public health and disaster preparedness academyhealth june 8, 2004 kristine m. gebbie, drph, rn...
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Public Health and Disaster Preparedness
AcademyHealthJune 8, 2004
Kristine M. Gebbie, DrPH, RNColumbia University School of Nursing
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AcademyHealth, June 8, 2004
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
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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
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AcademyHealth, June 8, 2004
Data and information: progress
Development of new surveillance sources ambulance usage OTC pharmacy use ER visits
More information on care resourcesMuch more information routinely
distributed or available to cliniciansCapacity of workforce to use unexamined
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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
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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
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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 planFirst 10 agencies certified this yearMuch anecdotal information on
improvement
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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
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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?
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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?
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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?
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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
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AcademyHealth, June 8, 2004
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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?
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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!
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AcademyHealth, June 8, 2004
Columbia University School of Nursing
Center for Health Policy
www.nursing.hs.columbia.edu