1 Columbia University Center for Public Health Preparedness Emergency Preparedness Core Competencies for ALL Public Health Workers The Columbia University.

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Columbia UniversityCenter for Public Health Preparedness

Emergency Preparedness Core Competencies

for ALL Public Health Workers

The Columbia University Center for Public Health Preparedness is a joint project of the New York City Department of Health and the Mailman School of Public Health, in collaboration with the Center for Health Policy at the

Columbia University School of Nursing. The Center is funded by a Cooperative Agreement between the Centers for Disease Control and

Prevention and the Association of Schools of Public Health, Project # S1544-20/20.

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This presentation has been approved for ( ) contact hours of

continuing education credit through the

(insert the accreditation agency here)

Columbia University Center for Public Health Preparedness

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Thank you for coming today

Before we start….


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ABOUT YOUR FOLDER


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Pre-test Form


(Insert your Pre-Test form here)

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Pre-test Procedures

1. Test sheet & pencil

2. Complete the test

3. Pass completed tests forward

4. Retain your pencil


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Presentation Agenda


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Training Development Team


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Purpose of Training

Provide a basic understanding of the Core Competencies for Emergency Preparedness and Response for the [Public Health Worker]


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The Public Health System Process

• a continuous cycle of gathering information, deciding, acting, evaluating

• Public health is always evaluating the health of the community


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Public Health Preparedness for: Threats and Emergencies

7 Core Capacities

• Workforce

• Information Systems

• Communication

• Epidemiology/surveillance

• Laboratory

• Policy and Evaluation

• Preparedness and Response


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Workforce

The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operation


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Information Systems

Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information.


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Communication

Public Health systems maintain communication mechanisms to:

• Routinely translate scientific and health information for communities and policy makers

• Provide timely, accurate public information and advice to policy makers during emergency events

• Coordinate logistical communication within the response community.


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Epidemiology/Surveillance

Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors.


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Laboratory

Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage.


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Policy and Evaluation

Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions.


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Preparedness and Response

Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies.


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In order to respond to any emergency/disaster, ALL public health

workers should be able to:

• IDENTIFY & LOCATE the emergency plan

• DESCRIBE the role of Public Health

• DESCRIBE the Chain of Command

• DESCRIBE & DEMONSTRATE one’s functional role

• RECOGNIZE deviations from the norm

• IDENTIFY limits to own authority

• DESCRIBE communication roles

• DEMONSTRATE use of communication equipment

• APPLY creative problem solving skills


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COMPETENCY

WHAT IS IT?


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COMPETENCY

A complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization

(Center for Public Health Practice, Emory University)


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World Trade Center DisasterSeptember 11, 2001

Scene of Sept. 11, 2001 Plane Crashes into the NYC WTC, Source: CNN

Photo by Michael RiegerFEMA News Photo


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Definitions

• Emergency

• Disaster


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Emergency

“An emergency is a sudden occurrence demanding immediate action that may be due to epidemics, technological catastrophes, or strife [from] natural or man-made causes.”

(W.H.O)


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Disaster“A disaster is any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community areas.”

(W.H.O)


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Definitions: Disasters/Emergencies

• Man-Made (Human-Made)

• Natural


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Man-Made Disasters/Emergencies

“Situation which man clearly causes such as: wars, armed conflicts or civil strife…[including] technological disasters.” (Guha-Sapir, 2000)


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Examples of a RANGE of:

Man-Made (Human-Made) Disasters/Emergencies that have Public Health Implications


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Potential Emergencies/Disasters

Transportation Accidents


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Aviation


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Fire


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Hazardous Material Incident

Baltimore train carrying hazardous materialscatches fire July 17, 2001


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Biological and Chemical Terrorism


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Potential Emergencies/Disasters Outbreak


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Common Features of Large Scale Disasters/Emergencies

• Pose a threat to public health & safety

• May disrupt social and economic infrastructure

• May require large scale mobilization of local resources to manage consequences


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Natural Emergencies/Disasters

Results of …ecological disruptions exceeding the adjustment capacity of the affected community. They are generally of sudden onset and imply unforeseen, serious and immediate threats to public health.

(W.H.O.)


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Examples of a RANGE of Natural Disasters/Emergencies

with Public Health Implications


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Potential Emergencies/DisastersWinter Storms (Snow Emergency)


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A HEAT WAVE SIZZLES: THE NEIGHBORHOOD; Blackout Stops Trains and Electricity for 200,000

Source: The New York Times, 7/7/99

Utility DisruptionsHeat Emergency


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Potential Emergencies/Disasters Hurricane


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Nor’easter Coastal Flooding

Canal Street, November 1950

Fulton Fish Market, November 1950


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EMERGENCY PREPAREDNESS COMPETENCY

IDENTIFY and LOCATE your agency emergency response plan (or the pertinent portion of the plan)


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Do You Know Where the Emergency/Disaster Plan is for Your

Agency?

