new mexico community health council training the prepared community spring 2005
TRANSCRIPT
New MexicoCommunity Health Council Training
The Prepared Community
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
What does health & medical emergency management look like at the national and state level?
Emergency Managementfrom 20,000 Feet
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:
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
Local Incident Command Post (ICP)
Local EOC
Local/County/TribalEmergency Response
Plans
Mayor/CEO Requests State
AssistanceMayor/CEO
Declares Local Emergency
If the incident exceeds local capacity, the Mayor or Chief Elected Official may request state assistance.
State Level Emergency Response
Local EOC
Local/County/TribalEmergency Response
Plans
Mayor/CEO Requests State Assistance
Mayor/CEO Declares Local Emergency
State EOC
New Mexico All-Hazard Emergency Operations
Plan
State Agency-Specific
Emergency Operations
Plans
Local Incident Command Post (ICP)
If the incident exceeds State capacity, the Governor may request Federal assistance.
Federal Level Emergency Response
State EOC
New Mexico All-Hazard Emergency
Operations Plan
State Agency-Specific
Emergency Operations
Plans
Governor Declares Emergency
Governor Requests Federal Assistance
Mayor/CEO Requests State Assistance
Mayor/CEO Declares Local Emergency
Local Incident Command Post (ICP)
Local EOC
Local/County/TribalEmergency Response
Plans
National Response Plan
President Declares
Emergency
Federal Agency Assistance and
other 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-HazardEmergency 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: Centers for Disease Control (CDC) –
Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism
Health Resources & Services Admin. (HRSA) – National Bioterrorism Hospital Preparedness Program
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 - Preparedness
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 Roles - Response
NMDOH Response Roles (cont.) Provide/coordinate laboratory testing Provide/coordinate provision of crisis response &
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
What does health & medical emergency management look like at the community and county level?
The Prepared Community
Goals of the Prepared Community
1. Informed and involved public2. Prepared and informed professionals3. Planning, preparation and policies4. Communication systems and connectivity5. Scientific and technical support and other
resources6. 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
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
Prevention: public education about public health emergencies and emergency response
Preparedness: emergency response plans that are integrated with NMDOH and local emergency responders
Response: participation in community response; 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: Public Health Office Personnel
Prepared & Informed Professionals: Volunteers
important component of emergency response both pre-identified and spontaneous, unaffiliated
volunteers could come from programs such as:
• 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)
email & fax notification of situations affecting the public health
Communication Systems:The Health Alert Network (HAN)
Communication Systems:EMSystem®
Provides hospital emergency departments with real-time information regarding: 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
BC
D
E
F
Individual Reactions
Emotional: sadness, grief, anxiety/fear, guilt, anger, irritability, numbness, neediness, etc.
Physical: tension, sleeplessness, aches and pains, appetite changes, agitation, etc.
Behavioral: hypervigilance, withdrawal, changesin normal patterns, drug/alcohol use, etc.
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
Usually these are normal responses to abnormal situations.
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 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
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.
And there are uniquely vulnerable population groups.
What makes some communities moreat 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
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: 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: 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: Difficulty accessing services Exacerbation of medical conditions due to
increased stress Increased reliance on others Separation from assistance animals,
caretakers, special equipment, medications Access to information channels
Vulnerable Groups:Culturally Diverse Communities Issues to be considered when planning
for culturally diverse communities: Previous exposure to racism, violence,
discrimination, poverty, trauma Reluctance to seek out services Cultural differences in coping Language barriers Undocumented status
Vulnerable Groups: Economically Disadvantaged Communities Issues to be considered when planning for
economically disadvantaged communities: Lack of access to resources Reliance on social service systems which may
be overtaxed in a crisis Lack of inclusion in planning, decision making 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: 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 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
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: 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
Create networks of related organizations The community is an interconnected matrix
of networks, for example: Civic (churches, social clubs, schools) Occupational (businesses, unions, professional
organizations) Informational (libraries, bulletin boards)
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
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
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 ProtectiveFactors (cont.) 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 DifferentPlanning Needs
Numbers
Locations, Providers, and Contact Points
Liaisons/Information Conduits
Populations:
Children Elderly People with chronic mental illness People with substance abuse problems People with cognitive or developmental
disabilities People with 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
County Emergency Manager Local Emergency Planning Committee
(LEPC) Members Local public health office emergency
preparedness contacts Hospital emergency manager School districts safety officer
Emergency Management Contacts
Directory Listings
Red Cross Local CERT program (if any) Other pre-identified and trained health
professional volunteers Emergency Medical Services (EMS) Law enforcement
Emergency Management Contacts
Directory Listings
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
Emergency Management Contacts
Health Care Provider Contacts
Directory Listings
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
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
Community Contacts