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:

When Preparation Meets Opportunity: Cameroon Gets a Jump on Outbreak Response

 Buea-Regional-Hospital-at-the-foot-of-Mt-Cameroon

When Dr. Aristide Abah stepped off the plane that brought him from Atlanta back to his home in Cameroon, there was no time to waste. An outbreak of H5N1 flu threatened the country, and it was up to Dr. Abah to lead the response.

Fortunately, he was prepared.

Dr. Abah had just spent four months at CDC headquarters as part of CDC’s Public Health Emergency Management Fellowship, which invites public health experts from all over the world to learn how to organize an emergency response in their country.

A deadly threat

In Cameroon, H5N1 was raging in poultry, putting people at risk. The virus can spread to people who come into contact with infected birds, and the result can be devastating. An estimated 60% of people who get the disease, die.

A swarm of activity took place around Cameroon’s response: culling chickens, contact tracing, delivering Tamiflu to people who needed it, providing personal protective equipment (PPE) to workers, and more. The country faced challenges; with over 500 sets of PPE needed each day, animal health workers ran out and had to repurpose supplies that were never used for the 2014 Ebola outbreak.

If they were to stop the deadly virus from spreading to humans, the country needed to act fast and be efficient. For Dr. Abah – and for Cameroon’s public health emergency operations center – it was time to put some newfound knowledge to the test.

From fellowship to field

Dr. Abah leads Cameroon H5N1 response
Dr. Abah leads Cameroon’s H5N1 response

Dr. Abah returned home from his fellowship on a Sunday night. On Tuesday, he stepped in as Incident Manager for the response. On Wednesday, he walked around the room and put nameplates at every desk.

This simple action served two important purposes.

The first was to make sure everyone knew their designated roles. In an emergency, we use an organizational structure called an Incident Management System to assign specific roles and responsibilities to every person. This ensures that everyone knows exactly what they and others are doing.

Nameplates also meant that everyone had an assigned seat, so that people who worked on the same tasks sat near each other. When information has to travel fast, proximity is priceless.

After he organized the people, Dr. Abah organized their time. He set up a system that gave everyone an allotted number of minutes to speak at meetings. He even appointed a timekeeper to help stay on track. “As you may or may not know,” joked Kerre Avery, a CDC Emergency Management Specialist who works closely with Cameroon, “it’s the French custom to talk a lot.”

Dr. Abah also improved the way information traveled, both within the response and outside it.  He adopted the CDC template for daily update slides and situation reports in the EOC, and added a communications team to the incident management structure to help get critical messages out to the public.

For Dr. Abah, these were the opening steps of a wider plan to respond to the crisis. During his fellowship, he had learned the critical importance of planning and organization. “For me, the planning was key,” he said. “I now know that we can’t do anything without a plan.”

Knowledge can’t wait                                                                  

When Dr. Abah first learned of the H5N1 outbreak, he had not yet completed his fellowship, but he knew that the lessons he was learning would help his colleagues back home. He set up an internet-based platform so they could all see and benefit from the lessons. He also reached out with new ideas: “I wanted to speak to higher management,” he said. “I told them they had to have an Incident Manager [in the EOC].”

Cameroon was already getting better and better at responding to health threats. A year ago, it took the country eight weeks to activate their public health emergency operations center in response to a cholera outbreak. Several months later, when Lassa fever erupted, they had reduced their response time to a week. By the time H5N1 appeared in local poultry, it took the country less than 24 hours to activate the PHEOC.

Cameroon’s recent improvements – including their investment in sending Dr. Abah to the fellowship – are all part of a worldwide effort to better prevent, detect, and respond to public health emergencies. And their efforts in preparedness are paying off: during the latest outbreak, there were zero transmissions of H5N1 to humans.

Inspiring lessons

The lessons the Public Health Emergency Management Fellowship teaches are designed to be applied to virtually any crisis situation. Since the 2013 inaugural class, CDC has hosted 39 fellows from 25 countries, giving them important education they can take back and use in their home countries.

While in the U.S., Dr. Abah was particularly inspired by a visit to meet Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response in Washington, D.C. Her advice to him summarizes perhaps the most important lessons from the fellowship.

