Preparedness: Moving Beyond the Stockpiling of Stuff

Equipment, plans, and personnel are only as good as their ability to perform when needed. When disaster strikes, it is imperative that local, state, and federal levels of government, emergency management, volunteer organizations, and healthcare coalitions are all operationally ready and trained to use all of the “stuff” they have acquired over the years.

For many years, the prevailing focus of preparedness programs focused on “stuff” – for example, personal protective equipment, ventilators, generators, plans. Preparedness planners were evaluated based on how much stuff could be acquired and stored, only to watch it expire. For too long, being prepared meant being “fully stocked.” However, all of the stuff in the world cannot make up for a lack of trained professionals with the knowledge and expertise to lead responses.

Shifting Strategies – From Stockpiles to Real-World Application

Over the past few years, there has been a growing national movement away from measuring stuff and toward measuring actual operational capacity to recognize triggers, activate systems, and perform essential tasks. Perhaps the biggest evidence of this shift is occurring with the Centers for Disease Control and Prevention’s (CDC) Strategic National Stockpile Program, which is revising the way that medical countermeasures (MCM) programs are evaluated. From 2007 to 2013, the CDC used the Technical Assistance Review (TAR) to ensure that local health department MCM plans met a standard set of criteria, which was used as a means to measure preparedness across the country.

Beginning in 2014, the TAR was replaced with a new Operational Readiness Review, which focuses more on the demonstration of operational capacity for preparedness and response activities. This represents a shift in the way MCM programs will be measured, from evaluating preparedness plans to actually proving that these plans can be carried out in the real world. Through this shift, the overarching goal is to regularly practice, evaluate, and improve preparedness plans through real-world responses or exercises that engage key partners and systems. The regular engagement, training, and practice gained through these responses and exercises will ensure operational readiness and coordinated responses when emergencies occur.

The demonstration of operational capability requires additional time, resources, and planning. However, by actually testing plans, policies, and procedures, there is a tremendous opportunity to identify gaps. Through this new review, public health must train not only the public health workforce but also the workforce of its partners. This will ensure that fellow responders and partner organizations have a solid grasp of their specific tasks and expectations.

Ongoing Analysis of Training & Funding

The National Association of County and City Health Officials (NACCHO) has been closely tracking funding and staffing issues at local health departments through the National Profile of Local Health Departments. This study is the only comprehensive analysis of local health departments and provides longitudinal data since 1989. The latest “Profile,” released in early 2014, contains some troubling findings regarding funding levels and the amount of resources dedicated to preparedness and, specifically, preparedness training. Over the past three years, the data shows a significant drop in per capita funding for preparedness, from $2.07 per capita in 2010 to $1.15 in 2013. At the same time, federal funding for state and local preparedness dropped more than 38 percent between 2005 and 2012. Both of these findings paint an alarming picture, as more than half of local health departments rely solely on the federal government for preparedness funds.

Although funding has declined, the latest “Profile” revealed an interesting trend. Despite the cuts to preparedness, local health departments did not report a corresponding decrease in preparedness staff. In fact, emergency preparedness staffing has increased from 65 percent to 77 percent of local health departments reporting a full-time preparedness staff person from 2010 to 2013, respectively. Nationally, the estimated number of emergency preparedness staff employed by all local health departments grew to 2,900 full-time employees, an increase of 200 from 2010.

This may seem like an unexpected victory for preparedness. However, anecdotal evidence provided by local health department interviews reveals a different picture. Since 2009, local health department staffing has fallen overall from 190,000 to 162,000 personnel in 2013. This represents a huge loss for the capacities of local health departments throughout the country. This also represents a diminished capacity to respond to public health emergencies, which often require an all-hands-on-deck approach that includes staff not designated to preparedness activities.

More concerning, it seems likely that local health departments are cutting back on vital functions – namely trainings and exercises – in order to maintain full-time preparedness positions. Training and education provide the foundation for emergency preparedness and response capabilities. For example, in 2013, 87 percent of local health departments developed or updated a written emergency plan; however, only 38 percent of local health departments participated in a full-scale exercise or drill.

As highlighted by the personal protective equipment training needs for treating an Ebola patient, in-person training must be prioritized. Although many individual agencies have written plans, far fewer have tested these plans in a real-world environment. Additionally, the challenges the nation faces are evolving faster than ever, and the increasingly interconnected world further accelerates these potential threats. As with Ebola, public health threats can emerge on the other side of the world and travel to U.S. communities within a day. Now, more than ever, preparedness professionals must be aware of the latest advances in the field and ensure that preparedness efforts are informed by the best available scientific evidence.

National Preparedness Summit

Difficulties created by the economic downturn – reinforced by cuts to preparedness funding and new federal travel restrictions – have made acquiring training at national conferences nearly impossible for some professionals. Those who do travel must choose wisely to ensure the best value for their limited resources. The 10th annual Preparedness Summit is a four-day annual event that attracts nearly 1,800 attendees who work at local, state, and federal levels of government, emergency management, volunteer organizations, and healthcare coalitions.

This year’s theme is timely: “Global Health Security: Preparing a Nation for Emerging Threats.” Global health security preparedness issues – such as protection against infectious diseases, the health effects of climate change and extreme weather, and cybersecurity threats to critical infrastructure – will be explored in a multidisciplinary environment. Additional sessions on medical countermeasures, volunteer recruitment and retention, radiation planning and response, and preparedness law also will be featured.

The Preparedness Summit delivers opportunities to connect with colleagues, share best practices, and learn about new advances in the field. Attendees will learn how to implement model practices that enhance capabilities to prepare for, respond to, and recover from disasters and emergencies. In keeping with the focus on operational readiness, this year the Summit will provide 28 workshops and demonstration sessions taught by subject matter experts, which offer participants an in-depth learning experience and hands-on training. Both the workshops and the demonstration sessions are designed to be highly interactive and frequently incorporate real-world events into the sessions.

In addition, workforce issues continue to be a challenge. More than 25 percent of local health department directors are more than 60 years old, creating a looming crisis and potential for mass exodus of historical knowledge. For the first time ever, NACCHO will be conducting a new preparedness coordinators training workshop in conjunction with the Summit to better train and sustain the preparedness workforce. This pilot program will pair preparedness coordinators who have less than two years of experience with a seasoned mentor. The response to this pilot project has demonstrated a need for this type of training, with more than 50 participants signing up within the first few weeks.

In a world with increasingly global challenges, the 2015 Preparedness Summit Planning Committee and NACCHO staff have carefully curated the sessions to ensure that attendees have the opportunity to learn from speakers and presenters that represent the best ideas in public health preparedness. Attendees will leave the Summit equipped with the knowledge of how to shift preparedness practices and planning beyond merely stocking shelves with “stuff.”

The 2015 Preparedness Summit will be held 14-17 April 2015 at the Atlanta Marriott Marquis.

Andrew R. Roszak

Andrew Roszak, JD, MPA, EMT-P, serves as the executive director for the Institute for Childhood Preparedness and as an advisor for the Domestic Preparedness Journal. He is the author of the Preparing for the Unexpected Series of books, which includes “Preschool Preparedness for an Active Shooter.” He has spent over 20 years working on emergency preparedness, response, and recovery issues. He is admitted to the Illinois and District of Columbia Bars and is admitted to the Bar of the U.S. Supreme Court. Find him on Twitter: @AndyRoszak.



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