New Mexico
Community Health Council Training
Spring 2005

 Module One: Emergency Management from 20,000 Feet
 Module Two: The Prepared Community
 Module Three: We Are All Affected
 Module Four: The Resilient & Healthy
Community
 Module Five: Community Profile

Emergency Management from 20,000 Feet
What does health & medical emergency management look like at the national and state level?

Module One: Emergency Management from 20,000 Feet
 What is an emergency?
 Who’s on first?
 National, State, & NMDOH plans
 NMDOH roles

What Makes an Incident an Emergency or Disaster?
 affects entire community
 community needs surpass capacity
 include:
 natural disasters
 human-caused disasters
 technological disasters
 economic disasters

 two types recognized by state law:
 Civil emergency (State Civil Emergency
Preparedness Act)
 Public health emergency (Public Health
Emergency Response Act, PHERA)
 may be declared simultaneously

Response begins and ends at the local level:
 local command post set up
 local, county, or tribal Emergency Operations
Plan (EOP) activated
 local Emergency Operations Center (EOC) established

Mayor/CEO Requests
State Assistance
Mayor/CEO Declares
Local Emergency
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command Post
(ICP)
If the incident exceeds local capacity, the
Mayor or Chief Elected Official may request state assistance.

State EOC
New Mexico
All-Hazard
Emergency
Operations Plan
State Agency-
Specific
Emergency
Operations
Plans
Mayor/CEO Requests
State Assistance
Mayor/CEO Declares
Local Emergency
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command
Post (ICP)
If the incident exceeds State capacity, the
Governor may request Federal assistance.

President Declares
Emergency
National
Response Plan
Federal Agency
Assistance and other plans
Governor Requests
Federal Assistance
Governor Declares
Emergency
State EOC
New Mexico
All-Hazard
Emergency
Operations Plan
Mayor/CEO Requests
State Assistance
Mayor/CEO Declares Local
Emergency
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command
Post (ICP)
State Agency-
Specific
Emergency
Operations
Plans

To achieve and sustain capabilities that enable the Nation to collaborate in successfully
 preventing terrorist attacks on the homeland, and
 rapidly and effectively responding to and recovering from any terrorist attack, major disaster, or other emergency that does occur to minimize the impact on lives, property, and the economy.

Focuses on building capabilities in six priority areas, including strengthening medical surge capabilities establishing emergency-ready public health and healthcare entities

 integrates prevention, preparedness, response, and recovery
 comprehensive, national, all-hazards approach
 defines the federal government’s interface with state, local, and tribal governments, and the private sector

New Mexico All-Hazard
Emergency Operations Plan
 Developed by the Office of Emergency
Management (OEM) of the New Mexico
Department of Public Safety
 Refers to specific responsibilities during disasters
 NMDOH responsible for Annex 5 – Public
Health, Medical & Mortuary

NMDOH Emergency Operations Plan
 Identifies responsibilities for public health, medical, and mortuary response
 Includes the Basic Plan and Hazard and Response Specific Appendices

NMDOH Office of Health Emergency
Management (OHEM)
 CDC & HRSA Grant Programs:


Centers for Disease Control (CDC) –
Cooperative Agreement on Public Health
Preparedness and Response for Bioterrorism
Health Resources & Services Admin. (HRSA) –
National Bioterrorism Hospital Preparedness
Program

 Establish policies, procedures & standards
 Assess preparedness; develop & exercise preparedness & response plans
 Develop public health statutes & regulations
 Provide education & training related to emergency preparedness & response

 Respond to incidents, natural disasters, major disease outbreaks
 Coordinate with local, state, federal, and international response agencies
 Activate the NMDOH Emergency Operations Plan.
 Provide information & risk communication
 Collect, assess, and disseminate health surveillance information
 Provide services at PHSS locations

 Provide/coordinate laboratory testing
 Provide/coordinate provision of crisis response & mental health services
 Coordinate with OMI
 Facilitate community support in the event of evacuation, quarantine, or isolation
 Coordinate medical radio communication
 Coordinate availability of resources; request the
Strategic National Stockpile, when needed

 Screening
 Dispensing of prophylactic medication or immunizations
 Education
 Referral for psychosocial support

The Prepared Community
What does health & medical emergency management look like at the community and county level?

1.
Informed and involved public
2.
Prepared and informed professionals
3.
Planning, preparation and policies
4.
Communication systems and connectivity
5.
Scientific and technical support and other resources
6.
Administration, management, and fiscal systems

 timely, accurate, and useful public information
 comprehensive and coordinated Risk
Communication
 trained spokespersons, trusted by the community
 media contacts and media plan

Informed & Involved Public:
Public Information
 information to help individuals and families develop emergency plans
 information for non-English speakers, people with sensory disabilities, and those in remote areas
 culturally sensitive communication

Informed & Involved Public:
Risk Communication
 provision of information about the nature of the risk and recommendations for action
 before, during, and after a crisis situation
 accurate, honest, and immediate

 clearly defined roles and relationships
 ongoing, collaborative training for all active players
 ongoing, collaborative drills and exercises
 plan to pre-identify, train, and certify volunteers

Prepared & Informed Professionals:
Roles & Responsibilities
 Initial Responders
(First Responders/First Receivers)
 Hospitals & Health Care Providers
 Behavioral Health Providers
 Public Health Office Personnel
 Volunteers

Prepared & Informed Professionals:
Initial Responders
 First Responders and First Receivers
(Patient Receivers):
 Trained EMS personnel
 Fire fighters, law enforcement
 Primary care clinics and hospitals
 Anyone who receives patients directly from the field
 Even bystanders

Prepared & Informed Professionals:
Hospitals & Health Care Providers
 Prevention: vaccination programs, public education
 Preparedness: comprehensive and coordinated emergency management plans
 Response: participation in community response; activation of EOP; liaison to local EOC
 Recovery: emotional support to survivors; documentation of expenses and other items for reimbursement; “lessons learned”

Prepared & Informed Professionals:
Behavioral Health Providers
 Prevention: mental health promotion; community resilience
 Preparedness: comprehensive, integrated plans; resources and collaborations
 Response: participation in community response; crisis intervention, psychological first aid, and psychosocial support
 Recovery: longer term psychosocial support to survivors; longer term behavioral health clinical services to those in need; community resilience

Prepared & Informed Professionals:
Public Health Office Personnel
 Prevention : public education about public health emergencies and emergency response
 Preparedness : emergency response plans that are integrated with NMDOH and local emergency responders
 Response : participation in community response; provision of emergency-related health services
 Recovery : ongoing public education; sharing
"lessons learned" with other public health personnel statewide, NMDOH, and community

Prepared & Informed Professionals:
Volunteers
 important component of emergency response
 both pre-identified and spontaneous, unaffiliated volunteers
 could come from programs such as:
• American Red Cross
• Faith-based organizations
• Citizen Corps - Community Emergency Response Teams (CERT)
• Volunteer Organizations Active in Disasters (VOAD)
• National Disaster Medical System, including DMAT & DMORT
• NM Volunteer Health Professional Program (in development)
• Albuquerque Medical Reserve Corp Project (in development)

 understanding of community hazards
& vulnerabilities
 local Emergency Operations Plan
(EOP) addressing vulnerabilities
 local laws, ordinances, & policies

Planning, Preparation, & Policies:
Hazards & Vulnerabilities
 community vulnerabilities/hazards:
e.g., floods, forest fires, tornados, chemical spills, gas line explosions
 psychosocial vulnerabilities:
 everyone is affected
 some individuals/communities more vulnerable than others

Planning, Preparation, & Policies:
Local Emergency Operations Plans
 The county/community EOP should include a health/medical component with:
 Psychosocial plan
 Evacuation, quarantine, and isolation plans
 Considerations for populations with special planning needs

Planning, Preparation, & Policies:
The Emergency Operations Plan
 comprehensive, all-hazard in approach, focused on most likely hazards
 overview of response organization and policies
 general description of roles and responsibilities, command structure
 drilled and exercised, “lessons learned” identified

 notification and alert systems
 interoperable and redundant radio communication
 EMSystem ® in local hospital(s)

Communication Systems:
The Health Alert Network (HAN) email & fax notification of situations affecting the public health

Communication Systems:
EMSystem ®
 Provides hospital emergency departments with real-time information regarding:



Hospital status
Current emergency situations
Health alerts

Bed counts
 Allows better management of EMS services during regular activity and emergencies.

Communication Systems:
Radio Communication
 radio communication:
 interoperable – everyone can talk to everyone else – and
 redundant – different equipment and systems to keep communication happening
 amateur (Ham) radio operators provide additional communication capability

 interoperable IT systems
 policies and procedures for reporting notifiable conditions
 connected medical labs using uniform data standards
 mortuary resources
 pharmaceutical caches

 plans for mass prophylaxis and patient screening
 isolation and patient decontamination capacity and adequate PPE
 plans and procedures for patient surge

 strategic leadership to manage public health emergencies and disasters
 process for setting goals and objectives and allocating resources
 accounting and other record systems for documenting actions, expenses, etc.

