Trends and Tea Leaves

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• Trends and Tea Leaves

• News from Washington

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(No Transcript)
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• Medical versus Public Health framework
• Clarity, Consolidation, Control
• Goals, Guidance, Grants
• All response is Federal versus all response is
  local

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• Medical versus Public Health Framework
• Mass casualty planning surge capacity
• Facility or site-based programs
• Disaster and emergency medicine versus disaster
  and emergency population health
• Need for frontline public health experience

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• Medical versus Public Health Framework
• Specify the public health agency role in a mass
  casualty event
• Describe public health based response versus
  clinical response
• Talk about consequence management
• Share local stories, host visits

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• Clarity, Consolidation, Control
• Major consolidation of DHS grant programs
• Same sheet of music now includes HHS
• Lets be careful what we ask for!

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Former FEMA grants DOJ/Office of Domestic
Programs State-based training Programs EMI
Public Health Preparedness C/A (CDC HRSA)
Stockpile
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• Same Sheet of Music
• HSPD 8 A Unified National Approach
• Requires a national preparedness goal
• Establish mechanism to coordinate
• Develop response capacities
• Sets Federal priorities

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From Interim National Preparedness Goal. March
31, 2005, p. 2
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• Same Sheet of Music
• Capabilities Based Planning
• 15 scenarios
• Universal Task List (UTL)
• Target capabilities listing (TCL)
• Measurable outcomes or metrics

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Not just public health
From Interim National Preparedness Goal. March
31, 2005, p. 5
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From Interim National Preparedness Goal. March
31, 2005, p. 7
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• 36 Targeted Capabilities
• Health Related Targeted Capabilities
• Fatalities management
• Isolation and quarantine
• Mass prophylaxis
• Medical supplies management distribution
• Medical surge
• Public health epidemiological investigation and
  laboratory testing
• Triage pre-hospital treatment
• Worker health and safety

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15 Scenarios

• Blister agent, toxic industrial chemicals, nerve
  agent, and chlorine tank explosion
• Plague, aerosolized anthrax, food contamination,
  and foot and mouth disease
• Pandemic influenza
• Earthquake and hurricane
• Dirty bomb"
• Improvised nuclear device
• Improvised explosive device scenario
• Cyber scenario

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• Same Sheet of Music
• National Incident Management System (NIMS)
• National Response Plan (NRP)
• Limited opportunities for comment, extreme
  pressure to produce

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• Centralization
• One stop shop for grants
• Performance measures and capabilities
• Reduction in redundancy

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• Centralization
• 1500 organizations commented on NPG
• Public Health continues to be seen as medical
  surge (MMRS or NDMS model)
• Training programs not public health specific

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• National Preparedness Priorities
• Implement NIMS and NRP
• Expand regional collaboration
• Implement NIPP
• Strengthen information sharing and collaboration
• Strengthen interoperable communications
• Strengthen CBRNE detection, response and
  decontamination
• Strengthen medical surge mass prophylaxis

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• National Preparedness Priorities
• Implement NIMS and NRP
• Expand regional collaboration
• Implement NIPP
• Strengthen information sharing and collaboration
• Strengthen interoperable communications
• Strengthen CBRNE detection, response and
  decontamination
• Strengthen medical surge mass prophylaxis

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• Goals, Guidance, Grants
• New CDC Guidance includes DHS language
• What is NIMS compliance for public health?
• Local Priority Area Designation
• Specifics on this are mostly, if not all, TO BE
  DETERMINED

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NIMS Compliance Department
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• Local initiatives will continue
• Increased focus on Stockpile
• Increased focus on surge capacity planning
• Perception that we arent doing anything because
  we cant measure it nationally

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• All Response is Federal versus All Response is
  Local
• Note how programs are building Federal capacity
• Watch programs to coordinate Federal, state,
  local tribal activities take pieces of local
  response (and who coordinates what)
• More assets placed regionally, less local
• More DHS guidance, more DHS oversight

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• All Response is Federal versus All Response is
  Local
• How to maximize Federal investment
• How to coordinate Federal assistance
• Local response is not just first 24-48 operation
  period. It is sustained response.

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Flu Vaccine
SARS
?
State Local Funding ()
Anthrax
Funding
9/11/01
Demand for Public Health Services
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Whats next???
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• Medical versus Public Health framework
• Clarity, Consolidation, Control
• Goals, Guidance, Grants
• All response is Federal versus all response is
  local

• Have you observed these trends in your practice?
• Do the programs we are going to discuss
  contribute to any of these trends?
• What should NACCHO do in response to these
  trends? What should the metro forum do?

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• Trends and Tea Leaves

• News from Washington