Research Priorities in Emergency Preparedness and Response for Public Health Systems A Letter Report (2008) / Chapter Skim
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As requested, the report delineates a set of near-term research priorities for emergency preparedness and response in public health systems that are relevant to the specific expertise resident at schools of public health and related fields. We understand that these priorities will be used by the Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER)
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, with invited experts giving their views on research priorities in emergency preparedness and response for public health systems. Based on the committee's expert judgment, as well as information exchanged in the public meeting and workshop, we identified four toppriority research areas.
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The committee acknowledges that -- and indeed intends for -- these areas to generate overlapping research initiatives. All research projects conducted under this initiative should address or be aware of issues regarding vulnerable populations, workforce, behavioral health, and the use and integration of new technologies as appropriate to the proposed area of study.
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The committee wishes to thank you for the opportunity to be of assistance to the Centers for Disease Control and Prevention and its Coordinating Office for Terrorism Emergency Preparedness and Response as they work to protect the nation's health. Kenneth I
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As a framework for their deliberations, the committee's statement of task required that they consider the areas of interest articulated in the CDC's Advancing the Nation's Health: A Guide for Public Health Research Needs, 2006–2015 (CDC, 2006) , with special attention given to • protecting vulnerable populations in emergencies; • strengthening response systems; • preparing the public health workforce; • improving timely emergency communications; and • improving information management to increase use.
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; • preparing the public health workforce (developing and evaluating strate gies and tools to train and exercise the public health workforce to meet responsibilities for detection, mitigation, and recovery in varied settings and populations) ; • improving timely emergency communications (evaluating characteristics of effective risk communication in emergency settings and system en hancements to improve effective information exchange across diverse partners and populations under emergency conditions)
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Jeffrey Koplan instructed the then-Public Health Practice Program Office to develop an agency-wide plan to address the CDC's training and continuing education needs.1 The plan was to establish a cohesive, integrated approach to training that focused on the domestic public health workforce, a group that was found to have little formal training in public health, particularly in bioterrorism. This led to the establishment of CPHPs, whose purpose was to leverage existing expertise and educational materials developed by academic public health institutions and create linkages to public health practice (Council on Linkages between Academia and Public Health Practice, 2000)
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5) and inserted this narrative into the report accompanying it: The committee finds that public health systems research is a priority because there has been tremendous financial investment made to date for public health preparedness with no evidence-based measures for evaluating progress or preparedness.
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This letter report is based on the committee's expert judgment and assessment of research priorities in emergency preparedness and response for public health systems. Definitions Public Health Emergency Preparedness Before identifying research priorities in emergency preparedness and response for public health systems, the committee believed that it was necessary to establish a definition of "public health emergency preparedness." It chose to adopt the definition proposed by Nelson and colleagues in a 2007 editorial in the American Journal of Public Health: Public health emergency preparedness (PHEP)
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Figure 1 illustrates these factors, which include communities, health-care delivery systems, employers and business, the media, homeland security and public safety, academia, and the governmental public health infrastructure. As highlighted in the 2002 IOM report, there are other less obvious actors that can play a significant role "by influencing and even generating the multiple determinants of health" (IOM, 2002)
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Educate, engage, and mobilize the public to be full and active participants in public health emergency preparedness.
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SOURCE: Modified from the Future of Public Health in the 21st Century, the shaded ovals represent the key actors who can work individually or together as part of a public health system to create the conditions necessary for public health emergency preparedness, response, and recovery. While each of these actors is a separate entity, a robust public health system for preparedness requires that each work together when appropriate.
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FINDINGS The organization and operations of effective systems of public health preparedness need to be constituted to cope with a wide range of threats -- the all-hazards approach -- including catastrophic health events. As discussed earlier these systems need to include state, local, tribal, and federal public health agencies; practitioners from emergency response and health-care systems; communities, homeland security and public safety, health-care delivery systems, employers and business, the media, academia, and individual citizens.
