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Appendix B2: Mixed-Method Review of Activating a Public Health Emergency Operations Center
Pages 333-356

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From page 333...
... It begins with a description of the results of the literature search and then sum 1 This section draws heavily on two reports commissioned by the committee: "Public Health Emergency Operations Coordination: Qualitative Research Evidence Synthesis" by Pradeep Sopory and Julie Novak; and "Public Health Emergency Operations Coordination: Findings from After Action Reports and Case Reports" by Sneha Patel (see Appendix C)
From page 334...
... are useful for determining when to activate public health emergency operations? •  what circumstances should public health agencies activate a separate public health In emergency operations center (EOC)
From page 335...
... » 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 B2-1  Analytic framework for public health emergency operations.
From page 336...
... 336 EVIDENCE-BASED PRACTICE FOR PHEPR FIGURE B2-2  Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of activating public health emergency operations.
From page 337...
... 1.  Determining Evidence of Effect The review identified no quantitative comparative or noncomparative studies or modeling studies eligible for inclusion, but information gleaned from the qualitative evidence synthesis and the case report and AAR evidence synthesis contributed to understanding in what circumstances activating public health emergency operations is appropriate. This is a difficult evidentiary situation; the lack of quantitative studies, in particular, speaks to the committee's high-level finding that more and improved research is needed in this field.
From page 338...
... . The qualitative evidence indicates that activation of public health emergency operations may lead to several undesirable effects, the salient of which are related to staffing deployment, staff stress and burnout, and adaptation-generated interorganizational distrust and chain-of-command disruption (high confidence in the evidence)
From page 339...
... . 3.  Acceptability and Preferences Qualitative Evidence Synthesis While the set of studies included in the qualitative evidence synthesis does not directly, or even indirectly, address the issue of acceptability and preferences, none of the articles reviewed mention any reluctance on the part of any agency to join emergency response operations for a real event or a preparedness training exercise.
From page 340...
... Challenges to effective public health emergency operations are many. Some of the most salient relate to interorganizational awareness, interorganizational relationships, interorganizational cultural differences, differences in team members' knowledge and experience, communication technology, rules and regulations, volume of information, and lack of training (high confidence in the evidence)
From page 341...
... Evidence from the case reports and AARs supports the above qualitative evidence with respect to barriers related to interagency relationships and coordination (Ansell and Keller, 2014; Boston Public Health Commission, 2013; Massachusetts Emergency Management et al., 2014; Moynihan, 2007; Oklahoma Department of Emergency Management, 2013; Phillips and Williamson, 2005; San Francisco Department of Public Health, 2010; Shipp Hilts et al., 2016; Texas Department of State Health Services, 2018; Wiesman et al., 2011; Williams et al., 2014) ; appropriate and reliable communication technology (Beatty et al., 2006; Boston Public Health Comission, 2013; Buffalo Hospital and Wright County Public Health, 2013; Chicago Department of Public Health et al., 2011; Delaware Division of Public Health, 2010; DuPage County Health Department, 2009; Governor's Office of Homeland Security and Emergency Preparedness, 2012; Kilianski et al., 2014; Moynihan, 2007; Multnomah County Health Department, 2010; Redd and Frieden, 2017)
From page 342...
... Fourteen qualitative studies examined the types of resources that can facilitate effective public health emergency operations (Freedman et al., 2013; Glick and Barbara, 2013; Gryth et al., 2010; Hambridge et al., 2017; Klima et al., 2012; Lis and Resnick, 2018; Lis et al., 2017; Mase et al., 2017; McMaster and Baber, 2012; Militello et al., 2007; Obaid et al., 2017; Reeder and Turner, 2011; Sisco et al., 2019; Thomas et al., 2005)
From page 343...
... . 6. Equity Qualitative Evidence Synthesis Two qualitative studies examined the needs of at-risk populations in the context of emergency operations (Chandler et al., 2016; Sisco et al., 2019)
From page 344...
... TABLE B2-2 Evidence to Decision Summary Table for Activation of Public Health Emergency Operations In what circumstances is activating public health emergency operations appropriate? Balance of Benefits and Harms Sources of Evidence No quantitative research on the effectiveness of public health emergency operations • ualitative Q center (PHEOC)
From page 345...
... of certainty or confidence) Furthermore, to facilitate the implementation of public health emergency operations, • escriptive survey D practitioners must believe that implementation of the National Incident Management study evidence System (NIMS)
From page 346...
... . The qualitative evidence indicates that public health emergency operations are fully activated, as support or lead, when an emergency event is large in size and complex in scope, or when the hazards it poses impact primarily or only human health as opposed to natural or built environments, as is the case, for example, with disease outbreaks.
From page 347...
... . Case Report and AAR Evidence Synthesis Findings from the case reports and AARs reviewed support the above qualitative evidence, suggesting that it was helpful to activate for more complex and multijurisdictional responses that presented threats to public health and to do so early, even if the event's size and scope were initially unknown (Cruz et al., 2015)
From page 348...
... 9.  Other Implementation Considerations The following conceptual findings inform the perspectives and approaches one should consider when implementing a PHEOC. Leverage Strong, Decisive Leadership and Create Shared Understanding in Response Qualitative evidence synthesis  Nine qualitative studies examined the use of mental models in public health emergency operations (Bigley and Roberts, 2001; Glick and Barbara, 2013; Gryth et al., 2010; Lis et al., 2017; McMaster and Baber, 2012; Militello et al., 2007; Moynihan, 2008; Rimstad and Sollid, 2015; Sisco et al., 2019)
From page 349...
... . Effective coordination of emergency operations depends to some extent on the degree to which accurate mental models are shared among members of the groups involved, leading to a shared understanding of an emergency event, as well as of interagency functions (Bigley and Roberts, 2001; McMaster and Baber, 2012; Militello et al., 2007; Moynihan, 2008; Sisco et al., 2019)
From page 350...
... . View Public Health Emergency Operations Teams as Social Groups Qualitative evidence synthesis  Seven qualitative studies examined viewing public health emergency operations teams as social groups (Bigley and Roberts, 2001; Buck et al., 2006; Freedman et al., 2013; McMaster and Baber, 2012; Militello et al., 2007; Moynihan, 2008; Rimstad and Sollid, 2015)
From page 351...
... Numerous AARs indicate that the previous knowledge and experience of staff enabled positive outcomes (Moynihan, 2007; Quinn et al., 2018; San Francisco Department of Public Health, 2010; Wisconsin Division of Public Health, 2010) , whereas a lack of familiarity with ICS or limited experience with larger-scale disasters was a barrier to effective response operations (Logan County Health District, 2015; Moynihan, 2007)
From page 352...
... 2007. Information flow during crisis management: Challenges to coordination in the emergency operations center.
From page 353...
... 2011. The pediatric hospital incident command system: An innovative approach to hos pital emergency management.
From page 354...
... 2015. Logan County Health District 2015 full scale exercise.
From page 355...
... Multnomah County Health Department.
From page 356...
... 1994. Community emergency planning: False assumptions and inappropriate analogies.


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