Public Health Emergency Preparedness (PHEP) funding program marks 20 years

Photo of three individuals wearing yellow personal protective equipment (PPE).

By Jill Sutton, specialist, Emergency Preparedness and Response, APHL

This year marks the 20th anniversary of the CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement, a program that was developed in 2002 to strengthen preparedness capabilities in public health departments across the US.

Public health preparedness today can be attributed to developments in policy and funding since the September 11, 2001 terrorist attacks and the anthrax attacks that followed shortly after. Over the last 20 years, public health preparedness has evolved from a bioterrorism focus to an all-hazards approach, a framework that focuses on how we prepare and respond to a wide range of public health threats like infectious diseases and natural disasters as well as biological, chemical, nuclear and radiological events.

What is PHEP?

Since 2002, the PHEP program has been a critical source of funding, guidance and technical assistance for state, local and territorial public health departments. Thanks to PHEP, health departments are able to support preparedness and response activities and strengthen their preparedness capabilities so they are ready when public health emergencies strike.

At the local level, public health departments invest their PHEP funds to:

  • Enhance preparedness infrastructure,
  • Conduct trainings and exercises,
  • Hire dedicated preparedness staff,
  • Establish and maintain systems that enable the early detection of public health threats like monkeypox or COVID-19,
  • Quickly acquire emergency supplies and equipment, and
  • Rapidly share public health data to inform response needs.

As a result of these investments, communities are more prepared for public health emergencies than they were 20 years ago, but there’s still more that needs to be done. Federal preparedness funding has declined over the last 20 years, forcing PHEP recipients to cut positions, preparedness trainings and exercises, and equipment needs from their budgets. This has caused public health departments to be unable to expand or maintain their preparedness capabilities. A lack of sustainable funding directly impacts the capacity of state, local and territorial health departments to prepare for and respond to public health threats that arise in the communities they serve.

As we also celebrate National Preparedness Month, we honor the 20th anniversary of PHEP and all that it has helped our nation accomplish. Whether we are facing a pandemic or not, we need to remain prepared for the next public health emergency. It is our sincere hope that funding for PHEP will rise to ensure our nation’s public health system is prepared for the next emerging threat.

The post Public Health Emergency Preparedness (PHEP) funding program marks 20 years appeared first on APHL Blog.

Partnerships Help Save Lives When Disaster Strikes

Emergency responders gathered in a circle.

Public health emergencies occur every day across the United States. Tornadoes, hurricanes, wildfires, floods, infectious disease outbreaks, terrorist attacks, and other emergencies have all occurred within the past few years and likely will happen again. Communities must be ready in the event of a public health emergency – both those they expect and those that come without warning.

Since 2002, CDC’s Public Health Emergency Preparedness (PHEP) program has provided funding and guidance to 50 states, four cities, and eight territorial health departments across the nation to protect communities. Planning and exercising plans help ensure that health departments are ready to respond and save lives when emergencies occur.

While we all hope that emergencies never happen, they are inevitable and the true test of any preparedness system. The following stories are examples of how CDC’s PHEP program works with states and local communities to ensure they are ready to respond to any emergency. Some of CDC’s partners include health departments, community organizations, national public health organizations, and private companies.

Restoring California Communities after Devastating Wildfires

A fire truck responds to a brush fire.In 2017, nearly 9,000 fires, almost double the average annual number, burned 1.2 million acres in California. The fires destroyed more than 10,800 structures and killed at least 46 people. However, thanks to years of planning for such events and building a public health infrastructure through the PHEP program, state and local health departments were ready to respond immediately and help their communities recover over the following months.

Through partnerships and support provided by the PHEP program in and around Sonoma County, local officials evacuated more than 1,160 patients from area hospitals and many other healthcare facilities. Additionally, because of the relationship the state built with the California National Guard through the PHEP program, more than 100 volunteer troops cleaned the Sonoma Developmental Center in one day. More than 200 patients with disabilities were then able to return safely to the facility.

