Future Planning for the Public Health Emergency Preparedness Enterprise Lessons Learned from the COVID-19 Pandemic: Proceedings of a Workshop (2023) / Chapter Skim
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5 Coordination, Government, and Leadership
5 Coordination, Government, and Leadership
Pages 55-80
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From page 55... ...
COORDINATION IN WASHINGTON STATE: A CASE STUDY Steven Mitchell, associate professor of emergency medicine at the University of Washington and medical director of Washington Medical Coordination Center, noted the role of the speakers living and working in Washington State during the pandemic. This section discusses cross-jurisdictional government coordination, beginning with Washington's experience at the state level when the virus first appeared; outlines the available guidance at the time and the difficulties in coordination across levels of government; and highlights some successful practices that emerged.
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From page 56... ...
FIGURE 5-1 Washington State Comprehensive Emergency Management Plan. NOTE: PSAP = public safety answering point; EMS = emergency medical services.
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From page 57... ...
The very next day people from CDC were on the ground in Washington to help support the state health department, helping to shape the case definition and who was considered a close contact. We were the first state with a known case and did not have all the information we needed to work through all of this, he noted.
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From page 58... ...
Working with local health jurisdictions and with the state has been very important to us, said Kutz, and I think that is the reason we have been successful. Kathy Lofy, former state health officer of the Washington State Department of Health, was primarily responsible for providing clinical and scientific technical advice to the governor and health office in her role.
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From page 59... ...
There was unrecognized transmission, and as soon as public health officials were able to start testing they were finding cases of COVID-19 everywhere. The resulting tsunami of work then overtook the local and state health departments, which reinforces some of the previous funding comments in Chapter 3.
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From page 60... ...
In terms of medical surge, Wiesman outlined the Disaster Medical Coordination Centers described in the plan to assist with patient placement. Health care coalitions are also the primary convener of health care facilities and responders within their region to coordinate sharing of information and resources.
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From page 61... ...
They had constant coordination calls, sharing vaccines and PPE, while also trying to procure freezers so they would be able to store vials of the Pfizer vaccine at subzero temperatures. Some tribes do not have medical facilities, he explained, so they were not able to be included initially but were able to join local county resources to stand up their vaccination program.
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From page 62... ...
He also acknowledged that it was helpful having people in response who had experience working in other agencies at other levels. In King County, emergency medical services and the medical examiner's office are part of the Public Health Department, which was critical in coordination for those aspects of the response, he explained.
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From page 63... ...
When he describes FEMA's role to people, he tries to simplify it to three tasks: gaining and maintaining situational awareness, establishing a federal footprint, and delivering aid to the American people. Since most of FEMA's responses are limited to certain affected regions of the country, having to apply these tasks to a nationwide incident was a huge challenge, even with the systems they had in place.
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From page 64... ...
"We like to think of ourselves as a conduit between national and local levels," she said. "We develop guidance, deploy teams on the ground to help with outbreaks and data collection, and coordinate information sharing." Department of Defense (DoD)
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From page 65... ...
Kosmos said that, from her perspective, what seemed so different from previous responses was that no plan she had been a part of ever contemplated something so catastrophic. This was not a public health emergency anymore, she said, it was an economic emergency and a supply chain catastrophe.
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From page 66... ...
Upon talking with the state health officer, Kadlec said, they explained that pro viders in Louisiana had developed a mechanism to place patients in a prone position and used a high flow nasal canula instead of using ventilators since they were in short supply. The result was that Louisiana was experiencing 20 percent mortality compared to 80 percent in New York because they were able to do this to so many more patients.
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From page 67... ...
He claimed that the only way to address the future is to focus on the two elements of how to exercise systems to see if they will work and how to effectively handle these crises. From a CDC public health perspective, Kosmos added that there is a unique opportunity now to evaluate the level of readiness within the public health system for something that affected the entire country, which is not an opportunity that comes often.
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From page 68... ...
Secondly, supply chain expertise is critical for the next catastrophe, he said, especially when managing a lack of resources. PUBLIC–PRIVATE PARTNERSHIPS Eileen Bulger, chair of the Committee on Trauma for the American College of Surgeons, invited panelists from a state health department, a university hospital system, a nonprofit health care coalition, and a private health care system to share their experience during the pandemic with PPPs.
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From page 69... ...
Even 2 years into the pandemic, MOCCs have only been stood up in approximately 15 to 20 different states, said Harvey. Some are run by public health departments and some by an emergency medical services (EMS)
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From page 70... ...
As an analogy, he said, we are missing a central nervous system with respect to disaster response -- missing the neural network that provides situational awareness and allows communication and quick exchange of resources where needed. Arizona Department of Health Services Lisa Villarroel, medical director for the Division of Preparedness at the Arizona Department of Health Services, presented the Arizona Surge
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From page 71... ...
It was designed, funded, and administered by the state health department, she explained, and it worked with a hospital steering committee comprising public, private, federal, county, and tribal representatives. They partnered with the Health Information Exchange to create a real-time statewide bed board, and it ran continuously for 2 years during the pandemic, successfully transferring nearly 10,000 patients to the right level of care.
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From page 72... ...
Villarroel added that through the Arizona Surge Line, they did mandate participation through a governor's executive order and learned some key strategies. First, she said, align with the values of the partners, including financial drivers.
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From page 73... ...
Most patients in a mental health crisis are either going to jail or an emergency department, he said. But working through the regional medical operations center, they are able to get the patient reliably taken to a mental health treatment facility initially, which is beneficial for the family and removes the burden from the emergency department.
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From page 74... ...
Villarroel added that they created something called the Postacute Care Capacity Tracker as an adjunct to the Arizona Surge Line, which was a web portal where all the care coordinators from every hospital in the state could see where postacute care beds were available. Those data were provided on a daily basis by postacute care facilities through a mandate from an executive order.
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From page 75... ...
Washington State Health Department Umair Shah, secretary of health at the Washington State Health Department, said he had been a practicing emergency department physician in Houston, Texas, and was also on the front lines as the executive director for Harris County Public Health, just outside Houston. As the pandemic emerged, he was on the front lines fighting the virus, while also sometimes fighting politics and what was happening at state and local levels in Texas.
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From page 76... ...
Oklahoma City County Health Department Phil Maytubby, deputy chief executive officer of the Oklahoma City County Health Department, said that when the pandemic started he was the chief operating officer at the health department and the deputy incident commander for its response. He described his role early on in the pandemic when his team started seeing some cases in Oklahoma related to travel directly to Wuhan and to Washington State.
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From page 77... ...
Massachusetts State Legislature Bill Driscoll, Massachusetts state representative and chair of the Joint Committee on COVID-19 and Emergency Preparedness and Management, explained that prior to being elected in 2016 he had spent 11 years in disaster response and recovery with nonprofits, especially through the National Volunteer Organizations Active in Disaster. He was notified of the pandemic beginning on Twitter, following reports out of China.
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From page 78... ...
For example, she said a community in northern Alaska relies on their whaling captains for decision making and guidance. So the health department started meeting with them to answer questions and share information.
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They were inspiring and brought out the mission to people, but this can only be sustained for so long. Driscoll added that in Massachusetts from a governance perspective, they held a listening tour with the legislative committee and tried to solicit feedback from health professionals, hospitals, and elected leaders.
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