HHS unveils strategy for disaster response

All responders will be on the same page

With the release of the National Health Security Strategy (www.hhs.gov/disasters) and interim implementation guide for protecting public health in a large-scale emergency, the Department of Health and Human Services (HHS) has taken the first step toward the realization of a vision long held by emergency response individuals and organizations: a cohesive plan to be followed by everyone in the nation who is involved in disaster response.

"I think most ED managers and other hospital-level emergency preparedness coordinators have all felt pretty isolated since [9/11 in] 2001," says Eric Toner, MD, an emergency physician who is a senior associate at the Center for Biosecurity at the University of Pittsburgh (PA) Medical Center. Toner also has worked with the Office of the Assistant Secretary for Preparedness Response on the Hospital Preparedness Program.

"In my hospital I worked on my response plans, but I did not know what others were doing, what the state or the federal government was doing," Toner says. "We need more local collaboration — collaboration that's really transparent — with other hospitals, and then close planning and exercise work with our state, neighboring states, and the federal government."

The country has made significant progress in preparing hospitals for what are referred to as common disasters, such as tornados and bus crashes, says Toner. "But we are not at all well prepared for catastrophic disasters, the kinds of things that really keep us up at night like a major terrorist attack, a large earthquake such as the one that hit Haiti, or a nuclear attack," he says. What is needed are a strategy and road map for how to become prepared, and that is what the new publication starts to provide, Toner says.

The National Health Security Strategy (NHSS) was required by the Pandemic and All Hazards Preparedness Act of 2006. It sets priorities for government and nongovernment activities over the next four years, while an interim guide sets forth initial implementation activities. (For a list of the key objectives of the strategy, see the box, below.)

The interim implementation guide, to be used until September 2010, focuses on accomplishing the following eight initial activities, which provide a foundation for further implementation of the NHSS:

  • Identify and prioritize a list of investments to enhance the capabilities required to achieve national health security.
  • Conduct a work force gap analysis and develop work force competencies for all sectors involved in national health security.
  • Coordinate HHS's efforts to improve national health security with those of Department of Homeland Security and all federal agencies involved in national health security.
  • Begin to identify and develop methods for risk analysis appropriate to the broad range of risks to public health.
  • Develop an evaluation framework, including plans for performance monitoring and evaluating the impact of investments.
  • Promote and implement quality improvement (QI) methods for health security on a broader scale.
  • Propose an agenda for research to enhance national health security.
  • Conduct an assessment of the countermeasures enterprise with the aim of identifying how to develop, manufacture, and ensure availability and delivery of countermeasures faster and more efficiently. (Editor's note: The guide can be found at www.hhs.gov/aspr/opsp/nhss/implementationguide.html.)

Among the initial actions for the federal government are conducting a review to improve the system for developing and delivering medications, vaccines, supplies, and equipment for health emergencies; identifying the and prioritizing capabilities of local and state governments; determining the investment needed to ensure national health security; and evaluating the impact of those investments. Plans call for the document to be updated every four years.

Gregg Pane, MD, FACEP, director of National Health Care Preparedness Programs, Department of Health and Human Services, says, "Some of the objectives of particular interest to EDs involve work force elements, communication, countermeasures, and situational awareness. These involve a trained-and-ready work force available for surge and scalable systems. This includes pre-hospital and hospital, drugs and vaccines, and surveillance activities, including reporting situations to the state public health officials." ED managers and their staffs "would be key partners," Pane says.

To Pane, the significance of the strategy is that "in my judgment it raises the profile [of disaster response] and puts it under one roof. It's the first effort to put everything strategic in one document."

Sources

For more information on the National Health Security Strategy, contact:

  • Gregg Pane, MD, FACEP, Director, National Health Care Preparedness Programs, Office of the Secretary, Department of Health and Human Services. E-mail: Gregg.Pane@hhs.gov.
  • Eric Toner, MD, Senior Associate, Center for Biosecurity, University of Pittsburgh (PA) Medical Center. Phone: (443) 573-4502. E-mail: etoner@upmc-biosecurity.org.

Key Objectives of the National Health Security Strategy

  • Foster informed, empowered individuals and communities.
  • Develop and maintain the work force needed for national health security.
  • Ensure that situational awareness so responders are aware of changes in an emergency situation.
  • Foster integrated, health care delivery systems that can respond to a disaster of any size.
  • Ensure timely and effective communications.
  • Promote an effective countermeasures enterprise, which is a process to develop, buy, and distribute medical countermeasures.
  • Ensure prevention or mitigation of environmental and other emerging threats to health.
  • Incorporate post-incident health recovery into planning and response.
  • Work with cross-border and global partners to enhance national, continental, and global health security.
  • Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods.

Source: Department of Health and Human Services, Washington, DC.


Strategy begins at 'a high level'

The good news is that with its National Health Security Strategy and interim implementation guide, the Department of Health and Human Services is, for the first time, outlining a cohesive plan for nationwide response to a major disaster. The "bad" news, if you can call it that, is that it is not yet in actionable form.

"Part of the problem is the strategy as written so far is really high-level," says Eric Toner, MD, an emergency physician who is a senior associate at the Center for Biosecurity at the University of Pittsburgh (PA) Medical Center. Toner also has worked with the Office of the Assistant Secretary for Preparedness Response on the Hospital Preparedness Program. "You cannot yet really drill down into the concrete specifics an ED manager needs to know," says Toner, noting that the interim implementation guide will be followed by an interim plan in September 2010. "Hopefully, that will have concrete guidance and strategies ED managers will find useful in their own planning; meanwhile they should continue improving their own strategies," he says.

Gregg Pane, MD, FACEP, director of the National Health Care Preparedness Programs, Office of the Secretary, Department of Health and Human Services, agrees that "this is high-level guidance and policy," Pane says. However, there is much ED managers can be doing right now, he says. The two big goals of the strategy, Pane explains, are building community resiliency and strengthening and sustaining health and emergency response systems.

"We have to be able to intervene if we have a major health event. That's where EDs and hospitals really come into play," notes Pane. He also recommends that ED managers look at the strategy and guide online, determine where they might fit in, and then make a contribution to its further development. (Editor's note: The Department of Health and Human Services will sponsor meetings and seminars on the strategy and encourages participation by ED representatives. We will make the schedule available to our readers when it is published.)

"I would take a look at what you're doing right now in terms of preparedness, and examine your connections with public health agencies and community organizations," Pane adds. Then, by looking at the document, "you can get an idea of where we're headed, and see where to better focus your energy," he says.