Ensuring Access to Medication during an Influenza Outbreak in Maine

Package of Oseltamivir (i.e., Tamiflu) capsulesIn March 2017, an influenza outbreak on Vinylhaven, a remote island off the coast of Maine with a population of about 1,165, sickened half of the island’s residents. The outbreak depleted the medical center’s Tamiflu® supply. Tamiflu® can greatly lessen the severity of influenza but it must be taken early in treatment.

Because of a partnership agreement established under PHEP with the Northern New England Poison Center, local pharmacies, and other organizations, and the Maine Department of Health staff quickly delivered 100 treatment courses of Tamiflu®. As a result, the state successfully reduced the impact of the influenza outbreak on the island.

Responding to a Water Contamination Incident in Illinois

Bottles of water on a conveyor belt.On May 2017, a water main break under a river contaminated water in Cumberland County, Illinois, and left some residents without water entirely. Health department staff funded through PHEP established water distribution sites with bottled water donated by private partners such as Walmart, Coca-Cola, and Anheuser-Busch. Staff also went door-to-door to check on residents and distribute materials about safe water.

The PHEP program ensures public health emergency management systems and experts are ready to respond when emergencies occur. Preparedness efforts throughout the years have saved lives and helped communities return to normal operations as quickly as possible.

From natural disasters to infectious diseases, the PHEP program protects America’s health, safety, and security to save lives. Check out the PHEP Stories from the Field to find out more about how the PHEP program has helped communities prepare for, respond to, and recover from public health emergencies.

Moving the Dial on Preparedness: CDC’s 2018 National Snapshot

Photo of a flooded apartment complex and office building during Hurricane Harvey.

Every year, CDC’s Office of Public Health Preparedness and Response publishes the Public Health Preparedness and Response National Snapshot, an annual report that highlights the work of CDC and our partners. No matter the type, size, or cause of a public health emergency, we must work together to respond to the best of our ability.

Photo of the cover of the Public Health Preparedness and Response 2018 National Snapshot report.
Read the full 2018 National Snapshot Report.

The Snapshot includes two sections:

  • The Narrative describes CDC preparedness and response activities in 2016 and 2017 and demonstrates how investments in preparedness enhance the nation’s ability to respond to public health threats and emergencies.
  • The Public Health Emergency Preparedness (PHEP) Program Fact sheets provide information on PHEP funding from 2015 to 2017 and trends and progress related to the 15 public health preparedness capabilities defined in the PHEP Cooperative Agreement. They also feature a short story that demonstrates the impact of the PHEP program.

Here are some highlights from the Snapshot that showcase how CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2017.

Hurricane Response and Recovery

In late summer 2017, three major hurricanes—Harvey, Irma, and Maria—made landfall in the United States and territories. This was the first time the United States experienced three Category 4 or greater hurricanes during a single hurricane season. CDC activated its Emergency Operations Center (EOC) on August 31, 2017 and the response is ongoing. CDC epidemiologists, environmental health specialists, emergency managers, health communicators, and scientists with expertise in waterborne and vector-borne diseases continue to work together to monitor and address public health threats in the aftermath of the storms.

Learn more about CDC’s role in the hurricane response.

The Opioid Epidemic

From 2000 – 2015, drug overdoses killed more than half a million people in the U.S. Six out of 10 of these deaths involved an opioid. CDC’s National Center for Injury Prevention and Control and the PHEP Program work together to support communities responding to the opioid epidemic. State health departments are using PHEP funds to identify communities hardest hit by the epidemic and to support the distribution of naloxone, a medical treatment to prevent death from opioid overdose.

Learn more about what states are doing to fight the opioid epidemic.

State and Local Readiness

Between 2017 and 2019, CDC and Public Health Emergency Preparedness (PHEP) program recipients will conduct nearly 500 medical countermeasure operational readiness reviews nationwide. Nearly 60% of the U.S. population resides in 72 metropolitan areas that are included in the reviews of 400 local jurisdictions. The reviews evaluate a jurisdiction’s ability to execute a large response that requires the rapid distribution and dispensing of life-saving medicines and medical supplies.

