Skip to main content

Currently Skimming:

5: Toolkit Part 2: Public Health
Pages 105-124

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 105...
... State public health has responsibility for the health of the population within the entire state, and may consist of locally run satellite state public health agencies. In either model, state public health has powers under the authority of the governor outlined in state statutes, which can be enacted in a public health, natural disaster, or catastrophic medical incident when usual mechanisms and powers are insufficient to meet the regulatory or response requirements of an incident.
From page 106...
... Discussion Participants From a public health perspective, any agency or organization that will be impacted in their service delivery by public health decisions should be discussion participants at some point in the deliberation process.2 Public health impacts all sectors and thus the need for integrated planning and long-term follow-up should be a key component in planning for and implementing CSC and will have a critical supporting role throughout an incident. Local public health discussions should include their agency emergency management/preparedness coordinator, health officer, and medical director at a minimum.
From page 107...
... , home care, impacted primary care providers, funeral directors, etc., for SME input as the incident expands. State public health entities involved may be a chief medical executive, state health officer, state epidemiologist, director of public health preparedness, an EMS and trauma system medical director or executive, a behavioral/mental health executive, health emergency management coordinator (EMC)
From page 108...
... 4. Has the local or state health department identified triggers to impact or restrict public gatherings to minimize exposures and thus decrease demand for medical resources?
From page 109...
... 9. How quickly and by what means can the risk communication and public information officer implement communication strategies in circumstances when usual means of communication are compromised?
From page 110...
... , focusing on key system indicators and triggers that will drive actions in their own organizations, agencies, and jurisdictions. As a reminder, indicators are measures or predictors of changes in demand and/or resource availability; triggers are decision points (refer back to the toolkit introduction [Chapter 3]
From page 111...
... • Continue to provide appropriate levels of • Interruption or contamination of water • Prolonged and widespread utilities communication to the media, community, supply or utilities (power, natural gas) outages and impacted health care organizations • Identified need to establish Tactics: communication hotlines • Use all established resources to • Requests for specialized services coordinate and communicate health and needs for broad public messages communications continued 111
From page 112...
... • Coordinate risk communication strategies with governmental public information officials Staff Indicators: Indicators: Indicators: • Increasing absenteeism among • Increasing absenteeism and inability • Impact of incident decreasing (Refer also to the public health staff; increased demand to fulfill critical missions to community • Personnel absenteeism is decreasing worker functional for staffing for community-based • Increased demand for resources • Personnel communicating need to initiate capacity table in interventions, etc. Crisis Triggers: activities to "return to normal operations" Toolkit Part 1 [Table Triggers: • Unable to fulfill critical missions (e.g., Triggers: 3-1]
From page 113...
... • Local health departments work with their primary care providers to identify mechanisms to expand services and protect personnel • Emergency Support Function-8 lead to keep each local emergency operations center aware of impact and contingency care implemented • State health implement statewide plans for nurse triage lines, 211, poison control support for callers related to event • State public health works with all health care coalitions to support implementation of statewide medical surge strategies • State health emergency coordination center to keep each local health department aware of impact and contingency care implemented continued 113
From page 114...
... is supply chain based on expanding or vaccine present significant risk to declining as event wanes incident; review communications persons who cannot receive them Triggers: from each health care coalition • National guidance on rationing • Critical medical supplies are sufficient to for the impact to their health care distributed meet the needs of the patients requiring organizations Tactics: them Triggers: • Focus allocation of scarce resources Tactics: • Decreased availability of critical to maintaining critical social/ • Continued, coordinated risk communication medical resources anticipated public safety function (civil order • Assessment if transition is temporary or • Requests to health care coalition maintenance) likely to be permanent medical coordination center for • Coordinated risk communication • Local public health should augment Points allocation of regional cache supplies strategies are critical of Dispensing plans to meet demands Tactics: • Use government purchasing powers to when vaccination is expanded as vaccine is • Prioritize resource allocation by support critical medical supplies available urgency of need and risk • Maintain communications with federal • Demobilization of SNS • Determine time frame and availability SNS program • State public health to review CSC guidelines from other vendors/sources • State and regional disaster medical for possible revision based on resource • Review and update risk advisory committees review triage availability communication strategies specific guidance available and propose to users of critical resources and recommendations community • State public health circulates • State health emergency coordination guidelines on allocation of resources center work with each health care • Legal, regulatory, and emergency coalition to allocate regional cache powers invoked as required to contents and other resources facilitate fair, planned allocation • State health emergency coordination process center initiates internal mechanisms to move anticipated Strategic National Stockpile (SNS)
From page 115...
... (NOTE: Requires • Local governmental agencies should extensive planning with multiple identify potential cultural barriers to state agencies to identify a location, modifications in death processes and tracking, and personnel support to prepare strategies to address these implement such a response to manage • Initiate strategies to expedite the mass fatality incident.) completion of death certificates/ • Consider transfer of decedents to investigations other locations for processing if • State public health investigates required modifications to laws, regulations, etc., for dealing with decedents • Governmental authorities initiate planning for possible alternate storage strategies • Consider federal or state disaster mortuary team resources • Consider temporary storage facilities implementation plan continued 115
From page 116...
