Planning Issues and Strategies for Rural Public Health Preparedness Western New York Public Health Alliance, Inc. Rural Preparedness Advanced Practice Center Agenda Completion of Pre-Test Introduction of Speakers History of WNYPHA WNY Regional Initiatives Overview of WNYPHA APC Cross Border Planning Issues Rural Preparedness Issues – Discussion Break Agenda (Continued) Development of an Urban to Rural Evacuation Planning Tool – Walsh Center for Rural Health Analysis Evacuation Project – Spatial Analysis Tool – Discussion and Feedback Completion of Post-Test Completion of session evaluation Adjournment Objectives Identify planning issues or obstacles that rural communities may face Share and discuss strategies to build a network of rural public health preparedness partners Share strategies to overcome preparedness planning obstacles Become familiar with a web-based evacuation modeling tool History of Western New York Public Health Alliance Donald W. Rowe, Ph.D. Public Health Liaison University at Buffalo School of Public Health & Health Professions Alliance n. “an association to serve the common interests of its members” Western New York Public Health Alliance Mission - “Through public and private partnerships and collaborations, the Alliance will attract resources to enable an integrated regional approach to achieving healthier communities through surveillance, education, prevention and intervention.” Vision - “Improve the health, safety and wellness of our eight county Western New York Region.” The Western New York Public Health Alliance, Inc. 1992 - The WNY Public Health Coalition began as an unstructured informal group of 8 Commissioners and Public Health Directors only, meeting on an ad hoc basis Funded by in kind contributions only Initial motivation – forum for sharing best practices of common challenges Other rationale included: MPHSP, Community Health Assessments, Rabies, Homecare, HIV, Early Intervention and Pre-K, Managed Care, etc. First Success – Regional Adult Behavioral Health Assessment 1997-1998 Questions regarding regional funding and administration Erie County applied for $ on behalf of all eight counties, regional administration Multiple funding agencies Multiple stakeholders and partners Community engagement Use of technology – “Concept Systems” approach Regional Adult Behavioral Health Assessment Included data on: – Access - Family History – Risk Behavior - Preventive Care – Health Perceptions - Chronic Diseases – Primary Prevention - Secondary Prevention – Socioeconomics Re-commissioned in 2004 with funding from HRSA and Community Health Foundation of Central and Western New York Multiple uses of data (State of Region Report, county Community Health Assessments, grant applications, health education campaigns, etc.) Second Success – Physician’s Guide to Public Health Developed an easy to use hard copy guide to public health services throughout the eight county region. Distributed to physicians at no cost ~2,000 copies. Third Edition in progress with emergency preparedness supplement included 2007 - distribution with assistance from Regional PHPRBT Grant WNYPHA - Timeline 2001-2002 - The Regional Office of Public Health Emergency Preparedness formed 2004 – August: WNY Public Health Alliance Incorporated 2005 – June: received 501 (c) (3) status 2005 – 2006: Governance Structure developed 2006 - Executive Director hired WNYPHA - Today A NY State 501(c)3 Corporation dedicated to: – Creating a community culture of sound public health practices – Promoting healthy lifestyle choices – Improving standards of care through evidence-based evaluation Fulfilling the Mission Governance Representation – Public Health Directors/Commissioners from eight county health departments – Area providers, payers, academia, & community Information Resources – WNY HelpNet – Health Risk Assessment – Physician’s Guide to Public Health Fulfilling the Mission (continued) Programs - Collaborations for grants procurement and administration for regional public health initiatives, e.g. – Asthma Coalition of Western New York – Western New York Coalition for Diabetes Prevention – WNY HIV/AIDS Public Health Coalition – Eat Well Play Hard Project – Healthy Heart Worksite Wellness Alliance – NACCHO Advanced Practice Center for Rural Public Health Emergency Preparedness Regional Office of Public Health Emergency Preparedness (Third Success) Tracy Fricano Chalmers APC Project Manager Regional Coordinator Office of Public Health Emergency Preparedness Why A Regional Effort? Disease knows no political border Smaller counties face overwhelming challenge given their limited funding All counties have limited public health resources