Freddy Gray, MPH, MCHES, Director of Health Communication and Preparedness Programs at ORAU
atastrophic events once considered rare now seem to occur with alarming frequency.
In March, a hurricane-like winter storm called a “bomb cyclone” caused devastating floods in Nebraska, Iowa and Wisconsin that resulted in at least two deaths and overwhelmed local infrastructure. In the same month, more than three dozen tornadoes ripped through the Deep South, killing 23 people and razing parts of entire communities.
In these and other cases, local responders are the first to provide aid to citizens affected by these disasters. Therefore, to meet the urgent and ongoing needs of residents impacted by disasters, whole-community preparedness is absolutely critical.
The three cornerstones to having a healthy community and a strong emergency response are public health, hospitals and emergency management. The better prepared these entities are, along with emergency medical services (EMS) and faith- and community-based institutions, the more resilient a community is going to be in the long term.
ORAU (Oak Ridge Associated Universities) works to support preparedness at all levels, from local to state to national, and has seen especially effective results when preparedness happens at the community level. For decades, ORAU has engaged state and local public health departments across the United States to develop tools that focus on a whole-community approach to emergency preparedness.
Together with our customers, ORAU has established and is continually refining some key best practices for community preparedness to ensure effective emergency and disaster response.
Expanding Medical Surge Capacity
Health care systems can quickly become overwhelmed with a surge of patients seeking care during disasters. For example, during an influenza pandemic, more people may seek care at a hospital than the hospital has the ability to manage. Additionally, other emergencies, such as heart attacks and car accidents, will still occur. How does the health care system adjust to ensure everyone gets the care they need?
The answer is to have a functional medical surge plan, which is essential to ensuring the health care system in every community is prepared to handle patient surge.
With this in mind, ORAU is partnering with the University of Nebraska Medical Center to expand medical surge capacity throughout Nebraska. We are identifying untapped resources in the community, enhancing training, creating plans and procedures for a tiered-care model and building upon proven approaches for improving availability of specialty care. Because of its previous close partnerships with the Centers for Disease Control and Prevention(CDC) to deliver community preparedness trainings to Public Health Emergency Preparedness grantees, ORAU’s experts are well positioned to assist Nebraska in enhancing their statewide emergency preparedness.
Exercising Response Plans
Planning is just the beginning of the preparedness process. Public health professionals, emergency managers, first responders and other stakeholders must be trained to understand their role in an emergency response situation. Exercises are conducted, where mock emergency scenarios are created to test the skills of those trained and determine whether the plan has any gaps. Exercises are evaluated, plans adjusted and trainings updated to ensure everyone involved is adequately prepared when a real emergency response is required. From 2003 to 2008, ORAU partnered with CDC to conduct more than 40 tabletop exercises with their response partners at U.S. ports of entry to ensure a high level of preparedness that positively impacts the health and safety of the citizens of the United States.
Addressing Needs of At-Risk Populations
Certain populations have special needs during emergencies, including people with chronic medical conditions, those with disabilities who may need evacuation assistance or those with language barriers who may not be able to understand the communicated messages. Preparedness efforts must include special planning for these populations.
In collaboration with the Arkansas Department of Health, Preparedness and Emergency Response Branch, and Arkansas State University Regional Center for Disaster Preparedness Education, ORAU supported the development of a series of five workshops in 2018, focused on emergency operations planning for at-risk populations and increasing community resilience. ORAU conducted evaluations of individual workshops and all five collectively. Goals of the workshops were threefold:
1. discuss the relationship of at-risk population preparedness to community resilience,
2. utilize the C-MIST (communication, maintaining health, independence, services, safety, and security, and transportation) Framework to facilitate emergency operations plans and
3. Wfacilitate communication between at-risk populations and emergency planners.
At the conclusion of the workshop series, ORAU provided reports and workshop improvement plans that were compliant with the Federal Emergency Management Agency (FEMA)Homeland Security Exercise and Evaluation Program (HSEEP).
By implementing the recommended improvements, future workshops will further enhance the ability of communities to meet the needs of at-risk populations during an emergency.
Communicating for Better Situational Awareness
ORAU worked with CDC in 2018 to transition previously developed, bidirectional text messaging protocols into a mobile app named StopAnthrax™. StopAnthrax was designed to gather data on adverse symptoms experienced by people who had been dispensed medical countermeasures following exposure to anthrax.
Originally intended to be deployed following an anthrax incident, the app was designed to encourage adherence to the prescribed MCM regimen and provide vital health education in an effort to prevent the development of anthrax disease. The bidirectional messaging capability was included to provide CDC and its partners with real-time data during a response, increasing situational awareness, improving disaster response and improving outcomes for impacted communities. The app currently is being assessed for the viability of expanding it to address all hazards.
Sharing Success Stories of Best Practices
For more than a decade, ORAU has worked with CDC’s Division of Environmental Health Science and Practice Emergency Management, Radiation, and Chemical Branch to develop radiation emergency preparedness products for state and local public health professionals and clinicians. During 2018, ORAU created a series of videos to communicate how radiation emergency preparedness has advanced at the community level and offer lessons learned for other state and local public health professionals.
Using Georgia, New Jersey and Tennessee as examples, ORAU staff developed the videos illustrating local use of the products and CDC’s technical resources in health physics. The videos promote 1) awareness of the types and availability of radiation emergency preparedness tools and staff resources from CDC and 2) the positive impact of the partners’ investment of time, energy and focus in successfully furthering the nation’s ability to respond to a catastrophic radiological or nuclear emergency. CDC has requested that ORAU create additional videos to showcase local radiation emergency preparedness efforts in California and Mississippi.
Through these projects and decades of extensive work with agencies at all levels of the preparedness spectrum, ORAU has established best practices and developed the ability to approach preparedness planning from a holistic viewpoint to improve whole-community resilience in times of disaster.