... TABLE 5-1 116 Continued Indicator Category Contingency Crisis Return Toward Conventional Congregate Indicators: Indicators: Indicators: gatherings • Epidemiologic models indicate • Statewide indication of high • Decrease in evidence for person-to-person person-to-person spread is prevalent transmission in gathering settings trends • Multiple jurisdictions reporting Crisis Triggers: • Criteria for identifying "superspreaders" as that large gatherings implicated in • Forced quarantine is required individuals allows targeted interventions outbreak investigations to prevent spread of dangerous Triggers: • Outbreaks linked to funeral services pathogen • Sustained decrease in disease transmission Triggers: • Public gatherings prohibited trends • Epidemiologic data indicate increasing Tactics: Tactics: outbreaks directly related to known • Executive order or governor's • Governor rescinds gathering orders congregate gatherings in more than declaration to eliminate congregate • Initiate public gatherings one jurisdiction gatherings • Local and state continue close monitoring Tactics: • Quarantine orders implemented as of epidemiologic data to ensure continued • Local and state review immediate indicated decline and are prepared to reinstate bans if and future large-scale venues for • Governmental agencies collaborate to cases increase anticipated cancellation enforce congregate-gathering bans • Local and state recommendations on school closures • State public health readies quarantine guidelines working with governor's office
From page 117...
... to state families EOC (SEOC) that medical and public • Continue established patient tracking health have significant impact to service system and allow access by non delivery governmental and other organizations as • Incident disrupts medical supply chain; required to facilitate reunification anticipate shortages • Unable to locate or track all patients impacted by incident Tactics: • Data collection to local EOC • State health emergency coordination center queries all health care coalitions to identify statewide impact to service delivery and plan response strategies (patient and resource movement)
From page 118...
... to clear impacted health care that could impact community, thus • Inability for multiple hospitals to organizations for repopulation or indicating a need for coordinated risk remain in their current building without resume suspended services communication strategies significant support • Local EOCs getting queries from • Multiple health care facilities require health care organizations about utility evacuation and inadequate transport restoration resources to accomplish this Tactics: • Local emergency management indicates • Support requests from health care a need to establish multiple shelters, organizations through health care including functional needs coalition Tactics: • Prioritize key public health activities to • Continued need for risk communications support critical jurisdictional needs and to community health care organization service delivery • Identify needs of health care • Local public information officials work organizations in collaboration with health with media on health-related risk care coalitions communication strategies • Local health departments should identify • State public information officials working staff, including volunteers, to assist with with other state agency and local public public health issues in shelters, including information officials for coordinated risk those targeted to functional needs communications • State public information officials working • Local EOCs establishing mechanisms to with other state agency and local public implement family reunification systems information officials for coordinated risk communications • State working with locals to ensure that family reunification systems can meet demands
From page 119...
... Tactics: • Use available staff and provide support for nonspecialized tasks to maximize response • Limit services to those related to life/ safety issues only • Facilitate out-of-area specialty consultation as applicable • Use volunteer health professional if available • State to seek additional personnel resources through federal programs (Department of Health and Human Services, Department of Defense, etc.) continued 119
From page 120...
... and similar facilities Crisis triggers: Triggers: • Hospital data indicate capacity exceeded • Requests to modify EMS transport • System data indicate returning to at multiple facilities despite surge protocols baseline transport status capacity plan activation • Requests for alternate care sites for Tactics: Triggers: inpatient overflow • Support efforts to return EMS to • Local requests for assistance with patient Tactics: normal operations and regulations movement • State ESF-8 works to implement protocol • Support demobilization of • Inadequate EMS resources to waivers to support modified transport alternate care sites and shelter accommodate demands plans medical support Tactics: • State public information official • Local and state public health staff • Need anticipated to modify EMS communicates efforts to all medical gather all after-action reports, transport protocols statewide and health entities meet with key stakeholders to suspend specific staffing and other • State coordination of field hospital and identify challenges, and plan to response requirements patient transportation assets from state, support future operations • Local EOCs work with regional health EMAC, and federal sources care coalitions to identify and prioritize transport resources • State health emergency coordination center to work on statewide available resources through health care coalition structure • State public health and SEOC identify additional resources through Mutual Aid Agreements (MAAs) or Emergency Management Assistance Compact (EMAC)
From page 121...
... or cache materiel organizational response; this would accountability to assess impact of Tactics: include implementing MAA and EMAC incident and plan for remediation • Local health care organizations work with requests for services and supplies needed of gaps their health care coalition to distribute to deliver care • Continue situational monitoring regional resources, including obtaining • Executive orders or public health/ -- is this a temporary or sustained resources from health care coalitions that emergency declaration if needed to improvement? are not impacted by the incident support altering the use of equipment, • State Emergency Support Function- supplies, or human resources (ESF-)
From page 122...
... • The key questions were designed to facilitate discussion -- customized for public health -- about the following four steps to consider when developing indicators and triggers for a specific organiza tion/agency/jurisdiction: (1) identify key response strategies and actions, (2)
From page 123...
... Scope and Event Type: __________________________________ Indicator Category Contingency Crisis Return Toward Conventional Surveillance data Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Communications and Indicators: Indicators: Indicators: community infrastructure Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Staff Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Space/infrastructure Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Supplies Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Other categories Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: 123
From page 124...
... 2012. Crisis standards of care: A systems framework for catastrophic disaster response.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.