Public Health Preparedness Capabilities: National Standards for State and Local Planning March 2011 Centers for Disease Control and Prevention Table of Contents Public Health Preparedness Capabilities: National Standards for State and Local Planning Page Executive Summary ..................................................................................................................................................................... 2 Using this Document for Strategic Planning ...................................................................................................................... 6 At-A-Glance: Capability Definitions, Functions, and Associated Performance Measures ............................... 10 Capabilities (in alphabetical order) 1. Community Preparedness ................................................................................................................................. 16 2. Community Recovery .......................................................................................................................................... 22 3. Emergency Operations Coordination ........................................................................................................... 27 4. Emergency Public Information and Warning ............................................................................................. 36 5. Fatality Management .......................................................................................................................................... 45 6. Information Sharing ............................................................................................................................................. 55 7. Mass Care ................................................................................................................................................................. 62 8. Medical Countermeasure Dispensing ........................................................................................................... 71 9. Medical Materiel Management and Distribution ...................................................................................... 81 10. Medical Surge ........................................................................................................................................................ 92 11. Non-Pharmaceutical Interventions .............................................................................................................. 102 12. Public Health Laboratory Testing ................................................................................................................. 109 13. Public Health Surveillance and Epidemiological Investigation ......................................................... 119 14. Responder Safety and Health ........................................................................................................................ 127 15. Volunteer Management ................................................................................................................................... 133 Endnotes .................................................................................................................................................................................... 140 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 1 EXECUTIVE SUMMARY Public health threats are always present. Whether caused by natural, accidental, or intentional means, these threats can lead to the onset of public health incidents. Being prepared to prevent, respond to, and rapidly recover from public health threats is critical for protecting and securing our nation's public health. The 2009 H1N1 influenza pandemic underscored the importance of communities being prepared for potential threats. Because of its unique abilities to respond to infectious, occupational, or environmental incidents, the Centers for Disease Control and Prevention (CDC) plays a pivotal role in ensuring that state and local public health systems are prepared for these and other public health incidents. CDC provides funding and technical assistance for state, local, and territorial public health departments through the Public Health Emergency Preparedness (PHEP) cooperative agreement. PHEP cooperative agreement funding provides approximately $700 million annually to 50 states, four localities, and eight U.S. territories and freely associated states for building and strengthening their abilities to respond to public health incidents. Evolving Threats and Strengthening the Public Health System Public health departments have made progress since 2001, as demonstrated in CDC's state preparedness reports (http://www.cdc.gov/phpr/reportingonreadiness.htm). However, state and local public health departments continue to face multiple challenges, including an ever-evolving list of public health threats. Regardless of the threat, an effective public health response begins with an effective public health system with robust systems in place to conduct routine public health activities. In other words, strong state and local public health systems are the cornerstone of an effective public health response. Today, public health systems and their respective preparedness programs face many challenges. Federal funds for preparedness have been declining, causing state and local planners to express concerns over their ability to sustain the real and measurable advances made in public health preparedness since September 11, 2001, when Congress appropriated funding to CDC to expand its support nationwide of state and local public health preparedness. State and local planners likely will need to make difficult choices about how to prioritize and ensure that federal dollars are directed to priority areas within their jurisdictions. Defining National Standards for State and Local Planning In response to these challenges and in preparation for a new five-year PHEP cooperative agreement that takes effect in August 2011, CDC implemented a systematic process for defining a set of public health preparedness capabilities to assist state and local health departments with their strategic planning. The resulting body of work, Public Health Preparedness Capabilities: National Standards for State and Local Planning, hereafter referred to as public health preparedness capabilities, creates national standards for public health preparedness capability-based planning and will assist state and local planners in identifying gaps in preparedness, determining the specific jurisdictional priorities, and developing plans for building and sustaining capabilities. These standards are designed to accelerate state and local preparedness planning, provide guidance and recommendations for preparedness planning, and, ultimately, assure safer, more resilient, and better prepared communities. Public health preparedness capabilities. CDC identified the following 15 public health preparedness capabilities (shown in their corresponding domains) as the basis for state and local public health preparedness: Biosurveillance Incident Management - Public Health Laboratory Testing - Emergency Operations Coordination - Public Health Surveillance and Information Management