Transcript Module 2: The Prepared Community

The Prepared Community
New Mexico
Community Health Council Training
Spring 2005
The Prepared Community

Module One: Emergency Management
from 20,000 Feet

Module Two: The Prepared Community

Module Three: We Are All Affected

Module Four: The Resilient & Healthy
Community

Module Five: Community Profile
Module One
Emergency Management
from 20,000 Feet
What does health & medical emergency
management look like at the national
and state level?
Module One: Emergency Management
from 20,000 Feet
 What is an emergency?
 Who’s on first?
 National, State, & NMDOH plans
 NMDOH roles
What is an Emergency?
What Makes an Incident
an Emergency or Disaster?
 affects entire community
 community needs surpass capacity
 include:
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natural disasters
human-caused disasters
technological disasters
economic disasters
Types of Emergencies
 two types recognized by state law:
 Civil emergency (State Civil Emergency

Preparedness Act)
Public health emergency (Public Health
Emergency Response Act, PHERA)
 may be declared simultaneously
Who’s on First?
Response begins and ends at the local
level:
 local command post set up
 local, county, or tribal Emergency Operations
Plan (EOP) activated
 local Emergency Operations Center (EOC)
established
Local Level Emergency Response
Mayor/CEO Requests
State Assistance
Mayor/CEO Declares
Local Emergency
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command Post
(ICP)
If the incident exceeds local capacity, the
Mayor or Chief Elected Official may request
state assistance.
State Level Emergency Response
State EOC
New Mexico
All-Hazard
Emergency
Operations Plan
Mayor/CEO Requests
State Assistance
Mayor/CEO Declares
Local Emergency
State AgencySpecific
Emergency
Operations
Plans
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command
Post (ICP)
If the incident exceeds State capacity, the
Governor may request Federal assistance.
Federal Level Emergency Response
President Declares
Emergency
Governor Requests
Federal Assistance
Governor Declares
Emergency
Mayor/CEO Requests
State Assistance
Mayor/CEO Declares Local
Emergency
National
Response Plan
Federal Agency
Assistance and
other plans
State EOC
New Mexico
All-Hazard
Emergency
Operations Plan
Local EOC
Local/County/Tribal
Emergency Response Plans
Local Incident Command
Post (ICP)
State AgencySpecific
Emergency
Operations
Plans
National Preparedness Goal
To achieve and sustain capabilities that
enable the Nation to collaborate in
successfully
 preventing terrorist attacks on the homeland,
and
 rapidly and effectively responding to and
recovering from any terrorist attack, major
disaster, or other emergency that does occur
to minimize the impact on lives, property, and
the economy.
National Preparedness Goal
Focuses on building capabilities in six
priority areas, including
strengthening medical
surge capabilities establishing emergency-ready public
health and healthcare entities
National Response Plan (NRP)
 integrates prevention, preparedness,
response, and recovery
 comprehensive, national, all-hazards
approach
 defines the federal government’s interface
with state, local, and tribal governments,
and the private sector
New Mexico All-Hazard
Emergency Operations Plan
 Developed by the Office of Emergency
Management (OEM) of the New Mexico
Department of Public Safety
 Refers to specific responsibilities during
disasters
 NMDOH responsible for Annex 5 – Public
Health, Medical & Mortuary
NMDOH Emergency Operations Plan
 Identifies responsibilities for public
health, medical, and mortuary
response
 Includes the Basic Plan and Hazard
and Response Specific Appendices
NMDOH Office of Health Emergency
Management (OHEM)
 CDC & HRSA Grant Programs:
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Centers for Disease Control (CDC) –
Cooperative Agreement on Public Health
Preparedness and Response for Bioterrorism
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Health Resources & Services Admin. (HRSA) –
National Bioterrorism Hospital Preparedness
Program
NMDOH Roles - Preparedness
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Establish policies, procedures &
standards
Assess preparedness; develop & exercise
preparedness & response plans
Develop public health statutes &
regulations
Provide education & training related to
emergency preparedness & response
NMDOH Roles - Response
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Respond to incidents, natural disasters, major
disease outbreaks
Coordinate with local, state, federal, and
international response agencies
Activate the NMDOH Emergency Operations Plan.
