying to evacuate the patients there, and whether criteria for first evacuees should be maximizing numbers of lives saved or maximum number of years of life saved.

“And because there is no right answer, we need to develop better evidence to [rely on] when difficult decision are needed,” said Fink, who had been a disaster and conflict first responder.

In response to the deaths and delays of Katrina, Fink and other panelists including Shah, Paul Biddinger, MD, FACEP, director, emergency preparedness and response exercise program at the Harvard School of Public Health, and Nicole Lurie, MD, MSPH, Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, ticked off disaster response improvements including the creation of Lurie’s office, and the development of new partnerships—in particular public and private ones such as with hospitals and health departments. One key change—mapped data from the Centers for Medicare and Medicaid Services—helps responders identify people in the community whose medical conditions require them to shelter in place.  

Fink shared some recommendations for additional preparedness needs:

  • A need to update infrastructure that is vulnerable to collapse or breakdown across the country
  • Engage the public so that they will show their support for preparedness funding
  • Face the fact that all power can be lost and respond in that way
  • Promote research
  • Maintain flexibility and creativity

Fink shared some examples of creativity at Memorial Hospital in New Orleans, including hospital workers who used a truck to transport patients to another side of the building and then carried them up rickety stairs to the helipad since it could not be reached by elevator; workers who hotwired boats to aid in evacuation; and workers who found that neonatal incubators would not fit on some of the evacuation helicopters and so kept babies warm by tucking their heads under their own clothing and continued to ventilate them manually.

>>Bonus Content: Read a NewPublicHealth interview with Paul Biddinger.

This commentary originally appeared on the RWJF New Public Health blog.

2014 Preparedness Summit: Q&A with Paul Biddinger

Apr 1, 2014, 11:37 AM

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Paul Biddinger, MD, FACEP, director of the Emergency Preparedness and Response Exercise Program at the Harvard School of Public Health, was a member of this morning’s opening panel on disaster preparedness at the 2014 Preparedness Summit. NewPublicHealth spoke with Biddinger ahead of the conference on what students and communities need to know and do to be best prepared for a disaster.

NewPublicHealth: Is it a requirement for students in graduate school for public health degrees to take at least one class in disaster preparedness?

Paul Biddinger: It is not. They have the option, but it is not a required element of what they have to take.

NPH: How do you think recent disasters have informed what students and public health staff members need to know about response?

Paul Biddinger: I think some of what students need to know has always been the case—but maybe has been underscored by recent events—which is that no matter what you do in public health you may be needed as part of the response, and whether you're working in maternal and child health or smoking cessation or HIV/AIDS, when a disaster happens it’s all hands on deck. And I think the hurricanes, the pandemic and other events have showed that often we need to reach well outside the traditional emergency response or preparedness work staff in public health, and so everyone has to be flexible, has to be able to participate in the response. I think in order to participate in the response you have to know that there is an emergency operations plan, what your role in it would be, how you would get information, to whom you would be responsible or to whom you would report. And those are things that you should know ahead of time.

I think the other thing we see when we see these wide-area disasters like we saw in Sandy, like we saw in Katrina, is the central role that public health can play in coordinating the health response—that multiple hospitals, long-term care facilities, out-patient facilities such as dialysis centers all need to be coordinated in their response to achieve the best possible health outcomes for the community. And public health is in a particularly strong place in the community to be able to help make sure that each of those individual participants is pointed in the same direction and is leveraging the community resources as best they can.

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2014 Preparedness Summit: Q&A with Jack Herrmann

Mar 28, 2014, 11:49 AM

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NewPublicHealth will be on the ground in Atlanta next week for the 2014 Preparedness Summit, an annual event since 2006 convened by the National Association of County and City Health Officials (NACCHO) and other partners including the U.S. Centers for Disease Control and Prevention (CDC) and the American Red Cross. Summit attendees include preparedness professionals working in local, state and federal government, emergency management, volunteer organizations and health care coalitions.

Goals of the summit include opportunities to connect with colleagues, share new research and learn to implement model practices that enhance capabilities to prepare for, respond to and recover from disasters and emergencies.

Additional partners include the American Hospital Association; the Association of State and Territorial Health Officials (ASTHO); the Association of Schools and Programs of Public Health (ASPPH); the Council of State and Territorial Epidemiologists (CSTE); the Association of Public Health Laboratories (APHL); the Office of the Assistant Secretary for Preparedness and Response (ASPR); the U.S. Food and Drug Administration (FDA); the Medical Reserve Corps (MRC); the U.S. Department of Homeland Security (DHS); the National Association of Community Health Centers (NACHC); and the Veterans Emergency Management Evaluation Center (VEMEC).

In advance of the summit, NewPublicHealth spoke with Jack Herrmann, Senior Adviser and Chief of Public Health Preparedness at NACCHO.

NewPublicHealth: What are some important issues going on in disaster preparedness in the United States right now that make the Summit especially important this year?

Jack Herrmann: There have been significant budget cuts to the ASPR Hospital Preparedness Program, and that is going to impact local and state public health departments and health care facilities pretty significantly across the country. Hopefully the summit will provide a venue to better understand what those impacts might be and allow us as a community to voice our concerns to our political leaders around the impacts of those budget cuts. It will also provide some very substantive evidence for organizations such as NACCHO , ASTHO and others to advocate on behalf of our constituents.

NPH: What are some of the key plenary talks?

