Overview of the Role of Public Health in Disaster Preparedness and Response

1. Overview of the Role of Public Health in Disaster Preparedness and Response Jason Cuomo, MPH UCLA Center for Public Health and Disasters May, 2005

2. Today’s Lecture in 5 Parts • Part 1: Defining Public Health • Part 2: Defining Disasters • Part 3: Public Health Roles and Responsibilities • Part 4: Is It All Worth It? • Part 5: Are We Prepared?

3. Part 1: Defining Public Health

4. Public Health’s Mission The mission of public health is to "fulfill society's interest in assuring conditions in which people can be healthy." • (Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services. 1988. The Future of Public Health. National Academy Press, Washington, DC)

5. What is Public Health? • Population focus, not individual • Interdisciplinary • Assess health status of populations • Develop policy • Promote access to healthcare

6. What Does Public Health Do? The fundamental obligations of public health agencies: • Prevent epidemics and the spread of disease • Protect against environmental hazards • Promote and encourage healthy behaviors and mental health • Respond to disasters and assist communities in recovery

7. Public Health Components • Epidemiology • Biostatistics • Health Policy and Administration • Environmental Health Sciences • Social and behavioral sciences • Health education

8. Major Public Health Functions in Disasters • Surveillance • Public information • Lab services • Shelter • Environmental health

9. Part 2:Defining Disasters

10. Review: Hazards, Disasters, and Risks, oh my! A hazard is a naturally occurring or man-made condition or phenomenon that presents a risk or is a potential danger to life or property American Geological Institute, 1984 • Hazards have different origins: • Natural – earthquakes, fires, floods, naturally occurring disease • Man-made – technological, CBRNE attacks • Characterized by location, intensity, frequency, and probability

11. Risk A risk is a probability of loss or harmful consequence and is a function of the hazard, the vulnerability of the population, and the resources of the community. Expressed rather simplistically: Risk = Hazard x (Vulnerability – Resources)

12. Disasters A disaster is a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources. United Nations/International Strategy for Disaster Reduction

13. Disaster Typology 1 PAHO / WHO System: • Natural – natural/unintentional hazards • earthquake, flood, fire • Technological – manmade hazards • industrial accidents, terrorism • Complex – involving politics • war, famine, etc

14. Natural Earthquake Flood Hurricane Disease outbreak Unnatural/Manmade War Industrial accidents Hazmat Disease outbreak Disaster Typology 2

15. Disaster Typology 3 • Acute • Sudden • Earthquake, tornado • “Creeping” • Slow, chronic • Drought, famine • Noji 1997

16. Part 3:Public Health Role and Responsibilities

17. Morbidity Mortality Impact on infrastructure Surge capacity Changes in risk for disease transmission Psychological effects Sociological effects Economic effects Nutrition Population movements Disaster Outcomes

18. Disasters and Public Health • 2 Fundamental questions: • What could this event do to people? • What did this event do to the people? • 3 Broad Categories of Responsibility • Preparedness • Detection and Identification • Response

19. 1. Preparedness • Activities aimed at being ready to quickly respond to the impacts of an event • Ability to conduct mass prophylaxis

20. Pre-Event Activities • Primary Prevention • Vaccinate population • Mitigation • Long-term efforts to reduce the potential impacts

21. Community Knowledge • Knowledge of population • Immunocompromised • Language barriers • Financial barriers • Age • Disease patterns

22. Resource Knowledge • Surge Capacity • Ability of the healthcare system and public health infrastructure to expand rapidly beyond normal levels of service to meet the increased demand for qualified personnel, medical care and public health services in the event of bioterrorism or other large-scale public health emergency

23. Lab Surge • Laboratories • Manage and process large amount of specimens • Adequate supplies

24. Hospital Surge • Hospitals • Triage • Patient management • Patient beds • Adequate supplies

25. Clinical Surge • Ambulatory settings • Recognition of illness • Isolation room • Patient management • Supplies • Personal Protective Equipment

26. Public Health Surge • Public health • Healthcare facilities • Epidemiological investigations • Ability to provide mass prophylaxis/vaccination • Legal authorities

27. 2. Detection and Identification • Determine something is “unusual” or “wrong” • Not always easy or obvious when dealing with non-specific symptoms (inhalation anthrax) • Determine the causal agent and source(s)

28. Outbreak Investigation CDC has identified ten steps of an outbreak investigation, as follows: • Case Definition • Case confirmation • Establish background disease rate • Case finding • Descriptive epidemiology • Generate hypothesis • Test hypothesis • Environmental investigation • Control measures • Interaction with the media and public Additionally, these activities may occur simultaneously or as part of a criminal investigation.

29. Define Scope • Characteristics of the agent (e.g. communicable versus non-communicable) • Source (e.g. point source and secondary transmission) • Origin (e.g. intentional or naturally occurring) • Treatment (e.g. oral antibiotics or vaccine), exposed population (e.g. age strata)

30. Surveillance System of continual data collection and analysis to recognize disease patterns in the community • Active • Aggressively seek health information • Conducting onsite surveillance • Visit/call doctor’s offices and hospitals • Passive • Health information is sent to the health department through the initiative of the reporter • Disease reporting

31. Laboratory Detection and ID • Sentinel cases • Laboratory Response Network • Sentinel labs • Rule Out and Refer • Can’t identify • Reference labs • Confirm • Orthopoox • National labs • Characterization • Monkeypox

32. Baseline Data • What is the normal epidemiology of the community?

33. How an Event is Recognized • Geographic Pattern of Illness • Sudden increase in severity or incidence of illness • Unusual expression of endemic disease • Appearance of unusual illness or syndrome in your community • Occurrence of vector-borne disease where there is no vector • Cluster of sick or dead animals

34. Early Detection of a BT Event:Finding a Zebra Among Horses • Early detection and control of bioterrorism will depend on alert clinicians reporting unusual illnesses or patterns of illness to Public Health • BEFORE definitive diagnosis • “When you hear hoof beats, think “zebras” (as well as horses)

35. 3.Response to Disasters • Public Health functions during disaster differ from normal in 2 important ways: • Decision and actions must occur on an accelerated time-frame and with limited resources • Response requires collaboration with other organizations (many non-health: fire, law, public works)

36. Different Hazards • Commonalities regardless of hazard • Differences lie in priority of responsibilies and time-frame by which objectives should be met • Example: • BT attack: higher priority/immediate resolution on disease prevention vs earthquake

37. Primary Response Roles • Assessing the needs of disaster-affected populations • Matching available resources to those needs • Assuring appropriate clinical care • Implementing disease control strategies for well-defined problems • Evaluating the effectiveness of disaster relief • Improving the contingency plans of various types of future disasters from Noji, EK. Public health issues in disasters. Critical Care Med. 2005;33(1 Suppl):S29-S33.)

38. Needs Assessment • Size and nature of the hazard may lead to different needs among the affected population • In the case of a disease outbreak—whether natural or intentional—needs assessment will focus on the medical needs of your exposed population and prevention and control of further spread • Focus of a needs assessment strategy is to determine immediate and acute needs, the process should be continuous and thus also used to determine medium- and long-term needs

39. Assessment Methods • Numerous needs assessment methodologies exist: • enhanced surveillance from reporting healthcare facilities • rapid survey of a sample of the affected population • immediate physical assessment of key infrastructure to determine the potential of environmental health hazards. See WHO and CDC guidelines for more

40. Matching Resources • Key tenet of preparedness knowledge of the kinds and quantities of available resources and the ability to augment them in times of disaster • Ideally, resource assessment should be performed to determine what one has available as well as highlight what needs to be obtained

41. Resource Source 1 • Community Resources • Schools of Public Health • Red Cross • Pharmacies • Schools • Medical Reserve Corps • Religious Organizations UCLA CPHD

42. Resource Source 2 • State and Local Resources • Mutual Aid • Memoranda of Understanding (MOU) • Facilities • National Guard • Legal authorities • Laboratories

43. Resource Source 3 • National Resources • Strategic National Stockpile • National Disaster Medical System • Military • MASH • CDC • National Laboratories

44. Strategic National Stockpile (SNS) • Congress established the Strategic National Stockpile (SNS) to augment/replenish local supplies of critical medical items in the event of a disaster or disease outbreak

45. SNS Contents • National repository of • Antibiotics • Chemical antidotes (CHEMPACK) • Antitoxins • Life-support medications • IV administration • Airway maintenance supplies, • Medical/surgical items.

46. SNS Continued • 12-hour push pack • Supplies • Medications • Managed Inventory • Vendor (VMI) • Stockpile (SMI) • CHEMPACK • Deployed • Re-supply Image Courtesy of CDC

47. SNS Request • Considerationsfor Requesting the SNS • Number of current casualties • Projected needs considering the population of the area (including transients), and possible infections versus non-infections. • Hospital capacity at the time of the event, including intensive care unit beds and ventilator needs.

48. SNS Request Continued • State resources identified, including pharmacy distributors, oxygen availability, other nearby hospitals, and in-state alternative care centers (casualty collection points) • Local resources, e.g. pharmacy distribution, oxygen availability, and transport capacity.

49. National Disaster Medical System(NDMS) • DMAT-Disaster Medical Assistance Team • DMORT-Disaster Mortuary Operational Response Team • VMAT-Veterinary Medical Assistance Team • NNRT-National Nursing Response Team • NPRT-National Pharmacy Response Team • NMRT-National Medical Response Team

50. DMAT • Rapid response team • Supplement not supplant local response • Self-sustaining for 72 hours • Triage • Provide care • Primary • Burn • Mental health • Some trauma • Immunity under FTCA