Tag public health

CDC Forgot About Planning

Tim Riecker, The Contrarian Emergency Manager 2 Comments

In late February, CDC released the highly anticipated notice of funding opportunity (NOFO) for the 2024-2028 Public Health Emergency Preparedness (PHEP) grant. The general concept of the grant wasn’t a big surprise, as they had been promoting a move to their Response Readiness Framework (RRF). The timing of the new five-year grant cycle seems ideal to implement lessons learned from COVID-19, yet they are falling short.

I’ve reflected in the past on the preparedness capability elements of Planning, Organizing, Equipment/Systems, Training, and Exercises (POETE). I also often add Assessing to the front of that (APOETE). These preparedness elements are essentially the buckets of activity through which we categorize our preparedness activities.

In reviewing the ten program priorities of the RRF, I’m initially encouraged by the first priority: Prioritize a risk-based approach to all-hazards planning. Activity-wise, what this translates to in the NOFO is conducting a risk assessment. Solid start. Yet nowhere else is planning overtly mentioned. Within the NOFO some of the other priorities reflect on ensuring certain things are addressed in plans, such as health equity, but there is otherwise no direct push for planning. Buried within the NOFO (page 62) is a list of plans that must be shared with project officers upon request (under the larger heading of Administrative and Federal Requirements) but the development of any of these plans does not correlate to any priorities, strategies, or activities within the document.

As for the rest of APOETE, there is good direction on Organizing, Equipment and Systems, Training, and Exercises. While that’s all great, planning is the true foundation of preparedness and it is so obviously left out of this NOFO. Along with my general opinion that most emergency plans (across all sectors) are garbage, that vast majority of findings from numerous COVID-19 after-action reports I’ve written (which included two states and several county and local governments) noted the significant need for improved emergency plans. Further, the other preparedness elements (OETE) should all relate back to our plans. If we aren’t developing, improving, and updating plans, then the other activities will generally lack focus, direction, and relevance.

Understanding that this is the first year of a five-year grant cycle, some changes and clarification will occur as the cycle progresses, but as planning is a foundational activity, it should be immediately and directly tied to the results of the assessment this year’s grant calls for. Otherwise, the findings of the assessments are generally meaningless if we aren’t taking action and developing plans to address them. This is leaving us with a significant gap in preparedness. Someone at CDC didn’t think this through and it leaves me with a great deal of concern, especially in the aftermath of the COVID-19 response.

What are your thoughts on this?

© 2024 Tim Riecker, CEDP

Emergency Preparedness Solutions, LLC®

Speculation on the Upcoming Role of Local Governments in Pandemic Recovery

Tim Riecker, The Contrarian Emergency Manager 1 Comment

Last night I remotely facilitated a session with the senior leadership of a mid-sized city discussing multi-agency coordination, incident management, and other concepts, mostly within the context of the coronavirus pandemic.  We spoke at great lengths about the role of local government in this, especially when they do not have their own health department, and what expectations there might be of them in the future.  In this discussion I had the realization of a potential scenario that seems to hold a fair amount of probability, and it’s one that is grounded in prior practice.

A bit of a disclaimer up front.  My regular readers know that I usually avoid speculation.  In the wrong context, speculation can cause undue stress or unnecessary effort.  Obviously, that is not my goal.  My goal is, as is typical of most of my articles, to promote thought and discussion on preparedness activities which are grounded in reality.  As I’ve said to people many times over the past several weeks, it’s not too late to prepare.  There are still plenty of things that we need to be preparing for in the midst of our response, including contingency plans for other potential hazards, and obviously continued operational needs.  The best emergency managers think ahead.  What I’m writing is not a call to action, but rather a call to thought. 

When it comes to vaccination (once a vaccine is developed), it’s apparent that everyone will need to be vaccinated.  While there are some factors which will force us to deploy vaccines in phases, including the supply of vaccine and the need to provide for fragile and critical populations first, there will eventually come a time when the population at-large will need to be vaccinated.  Obviously, our public health system is not equipped to administer inoculations for everyone in every jurisdiction in a timely fashion.  As such, there will be considerable reliance on local governments and advanced EMS providers, among others, to make this happen. 