Opportunity for best practice sharing Cost-effective approach WNY better positioned for future competitive funding Regional Resources Buffalo-Niagara International Airport Women and Children’s Hospital of Buffalo Western New York Poison Control Center WNY Healthcare Association Erie County Medical Examiner Greater Buffalo Niagara Regional Transportation Council Niagara Frontier Transit Authority Area Maritime Security Commission Erie County E C M C Medical Center On- and off-campus health centers 40 + outpatient specialty clinics Advanced academic medical center – 550 inpatient beds – 156 skilled nursing homes beds – Erie County Home (586 bed skilled nursing) Regional Center (trauma, burn, rehab) Major teaching hospital (SUNYAB) Rooftop heliport access WNY Regional Resource Center Mercy Flight • Main Base (Hamburg): 1981 • Independent • 24 / 7 • Olean Base: September 1998 • Eurocopter BO-105 Regional Laboratory Capacity Level B Laboratory Response Network (LRN) BSL-3 initiative Serve 17 counties of WNY – Microbiological testing for BT agents No molecular testing – Support Level A labs – Clinical & Environmental testing – Packaging & Shipping Protocol guidance and training Emergency Management SEMO Region V – Emergency Managers (10) WNY Stress Reduction Team (4) Regional Medical Advisory Committee (8) Regional EMS Councils – Big Lakes (Genesee, Niagara, Orleans) – Erie, Wyoming – Southwestern (Allegany, Cattaraugus, Chautauqua) HAZWEST Regional Milestones WNYPHA strategy development WNYPHA budget preparation Establish ROPHEP Legislative briefing Mutual Aid legislation Inter-county contracts for services Initiate procurement/training WNYPHA Emergency Preparedness Agreement Cost-based contractual arrangement Includes regional deliverables and workplan Erie County Department of Health lead fiscal agency County contributions based on % of total PHPRBT grant award All counties and public health commissioner/directors maintain complete autonomy and authority ROPHEP as coordinating entity Includes response capability through mutual aid agreement Mutual Aid Legislation S1692-A RATH Rath, DeFrancisco, Farley, Flanagan, Kuhl, Leibell, Libous, Little, Marchi, McGee, Meier, Mendez, Saland, Seward, Volker, Wright Add S99-u, General Municipal Law Authorizes any county, to enter into municipal cooperation agreements with one or more counties; provides that such agreements might include, but are not limited to, natural and man- made disasters, epidemic, or terrorist activities Effective 08/05/03 NYSDOH BT Grant Awards 08/31/06 – 08/30/07 County State Award Regional % State Award Contribution Contributed Allegany $ 75,000 $ 4,500 6% Cattaraugus $ 98,955 $ 9,986 10% Chautauqua $154,750 $ 15,475 10% Erie $950,265 $ 95,026 10% Genesee $ 85,000 $ 8,500 10% Niagara $219,846 $ 21,985 10% Orleans $ 75,000 $ 7,500 10% Wyoming $ 75,000 $ 7,500 10% Total Regional Funds: $170,382 Regional Budget Personnel (salaries, fringe) Travel, meeting expenses Communications devices Planning Training & Exercises Equipment & Supplies Regional Office of Public Health Emergency Preparedness Principle Staff – Regional Coordinator PHEP/ APC Project Manager – Erie County Bioterrorism Coordinator – Training Coordinator – Strategic National Stockpile Coordinator* – Point of Dispensing Nurse Manager* – Epidemiologist* * Primary work location is off-site Regional Office of Public Health Emergency Preparedness Support Staff – Administrative Clerk – Sr. Clerk Typist – Jr. Accountant – Account Clerk Typist – Medical Director (Part-time)* – Fee for Service Physician Consultant* * Primary work location is off-site WNY Public Preparedness Workgroup Chaired by Regional Coordinator Participants – ROPHEP, County PH Emergency Planners, NYSDOH, Healthcare partners (RRC, WNYHA), & Tribal Nations Meetings – Monthly (simultaneous with WNYPHA Executive Board) – As needed for various subcommittees Format – Robert’s Rule (light) WNY Public Health Preparedness Workgroup (continued) Purpose – Collaboration for completion of PHPRBT Grant deliverables – Updates and information – Advisory group to WNYPHA Executive Board Benefits – Stronger voice of concerns to NYSDOH – Sharing of best practices – Sharing of work-load WNYPHA - Planning Regional Response Plan developed by ROPHEP – Base PH Emergency Preparedness Plan – Event specific annexes Regional coordination of county plans – Collaborative effort through PH Emergency Planners Workgroup – Template allows for degree of standardization across region Ongoing multi-disciplinary planning groups (i.e. Mass Fatality) WNYPHA - Training Veterinary Response to PH Emergencies Smallpox Vaccination Training Disaster LAN Nerve Agent Antidote (Mark I Kits) (Video) Personal Protective Equipment (Video) Use of Regional Equipment Radiological Awareness Core Competency (Project Public Health Ready) Psychological First Aid NYSDOH sponsored trainings WNYPHA – Exercises SPOX 11-02: Smallpox simulation with Flu RADEX 08-03: Radiological Decon Operation Liberty Bell 09-03: NDMS casualty collection and reception VIREX 11-03: Regional Flu PODs LOGEX-SNS 04: Regional SNS reception and distribution to counties COPODEX 10-05: BDS and RDD Western Region Communicable Disease Exercise (CDEX) A multi-agency, State sponsored Regional exercise conducted, to assess the State, Regional, cross-border, Tribal and local ability to identify, track, monitor and mitigate a highly infectious communicable disease. Full-scale exercise conducted in the Western Region, all areas of New York State participated Incorporated cross border initiatives with the Province of Ontario, the Seneca Nation of Indians, and the Tuscarora Nation. CDEX – Multi-Phasic Phase I – Exercise design and planning Phase II – Table-top exercise Phase III – Interim exercise activities Phase IV – Full-scale exercise Phase V – After-Action report Phase VI – Post-exercise activities – Mass Fatality Workshop & Planning Group – Regional PIO Meeting WNYPHA – Equipment & Supplies Standardized – Bulk purchasing – Training – Familiarity for mutual aid Regional purchase, local maintenance/inventory Trailer Sets – Casualty Collection, triage, mobile PODs – Tents, generators, hand washing stations, etc. POD Go-Kits Personal Protective Equipment (PPE) Current Regional Initiatives Pandemic Flu Planning Regional Radiological Planning Mass Fatality Workgroup Public Information Officer Workgroup Hospital Water Infrastructure Best Practices Medical / Public Health Shelters Continuity of Operations Planning Rural Preparedness Advanced Practice Center Upcoming Sponsored Activities Pediatric PODs exercise program (Spring 2007) Great Lakes Border Health Initiative Annual Conference – Niagara Falls, NY – June 13-15, 2007 SMART / MRC participation in May 2007 Boy Scout Camperall, Lewiston, NY Bi-National Emergency Preparedness Conference – Niagara Falls, NY – October 2007 Western New York Public Health Alliance Rural Advanced Practice Center Western New York Five counties are considered rural: Allegany, Cattaraugus, Chautauqua, Genesee and Wyoming Three counties that are identified as “urban” have large rural population: Orleans – 57% rural Niagara – 25% rural Erie – 9% rural Population of Western New York is nearly 1.6 million Almost 376,000 residents are classified as living in a rural area Urban-to-Rural Evacuation In addition to Buffalo, the second largest city in New York State, Interstate I-86 runs through Western New York and is an evacuation route for New York City Many New York City and Buffalo residents have ties to rural areas within Western New York: Family, camps and vacation homes Unique Cross-Border Issues Lake Erie and Canada are to the West The international border crossing between Western New York and Canada is the second most traveled Canadian crossing in the U.S. for passenger travel and freight Pennsylvania is to the South Travel across the New York and Pennsylvania border is commonplace (especially for residents in these interstate border communities) WNYPHA Rural APC - Issues Evacuation/migration of populations from urban to rural areas and prediction of post-event population surge Cross border issues including legal, jurisdictional, mutual aid, constraints to collaboration, and ongoing activities Training needs of public health/emergency planners relevant to evacuation, rural issues Partnering and collaboration with new and diverse partners Project Goals Goal 1: Build the knowledge base and relevant tools for rural emergency planners around the issue of post-event evacuation/migration from urban to rural areas Goal 2: Cross Border (international and interstate) issue analysis Goal 3: Build the knowledge base around rural public health preparedness Goal 1: Build Tools for Emergency Planners for Urban-to-Rural Evacuation Objective 1.1 - Develop spatial analysis tool using GIS to predict post-event population surge – Three scenarios Pandemic Flu Dirty Bomb Industrial / Chemical Incident – Activity led by National Opinion Research Center (NORC) and Pennsylvania State University (PSU) Goal 1: Build Tools for Emergency Planners for Urban-to-Rural Evacuation Objective 1.2 - Conduct an urbanized area relocation to rural assessment – Assess ability/capacity of transportation infrastructure in the Buffalo-Niagara region to accommodate evacuation – Activity led by Greater Buffalo Niagara Regional Transportation Council (GBNRTC) Goal 2: Cross Border Issue Analysis Objective 2.1 – Conduct assessment of issues related to cross border cooperation (international and interstate) – Assessment will examine legal, mutual aid, cross border activities, form and function of public health systems and communication – Activity led by University at Buffalo, School of Public Health and Health Professions with input from APC Cross Jurisdictional Ad Hoc Committee Cross Border Cooperation Assessment Final Product: “A Guide to Cross Jurisdictional Public Health Partnerships” Content determined by assessment survey – Topics include: usefulness of guide, existing partnerships, mutual aid agreements, identification of critical resources, population surge, availability of assessment tools, etc. – Initial pilot included eight counties of WNY – Final survey currently active/available Goal 2: Cross Border Issue Analysis Objective 2.2 – Conduct Interdisciplinary Symposium Public Health Emergencies and Legal Preparedness A Cross-Border Challenge – November 17, 2006 – Activity led by University at Buffalo, School of Public Health and Health Professions – Collaboration with School of Law – Multiple sponsors – Bi-National, multi-disciplinary planning committee Public Health Emergencies and Legal Preparedness A Cross-Border Challenge Goal: provide knowledge of laws and jurisdictional issues that determine legitimacy of emergency response programs Target audience: public health officials, attorneys, judiciary members, hospital administrators, emergency managers, and business leaders Public Health Emergencies and Legal Preparedness A Cross-Border Challenge Program Topics: Keynotes – Mutual Aid Agreements – Essential Public Health Emergency Tools – Working Together: Complex but Necessary Legal Issues: Past, Present, and Future – SARS, The Toronto Experience: Moving Forward – The Great Lakes Border Health Initiative: Cross Border Communications in Practice Today – Building New Preparedness Bridges with the Private Sector – Privacy Concern: Legal Protections in Community Crisis Situations Public Health Emergencies and Legal Preparedness A Cross-Border Challenge Program Topics Continued: – Table-Top Exercise Incident at Airport X: Quarantine Law and Limits Panel of international experts Live, unrehearsed Results and Conclusions – Attendance Multi-disciplinary Included out-of-state and Canadian participants – Evaluations tabulated by Baldy Center – Overall positive feedback from participants Goal 3: Build the Knowledge Base Around Rural Public Health Preparedness Objective 3.1 – Prepare and disseminate one-hour video broadcasts related to rural public health preparedness – Activity led by SUNY Albany – “Mass Evacuation to Rural Communities” aired November 9, 2006 – “Mass Evacuation and Rural Communities: New Tools for Planning” scheduled for May 10, 2007 Objective 3.1 “Mass Evacuation to Rural Communities” Featured speaker: Dr. Brian Gerber – Assistant Professor, Division of Public Administration, School of Applied Social Sciences, West Virginia University – Presented results of a recent survey regarding potential behavioral responses of large populations to disaster events (including terrorist attacks) – Discussed key concerns for rural communities to consider as they plan for mass exodus from urban centers Featured speaker: Dr. Donald Rowe – Public Health Liaison, University at Buffalo School of Public Health & Health Professions – Presented the history of the Alliance and the APC grant initiatives related to rural preparedness Objective 3.1 “Mass Evacuation to Rural Communities” Viewing results: (as of December 6, 2006) – 330 sites from 46 states - total of 8,504 anticipated broadcast viewers – 229 registered for live webcast (1-7 individuals per connection) – 380 hits to the archived video-stream files of the program – 130 videotapes distributed Eighty-two percent of respondents were from states other than New York Respondents included local health department staff (34%), 22% hospital or community health clinic personnel (22%), state health department workers (16%) Remaining respondents included representatives from law enforcement/emergency response, academic, business and community-based organizations Based on online evaluations from 213 respondents Objective 3.1 “Mass Evacuation to Rural Communities” Majority of respondents were nurses (15%) and bioterrorism coordinators (14%) Respondents generally agreed or strongly agreed that: – Programs were of overall high quality (86%) – Moderators were helpful in framing questions and focusing discussion (87%) – Guest speakers effectively communicated concepts (88%) – Indicated that program content supported the