The University of Texas School of Public Health Scott R. Lillibridge, M.D Director

1. The University of Texas School of Public Health Scott R. Lillibridge, M.D Director Center for Biosecurity & Public Health Preparedness

2. Center Background • Funded/Formed in 2002 • Funding/projects • CDC – Center for Public Health Preparedness • HRSA – Texas Bioterrorism Continuing Ed. • Texas DSHS – La Frontera • DOD • DHS • NIH

3. Partnering with (in Texas) TALHO TPHA UT-SPH Texas Department of State Health Services Texas Institute for Health Policy Research Over 25,000 trained Preparedness Response Center Background

4. Focus • Education and Training • “Training together to respond together” • Targeted training (CDC/HRSA guidance) • Graduate education • Investigation/Research • Public health and safety emerging issues • Solutions for homeland security • Community Service • Expertise for community planning and leadership

5. “Train Together to Respond Together”

6. Core Programs • Crisis Leadership • Disease Outbreak Investigation • National Disaster Life Support (CDLS, BDLS, ADLS) • Risk Communications • “Collaborating Cores” • UNT—Public Health Law • TAMU—T-TIER

7. Texas Bioterrorism Continuing Education Project UTSW & UNT UTHC - Tyler UTMB UTHSC - H UTHSC - SA

8. Centers for Public Health Preparedness Houston

10. Response to Katrina • Rapid Assessment - - Assisting Local Health Departments • Daily “cot surveys” - Activate Student “EIS” • Command Center to coordinate volunteers • Paper forms, then PDAs

11. Response to Katrina

15. Heath and Security • Emerging Disease (SARS, Flu) • Population density • Civil Disruption (loss of public health) • Bioterrorism • Borders of little importance to disease

18. Classroom

20. BioWatch

23. Global Public Health Intelligence Network (GPHIN) • Internet-based "early warning" system • Gathers reports of PH significance in seven languages on a 24/7 basis • Monitors global media sources such as news wires and web sites. • GPHIN auto sorts media reports (including ProMED)—reviewed by humans

25. Flugate

26. Flu Vaccine 2004

28. Pandemic Influenza Global Outbreak, and must have • Novel virus, all or most susceptible • Transmissible from person to person • Wide geographic spread • Infrequent (3 – 4 /century)

29. surveillance select strains prepare reassortants standardize antigen assign potency review/license formulate/test/package vaccinate Vaccine Development Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec WHO/CDC) WHO/CDC/FDA CDC/FDA FDA FDA FDA manufacturers clinic

30. Constructing a SARS Hospital in Beijing

31. “On Diversion” Almost one in ten hospitals are in diversion status 20 percent ofthe time.

32. Uninsured in America • 1990s, uninsured in the US grew an average of one million persons per year • Today, 45 Million Uninsured Americans  • That is more than... • All Americans age 65 and older (35.9 million) • All African Americans (37.1 million) • All Hispanic or Latino Americans (39.9 million)

33. Emergency Dept. Squeeze • Between 1992 and 2001 • 20% increase in visits to emergency departments • 15% reduction in emergency departments • 62% of hospitals nationwide are receiving patients at or over the operating capacity of their emergency departments.

34. Number of Hospital Beds and Occupancy Rates by Hospital Type, 1980-2000 Decline in the total number of hospital beds has not kept up with declines in occupancy. Beds Occupancy Rate Total Other* Psychiatric All Hospitals Rehabilitation General Pediatric General

35. Table 2.17 Number of Hospital Discharges and Average Length of Stay,1980-2000 Hospitaldischarges and length of stay have declined over the last two decades. Note: Non-Federal short-stay hospitals. Source:Health, United States, 2002, National Center for Health Statistics. Table 91.

36. Future of Preparedness • Policy - (Regionalization) • Leadership • Training/Education • Multidiscipline • Technology • Integration with Practice

37. Conclusion Training, investigating, & serving to respond better together.