Herrmann: Sheri Fink, a correspondent at The New York Times, who is also the author of the Pulitzer Prize-winning book “Five Days at Memorial” about her experience during Hurricane Katrina, will be a keynote speaker. What we’re having her do during the session is look back to her experience during Hurricane Katrina and researching what happened during that time from a health care preparedness perspective—and the lives that were lost and the issues and challenges that health care facilities faced in the aftermath of that disaster—and looking at where we are now.

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Challenges Facing the Nation’s Emergency Care System: From Everyday Care to Disaster Preparedness

Mar 11, 2014, 9:00 AM

An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.

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Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?

Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble.   We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.

And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.

HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?

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The Affordable Care Act Bolsters Disaster Readiness

Mar 5, 2014, 9:00 AM

Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts  featuring RWJF Scholars who authored articles in the issue.

Nicole Lurie, MD, MSPH Nicole Lurie

As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.

The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.

Kacey Wulff, MPH Kacey Wulff

The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.

This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely. 

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Atlanta Needs Resiliency Lessons Before the Next Crisis

Jan 31, 2014, 10:45 AM

The fallout from this week’s snowstorm in Atlanta was a hot topic among many of the county officials attending the National Association of Counties (NACo) Health Initiative Forum in San Diego. Many have had to make tough decisions on crises in their communities—from flu to flooding to snow to shootings—and the consensus was that the snarled traffic, kids left to stay overnight in schools and thousands of cars abandoned marked a failure not of adequate preparation, but of communication and preparedness.

“You can’t know what disaster might hit, so you have to be prepared for everything,” said Linda Langston, NACo’s president and the supervisor of Linn County, Iowa, who has chosen resilient counties as her President’s initiative.

Langston said several steps can help reduce the trauma from disasters, including designating someone in each community to coordinate response, to stay up to date on dealing with emergencies, to building relationships among intersecting communities so that people trust each other in a disaster and to convening meetings with all sectors at the table. Langston pointed out that while schools and businesses don’t typically plan together, in the case of Atlanta’s snow storm most students and workers left the city for the suburbs at the same time of day, increasing traffic at the height of icy conditions. That might have been avoided by having a large pool of participants at the planning table.

“By inviting a member of the chamber of commerce, for example, to preparedness meetings and exercises, decisions can be made on traffic flow and other crowd control issues in the event of an emergency,” she said.

Langston, whose community saw devastating flooding in 2008, said recent preparations for possible flooding (that thankfully never happened) made city managers and the sheriff’s department—which controls the jail—realize they needed to coordinate on evacuation plans in the event of an emergency.

“And if the emergency never occurs, all those planning exercises create a more cohesive community, able to deal with run of the mill disasters like budget cuts, “ said Langston.

This commentary originally appeared on the RWJF New Public Health blog.

911 Needs an Update

Jan 21, 2014, 11:21 AM

A nine-year-old girl staying with her mother and siblings in a hotel room in Texas last month was unable to reach 911 to save her mother from an attack by the woman’s estranged husband because the child didn’t know to press “9” in the hotel room before “911” in order to reach an outside line. That death has led to a Federal Communications Commission (FCC) inquiry into how wide that problem is at U.S. hotels and is just one of many facets of the 911 response system that experts say needs updating. Other pressing issues include:

  • Call 911 from a land line and responding operators can usually track your location, which is crucial if a person is being attacked or collapses before completing a call. However, most centers don’t yet have the technology to track 911 calls placed from a cell phone. Current FCC rules call for wireless phones to have the needed GPS technology to allow 911 centers to track call locations by 2018.
  • While many people assume they can and do send 911 requests by text message, few 911 centers can access text messages currently and so most of those texts go unanswered. The four largest wireless telephone companies—AT&T, Sprint, T-Mobile and Verizon—have voluntarily committed to make texting to 911 available by May 15, 2014 in areas where the local 911 center is prepared to receive the texts. The FCC maintains a list of communities that can respond to 911 text messages which includes all of Iowa, Maine and Vermont, and some counties in a few other states.

“Our 911 systems today are pretty much voice-centric, last-century technology,” says Brian Fontes, CEO of the National Emergency Number Association (NENA). Fontes says that “the ability to have 911 communicate in the manner in which the public is communicating among itself today, is critically important.”

In addition, according to emergency experts new technologies would enhance the 911 response in many ways, including letting first responders see video and photos of an accident victim; demonstrate a needed emergency action, such as CPR, to responding laypersons; and even access medical records such as a victim’s medications, which could improve the response

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A Closer Look at California’s Drought

Jan 20, 2014, 12:33 PM

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For now, California’s drought is reported to be the state’s worst in forty years, but climate scientists fear the weeks ahead could see it get even worse.

A map (right inset) produced by scientists at NASA’s Goddard Space Flight Center shows how dry California is compared to other states. Climatologists generate groundwater and soil moisture drought indicators each week, based on satellite data and other observations. This map, from January 13, shows the extent of the drought in California, with lighter colors indicating better soil saturation and darker colors indicating very dry land, compared to historical averages.

California’s drought has public health implications for both the state and the rest of the country for several reasons, including the potential for continued fires fueled by dry grass and trees, which pose risks such as fire injuries, smoke inhalation injuries and even death.

There could also be a produce shortage linked to the water crisis. The Associated Press has reported that city water managers in the state say the drought conditions may mean they have, on average, only about 5 percent of the needed water for consumers and farms in California. According to the U.S. Department of Agriculture,  California supplies half of the fruits and vegetables consumed in the United States. Reduced crop sizes can also drive up produce prices because of a lower–than-usual supply and the need for imports, which can be more expensive because of shipping and other fees.

This commentary originally appeared on the RWJF New Public Health blog.