Future Directions for the Preparedness Programs

1. Future Directions for the Preparedness Programs Office of Public Health Preparedness South Carolina Department of Health and Environmental Control August 28, 2012

2. Overview • New directions for emergency management, public health preparedness and healthcare system preparedness • Program alignment • Healthcare system capabilities • Performance Measures • Emphasis on broad community coalitions

3. Changes in National Directions for Emergency Management • Presidential Policy Directive 8 was issued March 30, 2011 to facilitate “an integrated, all-of-Nation, capabilities-based approach to preparedness” • Replaces HSPD-8 (2003) • Provides guidance for National Preparedness Goal, National Preparedness System, National Preparedness Report

4. PPD-8 Implementation Plan • National Preparedness Goal – September 25, 2011 • National Preparedness System - November 24, 2011 • National Incident Management System • National Planning System • National Training and Education System • National Exercise Program • Remedial Action Management Program • National Preparedness Report – March 30, 2012 • National Planning Frameworks – June 30, 2012 • Interagency Operational Plans – September 25, 2012

6. National Preparedness Goal • A secure and resilient Nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk

7. National Preparedness Goal • Five Mission Areas • Prevention (of Terrorism) • Protection • Mitigation • Response • Recovery

10. National Preparedness System • National Preparedness System description released November 24, 2011 • Components: • Identifying and assessing risks • Estimating capability requirements • Building and sustaining capabilities • Planning to deliver capabilities • Validating capabilities • Reviewing and updating

11. National Preparedness System • Identifying and Assessing Risks • Threat and Hazard Identification and Risk Assessment (THIRA) guidance currently under development • Strategic National Risk Assessment identifies major risks for the nation • Estimating capability requirements • Setting target levels for core capabilities in each community

12. National Preparedness System • Building and sustaining capabilities • Identifying and prioritizing gaps • Leveraging community resources • Planning to deliver capabilities • A whole community approach • Federal guidance in National Frameworks • Validating capabilities • Exercises and training • Reviewing and updating • Senior level reviews of national preparedness

14. National Disaster Recovery Framework • Defines core recovery principles • Roles and responsibilities • Coordinating structure • Guidance for pre- and post-disaster recovery planning • Describes process for community rebuilding • Recovery Support Functions – core recovery capabilities

15. Core Principles • Individual and family empowerment • Leadership and local primacy • Pre-disaster recovery planning • Partnerships and inclusivity • Public information • Unity of effort • Timeliness and flexibility • Resilience and sustainability • Psychological and emotional recovery

16. National Preparedness Report, March 2012 • Overall, the National Preparedness Report found that the Nation has increased its collective preparedness not only for the countless threats posed by those who wish to harm America’s homeland, but also for the many natural and technological hazards that face the Nation’s communities. Areas of national strength include planning, operational coordination, intelligence and information sharing, and other response-related capabilities.

17. Public Health Emergency Preparedness • Alignment of CDC Public Health Preparedness Program and Hospital Preparedness Program • One application • Financial administration by CDC Program Grants Office • Two separate budgets • Two sets of requirements, capabilities and reports • Two Project Officers

18. Aligned Capabilities • 1. PHEP - Community Preparedness • 1. HPP – Healthcare System Preparedness • 2. PHEP - Community Recovery • 2. HPP – Healthcare System Recovery • 3. PHEP - Emergency Operations Coordination • 3. HPP – Emergency Operations Coordination • 4. PHEP - Emergency Public Information and Warning • 5. PHEP - Fatality Management • 5. HPP – Fatality Management

19. Aligned Capabilities • 6. PHEP - Information Sharing • 7. PHEP - Mass Care • 8. PHEP - Medical Countermeasure Dispensing • 9. PHEP - Medical Materiel Management and Distribution • 10. PHEP - Medical Surge • 10. HPP - Medical Surge • 11. PHEP - Non-Pharmaceutical Intervention • 12. PHEP - Public Health Laboratory Testing

20. Aligned Capabilities • 13. PHEP - Public Health Surveillance and Epidemiological Investigation • 14. PHEP - Responder Health and Safety • 14. HPP - Responder Health and Safety • 15. PHEP - Volunteer Management • 15. HPP - Volunteer Management

21. Each Capability Has Multiple Functions, Tasks and Resource Elements • PHEP: 15 capabilities, 65 functions, 237 tasks, 425 resource elements • HPP: 8 capabilities, 29 functions, 62 tasks, 111 resource elements • We must assess status of all these capabilities, functions and resource elements each year • We must address all functions and resource elements over the 5 year grant period

22. PHEP and HPP Requirements • Assessment, planning and implementation of the 15 PHEP capabilities and the 8 HPP capabilities • Assessment at state and local (regional) levels • Documented achievement of resource elements, functions for each capability • Required performance measures and reports • Budgeting by capability and function • Detailed accountability requirements include exercises, training, performance measures, expenditure reporting

23. SC Preparedness Funding FY 2012-13 • SC PHEP FY 2012-13 Funding • Total Funding: $9,759,429 • Base: $8,587,829 • Cities Readiness Initiative: $284,781 • Level 1 Chemical Lab: $886,849 • SC HPP FY 2012-13 Funding: $5,263,121

