The effects of funding change and reorganization on patterns of emergency response in a local health agency.

Indicators for Stress Adaptation Analytics (ISAAC) is a protocol to measure the emergency response behavior of organizations within local public health systems. We used ISAAC measurements to analyze how funding and structural changes may have affected the emergency response capacity of a local health agency. We developed ISAAC profiles for an agency's consecutive fiscal years 2013 and 2014, during which funding cuts and organizational restructuring had occurred. ISAAC uses descriptive and categorical response data to obtain a function stress score and a weighted contribution score to the agency's total response. In the absence of an emergency, we simulated one by assuming that each function was stressed at an equal rate for each of the two years and then we compared the differences between the two years. The simulations revealed that seemingly minor personnel or budget changes in health departments can mask considerable variation in change at the internal function level.

The adaptive response metric: toward an all-hazards tool for planning, decision support, and after-action analytics.

Local health departments are organized, resourced, and operated primarily for routine public health services. For them, responding to emergencies and disasters requires adaptation to meet the demands of an emergency, and they must reallocate or augment resources, adjust work schedules, and, depending on severity and duration of the event, even compromise routine service outputs. These adaptations occur to varying degrees regardless of the type of emergency or disaster. The Adaptive Response Metric was developed through collaboration between a number of California health departments and university-based preparedness researchers. It measures the degree of "stress" from an emergency response as experienced by local health departments at the level of functional units (eg, nursing, administration, environmental services). Pilot testing of the Adaptive Response Metric indicates its utility for emergency planning, real-time decision making, and after-action analytics.

Developing a measure of local agency adaptation to emergencies: a metric.

Local public health agencies often must respond to health-related emergencies or disasters, while continuing to fulfill all public health functions for which they are funded. This article reports the development and initial pilot test of a method for measuring the nature and degree of a public health agency's response to such an emergency or disaster. How the instrument was developed as well as the initial results from the pilot study of four local public health systems (LPHSs) are presented and discussed. The instrument measured the extent to which each function and division of each of the four LPHSs were affected and provided a metric that could be used across LPHSs to indicate the burden experienced by each due to the emergency. Results obtained from the pilot study indicate that size and complexity of an LPHS was not predictive of its ability to respond to the emergency. These results support the use of the framework and associated measurement procedures to provide valuable information to managers responsible for such LPHSs. Such information should provide a foundation for comparing variations in performance and outcomes to various types of emergencies that vary in their severity and focus.