objectives (88%) – Knowledge gained would help perform their jobs more effectively (76%) – Recommend the course to employees in positions similar to their own (80%) Post-test results indicate that the program was effective in imparting knowledge to participants Based on online evaluations from 213 respondents Goal 3: Build the Knowledge Base Around Rural Public Health Preparedness Objective 3.2 – Build knowledge base of Advisory Committee and program partners – Activity led by project staff – Provide opportunity for attendance at national conferences, workshops, and meetings that fall within the scope of rural public health preparedness Regional Rural Public Health Preparedness Advisory Committee Purpose – Serve as a project steering committee – Provide a forum for the exchange of information – Build partnerships and relationships – Draw out new ideas and perspectives – Recommend the establishment of ad hoc committees Regional Rural Public Health Preparedness Advisory Committee Membership – Subcontractors – Project Staff Members – 8 Western New York local health department Public Health Emergency Preparedness Coordinators Public Health Emergency Preparedness Coordinators Employed by local health departments to plan for public health emergencies Familiar with county infrastructure, resources and emergency response plans Collaborative relationships with County Emergency Management Successful relationships with local emergency response agencies Public Health Emergency Preparedness Coordinators Knowledgeable about county’s surge capacity (county-wide, hospitals, healthcare facilities, etc.) Offer insight into current areas of concern Work closely with the local health department Public Health Director or Commissioner Have established key contacts throughout the community WNYPHA Rural APC Products Web-based spatial analysis tool Urbanized area relocation assessment Symposium: Public Health Emergencies and Legal Preparedness A Cross-Border Challenge “A Guide to Cross Jurisdictional Public Health Partnerships” Video Broadcasts – “Mass Evacuation to Rural Communities” – “Mass Evacuation & Rural Communities: New Tools for Planning” Rural Public Health Preparedness: Issues and Concerns Michael Meit, MA, MPH Senior Research Scientist NORC at the University of Chicago Health Policy and Evaluation Rural Lessons from the 2005 Hurricanes The 72-hour myth Evacuees can overwhelm rural systems Hospitals are not a panacea for rural preparedness – little excess capacity Preparedness is not solely an urban concern – Also consider issues of agroterrorism, infectious disease (bird flu), technological disasters (TMI), etc. Rural Preparedness Concerns Rural communities are home to many potential targets (nuclear facilities, agro-chemical plants, and refineries) Rural areas are the home to agricultural production, with an estimated 2,000,000 vulnerable sites in the U.S. alone Urban water supplies often originate in rural areas Infectious diseases can more easily be targeted at small communities with the same effect Rural Preparedness Concerns (continued) Mass exodus from urban areas will undoubtedly affect rural communities Lack of surge population estimates create barriers to planning Low threat perception creates barriers to preparedness planning Issues of natural and technological disasters Rural PH Response Issues Capacity* Lack of state and local PH response capacities in many rural areas Lack of uniformity in state and local PH systems for planning consistency Identification of the expanded rural PH system for PH response * As identified in “Preparing for Public Health Emergencies: Meeting the Challenges in Rural America” Rural PH Response Issues Capacity* (continued) Identification of necessary competencies in rural PH response Perceived low threat of rural PH emergencies Need for model practices in rural PH response Limited human and financial resources to build necessary infrastructure * As identified in “Preparing for Public Health Emergencies: Meeting the Challenges in Rural America” Who Will Respond? County EMAs Red Cross Fire Salvation Army Law Enforcement Local Govt. Agencies EMTs Veterinary Services Hospital Personnel Public Works HAZMAT Ag Extension How do we assure that rural responders can fulfill public health response functions in lieu of or in support of limited rural public health capacities? Discussion What sorts of rural preparedness concerns exist in your community? Have you had any past experience with a disaster/emergency that led to an influx of people into your community? – Is this an area of concern? – How did your agency respond to this situation? – What lessons learned could you share? Time for a Break !