Learn more about the role of the PHEP program in state and local readiness.

Cutting-Edge Science to Find and Stop Disease

In 2017, CDC’s Federal Select Agent Program (FSAP) developed a new electronic information system to improve the efficiency of information sharing and exchange between FSAP and registered entities.

Learn more about how CDC safeguards lifesaving research with deadly pathogens and poisons through the Select Agent Program.

Read More

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If you have any feedback about the 2018 National Snapshot, please email us at preparednessreport@cdc.gov.  We welcome your suggestions and will use your feedback to improve future editions of the Snapshot.

Preparedness and Response in Action: Stories from the States

Celebrating 15 Years of PHEP

CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities.  Since 9/11, the PHEP program has saved lives by building and maintaining a nationwide public health emergency management system that enables communities to rapidly respond to public health threats.

The following stories are examples of how PHEP has equipped states for each of the four stages of preparedness: Ready. Steady. Show. Go!

READY: Planning for the inevitable6 domains of preparedness

Often the emergency managers and public health professionals who respond to an emergency are personally impacted by the same event. The ability of emergency response staff to take action during a disaster is limited when they are stranded in their homes due to an ice storm, without power, or unable to make it into the office.

The Connecticut State Department of Health, led by Jonathan Best, took on the challenge to ensure that operations can run smoothly even when their own staff are directly impacted by an emergency. They developed the Red Sheet Program, which trains three people for every key position in the emergency management structure – a primary contact with two back-ups. This means the health department can be fully staffed and ready to respond to a crisis within 20 minutes.

STEADY: Solving two problems at once

As the saying goes, even the best laid plans often go awry. Planning is an essential part of any preparedness program, but it is often difficult to imagine every scenario and obstacle that may arise during an emergency. But we also know that practice is the best way to identify and address those gaps– and practice is exactly what the Oklahoma State Department of Health does to improve its preparedness programs.

In September 2016, the Oklahoma Strategic National Stockpile team prepared to conduct a full-scale exercise of its ability to distribute medical countermeasures – medications and other products used to prevent and treat health conditions that may arise during a public health emergency.  Before the exercise began, the state realized they had shipments of flu vaccines that they needed to distribute around the state and the team distributed the vaccines as part of their regularly scheduled exercise. The team transported 11,960 doses of vaccine to eight local health departments while simultaneously completing this practice exercise.

SHOW: Creating a culture of preparedness

Emergencies impact all sectors of health, and experts from across departments are often asked to weigh in, from epidemiologists, to laboratorians, to mental health experts. However, public health staff in these positions may not often consider their roles in an emergency situation.

To build a culture of preparedness across the entire Oregon Health Authority, the Emergency Operations Division provided all staff with a 72-hour emergency kit, worked to enroll staff in the Health Alert Network, and trained staff on the Incident Management System. Since this initiative, staff personally feel more prepared for an emergency, and more staff are now prepared to respond should the need arise. “The culture has shifted. People are now talking in the elevator about what they would do in the event of a large-scale disaster,” acting PHEP director Akiko Saito said. “If we can build this culture of preparedness here, then we’re better equipped to build community resiliency on a larger scale.”

GO! Putting plans into action

While we all hope that emergencies never occur, they are inevitable and the true test of any preparedness system. Washington experienced an outbreak of mumps that affected more than 800 people of all ages in late 2016 and early 2017.

During this outbreak, the state and local health departments in Washington investigated new cases, advised local school districts on prevention measures, and developed culturally appropriate risk communication materials. Due to a robust preparedness system and the efforts of the health department staff and partners, more than 5,000 more people were vaccinated for measles, mumps, and rubella compared to previous years.

For 15 years, PHEP has been there, from Katrina to SARS; Joplin to H1N1 influenza. To find out more about how the PHEP program has equipped jurisdictions to prepare for, respond to, and recover from public health emergencies, check out our Stories from Field.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs: