Engaging the Public in Critical Disaster Planning and Decision Making Workshop Summary (2013) / Chapter Skim
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Engaging the Public in Critical Disaster Planning and Decision Making
Engaging the Public in Critical Disaster Planning and Decision Making
Pages 1-40
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Specifically, presentation and discussion objectives were to2 Introduce the key principles of public engagement Provide practical guidance on how to plan and implement a public engagement activity Provide attendees with sample tools to facilitate planning 1 The role of the ad hoc planning committee of the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events was limited to developing this session (i.e., workshop)
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Beginning by framing and defining public engagement outreach during the planning stages, it moves to describing the specific case studies speakers presented during the workshop. These include Seattle and King County, Washington; Harris County, Texas; the State of Michigan; and an example from the IOM and the Centers for Disease
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. Following these case studies, challenges and lessons learned are discussed, and finally a description of the two simulated public engagement exercises performed during the workshop: a community conversation simulation and a Q-sort activity based on a severe influenza pandemic scenario.
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Many of the benefits of public engagement are obvious, Shah said. In the short term, public engagement provides greater visibility and public awareness about the need for local disaster preparedness plans and initiatives and the importance of community and individual preparedness in general.
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, data collection templates, and other resources. These can be used to engage the lay public in discussion about the values that should underlie the allocation of scarce medical resources in a disaster.
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Medical Service Prioritization During an Influenza Pandemic Li-Vollmer shared the experiences of Seattle and King County Public Health from engaging the public on CSC for the allocation of scarce medical resources during an influenza pandemic. The meetings were funded using CDC grants to address pandemic influenza.
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Recruitment Four community engagement meetings were held at four distinct sites in different parts of King County. Participants were selected for broad diversity based on gender, race, ethnicity, age, income, and education (Seattle & King County Public Health, 2009)
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. Similarly, for key stakeholders, participants were recruited from a wide range of community organizations and agencies, including hospitals, health care providers, and administration staff, including community health clinics, home health care agencies, and nursing and adult living homes; emergency response and management; businesses; faith-based organizations; social service and advocacy organizations serving diverse populations, including immigrant and refugee service providers, sensory and physical disability providers, and housing service providers; and schools (Seattle & King County Public Health, 2009)
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. Two interactive public engagement exercises, including a Q-sort activity, were demonstrated at the workshop by Shah and Li-Vollmer and are described in further detail in the final section on exercises.
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Li-Vollmer clarified that, because everyone is really a stakeholder in a crisis situation, the term "vested stakeholders" was used to describe those who were already involved in planning and response in some fashion. For example, vested stakeholders in a public engagement exercise on the allocation of scarce medical resources would include health care providers, health care administrators, emergency management, large employers, schools, and advocates from community- and faith-based organizations.
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For useful resources, she referred participants to the public engagement toolkit from the Seattle and King County Advanced Practice Center in association with the NACCHO Advanced Practice Center,3 as well as to the IOM Crisis Standards of Care public engagement toolkit (2012a)
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Harris County, Texas As another example of a local public engagement project, Shah described the mass care/mass fatality planning activity undertaken by HCPHES in 2011. Harris County, Texas, is the third most populous county in the nation, with 4.1 million residents spread over 1,700 square miles (an area roughly equivalent to the size of Rhode Island)
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, adapting it to the needs of Harris County. Pandemic Influenza Public Engagement Project The basic meeting process included a pre-session survey, an overview and background presentation on pandemics, a question-andanswer period, presentation of scenarios (for vaccines, antivirals, and ventilators)
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There is no majority community in Harris County. The two largest groups are Hispanic (39 percent)
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. TABLE 2 Race/Ethnicity for Harris County Adults, Citizens, and Stakeholders Citizen Stakeholder Census Data Sample Sample Hispanic 39.8% 11.3% 12.0% (n=63)
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In addition, the public engagement process was perceived to be of high quality by citizens and stakeholders, and participants were pleased that they had a voice in the policy-making process. The 2.5-day partner workshop in July 2011 brought together representatives from a diverse array of sectors, including public health, fire departments, emergency medical services (EMS)
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This activity also resulted in a balanced, honest, and reasoned discussion of the issue among participants. State of Michigan Linda Scott, manager of the Healthcare Preparedness Program at the Michigan Department of Community Health, described the State of Michigan's experience in developing ethical guidelines and other support materials for the allocation of scarce medical resources during emergencies.
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, and local and state public health offices. There was also focused outreach to other advocacy organizations, such as those for the hearing- and visionimpaired, and community rights advocacy organizations, such as the American Civil Liberties Union.
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Providing Alternative Strategies for Increasing Access to Antiviral Medications and Treatment Advice In February and March 2012, at the request of the CDC, the IOM Forum on Medical and Public Health Preparedness for Catastrophic Events designed and convened a series of workshops that explored the public's view of strategies for access to antiviral medication and treatment during an influenza pandemic (IOM, 2012b)
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Expert Presentation: A slide presentation providing background on pandemic influenza, antiviral medications, anticipated challenges in delivery of antivirals during a pandemic, and proposed alternative strategies for discussion during the session. The information was targeted to general public audiences.