We Are All Affected.
How does a disaster affect individuals, families, and communities?

The ripple effect
E
F
A
B
C
D

 Emotional : sadness, grief, anxiety/fear, guilt, anger, irritability, numbness, neediness, etc.
 Physical : tension, sleeplessness, aches and pains, appetite changes, agitation, etc.
 Behavioral : hypervigilance, withdrawal, changes in normal patterns, drug/alcohol use, etc.
 Cognitive : confusion, disorientation, difficulty concentrating, indecisiveness, memory lapses, etc.

 Emotional withdrawal of family members, especially children
 Increased use of alcohol and other substances
 Discord and/or increase in domestic violence
 Decrease in functioning as a unit

 Usually these are normal responses to abnormal situations.
 However, some individuals and some families are more at risk than others for developing longer term behavioral health problems as a result of disasters.

What makes some individuals & families more at risk than others?
 Pre-existing mental illness/substance abuse
 Prior history of trauma
 Chronic illness
 Physical, sensory, or cognitive disabilities
 Lower socioeconomic status
 Lower educational level
 Lack of family connections/community support
 Language barriers
 Immigration/citizenship status

 Mass panic is rare.
 More often:
 acts of heroism, compassion, selflessness
 community cohesion, resiliency
 community creativity, resourcefulness
 volunteers, donations

 We are all affected, but we are not all affected equally.
 Like individuals, some communities are more at risk for developing longer term problems after a disaster.
 And there are uniquely vulnerable population groups.

What makes some communities more at risk than others?
 Proximity to the event
 Lack of access to resources and services
 Discrimination or stigmatization of certain groups
 Lack of access to information, notification
 Stressful, violent environments
 Marginalized socioeconomic status
 Level of pre-disaster functioning capacity

 Children
 Elderly
 People with chronic mental illness/substance abuse disorders
 People with disabilities
 Culturally diverse communities
 Economically disadvantaged communities
 Others: homeless, incarcerated, institutionalized populations

 Process information and experience emotions differently than adults
 Less developed coping skills
 Difficulty deciding between fact and fantasy
 May blame themselves
 Differs according to age group and developmental level

 Common reactions:

Clinging to parent







Fear of strangers
Regression to earlier behavior
Worry, nightmares, fear of the dark
Changes in sleeping/eating habits
Reluctance to go to school
Disruptiveness
Drop in school performance

 Some elderly people may be more at risk because of:

Sensory deprivation




Delayed response
Chronic illness
Past trauma/loss
Reluctance to seek help; difficulty negotiating systems

Vulnerable Groups: People with Chronic
Mental Illness/Substance Abuse Disorders
 Issues to be considered when planning for people with chronic mental illness or substance abuse disorders :
 Confusion between symptoms of illness v. reactions to disaster
 Prior history of trauma
 Disruption of support networks, medications
 Increase in recidivism

Vulnerable Groups:
People with Disabilities
 Issues to be considered when planning for people with disabilities:





Difficulty accessing services
Exacerbation of medical conditions due to increased stress
Increased reliance on others
Separation from assistance animals, caretakers, special equipment, medications
Access to information channels

Vulnerable Groups:
Culturally Diverse Communities
 Issues to be considered when planning for culturally diverse communities:





Previous exposure to racism, violence, discrimination, poverty, trauma
Reluctance to seek out services
Cultural differences in coping
Language barriers
Undocumented status

Vulnerable Groups: Economically
Disadvantaged Communities
 Issues to be considered when planning for economically disadvantaged communities:




Lack of access to resources
Reliance on social service systems which may be overtaxed in a crisis
Lack of inclusion in planning, decision making
Lack of community protective factors; high rate of exposure to violence, alcohol and substance abuse, etc.

The Resilient and Healthy Community
What can we do? How do we prepare?
How do we respond?

Disaster Phases & Psychosocial Services
Psychosocial Interventions
The Resilient Community & the Community
Health Council

 Impact (Heroic) Phase
 Cleanup/Rebuilding (Honeymoon) Phase
 Restoration (Inventory/Disillusionment)
Phase
 Reconstruction (Restabilization) Phase

 0 – 48 hours:
 Addressing basic needs (safety, food & shelter, reuniting with family)
 Psychological “first aid”
 Monitoring of services, media coverage, & rumors
 Technical assistance, training, & consultation to organizations and other caregivers

 Within 1 Week:
 Assessment of current psychological status & needs
 Triage & referral to behavioral health professionals, when needed
 Outreach & information dissemination
 Fostering of resiliency & recovery

 Community outreach: culturally & linguistically appropriate services & social support
 Public education: information on normal stress reactions, coping mechanisms, availability of resources
 Education to health care providers about psychosocial issues of incident

 Provision of behavioral health interventions:
 defusing
 debriefing
 providing relaxation training and respite care
 promoting coping skills and strategies
 Identification & referral of survivors with serious reactions/problems to behavioral health professionals
 Issuance of death notifications & provision of grief services to survivors

 Continued provision care to individuals with disaster-related behavioral health problems
 education of providers
 screening
 outreach
 provision of variety of treatment modalities
 Provision of community services & support
 Employment of symbols & rituals

 Could take several years
 Involves individuals rebuilding their lives, families, homes
 Opportunity to look at response and identify lessons learned
 Opportunity to foster resilience

Principles of Psychosocial Intervention
 Do no harm – validate individual reactions.
 Assume resilience.
 Everyone who experiences a disaster event is affected by it.
 Be culturally competent.
 Respect individuals’ differences in reactions.

Principles of Psychosocial Intervention
 Simple human presence is reassuring.
 Offer flexible services.
 Utilize a team approach.
 Coordinate services with the larger response activity (i.e., fire, police, recovery agencies, etc.).

Principles of Psychosocial Intervention
 Most individuals do not require additional assistance, and return to pre-disaster level of functioning within 18- 36 months.
 Survivors with severe or long-term disorders should be referred to professional behavioral health providers.

 Protect from viewing additional traumatic stimuli from event
 Direct away from trauma scene and into safe environment
 Connect individual with loved ones, and needed information and resources.

 Address immediate physical needs
 Comfort and console survivor
 Provide concrete information
 Listen to and validate feelings
 Link survivor to support systems
 Normalize stress reactions
 Reinforce positive coping skills
 Facilitate telling of the “trauma story” as appropriate
 Support reality-based, practical tasks

 Crisis Intervention - similar to psychological first aid; aims to empower survivor to meet immediate challenges
 Informational briefing – usually provided by officials about situation status
 Psychological debriefing – group intervention for highly exposed survivors, emergency responders

 Psychoeducation – information about the nature of emotional reactions to disasters, grief and bereavement, coping strategies, how to recognize when to seek professional assistance
 Community outreach – contact where community members gather; reaching out via the media; attendance at meetings of faith-based organizations, schools, community centers; resource and referral information

 Capable of “bouncing back” from adversity
 All sectors inter-related and share knowledge, expertise & perspectives
 Wide community participation, local government commitment
 Healthy public policies

 Adequate access to basic needs, i.e., water, food, shelter, work, learning, etc.
 Adequate access to health care services
 Strong & diverse cultural & spiritual heritage
 When disaster strikes, financial & human losses are reduced

 Train individuals & families to make emergency preparedness plans:
 Exit route from home
 How to contact each other
 Where to gather
 Care for pets
 Emergency preparedness kits

 Identify and understand various populations and vulnerable groups in community
 Identify liaisons (“gatekeepers”) to groups
 Partner with organizations representing specific communities; i.e., faith-based orgs., youth & senior centers; schools, daycare centers; cultural organizations, etc., and recruit partners and volunteers
 Identify training needs of organizations
See: Community Health Emergency Management Profile

 Develop relationships with County Emergency
Manager, first responder groups, and Red
Cross chapter
 Develop relationships with local/district public health offices
 Participate in local emergency planning via attendance at Local Emergency Planning
Committee
 Advocate for inclusion of health issues in emergency planning

 Identify community resources; maintain current contact information:
 Emergency response community: emergency manager, elected officials, first responders
 Service providers: hospitals, health & behavioral health care providers, schools
 Community groups: Red Cross, faith community, service and charitable organizations, professional associations
 Volunteer groups: Community Emergency Response
Team (CERT), Fire Corps, Neighborhood Watch
Programs, Medical Reserve Corps, Volunteers in Police
Service (VIPS); block associations, etc.
See: Community Health Emergency Management Profile

 Create networks of related organizations
 The community is an interconnected matrix of networks, for example:
 Civic (churches, social clubs, schools)
 Occupational (businesses, unions, professional organizations)
 Informational (libraries, bulletin boards)
 Each network can be a conduit for organizing public response for its own constituency.
 Identify training needs for each network

 The CHC is an active partner in the emergency response network in the County.
 The CHC is an active advocate for health emergency preparedness.
 The CHC is the lead advocate for community resilience and psychosocial response and recovery.
 Your county is ready to respond to public health emergencies.

 Psychosocial Response and Recovery
Planning
 Building Community Understanding
 Creating a Common Directory

 Part One: Psychosocial Assessment
 Part Two: Populations with Different
Planning Needs
 Part Three: Psychosocial Response
Capacity
 Part Four: Emergency Response and
Recovery Planning
 Part Five: The Directory

 Describing community vulnerabilities
 Demographics
 Socio-economic
 Family Composition
 Community Health
 Risk and Protective Factors

 Age distribution
 Race and Ethnic distribution
 Primary language

 Per capita personal income (last three years)
 Household income (last three years)
 Unemployment rate (last three years)
 Average monthly TANF and Food Stamp cases
 Average monthly Medicaid eligibles
 Estimated number and percent of people in poverty (last three years)

 Distribution of households by type: family, married, male head, female head
 Number and percentage of grandparent headed households; number of children raised by grandparents

 Birth rate (last three years)
 Birth rate to mothers under 20 years of age (last three years)
 Birth rate to single mothers (last three years)
 Number and percentage of children with chronic health conditions (last three years)

Community Health Characteristics (cont.)
 Number of child abuse cases investigated and substantiated (last three years)
 Number of adult abuse cases investigated and substantiated (last three years)
 Injury death rates by mechanism (last three years)
 Motor vehicle fatality rate (last three years)

Community Risk and Protective Factors
 School achievement and dropout rate
 Domestic violence
 Substance abuse – alcohol
 Substance abuse – other drugs
 Access to health insurance/medical care
 Access to child care

Community Risk and Protective
Factors (cont.)
 Housing characteristics
 Homelessness
 Crime rate – adult and juvenile
 Teen suicide rate (last three years)
 Adult suicide rate (last three years)
 DWI rate (last three years)
 Other community violence

Part Two: Populations with Different
Planning Needs
 Numbers
 Locations, Providers, and Contact Points
 Liaisons/Information Conduits

 Children
 Elderly
 People with chronic mental illness
 People with substance abuse problems
 People with cognitive or developmental disabilities
 People with physical disabilities

 People who are blind or have visual impairments
 People who are deaf or have hearing impairments
 Non-English speaking populations
 Undocumented individuals
 People who are homeless
 Incarcerated and other institutionalized people

Part Three:
Psychosocial Response Capacity
 Strengths
 Resources
 Challenges

 Leadership and local communication
 Volunteer groups and organizations
 Community and neighborhood organizations
 Experience with crisis
 Recent experiences or changes
 Overall strengths
 Needs for better coordination

Part Four: Emergency Response and
Recovery Planning
 Plans and planning
 Hazards and vulnerabilities
 Coordination

 Understanding - potential hazards and vulnerabilities
 Understanding - vulnerable people and populations
 The county emergency response plan
 Emergency Operations Center plans
 Other emergency response plans
 Plan coordination


 Name the players
 Create a directory for all

Directory Listings
Emergency Management Contacts
 County Emergency Manager
 Local Emergency Planning Committee
(LEPC) Members
 Local public health office emergency preparedness contacts
 Hospital emergency manager
 School districts safety officer

Emergency Management Contacts
 Red Cross
 Local CERT program (if any)
 Other pre-identified and trained health professional volunteers
 Emergency Medical Services (EMS)
 Law enforcement

Emergency Management Contacts
 Fire
 Search and rescue
 CISM members and others trained in crisis intervention/response
 Other agencies, organizations, and individuals who might be involved in emergency response

Health Care Provider Contacts
 Hospital(s)
 Primary care clinics and ambulatory care providers
 Other health care agencies, facilities (long term care, home health, etc.)
 Behavioral health care providers
 Pharmacies
 Laboratories (hospital-based and private)
 Mortuaries

Community Contacts
 Local/county government contacts for public utilities, public works, human services, public information, waste management, etc.
 Faith community contacts
 Food banks and shelters
 Supermarkets and other food resources
 Ham radio operators
 Others