Public Health and Disaster
Preparedness
AcademyHealth
June 8, 2004
Kristine M. Gebbie, DrPH, RN
Columbia University School of Nursing
Goals
aReview some of the major gains in public
health infrastructure and emergency
response
aIdentify 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: progress
aDevelopment of new surveillance sources
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
Systems and relationships:
progress
aPublic health more visible with policy
makers
aPublic health leadership is at local, state
and national emergency planning table
aRegional public health response systems to
support rural and small agency capacity
aStrengthened ties between public health
and medical care organizations
aGeneric ICS training of limited use
AcademyHealth, June 8, 2004
`ambulance usage
`OTC pharmacy use
`ER visits
aMore information on care resources
aMuch more information routinely
distributed or available to clinicians
aCapacity of workforce to use unexamined
AcademyHealth, June 8, 2004
Prepared workforce: progress
aAssessment of general and emergency
preparedness competencies
aNetwork of Centers for Public Health
Preparedness
aExpanded use of emergency drills and
exercises as developmental opportunities
aSpecialty training in emergency
preparedness in MPH & other programs
AcademyHealth, June 8, 2004
1
One attempt: Public Health
Ready
What we don’t know: data
& information
aCertification requires
aHow much makes a difference?
aWhat transmission routes work best?
aWhat language(s) facilitate
communication across cultural lines
`emergency plan integrated with overall local
plan
`competency training for all staff
`drills/exercises involving other agencies with
improvement plan
aFirst 10 agencies certified this year
aMuch anecdotal information on
improvement
`laboratories
`medical workers
`uniformed first responders
`public health
AcademyHealth, June 8, 2004
AcademyHealth, June 8, 2004
What we don’t know:
systems & relationships
What we don’t know:
prepared workforce
aWhat general and special legal structures
are effective?
aHow do formal and informal relationships
interact?
aHow the cultures of public health and
emergency response fit together?
aWhat is the minimum size (agency or
population) needed to support good
emergency response?
aHow much of this
knowledge is ‘dual
use’?
aWhat are the
leadership differences
in emergencies?
aWhat is the balance
between ‘systems’
and ‘science’?
AcademyHealth, June 8, 2004
If the answer to some of
these is “drills & exercises”
aHow do typical training activities intersect
with drills and exercises?
aWhat level of exercise?
aAt what frequency?
aTo what standard?
aAt what cost?
AcademyHealth, June 8, 2004
aHow do we measure
competency?
aWhat degree of
specificity is needed
by all workers vs.
specialists?
aWhat is the length of
knowledge/skill
retention?
AcademyHealth, June 8, 2004
Practice makes better
aPlanning for emergencies, building formal
interagency/inter-jurisdictional
agreements and training staff are only
part of the picture
aRegular reviews, exercises and drills are
essential to maintain awareness, identify
areas for improvement and develop
proficiency in response
AcademyHealth, June 8, 2004
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The biggest questions:
aWhat is the total cost, including lost
opportunity cost, of emergency
preparedness?
aHow would we assess the cost
effectiveness of any of the activities of
preparedness?
aWhat does ‘dual use’ really mean and is it
worthwhile as a concept?
AcademyHealth, June 8, 2004
AcademyHealth, June 8, 2004
We fervently believe
aAn effective public health infrastructure
can
`deliver essential public health services
`which means that emergency services are
effective and
`people and communities are protected
Columbia University
School of Nursing
Center for Health Policy
www.nursing.hs.columbia.edu
aBut we lack the evidence to demonstrate
and improve upon it!
AcademyHealth, June 8, 2004
AcademyHealth, June 8, 2004
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