“I keep in my memories three words of advice from Dr. Lurie.” Dr. Abah recalls. “Never give up, stay connected, and get better.”

The Public Health Emergency Management Fellowship is implemented by CDC’s Division of Emergency Operations. The program helps countries meet the goals of the Global Health Security Agenda, including having an emergency operations center that can respond within two hours of a public health emergency.

Learn More

 Read our other National Preparedness Month blogs:

CDC’s Emergency Management Specialists

CDC's Emergency Operation CenterMeet Mark Hall, an emergency management specialist in CDC’s Division of Emergency Operations in the Office of Public Health Preparedness and Response. As part of the Plans, Training, Exercise, and Evaluation Team — Mark and his team make sure CDC is prepared for emergencies and assesses how the agency performs during a response.

Being ready to respond to national and international emergencies takes practice. Large-scale exercises are held across CDC, with federal partners, and at the state and local level.  Mark and his colleagues are part of the team that evaluates the exercises that CDC administers. They ensure that exercise mimics real-world events and after the exercise, evaluate what worked and what needs to be improved. In an emergency response, the team also monitors the way in which CDC is conducting the response to see if any activities need to be tweaked.  As part of the monitoring and review processes,  the team looks at everything from the processes for deploying people and supplies, to the logistics and operations of CDC’s emergency operation center. This job requires strong analytical and communication skills and the flexibility to switch from exercise to emergency response mode when the need arises.

Mark Hall sits down with the Director of CDC's Office of Public Health Preparedness and Response to talk about his job as an emergency management specalist
Mark Hall sits down with the Director of CDC’s Office of Public Health Preparedness and Response to talk about his job as an emergency management specalist

Public Health Matters sat down with Mark to learn a little more about his job in emergency management and what has best prepared him for his important role at CDC.

How does your work help improve CDC’s ability to respond to emergencies?

Mark say, his job is to evaluate CDC exercises and response efforts to ensure that the agency continues to improve. The evaluations conducted by Mark and his team after each exercise, whether a CDC-wide exercise or for a specific group, help to identify issues and areas for improvement.  Mark emphasizes the importance of not only finding ways to improve CDC’s emergency response work, but also recognizing the good work is being done. “During these after-action reviews we also want to focus on the successes, not just what we did wrong, and communicate what worked best to the rest of CDC,” says Mark.

What has best prepared you for this job?

For Mark, his 20 years in the military and a background in operations, planning, and training helped prepare him to work in CDC’s Division of Emergency Operations. “I enjoyed the idea of going from operations, plans, exercises, and training focused on military and combat to a focus on public health.  As an emergency management specialist I still get to focus on doing good work for my country, my nation, and even for the world,” says Mark.

During his military career, Mark had the opportunity to travel to many different countries including Kazakhstan, Kuwait, Qatar, Iraq, Saudi Arabia, and Egypt. Going overseas, meeting different people, and experiencing different cultures has helped with working on emergency responses, including deploying oversees as part of CDC’s response to the West Africa Ebola epidemic.

CDC's emergency operation planning team meets to review and incorporate feedback from CDC exercises and after action reports
CDC’s emergency operation planning team meets to review and incorporate feedback from CDC exercises and after action reports

What are important skills needed for your job?

“You have to be flexible. We know that there’s a hurricane season every year that’s recurring.  However the majority of the events that require a CDC response occur without prior notice, and we have to be ready to respond,” says Mark. Having the ability to adapt to different emergency responses quickly is a crucial component of CDC’s ability to react to public health threats and emergency as soon as they arise.

What do you like most about your job?

“When programs make changes based on recommendations after exercises or a real-life event, it really shows that the work has had an effect. It is also rewarding to hear news stories or friends and family talking about the domestic and global work that CDC is doing and knowing you’re a part of that work.”

 

 

PHPR: Health Security in Action

This post is part of a series designed to profile programs from CDC’s Office of Public Health Preparedness and Response.

CDC’s Emergency Management Specialists are part of the CDC’s Public Health Preparedness and Response’s (PHPR) Division of Emergency Operations.