Priority Area: Community Preparedness

Community Preparedness - Effective Emergency Response and Recovery

• Planning and preparation are the foundation of effective emergency response and recovery. Since September 11, 2001, it has been clear that public health has a crucial role to play in any emergency, whether naturally-occurring or resulting from a deliberate act.
• Public health is now integrated into the emergency response system as a full partner, and often, as the lead player. That’s because any type of hazard or emergency can affect the health and safety of New Yorkers.
• Over the past several years the New York State Department of Health (NYSDOH) has worked closely with local health departments (LHDs) and other key partners to make sure that every county will be ready for the unexpected. Depending on where you live, natural hazards include blizzards and ice storms, tornadoes, floods, an occasional earthquake, and the effects of hurricanes hugging the Atlantic coast. Such extreme contrasts pose big challenges to health emergency preparedness planning, as does the state’s demographics:
  • 13% of New Yorkers are age 65 and older;
  • 15% live below the poverty level;
  • 20% are foreign born;
  • 28% speak a language other than English at home; and
  • Seven federally-recognized and two state-recognized Indian tribes live on reservations within New York State.
• New York State’s preparedness planning assumes that in spite of our diversity, some things pose a risk to each of us. An all-hazards approach is crucial to respond to all types of emergencies including biological, chemical, radiological, and weather related.
• No community, large or small, is immune to the effects of a natural disaster. A pathogen that arrives with an international traveler can spread from metropolitan to rural areas in the time it takes to board a bus or train. Chemical spills, pipeline explosions and derailments occur in rural and urban areas, alike. And although the threat of terrorist attacks is most keenly felt in New York City, upstate New York, with its reservoirs, nuclear power facilities, chemical plants, rivers and Great Lakes ports, and landmark tourist attractions is vulnerable, as well. For more information on preparing for all types of emergencies, go to the Department of Health’s webpage on Emergency Preparedness and Response: http://www.health.state.ny.us/environmental/emergency/index.htm
• Natural disasters, food-borne disease outbreaks and vaccine shortages occur more and more often, and when they do, a quick and effective public health response is crucial to reduce injury, prevent or control illness and save lives. For that reason, the NYSDOH Prevention Agenda Priority for Community Preparedness aims to empower LHDs and their community partners across the state to promote local readiness, foster community resilience and ensure a comprehensive and effective response, should disaster strike.

Objectives

• During the next five years, the percent of the population living within a jurisdiction with a state-approved emergency preparedness plan should be 100%. Baseline: 100%, Program data, 2007. (Maintain 100% level)

Indicators for Tracking Public Health Priority Areas

• Indicators For Tracking Public Health Priority Areas - Each county's Progress

Program Indicators

• Communities that select Community Preparedness as one of their Prevention Agenda priorities can select a number of indicators to measure their progress.

Indicator: Percent of the population living within a jurisdiction with an emergency preparedness plan that addresses:

• Comprehensive, all-hazards planning
• Isolation and quarantine of persons exposed to or infected with a communicable disease
• Pandemic influenza
• Continuity of operations to maintain essential public health services for the public during an emergency

Why is this important?

Simply put, if we fail to plan—we plan to fail. In New York State, 100% of the population lives in a jurisdiction with an emergency preparedness plan.  

Since 2001, Local Health Departments have collaborated with NYSDOH on local and state preparedness planning and response goals. Local Health Departments have completed different aspects of a comprehensive, all-hazards plan for each year and have made great strides in local planning and partnerships. Local Health Departments, in partnership with their key partners, have exercised their plans in local and statewide drills. In 2006, all Local Health Departments participated in the Western Region Communicable Disease Exercise (CDEX) during which they identified and tracked an influenza pandemic throughout the State. In 2008, 33 Local Health Departments and 64 Hospitals participated in the New York State Full Scale Logistics Exercise (NYFLEx). NYFLEx tested local plans to receive state medical assets from the state that would be needed to treat and care for people with pandemic influenza.

Indicator: Number of Local Health Departments (outside of New York City) that have an aggregate overall score of at least 69 for their Strategic National Stockpile (SNS) Technical Assistance Review (TAR)

Why is this important?