Epidemiological Investigation - Emergency Public Information and Warning Community Resilience - Information Sharing - Community Preparedness Surge Management - Community Recovery - Fatality Management Countermeasures and Mitigation - Mass Care - Medical Countermeasure Dispensing - Medical Surge - Medical Materiel Management and Distribution - Volunteer Management - Non-Pharmaceutical Interventions - Responder Safety and Health U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 2 EXECUTIVE SUMMARY These domains highlight significant dependencies between certain capabilities. A jurisdiction should choose the order of the capabilities it decides to pursue based upon their jurisdictional risk assessment (see Capability 1: Community Preparedness for additional or supporting detail on the requirements for this risk assessment) but are strongly advised to ensure that they first are able to demonstrate capabilities within the following domains: Biosurveillance Community resilience Countermeasures and mitigation Incident management Information management To identify the public health aspects for each capability, CDC used the names and definitions from the U.S. Department of Homeland Security (DHS) Target Capabilities List, content from the Pandemic and All-Hazards Preparedness Act (PAHPA), and capabilities from the National Health Security Strategy (NHSS) as a baseline. As part of this process, the biosurveillance aspects of animal disease and emergency support, food and agriculture safety and defense, and environmental health were incorporated into the public health surveillance and epidemiological investigation capability. In addition, the detection of chemical, biological, radiological, nuclear, and explosive agents were incorporated into the laboratory testing capability. Important cross-cutting preparedness topics such as legal preparedness, vulnerable or at-risk populations, and radiological/ nuclear preparedness are addressed in several of the 15 capabilities. Aligning across national programs. The Pandemic and All-Hazards Preparedness Act (PAHPA) specifies the need to maintain consistency with certain other national programs, specifically the NHSS preparedness goals. PAHPA also directs that the NHSS be consistent with the DHS National Preparedness Guidelines, a major component of which is the Target Capabilities List. The National Preparedness Guidelines represent a standard for preparedness based on establishing national priorities through a capabilities-based planning process. In addition to aligning with the National Preparedness Guidelines, CDC determined that the public health preparedness capabilities should be aligned with the 10 Essential Public Health Services model developed by the U.S. Department of Health and Human Services (HHS). CDC conducted a mapping process which determined that several of the public health preparedness capabilities aligned with multiple essential public health services. Thus, the state and local preparedness capabilities align with both the DHS target capabilities and the HHS 10 Essential Public Health Services, with a focus on public health capabilities critical to preparedness (see figure at right). The public health preparedness capabilities defined by CDC also directly align with 21 of the NHSS capabilities. Everyday use. The public health preparedness capabilities now represent a national public health standard for state and local preparedness that better prepares state and local health departments for responding to public health emergencies and incidents and supports the accomplishment of the10 Essential Public Health Services. Each of the public health preparedness capabilities identifies priority resource elements that are relevant to both routine public health activities and essential public health services. While demonstrations of capabilities can be achieved through different means (e.g., exercises, planned events, and real incidents), jurisdictions are encouraged to use routine public health activities to demonstrate and evaluate their public health preparedness capabilities. A systematic approach. The content of each public health preparedness capability is based on evidence-informed documents, applicable preparedness literature, and subject matter expertise gathered from across the federal government and the state and local practice community. In developing this document, CDC reviewed key legislative and executive directives to identify state and local public health preparedness priorities. These include the following: Pandemic and All-Hazards Preparedness Act (PAHPA), which authorizes state and local preparedness funding U.S. Department of Homeland Security (DHS) Homeland Security Presidential Directives 5, 8, and 21 National Health Security Strategy (NHSS) U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 3 EXECUTIVE SUMMARY CDC also reviewed relevant preparedness documents from national partners such as the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO), and third-party organizations including Trust for America's Health and RAND Corporation. The methodology for selecting the capabilities was peer reviewed by the Board of Scientific Counselors for CDC's Office of Public Health Preparedness and Response. The Board deemed that the methodological approach and the capabilities as presented were within the scope of state and local preparedness. Engaging stakeholders. Numerous stakeholders were involved in developing the 15 public health preparedness capabilities. Stakeholders included approximately 200 subject matter experts from CDC and other federal agencies and professional organizations. Federal agencies actively involved in the process included the HHS Office of the Assistant Secretary for Preparedness and Response, DHS Federal Emergency Management Agency and Office of Health Affairs, and the U.S. Department of Transportation's National Highway Traffic Safety Administration. CDC also worked with national associations including the American Hospital Association, the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, the National Emergency Management Association, and the National Public Health Information Coalition. In addition, CDC collaborated with national partners such as the ASTHO and NACCHO to engage the state and local practice community. This collaborative process began in January 2010 when CDC representatives and other subject matter experts began working together to develop the public health preparedness capabilities. Over the next year, CDC held weekly subject matter expert capability working groups to develop recommendations for the scope of the selected capabilities, capability functions, and resource elements for each capability. Their work was extensively vetted with many key stakeholders throughout the process. Moving Forward State and local public health departments are first responders for public health incidents, and CDC remains committed to strengthening their preparedness. CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning will assist public health departments in developing annual and long-term preparedness plans to guide their preparedness strategies and investments. These standards will be refined over time as emerging evidence becomes available to advance our preparedness knowledge. About this Document: How the Public Health Preparedness Capabilities Are Organized The public health preparedness capabilities are numbered and presented alphabetically in this document. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Community Preparedness Community Recovery Emergency Operations Coordination Emergency Public Information and Warning Fatality Management Information Sharing Mass Care Medical Countermeasure Dispensing Medical Materiel Management and Distribution Medical Surge Non-Pharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Responder Safety and Health Volunteer Management U.S. Department of Health and Human Services Centers for Disease Control and Prevention A Guide for Strategic Planning The 15 capability sections in this document are intended to serve as national standards that state and local public health departments can use to advance their preparedness planning. Public Health Preparedness Capabilities: National Standards for State and Local Planning 4 EXECUTIVE SUMMARY Each capability includes a definition of the capability and list of the associated functions, performance measures, tasks, and resource considerations. The Capability Definition defines the capability as it applies to state, local, tribal, and territorial public health. The Function describes the critical elements that need to occur to achieve the capability. The Performance Measure(s) lists the CDC-defined performance measures (if any) associated with a function. The Tasks describes the steps that need to occur to complete the functions. The Resource Elements section lists the resources a jurisdiction needs to have or have access to (via an arrangement with a partner organization, memoranda of understanding, etc.) to successfully perform a function and the associated tasks. CDC categorizes the Resources into three categories: 1. Planning, 2. Skills and Training, and 3. Equipment and Technology. CDC further defines some Resources Elements as \"Priority.\" Priority elements are considered to be the most critical of the Resource Elements and as \"minimum standards\" for state and local preparedness. The remaining Resource Elements are recommended or suggested activities for consideration by jurisdictions. Resource Elements: Planning: Elements that should be included in existing operational plans, standard operating procedures and/or emergency operations plans. This may include language on suggested legal authorities and at-risk populations. Skills and Training: The baseline competencies and skills necessary for personnel and teams to possess to competently deliver a capability. Equipment and Technology: The equipment that a jurisdiction should have in their possession (or have access to), and the equipment should be in sufficient quantities to adequately achieve the capability within the jurisdiction. Note: As a first step, jurisdictions are encouraged to self-assess their ability to address the prioritized planning resource elements of each capability followed by an assessment of their ability to demonstrate the functions and tasks within each capability. CDC has defined successful accomplishment of prioritized resource elements as the following: a public health agency has either the ability to have (within their own existing plans or other written documents) or has access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element. Jurisdictions are not required to submit plans to CDC but should have plans available for review upon request. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 5 USING THIS DOCUMENT FOR STRATEGIC PLANNING CDC's National Standards for State and Local Planning provides a description of the capabilities needed for achieving state and local public health preparedness. The content is intended to serve as a planning resource that state and local public health preparedness staff can use to assess their jurisdictional preparedness. CDC is making these national standards for public health preparedness available to the nation's public health system to support their planning efforts. Jurisdictions also are encouraged to use other tools and local-level input in their planning processes, such as existing jurisdictional strategic plans, data from current hazard and vulnerability assessments, and results from After Action Reports/Improvement Plans. Public Health Preparedness Capabilities Planning Model To assist jurisdictions in using the capabilities for planning, CDC has developed a Public Health Preparedness Capabilities Planning Model. The model describes a high-level planning process that state and local public health departments may wish to follow to help determine their preparedness priorities and plan their preparedness activities. This planning model fits into the planning phase of the U.S. Department of Homeland Security Preparedness Cycle. The Public Health Preparedness Capabilities Planning Model is not intended to be a prescriptive methodology, but rather it is intended to describe a series of suggested activities for preparedness planning. The diagram below depicts the model's three main phases and associated steps. The following are descriptions for the suggested steps to complete each of the three phases. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 6 USING THIS DOCUMENT FOR STRATEGIC PLANNING Phase 1: Assess Current State Step 1a: Assess Organizational Roles and Responsibilities The first step in the assessment phase is to determine which organizational entities within the jurisdiction are responsible for each capability and function. These entities may include state agencies, partner organizations, local and tribal health departments, and others. For instance, in some jurisdictions the coroner/medical examiner traditionally takes a lead role in fatality management activities; public health should, therefore, seek this partner when identifying what role public health contributes to this capability. Step 1b: Assess Resource Elements Each function within the capabilities includes a list of priority and recommended resource elements, divided into three categories: Planning, Skills and Training, and Equipment and Technology. These are the resources that CDC and subject matter experts have determined are the most critical for being able to build and maintain the associated capabilities. To assess public health's current capability, it is necessary to review the resource elements (particularly the priority resource elements) to determine the extent that these elements exist in the jurisdiction. Not all public health agencies are expected to own each resource element; jurisdictions are encouraged to partner with both internal and external jurisdictional partners to assure access to resources as needed. Jurisdictions are encouraged to first self-assess their ability to address the prioritized resource elements of each capability followed by their ability to demonstrate the functions and tasks within each capability. Successfully addressing prioritized resource elements is defined as a public health agency either has the ability to demonstrate that they have (within their own existing plans or other written documents) or have access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element. For each resource element, if not fully present as described in the capability definitions, any challenges or barriers to the full attainment of that resource element should be noted. In addition, CDC has crosswalked the resource element content with the Project Public Health Ready (PPHR) 2011 criteria and the Public Health Accreditation Board (PHAB) measures (July 2009 beta test version) - these appear in the Endnotes section where applicable. Jurisdictions which have or are pursuing PPHR or PHAB certification may be able to use this information to further facilitate their assessments. The resource elements described for each function are not intended to be an exhaustive list of all possible types of resources required; nor do they give any indication of quantity of resources required (e.g., number of staff ). Therefore, it is critical that in addition to assessing the defined resource elements, each jurisdiction notes the presence or absence of any other critical resources needed to meet its needs and any challenges or barriers. Step 1c: Assess Performance After completing the resource element assessment, the next suggested step is to assess the performance of each capability and function, and whether or not it meets the jurisdiction's needs. Performance demonstration and evaluation may be collected via activities to address CDC-defined performance measures or documented exercises or real incident activities. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 7 USING THIS DOCUMENT FOR STRATEGIC PLANNING Phase 2: Determine Goals Step 2a: Review Jurisdictional Inputs After assessing the jurisdiction's current level resource elements and performance, the next step is to identify needs and gaps. In addition to the resource element assessment from the previous phase, there are a number of additional inputs which can be used, including (but not limited to) the following: Existing data from jurisdictional hazards and vulnerability analyses Emergency management plans Funding considerations (e.g., guidance or funding requirements from related federal preparedness programs) Previous strategic plans or planning efforts Previous state and local accreditation efforts CDC's Strategic National Stockpile Technical Assistance Review results After Action Reports/Improvement Plans Previous performance measure results See Capability 1: Community Preparedness priority resource element requirements for additional detail on this topic. Step 2b: Prioritize Capabilities and Functions The capability definitions are broad; no jurisdiction is expected to be able to address all issues, gaps, and needs across all capabilities in the immediate short term. Therefore, jurisdictions should choose the order of the capabilities they decide to pursue based upon their jurisdictional risk assessments (see Capability 1: Community Preparedness for additional or supporting detail on the requirements for this risk assessment), but are strongly advised to ensure that they first are able to demonstrate capabilities within the following domains: Biosurveillance Community resilience Countermeasures and mitigation Incident management Information management Other prioritization criteria may include the following: Missing/incomplete priority resource elements Performance/ability is substantially lower than needed Risks and threats to the public health, medical, and mental/behavioral health system Ability to close gaps and develop capability is greatest Evidence-based practice Step 2c: Develop Short-term and Long-term Goals This planning model defines short-term goals: one year, and long-term goals: two years to five years. Jurisdictions should review the various inputs described in step 2a, analyze their priorities based on the prioritization criteria described in step 2b, and determine a set of short-term (one year) and long-term (two years to five years) goals. For the purposes of this model, all goals should refer to the capabilities, functions, and resource elements. For example, a short-term goal may be to fully build a particular function within a capability, including ensuring the presence of all priority resource elements. Long-term goals would be to build (individually or via partnerships), demonstrate performance, and, ultimately, sustain all capabilities and functions. Phase 3: Develop Plans U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 8 USING THIS DOCUMENT FOR STRATEGIC PLANNING Step 3a: Plan Organizational Initiatives After determining the short-term and long-term goals, the next step is to engage in concrete initiatives and activity planning, particularly for the short-term goals. While in practice jurisdictions may group together related activities to address multiple functions or capabilities within the scope of one project or initiative, for the purposes of this planning model all activities are viewed as related to individual capabilities, functions, and resource elements. Step 3b: Plan Capacity Building/Sustain Activities For each capability and function, jurisdictions generally will be either building, sustaining, or, perhaps, scaling back the capability and/or function, depending on the needs, gaps, priorities, and goals that have been identified. For build and sustain scenarios, jurisdictions are encouraged to pursue partnerships and memoranda of understanding with other agencies, partners, and jurisdictions. For scale-back scenarios, jurisdictions should identify the challenges and barriers causing them to scale back their efforts. States should consider what types of support are required by their local and tribal health departments and plan assistance or contracts accordingly. Support provided to local health departments should ideally describe which capabilities and functions are intended to be addressed. Jurisdictions should also determine any technical assistance needs they might have, whether from CDC or other sources. Technical assistance may be needed to address challenges, barriers, or other needs. For the purposes of this planning model, activities and technical assistance needs will, in general, relate to specific functions and resource elements (i.e., developing or modifying plans or processes, training staff, or building/buying equipment and technology). Step 3c: Plan Capability Evaluations/Demonstrations The final step in the planning process is to develop plans for demonstrating and evaluating the capabilities and functions, especially those that have been newly developed. Demonstrations of capabilities can be through many different means such as exercises, planned events, and real incidents. Jurisdictions are strongly encouraged to use routine public health activities to demonstrate and evaluate their capabilities. Documentation of the exercise, event, or incident, and the use of quality improvement-focused After Action Reports/Improvement Plans is a vital part of this process. For those capabilities and functions where CDC-defined performance measures have been developed, jurisdictions are encouraged to collect data for those measures. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 9 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Capability 1: Community Preparedness Definition: Community preparedness is the ability of communities to prepare for, withstand, and recover in both the short and long terms from public health incidents. By engaging and coordinating with emergency management, healthcare organizations (private and community-based), mental/behavioral health providers, community and faith-based partners, state, local, and territorial, public health's role in community preparedness is to do the following: Support the development of public health, medical, and mental/behavioral health systems that support recovery Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents Promote awareness of and access to medical and mental/behavioral health resources that help protect the community's health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation) of at-risk individuals Engage public and private organizations in preparedness activities that represent the functional needs of at-risk individuals as well as the cultural and socio-economic, demographic components of the community Identify those populations that may be at higher risk for adverse health outcomes Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities (e.g., improvised nuclear device or hurricane) Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Determine risks to the health of the jurisdiction Build community partnerships to support health preparedness Engage with community organizations to foster public health, medical, and mental/behavioral health social networks Coordinate training or guidance to ensure community engagement in preparedness efforts Capability 2: Community Recovery Definition: Community recovery is the ability to collaborate with community partners, (e.g., healthcare organizations, business, education, and emergency management) to plan and advocate for the rebuilding of public health, medical, and mental/ behavioral health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where possible. This capability supports National Health Security Strategy Objective 8: Incorporate Post-Incident Health Recovery into Planning and Response. Post-incident recovery of the public health, medical, and mental/behavioral health services and systems within a jurisdiction is critical for health security and requires collaboration and advocacy by the public health agency for the restoration of services, providers, facilities, and infrastructure within the public health, medical, and human services sectors. Monitoring the public health, medical and mental/behavioral health infrastructure is an essential public health service. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Identify and monitor public health, medical, and mental/behavioral health system recovery needs Function 2: Coordinate community public health, medical, and mental/behavioral health system recovery operations Function 3: Implement corrective actions to mitigate damages from future incidents Capability 3: Emergency Operations Coordination Definition: Emergency operations coordination is the ability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable system of oversight, organization, and supervision consistent with jurisdictional standards and practices and with the National Incident Management System. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 10 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Conduct preliminary assessment to determine need for public activation Function 2: Activate public health emergency operations Measure 1: Time for pre-identified staff covering activated public health agency incident management lead roles (or equivalent lead roles) to report for immediate duty. Performance Target: 60 minutes or less Function 3: Develop incident response strategy Measure 1: Production of the approved Incident Action Plan before the start of the second operational period Function 4: Manage and sustain the public health response Function 5: Demobilize and evaluate public health emergency operations Measure 1: Time to complete a draft of an After Action Report and Improvement Plan Capability 4: Emergency Public Information and Warning Definition: Emergency public information and warning is the ability to develop, coordinate, and disseminate information, alerts, warnings, and notifications to the public and incident management responders. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Function 2: Function 3: Function 4: Function 5: Activate the emergency public information system Determine the need for a joint public information system Establish and participate in information system operations Establish avenues for public interaction and information exchange Issue public information, alerts, warnings, and notifications Measure 1: Time to issue a risk communication message for dissemination to the public Capability 5: Fatality Management Definition: Fatality management is the ability to coordinate with other organizations (e.g., law enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the proper recovery, handling, identification, transportation, tracking, storage, and disposal of human remains and personal effects; certify cause of death; and facilitate access to mental/ behavioral health services to the family members, responders, and survivors of an incident. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Function 5: Determine role for public health in fatality management Activate public health fatality management operations Assist in the collection and dissemination of antemortem data Participate in survivor mental/behavioral health services Participate in fatality processing and storage operations Capability 6: Information Sharing Definition: Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of health-related information and situational awareness data among federal, state, local, territorial, and tribal levels of government, and the private sector. This capability includes the routine sharing of information as well as issuing of public health alerts to federal, state, local, territorial, and tribal levels of government and the private sector in preparation for, and in response to, events or incidents of public health significance. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 11 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Identify stakeholders to be incorporated into information flow Function 2: Identify and develop rules and data elements for sharing Function 3: Exchange information to determine a common operating picture Capability 7: Mass Care Definition: Mass care is the ability to coordinate with partner agencies to address the public health, medical, and mental/ behavioral health needs of those impacted by an incident at a congregate location. This capability includes the coordination of ongoing surveillance and assessment to ensure that health needs continue to be met as the incident evolves. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Determine public health role in mass care operations Determine mass care needs of the impacted population Coordinate public health, medical, and mental/behavioral health services Monitor mass care population health Capability 8: Medical Countermeasure Dispensing Definition: Medical countermeasure dispensing is the ability to provide medical countermeasures (including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment or prophylaxis (oral or vaccination) to the identified population in accordance with public health guidelines and/or recommendations. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Identify and initiate medical countermeasure dispensing strategies Function 2: Receive medical countermeasures Function 3: Activate dispensing modalities Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 4: Dispense medical countermeasures to identified population Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 5: Report adverse events Capability 9: Medical Materiel Management and Distribution Definition: Medical materiel management and distribution is the ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) during an incident and to recover and account for unused medical materiel, as necessary, after an incident. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 12 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Direct and activate medical materiel management and distribution Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 2: Acquire medical materiel Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 3: Maintain updated inventory management and reporting system Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 4: Establish and maintain security Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 5: Distribute medical materiel Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Function 6: Recover medical materiel and demobilize distribution operations Measure 1: Composite performance indicator from the Division of Strategic National Stockpile in CDC's Office of Public Health Preparedness and Response Capability 10: Medical Surge Definition: Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. It encompasses the ability of the healthcare system to survive a hazard impact and maintain or rapidly recover operations that were compromised. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Assess the nature and scope of the incident Support activation of medical surge Support jurisdictional medical surge operations Support demobilization of medical surge operations Capability 11: Non-Pharmaceutical Interventions Definition: Non-pharmaceutical interventions are the ability to recommend to the applicable lead agency (if not public health) and implement, if applicable, strategies for disease, injury, and exposure control. Strategies include the following: Isolation and quarantine Restrictions on movement and travel advisory/warnings Social distancing External decontamination Hygiene Precautionary protective behaviors U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 13 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Engage partners and identify factors that impact non-pharmaceutical interventions Determine non-pharmaceutical interventions Implement non-pharmaceutical interventions Monitor non-pharmaceutical interventions Capability 12: Public Health Laboratory Testing Definition: Public health laboratory testing is the ability to conduct rapid and conventional detection, characterization, confirmatory testing, data reporting, investigative support, and laboratory networking to address actual or potential exposure to all-hazards. Hazards include chemical, radiological, and biological agents in multiple matrices that may include clinical samples, food, and environmental samples (e.g., water, air, and soil). This capability supports routine surveillance, including pre-event or pre-incident and post-exposure activities. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Manage laboratory activities Measure 1: Time for sentinel clinical laboratories to acknowledge receipt of an urgent message from the CDC Public Health Emergency Preparedness (PHEP)-funded Laboratory Response Network biological (LRN-B) laboratory Measure 2: Time for initial laboratorian to report for duty at the CDC PHEP-funded laboratory Function 2: Perform sample management Measure 1: Percentage of Laboratory Response Network (LRN) clinical specimens without any adverse quality assurance events received at the CDC PHEP-funded LRN-B laboratory for confirmation or rule-out testing from sentinel clinical laboratories Measure 2: Percentage of LRN non-clinical samples without any adverse quality assurance events received at the CDC PHEP-funded LRN-B laboratory for confirmation or rule-out testing from first responders Measure 3: Ability of the CDC PHEP-funded Laboratory Response Network chemical (LRN-C) laboratories to collect relevant samples for clinical chemical analysis, package, and ship those samples Function 3: Conduct testing and analysis for routine and surge capacity Measure 1: Proportion of LRN-C proficiency tests (core methods) successfully passed by CDC PHEP-funded laboratories Measure 2: Proportion of LRN-C proficiency tests (additional methods) successfully passed by CDC PHEP-funded laboratories Measure 3: Proportion of LRN-B proficiency tests successfully passed by CDC PHEP-funded laboratories Function 4: Support public health investigations Measure 1: Time to complete notification between CDC, on-call laboratorian, and on-call epidemiologist Measure 2: Time to complete notification between CDC, on-call epidemiologist, and on-call laboratorian Function 5: Report results Measure 1: Percentage of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli O157:H7 submitted to the PulseNet national database within four working days of receiving isolate at the PFGE laboratory Measure 2: Percentage of PFGE subtyping data results for Listeria monocytogenes submitted to the PulseNet national database within four working days of receiving isolate at the PFGE laboratory Measure 3: Time to submit PFGE subtyping data results for Salmonella to the PulseNet national database upon receipt of isolate at the PFGE laboratory Measure 4: Time for CDC PHEP-funded laboratory to notify public health partners of significant laboratory results U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 14 AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Capability 13: Public Health Surveillance and Epidemiological Investigation Definition: Public health surveillance and epidemiological investigation is the ability to create, maintain, support, and strengthen routine surveillance and detection systems and epidemiological investigation processes, as well as to expand these systems and processes in response to incidents of public health significance. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. Associated CDC-defined performance measures are also listed below. Function 1: Conduct public health surveillance and detection Measure 1: Proportion of reports of selected reportable diseases received by a public health agency within the jurisdiction-required time frame Function 2: Conduct public health and epidemiological investigations Measure 1: Percentage of infectious disease outbreak investigations that generate reports Measure 2: Percentage of infectious disease outbreak investigation reports that contain all minimal elements Measure 3: Percentage of acute environmental exposure investigations that generate reports Measure 4: Percentage of acute environmental exposure reports that contain all minimal elements Function 3: Recommend, monitor, and analyze mitigation actions Measure 1: Proportion of reports of selected reportable diseases for which initial public health control measure(s) were initiated within the appropriate time frame Function 4: Improve public health surveillance and epidemiological investigation systems Capability 14: Responder Safety and Health Definition: The responder safety and health capability describes the ability to protect public health agency staff responding to an incident and the ability to support the health and safety needs of hospital and medical facility personnel, if requested. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Identify responder safety and health risks Identify safety and personal protective needs Coordinate with partners to facilitate risk-specific safety and health training Monitor responder safety and health actions Capability 15: Volunteer Management Definition: Volunteer management is the ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of volunteers to support the jurisdictional public health agency's response to incidents of public health significance. Functions and Associated Performance Measures: This capability consists of the ability to perform the functions listed below. At present there are no CDC-defined performance measures for these functions. Function 1: Function 2: Function 3: Function 4: Coordinate volunteers Notify volunteers Organize, assemble, and dispatch volunteers Demobilize volunteers U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 15 CAPABILITY 1: Community Preparedness Community preparedness is the ability of communities to prepare for, withstand, and recover in both the short and long terms from public health incidents.1 By engaging and coordinating with emergency management, healthcare organizations (private and community-based), mental/behavioral health providers, community and faith-based partners, state, local, and territorial, public health's role in community preparedness is to do the following: Support the development of public health, medical, and mental/behavioral health systems that support recovery Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents Promote awareness of and access to medical and mental/behavioral health 2 resources that help protect the community's health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation) of at-risk individuals Engage public and private organizations in preparedness activities that represent the functional needs of at-risk individuals as well as the cultural and socio-economic, demographic components of the community Identify those populations that may be at higher risk for adverse health outcomes Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities (e.g., improvised nuclear device or hurricane) This capability consists of the ability to perform the following functions: Function 1: Determine risks to the health of the jurisdiction Function 2: Build community partnerships to support health preparedness Function 3: Engage with community organizations to foster public health, medical, and mental/behavioral health social networks Function 4: Coordinate training or guidance to ensure community engagement in preparedness efforts Function 1: Determine risks to the health of the jurisdiction Identify the potential hazards, vulnerabilities, and risks in the community that relate to the jurisdiction's public health, medical, and mental/behavioral health systems, the relationship of those risks to human impact,3 interruption of public health, medical, and mental/behavioral health services, and the impact of those risks on the jurisdiction's public health, medical, and mental/ behavioral health infrastructure. Tasks This function consists of the ability to perform the following tasks: Task 1: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners, the public health, medical, and mental/behavioral health services for which the jurisdiction needs to have access to mitigate identified disaster health risks. Task 2: Utilize jurisdictional risk assessment to identify, with emergency management and community and faith-based partners, the public health, medical, and mental/behavioral health services within the jurisdiction that currently support the mitigation of identified disaster health risks. Performance Measure(s) At present there are no CDC-defined performance measures for this function. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 16 CAPABILITY 1: Community Preparedness Function 1: Determine risks to the health of the jurisdiction Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. P1: (Priority) Written plans should include policies and procedures to identify populations with the following: - - - - - Health vulnerabilities such as poor health status Limited access to neighborhood health resources (e.g., disabled, elderly, pregnant women and infants, individuals with other acute medical conditions, individuals with chronic diseases, underinsured persons, persons without health insurance) Reduced ability to hear, speak, understand, or remember Reduced ability to move or walk independently or respond quickly to directions during an emergency Populations with health vulnerabilities that may be caused or exacerbated by chemical, biological, or radiological exposure These procedures and plans should include the identification of these groups through the following elements: - - - - Review/access to existing health department data sets Existing chronic disease programs/maternal child health programs, community profiles Utilizing the efforts of the jurisdiction strategic advisory council Community coalitions to assist in determining the community's risks4, 5 P2: (Priority) Written plans should include a jurisdictional risk assessment, utilizing an all-hazards approach with the input and assistance of the following elements: PLANNING (P) - - Public health and non-public health subject matter experts (e.g., emergency management, state radiation control programs/radiological subject matter experts (http://www.crcpd.org/Map/RCPmap.htm)) Existing inputs from emergency management risk assessment data, health department programs, community engagements, and other applicable sources, that identify and prioritize jurisdictional hazards and health vulnerabilities This jurisdictional risk assessment should identify the following elements: - - - Potential hazards, vulnerabilities, and risks in the community related to the public health, medical, and mental/ behavioral health systems The relationship of these risks to human impact, interruption of public health, medical, and mental/behavioral health services The impact of those risks on public health, medical, and mental/behavioral health infrastructure6 Jurisdictional risk assessment must include at a minimum the following elements: - - - - A definition of risk Use of Geospatial Informational System or other mechanism to map locations of at-risk populations Evidence of community involvement in determining areas for risk assessment or hazard mitigation Assessment of potential loss or disruption of essential services such as clean water, sanitation, or the interruption of healthcare services, public health agency infrastructure Suggested resource - Hazard Risk Assessment Instrument, University of California, Los Angeles, Center for Public Health and Disaster: http://www.cphd.ucla.edu/hrai.html P3: Written plans, as a stand-alone plan, annex, or via other documentation, developed with input from jurisdictional partners7, 8 should indicate how the health department will assist with the following elements: -- Assurance of community public health, medical, mental/behavioral health services in an incident, with particular - attention to assure access to health services to populations and areas of low economic resources and displaced populations9,10 Addressing the concerns and needs of populations not directly impacted by a particular incident but concerned about the possibility of adverse health effects U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 17 CAPABILITY 1: Community Preparedness Function 1: Determine risks to the health of the jurisdiction Resource Elements (continued) - - - - - Family reunification assistance and patient tracking for family members impacted by the incident Providing for the functional needs of at-risk individuals for adverse health outcomes with social services or other lead agencies (e.g., disabled persons, low-income populations needing medication assistance, medical transportation, or assistance in accessing sub-specialty medical technology and medical care) Child care Pet services and pet care Psychological first aid and other relevant mental/behavioral health services11 PLANNING (P) Suggested resources -- - CDC Radiation Emergencies website: http://emergency.cdc.gov/radiation/ Planning Guidance for Responding to a Nuclear Detonation, Second Edition, June 2010: http://hps.org/hsc/documents/Planning_Guidance_for_Response_to_a_Nuclear_Detonation-2nd_Edition_ FINAL.pdf - Listening Session on At-Risk Individuals in Pandemic Influenza and Other Scenarios: After Action Report, U.S. Health and Human Services, Assistant Secretary for Preparedness and Response Office for At-Risk Individuals, Behavioral Health, and Human Services Coordination: http://www.phe.gov/Preparedness/planning/abc/Documents/abc_listening_session.pdf - Preparedness Tools and Resources for Disabled Populations: http://www.disability.gov/emergency_preparedness SKILLS AND TRAINING (S) P4: Written plans should include memoranda of understanding or other letters of agreement with community health centers, non-profit community agencies, hospitals, and private providers within the jurisdiction or with neighboring jurisdictions, if applicable, who are willing to or who can provide access to medical and mental/behavioral health services during and after an incident.12,13 S1: Have or have access to services of persons with expertise in Geospatial Informational Systems to assist in locating/ mapping locations of at-risk populations. These Geospatial Informational System services may be found within other governmental agencies (e.g., emergency management) or within academic settings (e.g., schools of public health). Function 2: Build community partnerships to support health preparedness Identify and engage with public and private community partners who can do the following: Assist with the mitigation of identified health risks Be integrated into the jurisdiction's all-hazards emergency plans with defined community roles and responsibilities related to the provision of public health, medical, and mental/behavioral health as directed under the Emergency Support Function #8 definition at the state or local level Tasks This function consists of the ability to perform the following tasks: Task 1: Identify community sector groups to be engaged for partnership based upon the jurisdictional risk assessment. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Public Health Preparedness Capabilities: National Standards for State and Local Planning 18 CAPABILITY 1: Community Preparedness Function 2: Build community partnerships to support health preparedness Tasks (continued) Task 2: Create and implement strategies for ongoing engagement with community partners who may be able to provide services to mitigate identified public health threats or incidents (concept of \"strategic advisory council\" or joint collaborative). Task 3: Utilize community and faith-based partnerships as well as collaborations with any agencies primarily responsible for providing direct health-related services to help assure the community's ability to deliver public health, medical, and mental/behavioral health services in both short and long term settings during and after an incident. Task 4: Utilize a continuous quality improvement process to incorporate feedback from community and faith-based partners into jurisdictional emergency operations plans. Task 5: Identify community leaders that can act as trusted spokespersons to deliver public health messages. Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as Priority. PLANNING (P) P1: (Priority) Written plans should include a policy and process to participate in existing (e.g., led by emergency management) or new partnerships representing at least the following 11 community sectors:14 business; community leadership; cultural and faith-based groups and organizations; emergency management; healthcare; social services; housing and sheltering; media; mental/behavioral health; state office of aging or its equivalent; education and childcare settings.15 ,16 P2: (Priority) Written plans should include a protocol to encourage or promote medical personnel (e.g., physicians, nurses, allied health professionals) from community and faith-based organizations and professional organizations to register and participate with community Medical Reserve Corps or state Emergency Systems for Advance Registration of Volunteer Health Professionals programs to support health services during and after an incident.17,18,19 (For additional or supporting detail, see Capability 15: Volunteer Management) P3: Written plans should include documentation of community and faith-based partners' roles and responsibilities for each phase of the health threat. P4: Written plans should include a process to provide mechanisms (e.g., town hall meetings, websites) to discuss public health hazard policies and plans of action with community partners.20 P5: Written plans should include strategies to support the provision of community health services during multiple types of hazard scenarios (also known as robustness) in order to support the identified risks in the jurisdiction.21 SKILLS AND TRAINING (S) P6: Written plans should include a process to provide guidance to community and faith-based partners to support development of these groups' emergency operations plans/response operations. S1: Mid-level public health staff participating in community preparedness activities should be able to demonstrate the \"Plan For and Improve Practice\" domain within the core competencies in Public Health Preparedness and Response Core Competency Model. Suggested resource - Association of Schools of Public Health Preparedness Competencies: http://www.asph.org/userfiles/PreparednessCompetencyModelWorkforce-Version1.0.pdf For further information