First off, addressing the use of advanced EMS providers – this is not without precedent.  Advanced EMTs and paramedics have been used for a while now to support public health in mass inoculation needs, which have included H1N1, Hepatitis A outbreaks, and other viruses.  I expect that we will see these personnel used again to support the eventual vaccination of the global population against Coronavirus.  Because of the sheer volume needed, it is probable that we will see other medical practitioners likewise engaged.  When the time comes, state health departments and state EMS agencies will need to develop or update (if they have them already) protocols and just-in-time training for personnel on the proper administration of the vaccine.  Agreements in regard to paid third-party EMS service providers will also need to be addressed.  Overall, EMS will be a significant and necessary augmentation of our public health system in this regard. 

So what’s the role of local government that I expect?  Most public health outbreaks we deal with are fairly localized, allowing public health officials to establish and manage vaccination points of distribution where they are needed.  In a ‘typical’ outbreak, they can mobilize the resources needed, supported by state health departments and mutual aid from other public health offices.  The activities for these points of distribution include the development of protocol and record keeping standards and mechanism, identifying the population, securing suitable facilities, equipping those facilities (tables, chairs, internet, privacy screens, etc.), notifying the public, coordinating with local officials for control of traffic and movement of people, delivery and administration of the vaccine, securing of sharps and biological waste, and clean up; among other things.  In the scope of the coronavirus outbreak our public health offices doesn’t have the resources to do all this for every jurisdiction.  I suspect that along with providing the serum and supplies to administer it, public health will only be able to establish standards and provide guidance, but I don’t think it’s unreasonable to expect that jurisdictions will be asked to provide significant support in the non-clinical aspects of setting up and managing these points of distribution. 

What does this mean for local governments?  As I’m not a government official nor do I have an ability to definitively see the future, I certainly would not advise local governments to engage in any detailed efforts now to prepare for this scenario unless they have been advised by a public health entity to do so.  That said, it may be wise to pull together some stakeholders and at least outline a framework for how this can be done.  I’m confident that at least some of what is identified will be of use in the future of this pandemic.  Some jurisdictions may have already developed plans for points of distribution, which will be a good reference, but will likely be found to have inadequacies given current information on planning assumptions, the increased role of local governments I predict, and sheer numbers to be vaccinated. 

Who else has considered this future need?  I’m interested in hearing from others about their thoughts on these possibilities. 

Be smart, stay safe, stay healthy, and make a difference. 

© 2020 Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

8 Predicted Changes to Emergency Management Post-Pandemic

Tim Riecker, The Contrarian Emergency Manager Leave a comment

In public safety we learn from every incident we deal with.  Some incidents bring about more change than others.  This change comes not just from lessons learned, but an effort to apply change based upon those lessons. In recent history, we’ve seen significant changes in emergency management practice come from disasters like the 9/11 terrorist attacks and Hurricane Katrina, with many of the changes so significant that they are actually codified and have led to new doctrine and new practices at the highest levels.  What changes can we expect from the Coronavirus pandemic?

Of course, it’s difficult to predict the future.  We’re also still in the middle of this, so my thoughts may change a month or two into the future.  Any speculation will begin with idealism, but this must be balanced with pragmatism.  Given that, the items I discuss here are perhaps more along the lines of changes I would like to see which I think have a decent chance of actually happening. 