Provide information & risk communication
Collect, assess, and disseminate health
surveillance information
Provide services at PHSS locations
NMDOH Response Roles (cont.)
 Provide/coordinate laboratory testing
 Provide/coordinate provision of crisis response &
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mental health services
Coordinate with OMI
Facilitate community support in the event of
evacuation, quarantine, or isolation
Coordinate medical radio communication
Coordinate availability of resources; request the
Strategic National Stockpile, when needed
Public Health Service Sites
 Screening
 Dispensing of prophylactic
medication or immunizations
 Education
 Referral for
psychosocial support
Module Two
The Prepared Community
What does health & medical emergency
management look like at the
community and county level?
Goals of the Prepared Community
1.
2.
3.
4.
5.
Informed and involved public
Prepared and informed professionals
Planning, preparation and policies
Communication systems and connectivity
Scientific and technical support and other
resources
6. Administration, management, and fiscal
systems
Goal 1: Informed & Involved Public
 timely, accurate, and useful public
information
 comprehensive and coordinated Risk
Communication
 trained spokespersons, trusted by the
community
 media contacts and media plan
Informed & Involved Public:
Public Information
 information to help individuals and families
develop emergency plans
 information for non-English speakers,
people with sensory disabilities, and those
in remote areas
 culturally sensitive communication
Informed & Involved Public:
Risk Communication
 provision of information about the nature
of the risk and recommendations for
action
 before, during, and after a crisis situation
 accurate, honest, and immediate
Goal 2: Prepared & Informed
Professionals
 clearly defined roles and relationships
 ongoing, collaborative training for all
active players
 ongoing, collaborative drills and exercises
 plan to pre-identify, train, and certify
volunteers
Prepared & Informed Professionals:
Roles & Responsibilities
 Initial Responders
(First Responders/First Receivers)
 Hospitals & Health Care Providers
 Behavioral Health Providers
 Public Health Office Personnel
 Volunteers
Prepared & Informed Professionals:
Initial Responders
 First Responders and First Receivers
(Patient Receivers):
Trained EMS personnel
Fire fighters, law enforcement
Primary care clinics and hospitals
Anyone who receives patients directly
from the field
 Even bystanders
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Prepared & Informed Professionals:
Hospitals & Health Care Providers
 Prevention: vaccination programs, public
education
 Preparedness: comprehensive and coordinated
emergency management plans
 Response: participation in community response;
activation of EOP; liaison to local EOC
 Recovery: emotional support to survivors;
documentation of expenses and other items for
reimbursement; “lessons learned”
Prepared & Informed Professionals:
Behavioral Health Providers
 Prevention: mental health promotion; community
resilience
 Preparedness: comprehensive, integrated plans;
resources and collaborations
 Response: participation in community response;
crisis intervention, psychological first aid, and
psychosocial support
 Recovery: longer term psychosocial support to
survivors; longer term behavioral health clinical
services to those in need; community resilience
Prepared & Informed Professionals:
Public Health Office Personnel
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Prevention: public education about public health
emergencies and emergency response
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Preparedness: emergency response plans that are
integrated with NMDOH and local emergency
responders
 Response: participation in community response;
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provision of emergency-related health services
Recovery: ongoing public education; sharing
"lessons learned" with other public health
personnel statewide, NMDOH, and community
Prepared & Informed Professionals:
Volunteers
 important component of emergency response
 both pre-identified and spontaneous, unaffiliated
volunteers
 could come from programs such as:
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American Red Cross
Faith-based organizations
Citizen Corps - Community Emergency Response Teams (CERT)
Volunteer Organizations Active in Disasters (VOAD)
National Disaster Medical System, including DMAT & DMORT
NM Volunteer Health Professional Program (in development)
Albuquerque Medical Reserve Corp Project (in development)
Goal 3: Planning, Preparation,
& Policies
 understanding of community hazards
& vulnerabilities
 local Emergency Operations Plan
(EOP) addressing vulnerabilities
 local laws, ordinances, & policies
Planning, Preparation, & Policies:
Hazards & Vulnerabilities
 community vulnerabilities/hazards:
e.g., floods, forest fires, tornados,
chemical spills, gas line explosions
 psychosocial vulnerabilities:
 everyone is affected
 some individuals/communities more
vulnerable than others
Planning, Preparation, & Policies:
Local Emergency Operations Plans
 The county/community EOP should
include a health/medical component
with:
 Psychosocial plan
 Evacuation, quarantine, and isolation plans
 Considerations for populations with special
planning needs
Planning, Preparation, & Policies:
The Emergency Operations Plan
 comprehensive, all-hazard in approach,
focused on most likely hazards
 overview of response organization and
policies
 general description of roles and
responsibilities, command structure
 drilled and exercised, “lessons learned”
identified
Goal 4: Communication Systems
 notification and alert systems
 interoperable and redundant radio
communication
 EMSystem® in local hospital(s)
Communication Systems:
The Health Alert Network (HAN)
email & fax notification of situations
affecting the public health
Communication Systems:
EMSystem®
 Provides hospital emergency departments
with real-time information regarding:
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Hospital status
Current emergency situations
Health alerts
Bed counts
 Allows better management of EMS services
during regular activity and emergencies.