24. CDC Public Health Emergency Preparedness Funding Including All Categories

25. PHEP Base Funding

26. HPP Funding

27. Funding Issues • Outlook for future funding is not good: anticipate further reductions in both PHEP and HPP. • Do not expect a Federal budget for FFY 2013 to be passed before the election (or the end of the year) • A six-month Continuing Resolution is expected to fund the Federal programs from October 1, 2012 to March 30, 2013. This would mean that the 2013 PHEP and HPP application budgets would be ”planning figures” subject to reduction. • If sequestration begins January 2013, it would not affect current FY 2012 budgets (through June 30, 2013). Projected impact is about 8% reduction in FY 2013. • President Obama’s FY 2013 budget request in February 2012 asked for 30% cut in HPP and roughly level funding for PHEP. [It was DOA in Congress.]

28. Regional Healthcare Coalitions • New HPP vision - Greater emphasis on regional coalitions and planning: • “Federal leadership and grant funding to move from preparedness at the facility level to healthcare preparedness at the community level.” • National Health Security Strategy’s two strategic goals: • Build Community Resilience • Strengthen and sustain health and emergency response systems

29. 1. HPP - Healthcare System Preparedness • Healthcare system preparedness is the ability of a community’s healthcare system to prepare, respond, and recover from incidents that have a public health and medical impact in the short and long term. The healthcare system role in community preparedness involves coordination with emergency management, public health, mental/behavioral health providers, community and faith-based partners, state, local, and territorial governments to do the following: • ..Provide and sustain a tiered, scalable, and flexible approach to attain needed disaster response and recovery capabilities while not jeopardizing services to individuals in the community • ..Provide timely monitoring and management of resources • ..Coordinate the allocation of emergency medical care resources • ..Provide timely and relevant information on the status of the incident and healthcare system to key stakeholders • Healthcare system preparedness is achieved through a continuous cycle of planning, organizing and equipping, training, exercises, evaluations and corrective actions.

30. 1. HPP Healthcare System Preparedness • Function 1: Develop, refine, or sustain Healthcare Coalitions • Function 2: Coordinate healthcare planning to prepare the healthcare system for a disaster • Function 3: Identify and prioritize essential healthcare assets and services • Function 4: Determine gaps in the healthcare preparedness and identify resources for mitigation of these gaps • Function 5: Coordinate training to assist healthcare responders to develop the necessary skills in order to respond • Function 6: Improve healthcare response capabilities through coordinated exercise and evaluation • Function 7: Coordinate with planning for at-risk individuals and those with special medical needs

31. Function 1 • Develop, refine, or sustain Healthcare Coalitions consisting of a collaborative network of healthcare organizations and their respective public and private sector response partners within a defined region. Healthcare Coalitions serve as a multi-agency coordinating group that assists Emergency Management and Emergency Support Function (ESF) #8 with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. The primary function of the Healthcare Coalition includes sub-state regional, healthcare system emergency preparedness activities involving the member organizations. Healthcare Coalitions also may provide multi-agency coordination to interface with the appropriate level of emergency operations in order to assist with the provision of situational awareness and the coordination of resources for healthcare organizations during a response.

32. Coalition Members • The State and Healthcare Coalition member organizations encourage the development of essential partner memberships from the community’s healthcare organizations and response partners. These memberships are essential for ensuring the coordination of preparedness, response, and recovery activities. Memberships may be dependent on the area, participant availability, and relevance to the Healthcare Coalition. Prospective partners to engage (assuming they are not already members): • ..Hospitals and other healthcare providers • ..EMS providers • ..Emergency Management/Public Safety • ..Long-term care providers • ..Mental/behavioral health providers • ..Private entities associated with healthcare (e.g., Hospital associations)

33. Coalition Members • ..Specialty service providers (e.g., dialysis, pediatrics, woman’s health, stand alone surgery, urgent care) • ..Support service providers (e.g., laboratories, pharmacies, blood banks, poison control) • ..Primary care providers • ..Community Health Centers • ..Public health • ..Tribal Healthcare • ..Federal entities (e.g., NDMS, VA hospitals, IHS facilities, Department of Defense facilities) • Note: Active membership from these constituencies are evidenced by written documents such as MOUs, MAAs, IAAs, letters of agreement, charters, or other supporting evidence documents

34. Coalition Members • P4. Additional Healthcare Coalition partnerships/memberships • The State and Healthcare Coalition member organizations network with subject matter experts (SMEs) for improved coordination of preparedness, response, and recovery activities. These memberships may be dependent on the area, participant availability, and the Healthcare Coalition’s unique needs. Examples of organizations that may be considered include but are not limited to: • ..Local and state law enforcement and fire services • ..Public Works • ..Private organizations • ..Non-governmental organizations • ..Non-profit organizations • ..Volunteer Organizations Active in Disaster (VOAD) • ..Faith-based Organizations (FBOs) • ..Community-based Organizations (CBOs) • ..Volunteer medical organizations (e.g., American Red Cross) • ..Others partnerships as relevant

35. Thank You South Carolina is fortunate to have committed leadership in our hospitals, community organizations, and professional associations and the support of knowledgeable and dedicated emergency management professionals like yourselves. Thank you for all you have done and for all you will do to prepare for the next disaster.