During a widespread disease outbreak, natural disaster or terrorist attack the ability to get “pills to people” quickly would be a matter of life and death.

For 2008-09, all 57 Local Health Departments outside of New York City had a baseline assessment of their SNS plan. Aggregate scores are available for 2008-09, and scores by individual county will be available for the 2009-10 SNS TAR.

The average SNS TAR score for all Local Health Departments outside of New York City was 64. Cities Readiness Initiative (CRI)* jurisdictions had an average score of 90, while non-CRI jurisdictions averaged 57.

The New York State Department of Health relies on Local Health Departments (LHD) to provide mass prophylaxis – that is to dispense pharmaceuticals and other medical supplies to affected populations in response to an emergency. Local Health Departments conduct Strategic National Stockpile planning and exercises to assure timely request, receipt, storage and distribution of emergency medicines, equipment and supplies. For 2007-2008, counties updated and evaluated their County Strategic National Stockpile (SNS) plans. The plans were evaluated using the CDC’s Technical Assistance Review (TAR) tool. The tool has been used by the CDC for the past two years to evaluate and assess SNS plans for all states and all Cities Readiness Initiative* (CRI) jurisdictions. The tool is broken down into twelve functional areas. Each area is evaluated through a series of questions and points are assigned based on completion status of the tasks. Areas for improvement include: security planning, dispensing, and training and exercising.

*NOTE: The Cities Readiness Initiative (CRI) is a federally funded effort to prepare major US cities and metropolitan areas to effectively respond to a large scale bioterrorist event by dispensing antibiotics to their entire identified population within 48 hours of the decision to do so. The CRI areas in New York include the counties of: Albany, Schenectady, Saratoga, Schoharie, Erie, Niagara, Putnam, Rockland, Nassau, Suffolk and Westchester and the city of New York.

The CRI project began in 2004 and has grown each year thereafter:

• 2004: CRI started with 21 cities
• 2005: CDC funded 15 additional cities, for a total of 36 CRI cities
• 2006: CDC funded an additional 36 cities, for a total of 72 participating cities, and at least one CRI city in each state

2008 County Aggregate TAR Scores by Functional Area

Section	Average CRI Counties	Average Non-Cri Counties	Average All New York Counties
1. Developing a Plan	96	72	77
2. Management of SNS	95	68	74
3. Requesting SNS	100	92	94
4. Communications Plan (Tactical)	99	68	75
5. Public Information & Communication (PI&C)	98	66	73
6. Security	75	47	53
7. Regional Distribution Site ( County Staging Site)	97	64	71
8. Controlling Inventory	98	72	78
9. Distribution	92	52	60
10. Dispensing Prophylaxis	83	49	56
11. Hospitals & Alternate Care Facilities	97	59	67
12. Training, Exercise & Evaluation	89	45	54

Indicator: Percent of Local Health Departments that acknowledge an alert notification sent by the New York State Department of Health without use of electric grid power and primary land-line telephone service within 60 minutes of receipt.

Why is this important?

In an emergency, the regular means of communication may not be working. The ability to quickly receive and share information to reduce risk and save lives is crucial.

To test this ability, the NYSDOH Integrated Health Alerting and Notification System (IHANS) was used to initiate an alert drill after business hours (weekday evening). IHANS encompasses the NYSDOH Communications Directory which is the NYSDOH public health directory which maintains accurate 24/7 contact information for key response partners, including cell phone contact information. Cell phone numbers were verified prior to the drill by drill participants and cell phones were the sole means of contact used for notifying the participants in this drill. Notification was sent simultaneously to all public health and tribal nation participants.

Participants were contacted by IHANS on their cell phones, were given a phone number to a phone bridge, and were instructed to immediately call the number using the same cell phone on which they were contacted to demonstrate 2-way communications capability, without land line. The phone bridge recorded the time and the phone number of all callers during the drill, and numbers recorded on the bridge were matched against the Department's Communication Directory cell phone numbers to verify use of non-land line devices during the drill.

