Public Health and Disaster
Preparedness
AcademyHealth
June 8, 2004
Kristine M. Gebbie, DrPH, RN
Columbia University School of Nursing
Goals
Review some of the major gains in public
health infrastructure and emergency
response
Identify areas in which public health
systems and services research are
essential to provide the evidence base for
improvement
AcademyHealth, June 8, 2004
Public health
infrastructure for response
Data and
Information:
surveillance,
partner contacts,
laboratory data
Prepared
Workforce: they have
the competencies
Systems and
Relationships: a practiced
plan and ties to other
agencies
AcademyHealth, June 8, 2004
Data and information: progress
Development of new surveillance sources
ambulance usage
OTC pharmacy use
ER visits
More information on care resources
Much more information routinely
distributed or available to clinicians
Capacity of workforce to use unexamined
AcademyHealth, June 8, 2004
Systems and relationships:
progress
Public health more visible with policy
makers
Public health leadership is at local, state
and national emergency planning table
Regional public health response systems to
support rural and small agency capacity
Strengthened ties between public health
and medical care organizations
Generic ICS training of limited use
AcademyHealth, June 8, 2004
Prepared workforce: progress
Assessment of general and emergency
preparedness competencies
Network of Centers for Public Health
Preparedness
Expanded use of emergency drills and
exercises as developmental opportunities
Specialty training in emergency
preparedness in MPH & other programs
AcademyHealth, June 8, 2004
One attempt: Public Health
Ready
Certification requires
emergency plan integrated with overall local
plan
competency training for all staff
drills/exercises involving other agencies with
improvement plan
First 10 agencies certified this year
Much anecdotal information on
improvement
AcademyHealth, June 8, 2004
What we don’t know: data
& information
How much makes a difference?
What transmission routes work best?
What language(s) facilitate
communication across cultural lines
laboratories
medical workers
uniformed first responders
public health
AcademyHealth, June 8, 2004
What we don’t know:
systems & relationships
What general and special legal structures
are effective?
How do formal and informal relationships
interact?
How the cultures of public health and
emergency response fit together?
What is the minimum size (agency or
population) needed to support good
emergency response?
AcademyHealth, June 8, 2004
What we don’t know:
prepared workforce
How much of this
knowledge is ‘dual
use’?
What are the
leadership differences
in emergencies?
What is the balance
between ‘systems’
and ‘science’?
How do we measure
competency?
What degree of
specificity is needed
by all workers vs.
specialists?
What is the length of
knowledge/skill
retention?
AcademyHealth, June 8, 2004
If the answer to some of
these is “drills & exercises”
How do typical training activities intersect
with drills and exercises?
What level of exercise?
At what frequency?
To what standard?
At what cost?
AcademyHealth, June 8, 2004
Practice makes better
Planning for emergencies, building formal
interagency/inter-jurisdictional
agreements and training staff are only
part of the picture
Regular reviews, exercises and drills are
essential to maintain awareness, identify
areas for improvement and develop
proficiency in response
AcademyHealth, June 8, 2004
AcademyHealth, June 8, 2004
The biggest questions:
What is the total cost, including lost
opportunity cost, of emergency
preparedness?
How would we assess the cost
effectiveness of any of the activities of
preparedness?
What does ‘dual use’ really mean and is it
worthwhile as a concept?
AcademyHealth, June 8, 2004
We fervently believe
An effective public health infrastructure
can
deliver essential public health services
which means that emergency services are
effective and
people and communities are protected
But we lack the evidence to demonstrate
and improve upon it!
AcademyHealth, June 8, 2004
Columbia University
School of Nursing
Center for Health Policy
www.nursing.hs.columbia.edu
AcademyHealth, June 8, 2004