  1. Legislation.  Similar to the aforementioned major disasters, this too will spawn legislation from which doctrine and programs will be derived.  We are always hopeful that it’s not politicians who pen the actual legislation, but subject matter experts and visionaries with no political agendas other than advancing public health preparedness and related matters. 
  2. More public health resources. This one, I think, is pretty obvious.  We need more resources to support public health preparedness, prevention, and detection efforts.  Of course, this begins with funding which will typically be spawned from the legislation mentioned previous.  Public health preparedness is an investment, though like most preparedness efforts, it’s an investment that will dwindle over time if it’s not properly maintained and advanced to address emerging threats and best practices.  Funding must address needs, programs to address those needs, and the resources to implement those programs. 
  3. Further integration of public health into emergency management.  Emergency management is a team sport.  Regardless of the hazard or the primary agencies involved, disasters impact everyone and many organizations and practices are stakeholders in its resolution and can contribute resources to support the resolution of primary impacts and cascading effects.  Despite some gains following 9/11, public health preparedness has still been treated like an acquaintance from another neighborhood. The legislation, doctrine, programs, and resources that we see MUST support an integrated and comprehensive response.  No longer can we allow public health to be such an unfamiliar entity to the rest of the emergency management community (to be clear – the fault to date lies with everyone). 
  4. Improved emergency management preparedness.  Pulling back to look at emergency management as a whole, we have certainly identified gaps in preparedness comprehensively.  Plans that were lacking or didn’t exist at all.  Equipment and systems that were lacking or didn’t exist at all.  People who didn’t know what to do.  Organizations that weren’t flexible or responsible enough.  Processes that took too long.  Poor assumptions on what impacts would be. We can and must do better.
  5. An increase in operational continuity preparedness.  We’ve been preaching continuity of operations/government for decades, yet so few have listened. The Coronavirus pandemic has shown us so many organizations jumping through their asses as they figure it all out for the first time.  By necessity they have figured it out, some better than others.  My hope here is that they learned from their experience and will embrace the concepts of operational continuity and identify a need to leverage what they have learned and use that as a basis for planning, training, exercises, and other preparedness efforts to support future continuity events. 
  6. Further expansion of understanding of community lifelines and interdependencies of critical infrastructure.  This pandemic gave us real world demonstrations of how connected we are, how vulnerable some of our critical infrastructure is, and what metrics (essential elements of information) we should be monitoring when a disaster strikes.  I expect we will see some updated documents from DHS and FEMA addressing much of this. 
  7. More/better public-private partnerships.  The private sector stepped up in this disaster more than they previously ever had. Sure, some mistakes were made, but the private sector has been incredibly responsive and they continue to do so.  They have supported their communities, customers, and governments to address needs they identified independently as well as responding to requests from government.  They changed production.  Increased capacity.  Distributed crisis messages.  Changed operations to address safety matters.  Some were stretched to capacity, despite having to change their business models.  Many companies have also been providing free or discounted products to organizations, professionals, and the public.  We need to continue seeing this kind of awareness and responsiveness.  I also don’t want to dismiss those businesses, and their employees, that took a severe financial hit.  Economic stabilization will be a big issue to address in recovery from this disaster, and I’m hopeful that our collective efforts can help mitigate this in the future. 
  8. An improved preparedness mindset for individuals and families.  Despite the panic buying we saw, much of the public has finally seemed to grasp the preparedness messaging we have been pushing out for decades.  These are lessons I hope they don’t forget. Emergency management, collectively, absolutely must capitalize on the shared experience of the public to encourage (proper) preparedness efforts moving forward and to keep it regularly in their minds. 

In all, we want to see lasting changes – a new normal, not just knee-jerk reactions or short-lived programs, that will see us eventually sliding backwards.  I’m sure I’ll add more to this list as time goes on, but these are the big items that I am confident can and (hopefully) will happen.  I’m interested in your take on these and what you might add to the list.

Be smart, stay safe, stay healthy, and be good to each other. 

© 2020 Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

CDC Releases New Public Health Emergency Preparedness and Response Capabilities

Tim Riecker, The Contrarian Emergency Manager Leave a comment

The CDC recently released its updated Public Health Emergency Preparedness and Response Capabilities.  While this is certainly important for public health preparedness personnel, these are something that most emergency management professionals should also be aware of.  Public Health is an incredibly integral partner in emergency management and homeland security.  Last year I did a review of the new HHS ASPR Health Care Preparedness and Response Capabilities and also included the previous version of the CDC Public Health capabilities in my discussion.