Participants were contacted by the NYSDOH Integrated Health Alerting and Notification System (IHANS) to verify the use of non-land line devices during the drill. Results of the drill indicated:

• 74% of the LHDs (42/57) responded within 45 minutes;
• 26% of the LHDs (15/57) did not confirm receipt of the call within 60 minutes

Indicator: Percent of Local Health Departments that have involved the public in preparedness initiatives to educate, promote resilience, and/or solicit feedback on local health emergency planning.

Why is this important?

Unless community members are informed and involved in the planning process, preparedness and response efforts will fall short. It’s not enough to give out information. Local planners must get information from the people they serve, and use that information to improve the service they provide.

By May 2009, all 57 upstate LHDs will conduct a community engagement activity to solicit public participation on planned health emergency preparedness strategies. Currently, three LHDs have participated in public engagement meetings on pandemic influenza planning.

The NYSDOH, along with Cortland, Chautauqua and Nassau health departments, and the University at Albany Center for Public Health Preparedness hosted daylong, public engagement meetings at four sites on April 12, 2008. Representatives of at-risk/vulnerable populations such as the elderly, individuals with disabilities or mental health issues, tribal nations, and minority New Yorkers participated. Both service providers and consumers attended the meetings.

The project was designed to educate the public about pandemic influenza and find out how well their knowledge, attitudes and beliefs compare with current pandemic planning assumptions. Having this information will provide a reality check for the planning process and identify gaps, barriers, and unintended consequences that would get in the way of a successful response during a public health emergency. Through community engagement, State and local health officials hope to create an ongoing dialogue about New York’s pandemic influenza planning.

A complete report on Community Meetings on Pandemic Influenza is available online.

Office of Health Emergency Preparedness

The New York State Department of Health Office of Health Emergency Preparedness (OHEP) is responsible for the coordination and management of all activities for Public Health and Healthcare Facility Preparedness. This includes preparedness planning, and making sure that emergency plans work in drills, exercises and real life. OHEP coordinates preparedness activities with all 58 Local Health Departments in the state including New York City, state and local emergency managers, acute care hospitals, nursing homes, adult care facilities, the state Office of Homeland Security, and the 23 Disaster Preparedness Committee (DPC) state agencies. OHEP also coordinates the Department’s planning for the request, receipt, storage and distribution of the federal Strategic National Stockpile (SNS), a national repository of pharmaceutical and medical supplies designed to supplement and re-supply states in the event of a national emergency. OHEP manages and maintains the Department’s Medical Emergency Response Cache (MERC) – a critical asset for the Department. The MERC contains medicines, medical supplies and equipment including beds, ventilators, IV equipment, masks, respirators, gloves, etc. that are not available from the SNS. MERC assets will be used for first responders, medical surge, and to bridge the gap from the time an emergency starts until receipt of SNS supplies. In addition, OHEP manages the Department’s Medical Volunteer Management System. This statewide, coordinated medical volunteer program will make sure that there are enough medical personnel to staff hospitals, alternate care facilities and help to dispense medications during an emergency. The Office also coordinates the Health Emergency Response Data System (HERDS). HERDS is an electronic, real-time tool that determines the needs and status of healthcare facilities during an emergency. HERDS can be used to help set up Alternate Care Sites if all hospital beds are full during an emergency. It also oversees evacuation planning for healthcare facilities in hurricane flood zones across the state

Preparedness Planning Partners

The Office of Health Emergency Preparedness works with a number of partners including:

• Adult Care Facilities
• Centers for Disease Control and Preparedness
• Hospice
• Hospitals
• Nursing Homes
• State and Local Emergency Managers
• State and Local Law Enforcement
• State Office of Homeland Security
• Tribal Nations
• U.S. Department of Health and Human Services

Resources

A wide variety of resources for families, schools, health care providers and others is available on the Department’s Emergency Preparedness webpage.

Additional information may be found on the following websites:

New York State Emergency Management office

New York State Association of County Health Officials

National Association of City and County Health Officials (NACCHO), Emergency Preparedness

Centers for Disease Control and Prevention (CDC), Emergency Preparedness and Response

American Public Health Association (APHA), Get Ready Campaign

U.S. Department of Homeland Security Resources, on-line emergency planning tools

The American Red Cross, Emergency Preparedness

Association of State and Territorial Health Officials, Public Health Emergency Preparedness