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Local Partner Presentation: Short presentations by local partners or their designees on public health preparedness planning and resources available to the local community, and an opportunity for participants to receive answers to questions about local preparedness initiatives. ARS Post-Survey: After the last group activity, a repeat of the same opinion statements to which participants responded in the pre-survey, immediately followed by display of the comparative responses from the pre- and postsurveys for participant reaction and discussion.
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Some of the challenges and relevant experiences shared include regulations around IRBs and the Common Rule, garnering leadership buy-in, and consequently managing changes in organizational leadership. Regulatory Considerations: Public Engagement and the Common Rule Donna Levin, general counsel for the Massachusetts Department of Public Health, discussed public engagement from a human subject research perspective, particularly the applicability of the Common Rule.11 The purpose of the Common Rule, she explained, is to protect human subjects who participate in research from unwarranted risks, ensure that any risks are adequately explained, and ensure that human 11 The Federal Policy for the Protection of Human Subjects (45 CFR part 46, subpart A)
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As defined in the Common Rule, research is "a systematic investigation, including research, development, testing, and evaluation, designed to develop or contribute to generalizable knowledge." A key challenge in applying the Common Rule is interpreting terms such as "systemic investigation," "testing," and "generalizable knowledge," and Levin noted that there is some ongoing discussion on revising these regulations to achieve better understanding. Levin suggested that when participants are planning a public engagement initiative, they should first contact their institutional attorneys to determine if the Common Rule applies.
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sound bite. For example, Levin noted that the term "death panel" was used by some to describe the process of health care providers engaging their patients on end-of-life care options.
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The Value of Outside Expertise and Sharing Best Practices Bringing outside expertise or benchmarking to best practices can help jurisdictions get a public engagement project up and running more quickly and often uses fewer resources than if the engagement exercise were designed from scratch. For example, the Michigan ethical guidelines project started out by adapting the model that the CDC used for its deliberative meetings, Scott said.
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Shah concurred, reiterating that Harris County offered a $75 stipend for the pandemic influenza public engagement meeting, as well as a $50 gift card for the nurse triage line project. Even so, it was still challenging to gather a diversity of perspectives.
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These might include community centers or civic or religious centers community members already frequent. In cases where it is not feasible for members of the community from a sensory or functional needs group to participate, input can be obtained from community organizations that advocate on behalf of these groups.
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Given the scenario of a severe influenza pandemic, the Q-sort exercise engaged workshop participants in a hands-on activity for ranking opinion statements from least to most important. These exercises gave workshop participants experience with tools they can utilize in public engagement activities for their own communities.
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Also, withdrawals of treatment and whether 13 See Volume 6 of the IOM Crisis Standards of Care report: http://books.nap.edu/ openbook.php? record_id=13351&page=347 (accessed April 26, 2013)
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12. Wrap-Up Words from sponsor about local disaster preparedness planning initiatives and resources and the importance of individual and community preparedness.
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6. Every hospital in the disaster area should follow the same rules when deciding how to use limited medical resources.
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Attendee Discussion of the Simulated Community Conversation Although workshop attendees discussed actual policy questions about CSC as part of these simulated exercises, the purpose was not to collect public opinion data on the issues but rather for attendees to experience the process. As such, this summary of the discussion of the issues is included to illustrate the process and some of the challenges participants might face during the activities, and is not a presentation of valid public opinion data on the issues.
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The group also noted that it would be important to have a mechanism for each participant's voice to be heard, and the importance of strong facilitation was stressed. BOX 4 Deadly Virus Scenario A new deadly virus has killed many thousands of people around the world.
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Li-Vollmer encouraged the inclusion of health care workers in engagement sessions that consider whether health care workers should be prioritized. She reiterated that, in her experience, although the public wanted to give priority to health care workers, many health care workers did not feel that they should have priority access to treatments, and they offered a variety of reasons why.
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Otherwise, the hospital will fill up with people who get there first and those who get sick later may not get medical care." Li-Vollmer explained that these statements reflect actual opinions given by both members of the general public and health care experts. BOX 5 Pandemic Influenza Scenario During a severe influenza pandemic, hospitals become extremely overcrowded and must attend to numerous people who are very ill with flu while still caring for the other incoming patients they see every day (e.g., accident victims, heart attack victims, pregnant women in labor)
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The opinion statements must then be carefully worded so that they are easily understandable and fit on a small card.
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In public engagement exercises in Seattle and King County, the Q-sort is used as the first activity (after the pre-survey, overview of the issue, and the subject matter expert presentation)
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Some participants cited the ethical principle of justice for their choices, as well as the need to have a rational process instead of an arbitrary distribution for their choices. FIGURE 3 Example of a Q-sort board completed during the simulated public engagement exercise at the workshop.
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Voting during a community conversation, for example, can be done using the clicker audience response system or by simply having participants put stickers in different columns on poster boards. Conducting these activities, various speakers pointed out, can help to inform policy 15 See Box 1 for details on Q-sort methodology.
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40 ENGAGING THE PUBLIC IN CRITICAL DISASTER PLANNING decisions and educate the community, as well as increase the legitimacy and public acceptance of local disaster plans. Solutions might not be identified in just one or two meetings, but starting the conversations and building strong stakeholder relationships in the planning stage are vital to efficient and successful execution of disaster plans and communication when a disaster occurs.
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