The new CDC standards, at a glance, are the same as the previous version.  All 15 capabilities have been continued.  Upon closer examination, there has certainly been some refinement across these capabilities, including some adjustments in the functions, or primary activities, associated with each capability; as well as a better look at preparedness measures for each.  As with the previous version, they front load some guidance on integrating the capabilities into preparedness and response activities.

For those keeping track from the previous version, each capability narrative includes a summary of changes which were adopted from lessons learned over the past several years.  Similar to the previous version, each capability is broken into functions and tasks, with suggested performance measures.  For those of you who remember the old Target Capabilities List and Universal Task List, it’s a similar, although more utilitarian, concept.

So what do emergency managers need to know?  Fundamentally, be aware that these capabilities are what public health will be primarily focused on rather than the National Preparedness Goal’s 32 Core Capabilities.  These aren’t mutually exclusive to each other, though.  In fact, the new CDC document references the National Preparedness Goal.  There are some public health capabilities that cross walk pretty easily, such as Fatality Management.  The public health capability, however, has a strong focus on the public health aspects of this activity.  Some public health capabilities don’t necessarily have a direct analog, as many of them would be considered to be part of the Public Health, Healthcare, and Emergency Medical Services Core Capability.

My recommendation is to have a copy of this document handy.  Review it to become familiar with it, and, depending on how heavy your involvement is with public health, you may be making some notes on how these capabilities compare with and interact with the 32 Core Capabilities.

© 2018 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC℠

Public Health Preparedness as Part of Emergency Management

Tim Riecker, The Contrarian Emergency Manager Leave a comment

I’ve written in the past on the need for emergency managers, in the broadest definition, to become more familiar with public health preparedness.  As emergency management continues to integrate, by necessity, into and with other professions, this understanding is imperative.  We need to stop considering EMS as our only public health interface.  Public health incidents, of which this nation has yet to be truly and severely struck by in decades, require more than public health capabilities to be successfully managed – so we can’t just write off such an incident as being someone else’s responsibility.  We’ve also seen non-public health-oriented disasters take on a heavy public health role as concerns for communicable diseases, biological agents, or chemical agents become suspect.  If you are an emergency manager and you aren’t meeting regularly with public health preparedness officials for your jurisdiction, you are doing it wrong.

Aside from meeting with public health preparedness staff, you should also be reading up on the topic and gaining familiarity with their priorities, requirements, and capabilities.  (don’t skip either of those links… seriously.  They each contain more info on public health preparedness).  One of the best resources available is TRACIE.  TRACIE is a resource provided by the US Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR).  TRACIE stands for the Technical Resources, Assistance Center, and Information Exchange.  I’ve been digging around in ASPR TRACIE for the past several years and also receive their monthly newsletter.  I get a lot of newsletters from different sources… some daily, some weekly, some monthly.  I’ve recently unsubscribed to a bunch which seem to have information that has diminished in value, doesn’t seem to be timely, or are poorly written.  TRACIE is one of those that stays.  It has tremendous value, even if you aren’t directly involved in public health preparedness and response.  The information and resources provided here come from public health preparedness experts – these are emergency managers.

Recently, ASPR did a webinar on Healthcare Response to a No-Notice Incident, highlighting the Las Vegas shootings. Check it out.

But public health speaks a different language!  True.  So do cops, firefighters, and highway departments.  So what’s your point?  While public health certainly does have certain terminology that covers their areas of responsibility, such as epidemiology, med-surge, and others, that doesn’t mean their language is totally different.  In fact, most of the terminology is the same.  They still use the incident command system (ICS) and homeland security exercise and evaluation program (HSEEP), and can talk the talk of emergency management – they are just applying it to their areas of responsibility.  Are there some things they might not know about your job?  Sure.  Just like there are things you don’t know about theirs.  Take the time to learn, and make yourself a better emergency manager.

