Building Infrastructure and Developing Partnerships:

Public Health and Healthcare Emergency Preparedness and Response in Virginia Lisa G. Kaplowitz, MD, MSHA Deputy Commissioner, Emergency Preparedness and Response Virginia Department of Health

Virginia Department of Health (VDH) Emergency Preparedness and Response Program (EP&R) Since 2002 Preparedness and response to all emergencies, naturally occurring as well as terrorist related (all hazards approach) Rapid response to outbreak situations Build public health infrastructure in VA Involve all programs in VDH, all VA emergency response programs, all healthcare providers Availability to respond to emergencies 24/7 at both local and state levels

VDH EP&R Programs: Many Successes 97/100 rating for SNS plan, tested with multiple statewide and annual district exercises – High rating for CRI and ChemPack plans 10/10 rating by Trust for America’s Health in 2007, with progressive improvement over prior 5 years High federal rating of state pandemic influenza plan Clear evidence of progressive improvement in response to public health and healthcare emergencies: ICS for response to infectious disease outbreaks; public health/healthcare response to floods, storms and drought; response to Virginia Tech shooting in April, 2007

Virginia Department of Health Unified Public Health System 35 health districts serve entire state – 33/35 are part of state public health system – 2 are locally administered under contract to state, function same as other districts Strong relationship between state and local public health – functions as partnership – Local input on all programmatic issues – Resources allocated to districts and regions

VDH EP&R: Investment in Public Health Capacity and Infrastructure Local and state levels – Planner and epidemiologist in each district – Regional teams Expertise is WITHIN VDH – not with contractors – Development of plans, exercises, response to emergency events – Epidemiology, IT, laboratory response, training

VDH EP&R: Support of Leadership State and agency levels Governor – Rapid recruiting of positions – Health dept control of federal funds – Engagement in issues: direct involvement in exercises, pan flu video, antiviral purchase decision Commissioner – High level program leadership (Deputy Commissioner) – Ongoing access for key decisions, policies

VDH EP&R Programs: State Agency Partnerships Office of Commonwealth Preparedness; Depts of Emergency Management, Social Services, Mental Health, Agriculture, General Services, Transportation, Education, Environmental Quality; State Police, National Guard Appropriate role definition for planning, exercises, response to emergencies Example: strong collaborative state pandemic influenza plan with Governor mandated Cabinet exercise to test plan

VDH EP&R Programs: Health System Partnerships All components of health system: hospitals, EMS, CHCs, long terms care, individual providers Contract with Virginia Hospital and Healthcare Association for management of HHS/ASPR funds – Hospital Emergency Management Comm (HEMC) – 6 planning regions with RHCC, hosp coordinator

VDH EP&R Programs: Private/Public Partnerships Use existing expertise (don’t reinvent wheel) – UPS to distribute SNS in state – Walmart distribution center as RSS – Pharmacies to dispense antivirals Partner with business – Pan flu planning, antivirals – Exercises – Communications – including media Partner with military

VDH EP&R Programs: Set Program Expectations, Goals Strategic planning process Annual task list for districts – Now with annual assessment visits using standard assessment tool Set high expectations, with willingness to go beyond standard public health capabilities – Engagement of ALL health dept employees in emergency preparedness and response Understand role of ESF-8, NIMS and incident command

VDH EP&R Programs: Future Challenges Identifying meaningful performance metrics that accurately measure capabilities and capacity Addressing healthcare provider shortages – Routine: nursing, other individual providers – During emergencies: volunteers, recognize that healthcare shortages WILL occur and WILL impact standards of care with health and legal implications

FUNDING

: loss of funding will result in loss of capacity, loss of infrastructure and ultimately loss of capabilities