Communication Systems:
Radio Communication
 radio communication:
 interoperable – everyone can talk to everyone

else – and
redundant – different equipment and systems
to keep communication happening
 amateur (Ham) radio operators provide
additional communication capability
Goal 5: Scientific/Technical
Support & Other Resources
 interoperable IT systems
 policies and procedures for reporting
notifiable conditions
 connected medical labs using uniform data
standards
 mortuary resources
 pharmaceutical caches
Goal 5: Resources (cont.)
 plans for mass prophylaxis and patient
screening
 isolation and patient decontamination
capacity and adequate PPE
 plans and procedures for patient surge
Goal 6: Administration, Management,
& Fiscal Systems
 strategic leadership to manage public
health emergencies and disasters
 process for setting goals and objectives
and allocating resources
 accounting and other record systems for
documenting actions, expenses, etc.
Module 3
We Are All Affected.
How does a disaster affect individuals,
families, and communities?
Psychosocial Reactions to a Disaster
The ripple effect
A
B
C
D
E
F
Individual Reactions
 Emotional: sadness, grief, anxiety/fear, guilt,
anger, irritability, numbness, neediness, etc.
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Physical: tension, sleeplessness, aches and pains,
appetite changes, agitation, etc.
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Behavioral: hypervigilance, withdrawal, changes
in normal patterns, drug/alcohol use, etc.
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Cognitive: confusion, disorientation, difficulty
concentrating, indecisiveness, memory lapses, etc.
Family Reactions
 Emotional withdrawal of family members,
especially children
 Increased use of alcohol and other
substances
 Discord and/or increase in domestic
violence
 Decrease in functioning as a unit
Individual & Family Reactions
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Usually these are normal responses to
abnormal situations.
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However, some individuals and some
families are more at risk than others for
developing longer term behavioral health
problems as a result of disasters.
What makes some individuals & families
more at risk than others?
 Pre-existing mental illness/substance abuse
 Prior history of trauma
 Chronic illness
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Physical, sensory, or cognitive disabilities
Lower socioeconomic status
Lower educational level
Lack of family connections/community support
Language barriers
Immigration/citizenship status
Community Reactions
 Mass panic is rare.
 More often:
 acts of heroism, compassion,
selflessness
 community cohesion, resiliency
 community creativity, resourcefulness
 volunteers, donations
Community Reactions
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We are all affected, but we are not all
affected equally.
 Like individuals, some communities are more
at risk for developing longer term problems
after a disaster.
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And there are uniquely vulnerable population
groups.
What makes some communities more
at risk than others?