What have you learned from public health preparedness?  How do you interface with them?

© 2018 – Timothy Riecker, CEDP

EPS New logo

Awareness of Public Health Preparedness Requirements – CMS

Tim Riecker, The Contrarian Emergency Manager 2 Comments

Emergency management and homeland security are collaborative spaces.  Think of these areas a Venn diagram, with overlapping rings.  Some of the related professions overlap with each other separately, but all of them overlap in the center.  This overlap represents the emergency management and homeland security space.  What’s important in this representation is the recognition that emergency managers and homeland security professionals, regardless of what specific agency they may work for, need to have awareness of that shared space and the areas of responsibility of each contributing profession.  One of the biggest players in this shared space is public health.Presentation1

For nearly a year, public health professionals have been talking about new requirements from CMS, which stands for The Centers for Medicare and Medicaid Services.  How does Medicare and Medicaid impact emergency management?  CMS, part of the Department of Health and Human Services (HHS) covers over 100 million people across the US – far more than any private insurer.  As an arm of HHS and a significant funding stream within public health, they set standards.

The most relevant standard to us is the Final Rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.  The rule establishes consistent emergency preparedness requirements across healthcare providers participating in Medicare and Medicaid with the goal of increasing patient safety during emergencies and establishing a more coordinated response to disasters.

The CMS rule incorporates a number of requirements, which include:

  • Emergency planning
  • Policies and procedures
  • Communications planning with external partners
  • Training and exercises

These are all things we would expect from any emergency management standard.  Given the different types of facilities and providers, however, the implementation of the CMS rule can be complex.  A new publication released by the HHS ASPR (Office of the Assistant Secretary for Preparedness and Response) through their TRACIE program (Technical Resources, Assistance Center, and Information Exchange), provides some streamlined references to the CMS rule.  It’s a good document to study up on and keep on hand to help keep you aware of the requirements of one of our biggest partners.

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

2017 Health Security Index

Tim Riecker, The Contrarian Emergency Manager Leave a comment

The 2017 National Health Security Preparedness Index has been released by the Robert Wood Johnson Foundation.  The Index provides measures of data nationally and for each state in the US across six public health domains, which include:

  1. Health security surveillance
  2. Community planning and engagement
  3. Information and incident management
  4. Healthcare delivery
  5. Countermeasure management
  6. Environmental and occupational health

The documents found on the website indicate a continued trend of improvement across the nation, but progress is slow, with some states lagging behind significantly according to the study, particularly in the deep south and mountain west regions.

The report identifies the following factors as having the greatest influence on the increase and intensity of US and global health threats:

  • Newly emerging and resurgent infectious diseases like Zika, MERS, and Ebola.
  • Growing antibiotic resistance among infectious agents.
  • Incomplete vaccination coverage.
  • Globalization in travel and trade patterns.
  • Political instability, violence and terrorism risks.
  • Aging infrastructure for transportation, housing, food, water, and energy systems.
  • Extreme weather events including storms, fires, floods, droughts, and temperature extremes.
  • Cyber-security vulnerabilities.

I think it’s important to note that while some of the factors listed above are distinctly within the public health realm, others are more universal in nature.  So not only are the findings of this study relevant to everyone, because public health is relevant to everyone, but many of the factors that influence the threats fall within areas of responsibility of broader emergency management and homeland security.

Public health matters are near the top of my list of greatest concern.  This report clearly shows that while we have made great strides in public health preparedness, we have a long way to go.  There is also no end game.  We don’t get to say we won after playing four quarters, three periods, or nine innings.  These are efforts in which we must persist, and not only with today’s tools and capabilities, but we must constantly look toward new tools.  However, as we do this, new threats will emerge.  It may seem intimidating, but it’s essential.

What are you doing to further public health preparedness capabilities?

