Packaging and shipping capabilities of New York State hospital laboratories: a 3-year drill assessment.

In a previous publication, we discussed the results of the 2006-2007 New York State (NYS) Hospital Laboratory Drill Series which emphasized the need for ongoing testing and evaluation of laboratory preparedness capabilities, particularly those required to support hospital functions during a public health emergency. In this paper, we will discuss how a followup drill series in 2007-2008 was implemented in an effort to re-assess the ability of NYS acute care hospital facilities to recognize and respond to a suspected bioterrorism, chemical terrorism or pandemic flu emergency specimen submission event. We will explain how the results of the follow-up drill series, when compared to those of the original exercise, warranted a statewide hospital laboratory preparedness drill held in 2009, focused solely on addressing the overarching deficiency of chemical terrorism (CT) specimen submission capabilities. Although drill results conclude that NYS acute care hospital facilities are much better prepared than 3 years ago to support hospital functions during a CT public health emergency event, they also highlight the continued need to improve competency.

The COPEWELL Rubric: A Self-Assessment Toolkit to Strengthen Community Resilience to Disasters.

Measurement is a community endeavor that can enhance the ability to anticipate, withstand, and recover from a disaster, as well as foster learning and adaptation. This project's purpose was to develop a self-assessment toolkit-manifesting a bottom-up, participatory approach-that enables people to envision community resilience as a concrete, desirable, and obtainable goal; organize a cross-sector effort to evaluate and enhance factors that influence resilience; and spur adoption of interventions that, in a disaster, would lessen impacts, preserve community functioning, and prompt a more rapid recovery. In 2016-2018, we engaged in a process of literature review, instrument development, stakeholder engagement, and local field-testing, to produce a self-assessment toolkit (or "rubric") built on the Composite of Post-Event Well-being (COPEWELL) model that predicts post-disaster community functioning and resilience. Co-developing the rubric with community-based users, we generated self-assessment instruments and process guides that localities can more readily absorb and adapt. Applied in three field tests, the Social Capital and Cohesion materials equip users to assess this domain at different geo-scales. Chronicling the rubric's implementation, this account sheds further light on tensions between community resilience assessment research and practice, and potential reasons why few of the many current measurement systems have been applied.

Functional assessment of hospital laboratory packaging and shipping preparedness in New York State.

The 2006-2007 New York State (NYS) Hospital Laboratory Drill Series was implemented in order to test notification, referral and packaging and shipping (P&S) procedures at acute care hospital facilities (statewide, excluding New York City) that submit suspect bioterrorism (BT), chemical terrorism (CT), and/or pandemic influenza (Pan Flu) clinical specimens to the NYS Department of Health (DOH) Wadsworth Center for confirmatory testing. Results showed that 97% and 84% of hospital facilities had the ability to directly access the notification network and retrieve drill guidance, respectively. Most hospital laboratories (92%) demonstrated the ability to refer specimens to the Wadsworth Center laboratory. Evaluation of specimen submissions found that 68% of BT packages, 27% of Pan Flu packages, and 20% of CT packages arrived to the laboratory with no P&S deficiencies. It can be concluded that acute care hospital facilities in NYS are more prepared to refer and submit clinical specimens during a BT public health emergency than during a Pan Flu or CT emergency event.

COPEWELL: A Conceptual Framework and System Dynamics Model for Predicting Community Functioning and Resilience After Disasters.

OBJECTIVE: Policy-makers and practitioners have a need to assess community resilience in disasters. Prior efforts conflated resilience with community functioning, combined resistance and recovery (the components of resilience), and relied on a static model for what is inherently a dynamic process. We sought to develop linked conceptual and computational models of community functioning and resilience after a disaster. METHODS: We developed a system dynamics computational model that predicts community functioning after a disaster. The computational model outputted the time course of community functioning before, during, and after a disaster, which was used to calculate resistance, recovery, and resilience for all US counties. RESULTS: The conceptual model explicitly separated resilience from community functioning and identified all key components for each, which were translated into a system dynamics computational model with connections and feedbacks. The components were represented by publicly available measures at the county level. Baseline community functioning, resistance, recovery, and resilience evidenced a range of values and geographic clustering, consistent with hypotheses based on the disaster literature. CONCLUSIONS: The work is transparent, motivates ongoing refinements, and identifies areas for improved measurements. After validation, such a model can be used to identify effective investments to enhance community resilience. (Disaster Med Public Health Preparedness. 2018;12:127-137).

Design of the national health security preparedness index.

The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI(™)) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts.

The importance of establishing a national health security preparedness index.

Natural disasters, infectious disease epidemics, terrorism, and major events like the nuclear incident at Fukushima all pose major potential challenges to public health and security. Events such as the anthrax letters of 2001, Hurricanes Katrina, Irene, and Sandy, severe acute respiratory syndrome (SARS) and West Nile virus outbreaks, and the 2009 H1N1 influenza pandemic have demonstrated that public health, emergency management, and national security efforts are interconnected. These and other events have increased the national resolve and the resources committed to improving the national health security infrastructure. However, as fiscal pressures force federal, state, and local governments to examine spending, there is a growing need to demonstrate both what the investment in public health preparedness has bought and where gaps remain in our nation's health security. To address these needs, the Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (PHPR), is creating an annual measure of health security and preparedness at the national and state levels: the National Health Security Preparedness Index (NHSPI).

An integrated information system for all-hazards health preparedness and response: New York State Health Emergency Response Data System.

Effective and timely exchange of information among healthcare, state and local public health, and other health emergency response partners is essential to all-hazards emergency preparedness and response. Since fall of 2001, NY State Department of Health has partnered with the healthcare and public health community in New York to implement a statewide Health Emergency Response Data System to meet this need. During this time, it has been used in a wide range of preparedness and response applications including regional and local exercises, surveillance, health facility asset tracking, and response to actual health events. The architecture, design, and implementation model used in the system readily support all-hazards preparedness and response at state, regional, and local levels. It has become one of the most important assets to health emergency response in New York State.