The plan should be:

• In an accessible location at work

• Reviewed by each employee on a regular basis

• Updated at least annually

• Practiced regularly


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First Steps to Emergency Preparedness

In order to be ready to respond to public emergencies you must develop, practice and maintain your own

1. Public Health Agency Emergency/Disaster Plan2. Personal Emergency/Disaster Plan3. Family Emergency/Disaster Plan


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DESCRIBE the public health role in emergency response in a range of emergencies that might arise.


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Core Functions of Public Health in America

• Prevent epidemics and spread of disease

• Protect against environmental hazards

• Prevent injuries

• Promote and encourage health behaviors

• Assure the quality and accessibility of health services

• Respond to disasters and assist communities in recovery


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The Role of the Local Public Health Agency in Emergency Response

• Collaborate with other agencies in policy decisions and actions

• Surveillance

• Investigation

• Public information


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The Role of the Local Public Health Agency in Emergency Response (cont’d)

• Medical provider information

• Reference laboratory support

• Public health interventions (e.g. mass vaccinations)

• Establish and staff shelters and assure the safety of the displaced


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Which Public Health Employees are Needed During Emergency or

Disaster Response?

• Some emergencies and disasters could require the mobilization of MOST or ALL public health employees.

• Therefore, ALL public health workers need to learn what their roles may be in these situations.


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Role of the State or Local Office of Emergency Management

(OEM)

Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations.


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Example of a Common Multi-level Scheme for Disaster Communication and Coordination

PRESIDENT FEMA

GOVERNOR’S OFFICE

Police

STATE OEM (or equivalent)

STATE DOH

HHSCDC

Office of LocalElected Official

LOCAL OEM(if applicable)

LOCAL DOH(if applicable)

Fire OtherState

Federal

City


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Example: NYCFederal, State and Local Coordination in DISASTERS

HHC

Voluntary Agencies(ARC, etc.)

NYPD

FEMA

STATE EMERGENCY MANAGEMENT OFFICE

State

Federal

City

FDNY-EMSVoluntary

Health Sector

MAYOR’SOFFICE

PRESIDENT HHS/CDC/VA etc.

NYC-DOH

NYS-DOHGOVERNOR’S

OFFICE

NYC OFFICE OF EMERGENCY MANAGEMENT

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Federal, State and Local Disaster Coordination for: (insert state or local community name here)

[Insert the appropriate coordination tree here]


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DESCRIBE the (YOUR AGENCY’S) chain of command in emergency response.


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Incident Command System

Incident Commander

Finance/Admin.Section

Information Officer

LogisticsSection

OperationsSection

PlanningSection

Safety Officer

Liaison Officer


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EXAMPLE: NYCDOH Disaster Command and Control

Health Commissioner Or Designee

City of New YorkMayor & OEM

Director

Incident-Specific Expert(s)

Division of HealthDeputy Commissioner

Public/Govt./LegalAffairs

Director or Designee

EOC

EOC LiaisonAdministrative Mgr.

Mayor’s Office of Emergency Management

EOC Coordinator

Senior ManagementManager

Chair or Desig.Sheltering

Chair or Desig.Epi/Surveillance

Chair or Desig.Operations

Chair or Desig.Med/Clinical

Chair or Desig.MIS

Chair or Desig.Environmental

Chair or Desig.Laboratory

New York City Department of Health Emergency Operations Center

Sen

ior-

Lev

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dvi

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/Co

nsu

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ed

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EXAMPLE: Epidemiology/SurveillanceRoles and Responsibilities in Emergency

Response

• Provide background info on emergency surveillance data

• Conduct field epidemiological investigations (prn)

• Monitor existing surveillance systems

• Establish new surveillance system- Assemble field teams - Establish databases

- Develop questionnaires/forms - Enter data

- Liaison with hospital/field personnel - Analyze data

- Collect data

- Develop recommendations for policy


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• Provide resources to facilitate others’ activities

EXAMPLE: OperationsRoles and Responsibilities in

Emergency Response

• Transportation

• Communication

• Facilities

• Security

• Personnel

• Printing

• Coordinate hotlines for public & providers


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• Prepare recommendations on clinical aspects of emergency-Public safety issues -Training of community MDs

-Occupational safety issues -Disinfection/decon issues

-Develop prevention & treatment message

• Establish and staff prophylaxis/treatment distribution centers

• Staff DOH clinics involved in emergency

• Liaison with OCME regarding mortuary issues

• Supplement clinical backup to school health program sheltering

activities

EXAMPLE:Medical/ClinicalRoles and Responsibilities in

Emergency Response


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Facilitate computing issues during emergencies

-Field to Headquarters data transmission

-Database management

-Mapping/GIS

EXAMPLE: Medical Information Systems (MIS)

Roles and Responsibilities in Emergency Response


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• Research specific topic

• Provide background information

• Prepare recommendations re:-Public health threat

-Sample collection

-Evacuation/reoccupation

• Collect samples

• Collaboration w/ FDNY Hazmat

EXAMPLE: EnvironmentalRoles and Responsibilities in

Emergency Response


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• Provide recommendations for specimen types and

handling

• Accept specimens for testing

• Ensure rapid transports to reference labs

• Perform testing

• Coordinate with epi/surveillance re: data entry

• Liaison with outside labs re: testing and data reporting

EXAMPLE: LaboratoriesRoles and Responsibilities in

Emergency Response


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“To work in cooperation with the ARC to ensure the staffing of shelter sites in response to OEM’s determination of a potential for an adverse weather event which may necessitate the activation of the shelter protocol”

School Health Program Shelter Protocol

EXAMPLE: ShelteringRoles and Responsibilities in

Emergency Response


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Incident Command Structure of: (insert YOUR state or local agency name here)

(Insert YOUR LOCAL Incident Command tree and specific department roles during emergency/response here)


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DESCRIBE your functional role(s) in emergency response


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Functional Roles of Public Health Workers in an Emergency/Disaster

• Your role may be the same or similar to what you do every day

or• Your role may be different from what

you usually do.


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Potential Functional Roles for thePublic Health

LEADER / ADMINISTRATOR

I. Agency Director: serve as Incident Commander; direct provision of a specific service

II. Division or Section Head: Communicate with the Liaison Officer; direct departmental operations; communicate with the Logistics Section Chief for procurement of supplies

III. Clinic Administrator: Coordinate departmental operations; monitor use of, need for and availability of resources.


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Potential Functional Roles for the Public Health (PH) PROFESSIONAL

I. PH Physician: communicate with medical providers; provide clinical expertise and consultation regarding bio-threats; develop clinical protocols

II. PH Nurse: administer immunizations and medications, staff shelters

III. Health Education Specialists: staff hotlines; develop special public information messages

IV. Environmentalists: monitor/test environment

V. Epidemiologist: coordinate local lab with CDC; conduct special investigations


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Potential Functional Roles for the Public Health

TECHNICAL AND CLERICAL SUPPORT STAFF

• Lab Technician: gather samples, staff the lab

• Environmental Worker: participate in cleanup or recovery

• Secretary: communicate with the field; maintain action logs

• Driver: deliver specimens or supplies


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RECOGNIZE deviations from the norm that might indicate an emergency, and…

DESCRIBE appropriate action (e.g. communicate clearly within the chain of command).


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Example:NYC West Nile Virus Outbreak

New York City Statistics

September 1999• 45 cases• 4 deaths Summer 2000• 14 cases • 1 death

August 2001• 2 cases


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Example: Recognize Deviations From The Norm

[Insert local examples here]


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• IDENTIFY limits to own knowledge/skills/authority and..

• IDENTIFY key system resources for referring matters that exceed these limits


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Some Examples

LIMITS TO OWN SKILLS OR AUTHORITY

• Communication with media

• Legal authority

• Supervision of others

• Allocation of resources

• Clinical skills or decision making

• Policy decision

KEY SYSTEM RESOURCES

• Agency chain of command

• Web resources

• Logistics Officer

• Policy and procedure manual

• Disaster plan / protocols


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Some Examples for a Public Health Nurse in the Shelter Setting:

Limits• Treatment of the

seriously ill

• Providing information to the media

• Re-assigning roles of other shelter staff

Resources• Local Emergency Room

• DOH Public Relations (or Public Affairs Dept.)

• Shelter manager


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DESCRIBE communication role(s) in emergency response:

• Within agency• Media• General public• Personal (family, neighbors)


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Communication Within the Agency

Communication through the Chain of Command will insure that your information and requests for support get to the correct individual.


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Communication with theMedia

• In emergency situations, there are many media inquiries, and they are made to everybody.

• Know you agency’s media plan

• Usually, all press inquiries are to be referred to the Commissioners Office.


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Communication with the General Public

• As a public health employee, you always represent PUBLIC HEALTH to the community in your day to day lives.

• You may be required to answer queries and take information through hotlines or disseminate public health messages.


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Communication with Your Family

Your family may be concerned, involved and/or have their routines changed.

Do you have a:• Family Disaster Plan

• Personal Emergency Plan


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Family Disaster Plan Materials

Source: FEMA: www.fema.gov/library/epc.pdf and www.fema.gov/library/yfdp.pdf

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NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM

PERSONAL EMERGENCY PLAN

In the event that I am called upon to respond to an emergency as a Department of Health

employee I, _____________________________________, have made the following

arrangements to ensure that my family and pets are cared for while I am on duty:

My child(ren) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address

)

My pet(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

My parent(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

Personal Emergency Plans For:

NEW YORK CITY DEPARTMENT OF HEALTH SCHOOL HEALTH PROGRAM

PERSONAL EMERGENCY PLAN

In the event that I am called upon to respond to an emergency as a Department of Health

employee I, _____________________________________, have made the following

arrangements to ensure that my family and pets are cared for while I am on duty:

My child(ren) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address

)

My pet(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

My parent(s) will be cared for by: ___________________________________(Name)

__________________________________(Phone

#)

________________________________________________________________(Address)

NYC-DOH School Health Program Draft, August 2001

During Working Hours After Working Hours


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Remember……

Make provisions for:•Child(ren) •Spouse/Partner•Parents•Pets•Others


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DEMONSTRATE correct use of all communication equipment used for emergency communication (phone, fax, radio, etc.).


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Communication Equipment Frequently Used in a Disaster/Emergency

• Telephone: know how to transfer a call

• Fax: know how to operate the copier or group fax functions

• Walkie-talkie

• E-mail

• Bullhorn

• Paper and pencil • Use of “runners” (staff to deliver messages)

• Intercom system


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Communication Equipment Used by: (insert Agency name here)

(Insert the types of communication equipment likely to be used during an emergency/disaster operation here)


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APPLY creative problem solving and flexible thinking to unusual challenges within functional roles and responsibilities and

EVALUATE the effectiveness of all actions taken.


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CREATIVE PROBLEM SOLVING

What situations requiring creative problem solving and flexible thinking can you imagine occurring?

• Telephone system fails?

• Expected supplies are not delivered?

• Agency facility is inaccessible?

• Other types of problems???


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CREATIVE PROBLEM SOLVING

What situations requiring creative problem solving and flexible thinking can you imagine occurring?



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Evaluation of All Actions

How would you evaluate the effectiveness of all actions you took?

• Were the issues you referred to others acted upon?

• Was the issue that you addressed resolved?

• After the situation, evaluate the effectiveness of the plan.


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Examples of Evaluations of Actions Taken



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Core Public Health Worker Competencies for Emergency Preparedness and Response

Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.

Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team.


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In order to respond to any emergency/disaster, ALL public health

workers should be able to:

• IDENTIFY & LOCATE the emergency plan

• DESCRIBE the role of Public Health

• DESCRIBE the Chain of Command

• DESCRIBE & DEMONSTRATE one’s functional role

• RECOGNIZE deviations from the norm

• IDENTIFY limits to own authority

• DESCRIBE communication roles

• DEMONSTRATE use of communication equipment

• APPLY creative problem solving skills


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National Network of Academic Centers for Public Health Preparedness

• Columbia University Center for Public Health Preparedness (Columbia University)

• Heartland Center for Public Health Preparedness (St. Louis University)

• Illinois Public Health Preparedness Center (University of Illinois)

• Iowa Center for Public Health Preparedness (University of Iowa)


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National Network of Academic Centers for Public Health Preparedness (cont’d)

• University of North Carolina (Chapel Hill) Center for Public Health Preparedness

• University of South Florida Center for Public Health Preparedness

• Northwest Center for Public Health Preparedness

(University of Washington)

http://www.phppo.cdc.gov/owpp/centersforPHP.asp


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THANK YOU!

QUESTIONS?


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Post-test Procedure


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Post-test Form


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Post-test Procedures

1. Test sheet & pencil

2. Complete the test

3. Pass the test to the center aisle


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Columbia UniversityCenter for Public Health Preparedness

Website:http://cpmcnet.columbia.edu/dept/sph/CPHP/index.html

1 Columbia University Center for Public Health Preparedness Emergency Preparedness Core Competencies for ALL Public Health Workers The Columbia University.

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