Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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5 Activating a Public Health Emergency Operations Center
5 Activating a Public Health Emergency Operations Center
Pages 138-159
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From page 138... ...
h ; Justification for the Insufficient Evidence Statement ; Partly because of its long tenure as a common and standard practice, direct research evidence does not focus on whether PHEOCs should be utilized, but rather how they should be implemented. Experiential ; evidence from a synthesis of case reports and after action reports (from within and outside of public health emergency preparedness and response [PHEPR]
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From page 139... ...
distrust and chain-of-command disruption ; Leadership prioritizes maintaining routine public health func tions over response needs Considerations for how to make the decision to activate Emergency Phase public health emergency operations The evidence review ; Respect staff knowledge, and involve staff with past emer- included a mix of gency experience in leadership discussions preparedness and re; Ensure strong leadership, even using leaders outside the sponse phase studies. regular hierarchy ; Provide support to address the social functioning of the PHEOC Emergency Type ; Resource common operating picture functions to increase Emergencies includ shared understanding ed a mix of real and ; Encourage staff flexibility within the PHEOC simulated events and were diverse (all haz; Conduct just-in-time training to minimize disruptions caused ards, natural disasters, by less-experienced staff and infectious disease ; Continuously monitor and evaluate response functions to epidemic)
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From page 140... ...
This capability is important to establish a common operating picture, a necessary element of successful public health emergency operations. Capability 13: Public Health Surveillance and Epidemiological Investigation -- involves the ability to coordinate surveillance and epidemiological activities with jurisdictional laboratories, partners, and stakeholders who can provide data to potentially activate public health emergency operations as well as support routine and emergency responses requiring surveillance and epi demiological investigation. Capability 15: Volunteer Management -- is the ability to coordinate with partners to identify, r ecruit, register, verify, train, and engage volunteers to support the activities during pre eployment, d deployment, and postdeployment.
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The process of activating a PHEOC may include, but is not limited to, the following actions: • conducting a preliminary assessment to determine the need for and level of activa tion of public health emergency operations (e.g., whether public health will have a lead, supporting, or no role) ; • activating necessary public health functions; • supporting mutual aid according to the public health role and incident requirements; • identifying personnel with the skills necessary to fulfill the required incident com mand for activation; and • establishing primary and alternative locations for the PHEOC and notifying ersonnel p to report either physically or virtually to the PHEOC (CDC, 2018)
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From page 142... ...
with the coordination and decision making of a jurisdictional EOC. For this reason, as well as some skepticism within the medical community regarding the idea of "command and control," it took some time for public health agencies to adopt an EOC model, although they were often represented in the jurisdictional EOCs described above.
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Both organizations now have integrated ICS frameworks that outline the key concepts and essential requirements for maintaining public health emergency operations in an EOC (Rose et al., 2017; WHO, 2015a)
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. • Threshold events described in the Emergency Operations Plan occur.
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• what circumstances should public health agencies activate a separate public health In emergency operations center (PHEOC) , lead a multiagency PHEOC, or play a supporting role in a multiagency PHEOC based on identified or potential public health consequences?
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» Improved internal staff situational » Activate public health emergency operations (separate EOC or lead or awareness, coordination, and supporting role in multiagency EOC) decision making » Improved information collection and integration Potential Effect Modifiers » Improved access to and deploy ment of resources, such as staff and equipment Outcome » Public health issues arise during the event, but it was Improved response previously determined public health did not have a role » Cohesive and effective response » Potential threshold criteria: operations type and scale of event, complexity of event, type of Intermediate Outcome » Improved ability to pro command, past experience, vide emergency services mutual aid requests, policy External facing » Economic impact » Improved expertise-driven Population response » Improved dissemination of risk Public health officials, emergency management officials, and other communication messages to response partners as appropriate target audiences and the gener al public Outcome » Improved bidirectional ex Potential Harms change of information Potential Effect Modifiers Reduced morbidity » Improved coordination and and mortality » Staff are pulled away from decision making with response Related to planning their primary responsibilities partners and capacity » Legal issues » Previously developed internal plans, procedures, and policies » Financial » Previous coordination and exercising of plans with response partners » Situational awareness capabilities FIGURE 5-1 Analytic framework for public health emergency operations.
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From page 147... ...
(Refer to Section 1, "Determining Evidence of Effect," in Appendix B2 for additional detail.) Balance of Benefits and Harms As stated above, no quantitative research on the effectiveness of PHEOC activation was identified.
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Furthermore, to facilitate the implementation of public health emergency operations, practitioners must believe that implementation of the NIMS and ICS has the potential to
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Equity Inequities in the implementation of public health emergency operations for different populations due to variability in the availability of resources, infrastructure, and funding likely exist among state, local, tribal, and territorial public health agencies (and are also related to the resource and economic considerations discussed above)
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PHEOCs likely reflect the implicit biases of their decision makers and will support equity more or less well based on the perspective of those individuals. (Evidence source: qualitative evidence synthesis and case report and AAR evidence synthesis.
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Determination of Separate, Lead, or Support Public Health Emergency Operations Public health agencies appropriately lead a multiagency EOC in response to acute public health threats (e.g., infectious disease outbreaks) when coordination and information sharing among response agencies are critical to the achievement of response objectives.
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Refer to Section 8, "Factors in Determining When to Activate a PHEOC," in Appendix B2 for additional detail.) Other Implementation Considerations The following conceptual findings inform the perspectives and approaches to be considered when implementing public health emergency operations.
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Refer to Section 9, "Other Implementation Considerations," in Appendix B2 for additional detail.) View Public Health Emergency Operations Teams as Social Groups To help balance these different demands, it is important to see public health emergency operations teams not just as task groups but also as social groups.
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From page 154... ...
PRACTICE RECOMMENDATION, JUSTIFICATION, AND IMPLEMENTATION GUIDANCE Insufficient Evidence Statement Activating a public health emergency operations center (PHEOC) is a common and standard practice, supported by national and international guidance and based on earlier social science around disaster response.
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The committee offers a set of implementa tion considerations based on the evidence from qualitative studies and experiential evidence from case reports and AARs to support planning. Based on this evidence, public health agencies should consider the following factors to make more successful decisions regarding the activa tion of public health emergency operations.
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From page 156... ...
A key aspect of this consideration is leadership's willingness to a llow staff to work at or with the PHEOC, possibly for long hours. Considerations for how to make the decision to activate public health emergency operations: • Respect staff knowledge, and involve staff with past emergency experience in leadership discussions.
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From page 157... ...
The lack of a sufficient narrative describing a PHEOC in the corpus of qualitative studies, case reports, and AARs made it difficult for the committee to determine the impact of PHEOC activation. Furthermore, the lack of uniform terminology and insufficient reporting and articulation of methodology hampered consistency in searching and reviewing the literature, especially when the committee was attempting to review public health emergency operations, which involves a fairly new terminology.
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2019. CDC Emergency Operations Center.
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2015b. Summary report of systematic reviews for public health emergency operations centres: Plans and procedures; communication technology and infrastructure; minimum datasets and standards; training and exer cises.
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