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The four areas are • enhancing the usefulness of training; • improving timely emergency communications; • creating and maintaining sustainable response systems; and • generating effectiveness criteria and metrics. This fourth research priority area, generating effectiveness criteria and metrics, does not preclude such criteria and metrics from being developed as part of the research in the other three priority areas.
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To optimize the research opportunities across CPHPs, centers should also have the capacity to work in partnership with other schools of public health and relevant academic centers that have complementary research expertise. Further, the committee also advises the CDC to fund centers that agree to work together and collaborate, in a network, with other funded centers, and thereby leverage scarce resources.
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The evaluation of research proposals should consider the extent to which multidisciplinary, interdisciplinary, and/or crossdisciplinary knowledge, expertise and collaboration are employed to maximize effective and efficient response. Evaluation of proposals should also consider clear efforts to define criteria and metrics for effective programs that include vulnerable populations, an appropriately prepared workforce, the potential for appropriate and timely change, and the capacity for continuous quality improvement.
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Recommendation 3: Create and Maintain Sustain able Preparedness and Response Systems CPHPs should conduct research that will identify the factors that affect a community's ability to successfully respond to a crisis with public health consequences, and the systems and infrastructure needed to foster construc tive responses in a sustainable manner. Recommendation 4: Generate Criteria and Metrics to Measure Effectiveness and Efficiency CPHPs should conduct research that will generate crite ria for evaluating public health emergency preparedness, response, and recovery and metrics for measuring their efficiency and effectiveness.
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To address these deficiencies, the committee believes that it is necessary to • better define the public health emergency response system and its performance outcomes; • clarify the roles and responsibilities of public health emergency preparedness and response systems within and across local, state, tribal, and federal public health systems and the larger emer gency response system; • create measurable, meaningful input, process, and outcome per formance measures; and • evaluate how training, as defined above, improves the profi ciency and performance of public health response systems.
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• Which, and how valid are, training modalities that improve in formation management and visualization4 to improve decision analysis and outcomes? • How valid are case studies and standardized assessment tools for after-action reporting when applied retrospectively to actual pub lic health emergency events?
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Effective emergency communication is also integral to the larger process of information exchange aimed at eliciting trust and promoting understanding of the relevant issues or actions. However, while emergency communication is an integral component, pre-emergency preparedness communication, including risk communication, also plays a significant role in the development of resilient communities and sustainable response systems.
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be better used to fill risk communication gaps in emergency settings, including those ex perience by vulnerable populations? • How does one optimize and leverage the use of existing channels of risk communication in emergency settings to reach diverse audiences, including nonprofit organizations, faith-based organi zations, schools, business community, and relevant professional associations?
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• How can information technology innovations (e.g., wireless technologies, electronic health records, systems integration, emergency medical response) strengthen emergency response systems by improving situational awareness, data sharing, and decision support for the public health workforce?
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However, lessons can also be learned from other fields not traditionally a part of the public health system, including operations research, systems engineering, and the business sector. The major issue to be addressed is what are the preparatory activities that public health officials can take -- working with communities, agencies, and organizations -- to maximize effective outcomes of the emergency response system that will have both planned and emergent selforganizing components?
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• To what extent do coordinated pre-event preparedness activities impact the efficacy and capability of the public health system to integrate into the broader response system, including public, community, and private sectors? о How can these findings be better integrated into the public health preparedness system?
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The committee believes that work in this area should concentrate on the following issues: 1. What are the appropriate criteria for evaluating public health emergency preparedness, response, and recovery?
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The proposed research projects seek to provide evidence on which important decisions about the nature and distribution of public health preparedness resources can be based. By insisting on well-described metrics, the research offers the chance for more rational decisions about these resource requirements as well as the opportunity to undertake continuous quality improvement in the preparedness field.
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Through the engagement of those who provide public health preparedness services in the community, this initiative offers the opportunity for research that is practical, applicable, and sustainable. In so doing, it will strengthen the growing relationships between academic public health and public health practitioners, in addition to the broader public and other emergency preparedness practitioners.
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