 Proximity to the event
 Lack of access to resources and services
 Discrimination or stigmatization of certain
groups
 Lack of access to information, notification
 Stressful, violent environments
 Marginalized socioeconomic status
 Level of pre-disaster functioning capacity
Vulnerable Population Groups
 Children
 Elderly
 People with chronic mental illness/substance
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abuse disorders
People with disabilities
Culturally diverse communities
Economically disadvantaged communities
Others: homeless, incarcerated, institutionalized
populations
Vulnerable Groups: Children
 Process information and experience
emotions differently than adults
 Less developed coping skills
 Difficulty deciding between fact and
fantasy
 May blame themselves
 Differs according to age group and
developmental level
Vulnerable Groups: Children
 Common reactions:
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Clinging to parent
Fear of strangers
Regression to earlier behavior
Worry, nightmares, fear of the dark
Changes in sleeping/eating habits
Reluctance to go to school
Disruptiveness
Drop in school performance
Vulnerable Groups: Elderly
 Some elderly people may be more at risk
because of:
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Sensory deprivation
Delayed response
Chronic illness
Past trauma/loss
Reluctance to seek help; difficulty
negotiating systems
Vulnerable Groups: People with Chronic
Mental Illness/Substance Abuse Disorders
 Issues to be considered when planning
for people with chronic mental illness or
substance abuse disorders :
 Confusion between symptoms of illness v.
reactions to disaster
 Prior history of trauma
 Disruption of support networks, medications
 Increase in recidivism
Vulnerable Groups:
People with Disabilities
 Issues to be considered when planning
for people with disabilities:
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Difficulty accessing services
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Exacerbation of medical conditions due to
increased stress
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Increased reliance on others
Separation from assistance animals,
caretakers, special equipment, medications
Access to information channels
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Vulnerable Groups:
Culturally Diverse Communities
 Issues to be considered when planning
for culturally diverse communities:
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Previous exposure to racism, violence,
discrimination, poverty, trauma
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Reluctance to seek out services
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Cultural differences in coping
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Language barriers
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Undocumented status
Vulnerable Groups: Economically
Disadvantaged Communities
 Issues to be considered when planning for
economically disadvantaged communities:
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Lack of access to resources
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Reliance on social service systems which may
be overtaxed in a crisis
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Lack of inclusion in planning, decision making
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Lack of community protective factors; high rate
of exposure to violence, alcohol and substance
abuse, etc.
Module 4
The Resilient and Healthy Community
What can we do? How do we prepare?
How do we respond?
The Resilient & Healthy Community
Disaster Phases & Psychosocial Services
Psychosocial Interventions
The Resilient Community & the Community
Health Council
Disaster Phases
 Impact (Heroic) Phase
 Cleanup/Rebuilding (Honeymoon) Phase
 Restoration (Inventory/Disillusionment)
Phase
 Reconstruction (Restabilization) Phase
Impact Phase - Services
 0 – 48 hours:
 Addressing basic needs (safety, food &
shelter, reuniting with family)
 Psychological “first aid”
 Monitoring of services, media coverage, &
rumors
 Technical assistance, training, & consultation
to organizations and other caregivers
Impact Phase - Services
 Within 1 Week:
 Assessment of current psychological status &
needs
 Triage & referral to behavioral health
professionals, when needed
 Outreach & information dissemination
 Fostering of resiliency & recovery
Cleanup/Rebuilding Phase - Services
 Community outreach: culturally &
linguistically appropriate services & social
support
 Public education: information on normal
stress reactions, coping mechanisms,
availability of resources
 Education to health care providers about
psychosocial issues of incident
Cleanup/Rebuilding Phase - Services
 Provision of behavioral health interventions:
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defusing
debriefing
providing relaxation training and respite care
promoting coping skills and strategies
 Identification & referral of survivors with serious
reactions/problems to behavioral health
professionals
 Issuance of death notifications & provision of
grief services to survivors
Restoration Phase - Services
 Continued provision care to individuals with
disaster-related behavioral health problems
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education of providers
screening
outreach
provision of variety of treatment modalities
 Provision of community services & support
 Employment of symbols & rituals
Reconstruction Phase - Services
 Could take several years
 Involves individuals rebuilding their lives,
families, homes
 Opportunity to look at response and
identify lessons learned
 Opportunity to foster resilience
Principles of Psychosocial Intervention
 Do no harm – validate individual reactions.
 Assume resilience.
 Everyone who experiences a disaster event is
affected by it.
 Be culturally competent.
 Respect individuals’ differences in reactions.
Principles of Psychosocial Intervention
 Simple human presence is reassuring.
 Offer flexible services.
 Utilize a team approach.
 Coordinate services with the larger response
activity (i.e., fire, police, recovery agencies,
etc.).
Principles of Psychosocial Intervention
 Most individuals do not require additional
assistance, and return to pre-disaster
level of functioning within 18- 36 months.
 Survivors with severe or long-term
disorders should be referred to
professional behavioral health providers.
Psychosocial Interventions:
Psychological First Aid
 Protect from viewing additional traumatic
stimuli from event
 Direct away from trauma scene and into
safe environment
 Connect individual with loved ones, and
needed information and resources.
Psychosocial Interventions:
Psychological First Aid
Address immediate physical needs
Comfort and console survivor
Provide concrete information
Listen to and validate feelings
Link survivor to support systems
Normalize stress reactions
Reinforce positive coping skills
Facilitate telling of the “trauma story” as
appropriate
 Support reality-based, practical tasks
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Other Psychosocial Interventions
 Crisis Intervention - similar to
psychological first aid; aims to empower
survivor to meet immediate challenges
 Informational briefing – usually provided
by officials about situation status
 Psychological debriefing – group
intervention for highly exposed survivors,
emergency responders
Other Psychosocial Interventions
 Psychoeducation – information about the nature
of emotional reactions to disasters, grief and
bereavement, coping strategies, how to recognize
when to seek professional assistance
 Community outreach – contact where community
members gather; reaching out via the media;
attendance at meetings of faith-based
organizations, schools, community centers;
resource and referral information
Characteristics of the Resilient
& Healthy Community
 Capable of “bouncing back” from adversity
 All sectors inter-related and share
knowledge, expertise & perspectives
 Wide community participation, local
government commitment
 Healthy public policies
Characteristics of the Resilient
& Healthy Community
 Adequate access to basic needs, i.e.,
water, food, shelter, work, learning, etc.
 Adequate access to health care services
 Strong & diverse cultural & spiritual
heritage
 When disaster strikes, financial & human
losses are reduced
Role of the CHC
 Train individuals & families to make
emergency preparedness plans:
 Exit route from home
 How to contact each other
 Where to gather
 Care for pets
 Emergency preparedness kits
Role of the CHC
 Identify and understand various populations
and vulnerable groups in community
 Identify liaisons (“gatekeepers”) to groups
 Partner with organizations representing specific
communities; i.e., faith-based orgs., youth &
senior centers; schools, daycare centers; cultural
organizations, etc., and recruit partners and
volunteers
 Identify training needs of organizations
See: Community Health Emergency Management Profile
Role of the CHC
 Develop relationships with County Emergency
Manager, first responder groups, and Red
Cross chapter
 Develop relationships with local/district public
health offices
 Participate in local emergency planning via
attendance at Local Emergency Planning
Committee
 Advocate for inclusion of health issues in
emergency planning
Role of the CHC
 Identify community resources; maintain current
contact information:
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Emergency response community: emergency manager,
elected officials, first responders
Service providers: hospitals, health & behavioral health
care providers, schools
Community groups: Red Cross, faith community,
service and charitable organizations, professional
associations
Volunteer groups: Community Emergency Response
Team (CERT), Fire Corps, Neighborhood Watch
Programs, Medical Reserve Corps, Volunteers in Police
Service (VIPS); block associations, etc.
See: Community Health Emergency Management Profile
Role of the CHC
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Create networks of related organizations
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The community is an interconnected matrix
of networks, for example:
 Civic (churches, social clubs, schools)
 Occupational (businesses, unions, professional
organizations)
Informational (libraries, bulletin boards)
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Each network can be a conduit for organizing
public response for its own constituency.
Identify training needs for each network
Role of the CHC - Results
 The CHC is an active partner in the
emergency response network in the County.
 The CHC is an active advocate for health
emergency preparedness.
 The CHC is the lead advocate for community
resilience and psychosocial response and
recovery.
 Your county is ready to respond to public
health emergencies.
Purpose of Profile
 Psychosocial Response and Recovery
Planning
 Building Community Understanding
 Creating a Common Directory
Five Parts
 Part One: Psychosocial Assessment
 Part Two: Populations with Different
Planning Needs
 Part Three: Psychosocial Response
Capacity
 Part Four: Emergency Response and
Recovery Planning
 Part Five: The Directory
Part One: Psychosocial Assessment
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Describing community vulnerabilities
Demographics
Socio-economic
Family Composition
Community Health
Risk and Protective Factors
Demographic Indicators
 Age distribution
 Race and Ethnic distribution
 Primary language
Socio-Economic Indicators
 Per capita personal income (last three
years)
 Household income (last three years)
 Unemployment rate (last three years)
 Average monthly TANF and Food Stamp
cases
 Average monthly Medicaid eligibles
 Estimated number and percent of people
in poverty (last three years)
Family Composition Indicators
 Distribution of households by type: family,
married, male head, female head
 Number and percentage of grandparent
headed households; number of children
raised by grandparents
Community Health Characteristics
 Birth rate (last three years)
 Birth rate to mothers under 20 years of
age (last three years)
 Birth rate to single mothers (last three
years)
 Number and percentage of children with
chronic health conditions (last three
years)
Community Health Characteristics (cont.)
 Number of child abuse cases investigated
and substantiated (last three years)
 Number of adult abuse cases investigated
and substantiated (last three years)
 Injury death rates by mechanism (last
three years)
 Motor vehicle fatality rate (last three
years)
Community Risk and Protective Factors
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School achievement and dropout rate
Domestic violence
Substance abuse – alcohol
Substance abuse – other drugs
Access to health insurance/medical care
Access to child care
Community Risk and Protective
Factors (cont.)
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Housing characteristics
Homelessness
Crime rate – adult and juvenile
Teen suicide rate (last three years)
Adult suicide rate (last three years)
DWI rate (last three years)
Other community violence
Part Two: Populations with Different
Planning Needs
 Numbers
 Locations, Providers, and Contact Points
 Liaisons/Information Conduits
Populations:
Children
Elderly
People with
People with
People with
disabilities
 People with
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chronic mental illness
substance abuse problems
cognitive or developmental
physical disabilities
Populations (cont.)
 People who are blind or have visual
impairments
 People who are deaf or have hearing
impairments
 Non-English speaking populations
 Undocumented individuals
 People who are homeless
 Incarcerated and other institutionalized
people
Part Three:
Psychosocial Response Capacity
 Strengths
 Resources
 Challenges
Descriptors
 Leadership and local communication
 Volunteer groups and organizations
 Community and neighborhood
organizations
 Experience with crisis
 Recent experiences or changes
 Overall strengths
 Needs for better coordination
Part Four: Emergency Response and
Recovery Planning
 Plans and planning
 Hazards and vulnerabilities
 Coordination
Areas to be described:
 Understanding - potential hazards and
vulnerabilities
 Understanding - vulnerable people and
populations
 The county emergency response plan
 Emergency Operations Center plans
 Other emergency response plans
 Plan coordination
Part Five: The Directory
 Purpose:
Name the players
Create a directory for all
Directory Listings
Emergency Management Contacts
 County Emergency Manager
 Local Emergency Planning Committee
(LEPC) Members
 Local public health office emergency
preparedness contacts
 Hospital emergency manager
 School districts safety officer
Directory Listings
Emergency Management Contacts
 Red Cross
 Local CERT program (if any)
 Other pre-identified and trained health
professional volunteers
 Emergency Medical Services (EMS)
 Law enforcement
Directory Listings
Emergency Management Contacts
 Fire
 Search and rescue
 CISM members and others trained in crisis
intervention/response
 Other agencies, organizations, and
individuals who might be involved in
emergency response
Directory Listings
Health Care Provider Contacts
 Hospital(s)
 Primary care clinics and ambulatory care
providers
 Other health care agencies, facilities (long
term care, home health, etc.)
 Behavioral health care providers
 Pharmacies
 Laboratories (hospital-based and private)
 Mortuaries
Directory Listings
Community Contacts
 Local/county government contacts for public
utilities, public works, human services, public
information, waste management, etc.
 Faith community contacts
 Food banks and shelters
 Supermarkets and other food resources
 Ham radio operators
 Others