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ASSESSMENT OF PUBLIC HEALTH AND HEALTHCARE PREPAREDNESS CAPABILITIES: ANALYZING
CORRECTIVE ACTIONS TO IDENTIFY PRIORITIES
Lisa McCormick, DrPH; Jonathan Wilson, RN, MSN, CHEP; Elena Linn, MPH; W. Terry McLeod, RN, BSN, CHEP; Jim Craig, BS, CPM
• Initial Detection
• Initial Response
• Initial Recovery
All Disasters Begin Locally!
Local Preparedness Is Essential
Medical & Mental Health Services
First RespondersFire/EMS
Emergency Management
Public Health
Law Enforcement
Linking Response Systems
Capability Overlap
Healthcare
Public Health Emergency Management
10 Essential Services of Public Health PHP and HCP
Capabilities
National Preparedness and Core Capabilities
Public Health Preparedness Capabilities Healthcare Preparedness Capabilities1 Community Preparedness 1 Healthcare System Preparedness
2 Community Recovery 2 Healthcare System Recovery
3 Emergency Operations Coordination 3 Emergency Operations Coordination
4 Emergency Public Information and Warning 4
5 Fatality Management 5 Fatality Management
6 Information Sharing 6 Information Sharing
7 Mass Care 7
8 Medical Countermeasure Dispensing 8
9 Medical Materiel Management and Distribution 9
10 Medical Surge 10 Medical Surge
11 Non-Pharmaceutical Interventions 11
12 Public Health Laboratory Testing 12
13 Public Health Surveillance and Epidemiological Investigation 13
14 Responder Safety and Health 14 Responder Safety and Health
15 Volunteer Management 15 Volunteer Management
Capabilities Overview
National Preparedness Core Capabilities
• Capabilities are tested via exercises and real-life events• Information and data collected in AARs/IPS are
used to identify:• strengths• areas for improvement• capability performance• corrective actions
Exercises and Real-life events
• Need exists for a systematic, rigorous process for examining AARs and IPs
• Method to examine trends and patterns within areas of improvement across capabilities in order to ensure:• Lesson learned are not ignored• Lessons learned are incorporated into future planning• Mistakes are not repeated
Current Need
• Purpose: creation of a tool that captures themes within corrective actions overtime• Depicts trends in areas of improvement • Allows for comparisons (event vs. exercises, exercise type vs.
exercise type, year to year)• Identifies systemic problem areas that occur over time
• Goal: enhance preparedness and response by prioritizing resources & strengthening capabilities
Introduction to the CAP (corrective action prioritization) process
Note: This analysis does NOT look at strengths resulting from exercises/events. It is a way to look at reoccurring themes in areas for improvements.
• Data was collected from 12 MSDH after-action reports (AARs) from 2010 to 2013 • 3 Events (note: two events flood/tornado 2011 combined into one AAR)• 9 Exercises
• A total of 405 Corrective Actions identified• 118 from Events• 287 from Exercises
• Created an Excel database and tool for recording, tracking, and analyzing AAR/IPs and CAs
Data
• Reviewed, coded, and assigned by:• 1) Capability: PHP Capabilities & HCP capabilities, function
(s), task (s), resource element (s) • 2) Theme: Macro-Theme, Needed Action, Unit of
Improvement/Focal Point, Mezzo-Theme, Micro Theme, and Agency/Function Responsible
• Capability and themes for CAs were determined by the context of the CA (i.e. what was trying to be accomplished)• Filters and pivot charts are used to analyze results
and trends
Methods
• Staffing: Corrective Actions pertaining to issues regarding staffing (ex. Identifying additional staff, staff assignments, the management of staffing, etc.).
• Training: Corrective Actions pertaining to the need for additional training (ex. training on roles and responsibilities, policies and procedures, equipment, systems/logistics, ICS, future exercises/drills, etc.).
• Policies and Procedures: Corrective Actions pertaining to the planning and policies & procedures (ex. operational plans, systems/logistics, equipment, documentation & forms, etc.).
• External Partners: Corrective Actions pertaining to partnering or communicating with external partners (identifying and developing partnerships/collaborations, MOUs, communication plans, etc.).
• Internal Partners: Corrective Actions pertaining to communicating, coordinating and partnering with internal partners.
• Equipment/Resource Need: Corrective Actions pertaining to the need for or standardization of equipment, systems, resources or supplies (ex. communications equipment, documentation & forms, systems/logistics, etc.).
Macro Theme Definition
Theme Description
Macro Theme Broadest Description of the Corrective Action
Unit of Improvement/Focal Point Area that will be improved by CA
Needed Action What needs to be done (verb of the CA)
Mezzo Theme Provides more detail about the Macro Theme (subject of the CA)
Micro Theme Provides more detail about the Mezzo Theme
Agency/Function Agency/Function responsible for the CA
• CA Description: Provide Additional basic and advanced training opportunities for CORES ESAR-VHP local System Administrators.
Example using Themes
Macro Theme Training
Unit of Improvement/Focal Point Volunteer Management
Needed Action Provide Training
Mezzo Theme SOP - Policies and Procedures/Roles and Responsibilities
Micro Theme Staffing a state created mission and notifying volunteers
Agency/Function ViPR
Analysis Examples
Community Prep
Community Rec
overy
Emerg
ency
Operations C
oordinati
on (EOC)
Emerg
ency
Public In
fo and W
arning
Fatal
ity M
anag
emen
t (MMRT)
Informati
on Shari
ng
Mass Care
Medica
l Counter
measu
re Disp
ensin
g (POD)
Med. M
aterie
l Mgm
t & D
istru
bution (RSS
)
Medica
l Surge
(SMAT)
Non-Pharmac
eutica
l Inter
ventions
Public Hea
th La
boratory
Testi
ng (MPHL)
PH Surve
illance
and Ep
i Inve
stiga
tion
Responder
Health
and Sa
fety
Volunteer M
anag
emen
t
0
1
2
3
Figure I:Frequency of PHP Capabilities Tested by Exercise vs Event
Event Exercise
Community Prep Community
Recovery Emergency Operations
Coordination (EOC)
Fatality Mgmt (MMRT) Information
Sharing Medical Surge (SMAT) Responder
Health and Safety
Volunteer Management
0
1
2
3
Figure II: Frequency of HCP Capabilities Tested by Exercise vs Event
Event Exercise
Corrective Actions by Macro Themes
Policies and Procedures36%
Training27%
Equipment/Resource Need14%
Staffing13%
External Partnerships8%
Internal Partnerships1%
N = 405
Corrective Actions by PHP Capabilities
Med Surge46%
Non-pharm Interventions13%
Medical Count Dispensing11%
EOC9%
Medical Mgmt5%
Fatality Management
5%
PH Lab3%
Volunteer Mgmt3%
Mass Care2%
Community Prep1% Responder Health & Safety
1%
Information Sharing1%
N = 405
Examine Themes within Capabilities
Med Surge52%
Medical Counter Disp13%
EOC12%
Non-Pharm Int11%
Fatality Mgmt4%
Med Count Dispensing3%
PH Lab1%
Volunteer Mgmt0%
Worker Safety1% Mass Care
1%
Information Sharing1%
Community Prep1%
Corrective Actions regarding Policies and Procedures by PHP Ca-pability
N=145
Examine Trends within Agencies/Functions (ex. SMAT)
Policies and Procedures
Training
Equipment/Resource Need
Staffing
External Partnerships
Internal Partnerships
SMAT
41.67%
8.33%
8.33%
12.50%
25.00%
4.17%
43.31%
25.98%
16.54%
7.87%
3.94%
2.36%
CA by Theme – Percentage of CA in each Theme for Exercises & Events
Exercise Event
• Monitor quality of evaluation process• Realization of the utility of corrective actions/reduce
stigma associated with identifying corrective actions• Database to track capability improvement over time
Conclusion – Tool for Assessments
2010 2011 2012 2013
8
121
153
123
Number of Corrective Actions by Year
• Assistance in conducting a needs assessment• Identify reoccurring & understated areas for
improvement• Prioritize for future PHEP and HPP work plans
Conclusion – Tool for Prioritization
Deactivation/DemobilizationImmunization & Vaccinations
Volunteer ManagementTriage
Responder Health & SafetySite Control & Planning
Activation & DeploymentPatient Movement & TrackingEmergency Operations Plans
CommunicationsMedical Transport
ICSOperations
Trai
ning
12234455678
1648
Training by Unit of Im-provement