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

Reviewing Health Care and Public Health Capabilities

Tim Riecker, The Contrarian Emergency Manager 2 Comments

Most in emergency management and homeland security are aware of the National Preparedness Goal’s 32 Core Capabilities, but are you aware of the Health Care and Public Health capabilities promulgated and published by the HHS/ASPR and the CDC?

Recently updated, the 2017-2022 Health Care Preparedness and Response Capabilities are assembled by the US Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR).  According to ASPR, these capabilities are intended to ‘describe what the health care delivery system must do to effectively prepare for and respond to emergencies that impact the public’s health’.  The health care delivery system includes health care coalitions (HCCs), hospitals, and EMS.  These consist of four capabilities:

  1. Foundation for Health Care and Medical Readiness
  2. Health Care and Medical Response Coordination
  3. Continuity of Health Care Service Delivery
  4. Medical Surge

The Centers for Disease Control and Prevention (CDC) (also part of HHS) publishes the Public Health Preparedness Capabilities.  The current version of the Public Health capabilities is dated 2011, with the CDC being anticipated to begin updating the document in late summer of 2017.  The CDC’s Public Health Preparedness Capabilities help to establish standards for state and local public health preparedness through 15 capabilities, which are:

  1. Community Preparedness
  2. Community Recovery
  3. Emergency Operations Coordination
  4. Emergency Public Information and Warning
  5. Fatality Management
  6. Information Sharing
  7. Mass Care
  8. Medical Countermeasure Dispensing
  9. Medical Material Management and Distribution
  10. Medical Surge
  11. Non-Pharmaceutical Interventions
  12. Public Health Laboratory Testing
  13. Public Health Surveillance and Epidemiological Investigation
  14. Responder Safety and Health
  15. Volunteer Management

Similar to the use of the Core Capabilities in emergency management and homeland security broadly, I see the ASPR and CDC sets of capabilities as providing an opportunity to identify capabilities which are functionally focused.  Aside from the three common Core Capabilities (Planning, Public Information and Warning, and Operational Coordination), there is only one public health/health care-specific Core Capability: Public Health, Health Care, and Emergency Medical Services.  It makes sense for these areas to need to further identify and refine their own capabilities.  It might be interesting to see other sub-sets of public safety, such as fire and law enforcement do the same relative to the Core Capabilities they each heavily participate in.  Or it might send us down a rabbit hole we don’t need to jump down…

That said, I always champion opportunities for synergy and streamlining of existing systems and doctrine, and I’m rather disappointed that has not been done.  There is clearly overlap between the ASPR and CDC capabilities as compared to the Core Capabilities; that being apparent in even the titles of some of these capabilities addressing topics such as operational coordination, mass care, and public information and warning.

Corresponding to the recent release of ASPR’s updated Health Care Preparedness and Response Capabilities, I sat through a webinar that reviewed the update.  The webinar gave an opportunity for me to ask if there was any consideration given to structuring these more similarly to the National Preparedness Goal’s Core Capabilities.  In response, ASPR representatives stated they are working with the Emergency Preparedness Grant Coordination Working Group, which consists of ASPR, CDC, Health Resources and Services Administration, DHS/FEMA, US DOT, and the National Highway Traffic Safety Administration.  This working group has developed an interim crosswalk, applicable to the current documents, and expected to be updated with the CDC’s update to the Public Health Preparedness Capabilities.  While a crosswalk helps, it still acknowledges that each are operating within their own silos instead of fully coordinating and aligning with the National Preparedness Goal.  The world of preparedness is dynamic and made even more complex when efforts aren’t aligned.

Regardless of the lack of alignment, these are great tools.  Even if you aren’t in public health and health care, you should become familiar with these documents, as they represent important standards in these fields.  Similar to the Core Capabilities, grants and preparedness activities are structured around them.  If you interface with public health and health care, you have even more reason to become familiar with these – as they are likely referenced in multi-agency discussions and you should be aware of the similarities and differences between these and the Core Capabilities.

© 2017 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC