The People, Process, & Progress Podcast - How America Can Meet the Public Health Emergency Preparedness and Response (PHEP) Capability Standards | PPP #15

Episode Date: April 4, 2020

I am distilling the 15 Public Health Emergency Preparedness and Response (PHEP) Capabilities into easy-to-follow and actionable steps.

Hello everyone. Welcome back to the podcast. Thank you so much for listening. If you haven't yet, please click that subscribe button on whatever platform you're listening to. Throw a rating in there, however many stars you think. Leave comments or contact me at peopleprocessprogress at gmail.com or you can look at peopleprocessprogress.com and there's various ways on the different socials that I have there. On today's episode, I'll share some thoughts. And the way I want to frame this is I've kind of, you know, had discussions, consulted, if you will, collaborated with folks that I've never even met before, which again,

the power of podcasting, the power of social media, including professional things like LinkedIn or Facebook, being able to share some of the planning I did when I was a public health emergency coordinator or incident management team better, and then also learn from other people, which for me is helping a lot, both for my primary job and then for just free, talking to folks and sharing knowledge has been great. So one thing I want to do to try and help folks, whether you're public health or you're not public health, maybe public safety, emergency management, healthcare systems that are trying to on the fly, and I heard a great analogy this week, build the airplane as you're flying in it or the ship as you're floating on it. I want to go over, there are 15 public health

emergency preparedness or response capabilities. So on a sunny day, every day, and I spoke on some of this, just talking about, you know, what is public health preparedness, but these in particular, I'm going to read some quotes from each of the functions of them. Then I'm going to talk about when things are going normal, what should we be doing together as public safety, public health, and emergency management. And then what I think is more relevant, more important, I am going to transition and say, if you're not doing these, or if you are, here are some considerations that I feel can practically help you, your planning, your people, your state of mind, just I think every aspect of it, right? Because when we're working together well, when we prepare well, when we respond well, when we're communicating, no egos, no silos,

all the stuff we've talked about, I think it's helpful. So I'm going to go through these. And again, there's 15. You can look up public health emergency preparedness and response capabilities. It's on the CDC website. Then they have tons of links. So again, it's a super great resource to jump into if you find yourself as an emergency manager that hasn't done mass fatality planning and public health has just swamped or whatever instance where you need resources, these are great. And hopefully my two cents, which isn't just my knowledge, right? A lot of it I built with experience and working through things, but through partnerships and relationships and trial error, succeeding and failing, right? Just like everyone else. But again, I hope this is helpful.

Let's jump into number one, community preparedness. Here's the quote from the function from the site. And these quotes are the summary statement. There's, you know, like any government document, quite frankly, we're in separations plan, other things, often they're a bit wordy. I, as I did on between the slides, as I'm doing here on people process progress, I'm going to distill that down for the listener for myself. And so these these sections of a full statement I took out just to give the gist of what these mean. So, again, the number one of the public health emergency preparedness response capabilities is community preparedness, which is to prepare for withstand and recover from public health incidents in both the short and long term. What does this mean when we're doing this in our day jobs and there's no pandemic?

We're building relationships. We're building partnerships. We can do these things called community health assessments where we put together strike teams and task forces. And again, strike teams is all the same. Task force is a mix of stuff. So like a strike team where you have three epidemiologists or a task force of an epidemiologist and two nurses, whatever, we won't go down the ICS road too far. However, I bet a lot of folks right now are finding that those incident command system classes

that seemed a little pesky and a little bit in the way would come in handy and hopefully they are coming in handy. So listen to some archive episodes. Shameless plug looping in there. So the community health assessment is you would get strike teams, task forces, plan out going to different communities, go through this whole checklist, and then you could aggregate that data and say, hey, we have these chronic conditions in these areas, in these areas, or not, right?

And so that's a good assessment to give you a picture of your locality. I know folks that have done that. It's a lot of planning and groundwork, but worth it. The other big thing is training and information sharing. And here's where I'm seeing a big gap now that will certainly be an after action. So community preparedness, not just for public health, but let's say awareness of hand hygiene, all the stuff we're doing now, right? Distancing, staying home, quarantine, isolation, public health isn't in the public eye like public safety is. It hasn't been.

It certainly is now. But there's a clear gap in an understanding of what folks should do before, during, and after a disaster, whether it's a hurricane or a public health thing or whatever, because you see, as I stated on previous episodes, stuff that will go bad instead of shelf-stable stuff being purchased, you know, all the toilet paper thing, blah, blah, blah. So if your folks aren't prepared now, spin up or shore up your information campaigns.

And I think by and large that's happening, right? Especially kind of the big ones hand washing distancing stay home no more than 10 14 day quarantine all that so but you know the thing is now like 9-11 katrina every other you know mass shooting bad things that happen we we tend to learn from things during or after they happen so the opportunity we have now on the fly is to keep our people prepared keep them informed um you know get some some just-in-time training done. And this can be done, too, as people call your 911 centers or call your hospitals. You know, you can give them the screening questions, and they can kind of self-screen,

which, again, there's tons of resources between the CDC, your state health department. So community preparedness is getting folks ready for what we're going through now, whether it takes a little bit of time, which so far for us is actually pretty short term versus long term if this is like a year long thing, which would be pretty kooky. So the second of these 15 public health emergency preparedness and response capabilities is community recovery and a general principle in emergency management is recovery starts early, right? During the response, you're already thinking about how do we get back to normal?

And I know that's on people's minds and it's probably hard to think about. So number two, community recovery, the kind of thing I plucked out of the long statement is to identify critical assets, facilities, and other services within public health, emergency management, healthcare, human services, mental slash behavioral health, and environmental health sectors that can guide and prioritize recovery operations. And that's not all of it. So think about it, though. There was no one discipline there, right? Like there should be no one discipline right now. So how do we think about that? How do we think about scaling back down from healthcare surge, right? When we build all these different locations, and then we're going to pull all the supplies back and the people back,

and how do we rehab our people? Meaning how do we give them a break from getting barraged with this number of patient loads? And, you know, how do we get to a new normal? We have a post 9-11 new normal. We have a post Katrina new normal. We have an active shooter new normal. Now we have, because it's not normal right now, but we'll have a new normal pandemic, right? And for us, H1N1 didn't seem to kind of get that into people. Ebola scare and being inside of it for Ebola are concerned or anywhere that had a high chance of either having to be a part of screening potential Ebola patients a few years ago or that they would come to their clinic was very real.

But for the general public, it was just a thing that happened somewhere else in the world and we saw it on the news. And I think this recovery piece is start thinking about how are you going to get back to your normal mode? And it's going to be hard both mentally and physically. That's why that mental and behavioral health thing is in there. And one of the best suggestions I have, and I think we should be doing both on the fly, and I know some folks that are taking notes in notebooks or typing them up, however you do it,

is we have to have objective after action reports. Seriously, be honest, right? What is not working now? Where are we spinning our wheels? Are we actually applying the things we said we had in our plan because it was part of a checklist to say we had a plan have we ever exercised standing up our incident command center do we have folks trained up to you know do these this field work if the answer is you know no or even if it's yes capture it capture it on the fly because if we wait another three months you know people are going to forget it's going to get so mixed up they'll be so tired and that. So, again, recovery is for the whole community. It starts at the individual level with you all out there that are keeping this going. But then also is, you know, what's going to be left in place that's still normal?

My wife and I were just talking about we've used delivery services or curbs pickup, and I'm sure you all have too. Is that going to last? Are places that deliver now, like an Outback, you know, going to continue to deliver, right? Is that sustainable to last? Are places that deliver now like an Outback going to continue to deliver? Is that sustainable business model? So for them, just like thinking about continuity of operations, continuity or growth or future business is, I think, really important. So the third thing of these capabilities is emergency operations coordination right so here's the quote to coordinate with emergency management and to direct and support an incident or event with public health or health care implications here that statement is one of if not one i worked with really awesome people and learned great

skills that translated an emergency incident management public health project management whatever but more importantly the reason that i got so much into and some of my colleagues incident management, all hazard incident management, and then applied it to our crafts, and then collectively, like public health, public safety, fire, EMS, police, is because it no doubt works, right? And so ahead of time, you need to run simulations just like this. And my colleagues and I did, I'm sure other folks did. The CDC did a campaign like this. We did zombies, right? They're in this area of the city. Here's the only way to treat it. You run through the exact same things you would for a real point of dispensing, for mobile COVID testing, for how do we set up this

field hospital? How do we do this, that, because you're going to work the planning cycle. If I wish that everyone really anywhere knew the planning P and that cycle and worked it. And here's why, because a lot of the, how do I do this? And how do we coordinate that is answered absolutely in that process. And I'm just not kind of an evangelical planning P guy. I see it and compare it to other processes and certifications or credentials or whatever that I have or that I'm seeing work or not work. So ahead of time, Incident Command System classes, and some are for government workers, but for private sector, I believe should be mandatory.

I believe that the hospital incident command system should go away and that we should have just the incident command system. I know that's a big statement. HICS is neat, but it's very customized. And the power of being good at all hazards means it can be a hospital-based hazard. It can be a hurricane. It can be a shooter, a missing person. It does not matter. It builds more capacity for your people.

So for now, right, for the Sunday day rather, you know, it means we're partnering all the time in incident action planning. One of the best examples that I can share with this is a big sporting event where you have public health folks that have to inspect the food like a hot dog vendor. You have fire folks that are doing fire MS and fire prevention if there's areas where they camp out like a NASCAR race. You have law enforcement, of course, securing areas and looking at the crowd. You have communications and media folks. And on sunny days when things are happening and that happens once, twice a year, make that the priority and your proving ground and your training ground and make a difference. Otherwise, you see some things that I've seen or heard of where now folks don't know what to do because they've never actually put into practice what's on a piece of paper. And that's a huge challenge. We have to have active partnership with emergency management and ESF-8, which is public health and medical services. It has to happen regularly. It has to happen whether there's a small little tuberculosis investigation

and largely the information sharing, not necessarily the resources. But in an instance like right now, if we don't have a true emergency support function representation in our local, state, regional and federal emergency operation centers, then we are wrong collectively. And that's just true. And I know everyone's busy, but that is how the information is going to flow. That is how resources are going to be used the best, how we're going to take care of our people better by being able to staff up more effectively. So kudos to everyone out there trying to get this done on the fly. Just look at your partnerships and your information flow, and if it's going well, build on it. And if it's not, plug the gaps and move on.

The fourth thing from the response capability is emergency public information and warning and here's the the part of the statement from that to develop coordinate and disseminate information alerts warnings and notifications to the public and incident management personnel so kind of a public focus kind of a incident management team focus right public information and warning is going crazy right now, but part of it is media sensationalism with breaking news, which is not breaking anymore because it just happens all the time, versus official statements that you see from governments going on the news together and making the stay-at-home orders or here's the case numbers or here are those. That's a joint information system. The public information officers are working together.

Their agencies are working together. And the thing now, the joint information center is not a great concept, right, because that's a bunch of people in the same place. But the system can happen virtually, right? Zoom, Skype, whatever, emails, texts. And so ahead of time, just like we would practice a full scale exercise or a drill on a certain skill, we need to practice information sharing because it's not a fire you can put water on. It's not, you know, more security. It's, it's information. How do we send the message? So it is

the same message across departments, across localities, regions, et cetera. And how do we shore that up, make it good and direct and adjust them for different audiences, different languages, hearing impaired. And that's one great thing we see is, you know, um, a lot of the sign language on those, on the, uh, press conferences, um, contribute all folks need to contribute or be asked to contribute and push information to the situation reports and, and provide helpful information to overall situational awareness. Right now, that situational awareness focuses on how many reported cases, how many confirmed cases, how many decedents do we have, how many people have died, what is a projection based on past caseload. And a challenge there is there's always variability in the reporting of data

meaning i could tell you the wrong number there's also always a lag because we don't all have chips in us and automatically switch to positive negative negative positive we have to rely on people to tell us we have to ask the questions so there's always a bit of a lag but what we can do as we continue to move forward together and make this all better is streamline our information receiving processing vetting and and sending a process right so look at that how are we getting information is that working well is it not how are we coordinating that and vetting it what's real what's not what's uh substantiated or not and then how are we sharing this? And are we sharing this with all of our partners or are we holding things close to the chest? And if we are, and particularly thinking of the public health folks, why?

Right, why? Because we have folks in the field that are answering 911 calls. We have folks working security at a grocery store. We have all these people out in the field who, again, the concept of emergency management support and incident management is we're all there to support our people in the field and operations. So my prompt with this, emergency public information and warning to everyone, and particularly public health, is be transparent with your partners. And I get HIPAA and everybody puts the HIPAA card up

there, but we're in a different time. They are our partners, right? There's no special information that we should be holding onto and we need to share it. We need to share it in a timely fashion. And again, ahead of time that takes practice running through exercises and trainings, doing information sharing. If you need to catch up now, do it. Here's one that nobody wants to talk about, nobody wants to actually do, that I've been fortunate to work with a great emergency manager and other partners and actually put some work in. It's fatality management.

This is, if you picture contagion or other things, this is the mass deceased, and now you have to practically plan for what are you going to do with these folks so number five in the list of capabilities is fatality management it is to coordinate with organizations and agencies to provide fatality management services this is one of this and family assistance centers i would say two of the biggest hot potatoes that in in my time in public health and emergency management that nobody wanted to fully own and not a lot of people put a lot of work into. And the problem is when you get to big pandemics like this, it's a practical consideration that now we have to scramble to

solve, right? And it's not fun to talk about who has legal custody of deceased bodies. How do we transport bodies and store them so they don't, you know, go bad, so to speak, so that, you know, it's not just bodies that aren't temperature regulated and they're, you know, saved for appropriate burial. And how do we plan for if we run out of space for that, for burial? And then mental health. We're going, you know, seeing folks die and then dealing with dead people is extremely traumatic and exhausting. And I say that from personal experience. Planning for it is depressing. Putting into action, same thing. So for our people and for the folks we're taking care of, but for our our people we need to include mental health so right now everyone that's in the emergency incident management health care business

public health needs to consider how we're going to shore up fatality management i don't have a crystal ball but we keep seeing deaths rise and think practically to the point of hospitals have a given number of morgue slots, right? The spaces where they store bodies. The Office of the Chief Medical Examiner has a given number. They store some, but largely for crimes, right, or unnatural deaths. And a disease is not necessarily unnatural, right? It's not unnatural.

So funeral homes also have some capacity. So consider that in your planning. But they also don't have infinite space. So right now, if you've never planned for this before, those contacts I mentioned, you need to reach out to them. Also consider trucks, right? Seedling trucks. So nursery companies that have trucks with coolers for the seeds that they have in their seedlings because nobody wants a fruit truck back after

it's had dead bodies in it. And there are whole systems that are racks that are cots that you can put inside those just for this planting purpose. But again, if you've never thought about it or truly planned it out, then you don't think about these. But right now, why not have that all planned out and never even have to use it? Then wait for the next one and try and play catch up again, right? So number five, fatality management. It's a hot potato. You got to work through legal things like custody of the body, moving the bodies, and then, you know, where they'll be stored. And then the practical piece of, you know, do you have connections to do that? Number six of the 15 public health emergency preparedness capabilities is information sharing. So this is more with our teammates, right, less than public information, even though they'll get some of the information,

but it's to conduct multi-jurisdictional and multidisciplinary exchange of health-related information and situational awareness data. So this probably speaks to more actually the situation report contribution, what's the common operating picture for my locality, my region, my state, nationally? How do they all connect? How much PPE do we have, right, from the stockpile, which we'll get into in a second? How many staff do we have? So in all aspects of whatever's in your situation report, right, clearly it's going to be COVID numbers based,

whatever it is, suspected, confirmed deaths, projections. Also, how are we staffing that? How many people do we have? What locations do we have? All this common operating picture. But we need to make sure that we have a good information flow from public health to local, state, and federal partners, which I mentioned in the public information and warning. And from, you know, one thing that I found helpful is I had regular ESF-8 hosted and coordinated meetings with all the partners that are going to be on this list that I mentioned. So we would look at each one of those things and have representatives from who can speak to these. And we would have just like there's a thing called a local emergency planning committee or LEPC. So those are regular things that are kind of hazmat focused.

There's other regular cadences you can set. But for public health in particular, on a sunny day, which it is today, go figure, but a sunny day without COVID everywhere. How do we meet with our partners regularly where we're the driver? We don't wait for emergency management to ask us to show up. We don't wait for the incident management team just because we happen to be involved in it. We drive as public health or healthcare even, making sure that we're connected with our partners ahead of time. And we need that common operating picture. And sometimes this is COVID-19 like this pandemic, right? This is the pie in the sky in the sky this is the as I said with a buddy of mine and other friends earlier today this COVID-19 actually happening is like an 0-305 pandemic scenario that's that

week-long incident management course come to life right so when we put it in one facility it's one thing and you still see people trying to use their old skills, meaning police doing police stuff for an outbreak or fire to fire and that kind of thing. So if we can work those scenarios really hard and push like, hey, let's get this info

from the experts, this information sharing will be a lot more helpful as well and we'll get into the tactics piece of that. But that's a huge thing, clearly, right? Communicate, communicate, communicate, share information. Nobody really owns this information unless it's specific, like patient in their chart information. So, you know, consider that in all fronts. Same thing the other way, right? So public safety to public health. Hey, we've had this many calls. Hey, we're having these security issues. like it should be an information flow

constantly number seven is mass care so this is the short word for that is sheltering but there's a statement of it to coordinate with and support partner agencies to address with a congregate location excluding shelter in place locations well setting up a shelter now not great and that's what you set up like after like katrina right or another storm or the power outage so you set up an emergency shelter often they're actually in school gymnasiums with cots and then you have do some medical screening then you have folks kind of observing everyone going around you can do basic medical support or transport folks if you need to but it's a place for people to live. It's usually run by social services. Public health, since these are the public health components, you know, initially, again, on a normal time, we'd be having regular

meetings with social services hosting those supported by health and local or state emergency management. How do we stand up the shelters, whether it's a local one or a state-sized one? Who are the partners so that we can have medical support, administrative work, security inside and outside, work through all those different things. And now what we're looking at, and we'll get into that, is like the emergency field hospitals, right? So it's a similar process, right? It's a structure somewhere, whether it's a tent or a hotel or a school gym.

But how do we set that up to get people in, to screen them before they come in, to watch after when they're there, to support that ahead of time? It needs to be planned for. It's something right now you can still do, and why not prepare for it, right? So screen functional needs support as well. So do folks have mobility issues? Do they have hearing or vision or other impairments or challenges, I guess we'll say. And then basic medical care. Do you have staff? You don't have to have the highest level medical person to support a shelter or even a field hospital.

If someone can see something, and then they can connect to a higher level if they just know basic CPR or basic something, that's helpful. So considering your staffing plans now, another big thing that is integral, even again, if it was a shelter just after a natural disaster, not a pandemic, is always having some sort of epidemiological surveillance. That means the epidemiologists or the disease experts, they're looking for, is there an outbreak happening in this facility we set up, right? Let's think about the common flu. If it was just regular flu season, if we put all these folks together in a small space, are folks starting to get sick over here because they're close? And then what's the space? And there are, you can actually look up,

there's space specifications of how much space you should have between each cot to help with infection control. And that's even without COVID, even before that, stay six feet apart, don't touch each other no more than 10 people. So those standards exist out there. You just maybe reach out to somebody else that has a solid plan or maybe your state emergency manager might have those plans. So mass care, a big consideration now.

And we are not far from hurricane season or storm season. So, you know, mother nature, as I've talked about on a couple episodes, isn't going to go on, you know, timeout because we have a pandemic. So something to think about, how are we going to do sheltering? Or are we, or can we, if we're in the middle of this pandemic? That's not an easy discussion to have, but we need to have it. Number eight, medical countermeasure dispensing and administration. This was the driving principle or driving where I've mentioned before, you know, we're going to get a 10-day supply of antibiotics to over 300,000 people within 48 hours. And the people being the residents of wherever you are, this is that capability, right?

So it's how do we provide medical countermeasures to targeted populations to prevent, mitigate, or treat the adverse health effects of a public health incident? Like every single other thing on this list, it starts with pre-planning, cooperation, practice, exercises. I mentioned on a previous episode about the annual flu vaccination clinics. If you plan those like you're trying to do that emergently, then you're going to be ready for it. And if you happen to get a big volume, great. But if you don't, you're still working the process. You're still enabling others. Each time you do that, put a new person in charge mentored by the

previous person in charge. All the good principles of teamwork, and it's an action planning. Don't just pencil whip last year's plan. Don't just skip the process. Points of dispensing will help you plan for tons of things where you need to get maximum throughput, whether it's giving a bunch of equipment out as fast as you can, whether it's testing a bunch of people for COVID as quickly and efficiently as you can. whether it's testing a bunch of people for COVID as quickly and efficiently as you can. The point of dispensing model and planning and instant action planning is the framework for how you're going to get that done quickly, efficiently, and with all the right partners. And all the right partners need to be involved with the plan creation and planning process.

Don't show up with an instant action plan and say, here it is, because one, you don't own any of the resources that are on there that aren't in your department, whether you're police, fire, EMS, but these are public health. So if you're public health and you go to somebody with a plan already made, that's not helpful, right? Plus you didn't have the good conversations, build the relationships, all the good stuff that comes with it. So right now, if you haven't had a chance to practice that through flu clinics or whatever else fake ones giving out m&ms do it right look at your point of dispensing plan get your comrades together from you know all the different disciplines where you are locally regionally or state level

and talk through it first tell them what it is if you haven't done this before do a practice run set one up all that kind of stuff because you're going to be doing it if you haven't done this before do a practice run set one up all that kind of stuff because you're going to be doing it if you haven't already when you test a bunch of covid people anyway here we go we are coming up on number nine so a little more than halfway through again if you're listening still thank you so much if you haven't subscribed please do so on your favorite platform give me a rating reach out to me people process progress at gmail.com i'm on linkedin kevin pinnell twitter pinnell kg p-n-n-e-l-l-k-g number nine is medical material management and distribution boy are we seeing a lot about this so this is the ability to acquire manage transport and track medical material during a public health incident or event.

Masks, gowns, IV bags, ventilators, all the stuff, right? So what are these materials we're going to use for the medical treatment of people? So the Strategic National Stockpile has been in the news. Most public health folks know about it. If you're not training your partners about it ahead of time, hey, here's this thing. We can ask for it. It can fly in. We can break it up into pallets. We can put that in a warehouse. Then we can distribute it. That's the very basic of it. It's to request, receive, prioritize, dispense, return, and manage the inventory. You can look up Strategic National Stockpile. This isn't top secret. It's full of nerve agent things. It's got, again, medical support stuff, trauma stuff. So it's a mix of things. And the whole deal is it's federal level augment to big, bad things. If you're public health, you're the gateway, right?

You're the key master, whichever analogy you want to use to the SNS. You ask for it, it goes through your state, your state asks for it, they get it, you coordinate it. Keep in mind who needs this the most. And in tough times, how are you prioritizing? Are you prioritizing the people on the streets that are still running calls because people still call 911 and have domestic disputes and fall down and break their leg and all those kind of things? Are you prioritizing them after or before the hospital folks that are treating all the people that get transported? How are you evenly distributing? How are you sharing the wealth and putting that out? It's no small task. We are very close to crisis standards of care. Crisis standards of logistics is also a thing right who gets what when everybody wants it everybody wants uh technology right now like smartphones and

smart pads and the holders that go with them and cameras because we're all remote everybody wants them now right it's interesting the variability in companies all across the public private sector before now where some really frowned upon teleworking some were all about it some was like well let's do a balance and now it is the model that's keeping economies and logistics and things going so how do we continue to do the medical material management distribution the ninth of the capability, as we're virtual, right? Are you connected to your systems with VPN? Can you get into your inventory management? Are you setting up processes to distribute things? Or are you partnering with folks that can help you distribute, right? So right now, we're kind of outside the box

of in the plan, it says these people have to go move the pallets but if you have other people that can move the pallets for you and it's under your umbrella if you're the the key master here why not take advantage of it something to consider right think about non-conventional non-traditional ways to do things now because that's what's having to happen number 10 is medical surge also happening big time nowide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure on an affected community. Well, the affected community right now is everyone, right? Every hospital, every standalone ER, every minute clinic type place, doctor's offices, et cetera. Everybody's getting hammered with, I'm sick, do I have this,

or showing up at the ER or something like that. So medical surge is no joke and it's happening. To plan ahead for it is to do what is happening now on the fly, or if folks had pre-planned it, how do we operate at 110% capacity, 125, double, et cetera? What are the facilities we have access to? How do we stand them up? How do we stand the infrastructure for those up? How do we staff them up? How do we do infection control on them, right? All these things ahead of time are great to have in place.

If we're not doing them now, if you're in an area that's not having to do this as much, plan for it now. Get it on the books. Talk through it. Work through it. Work through the stages of surge activation, right? Your staff repurposed space if you need to, whether it's, work through it, work through the stages of surge activation, right? Your staff repurposed space if you need to, whether it's in a hospital facility, whether it's, you know, looking at a facility that's not usually a care center, right, that has patients.

Can we make this place something for treatment, whether it's COVID or not COVID or something else? And how are we tracking facility census, right? How are we assisting if we, you know, there's a medical control model. So that usually is focused on mass casualty incidents, which means usually a level one trauma center, when something big happens and we're going to have 20, 25 patients, right, from this thing, overwhelm one ED, emergency department, this medical control says, hey, you know what, let us help you coordinate. Send two of your yellow patients to this other place and four red ones here and all your greens somewhere else. Well, if there are mechanisms in place, whether it's a hospital coalition or that medical control or somebody that can help look at surge

and report on surge and predict surge and share that across the board with your localities and your regions that's also another component of medical surge beyond the the practical space and staff planning and supplies and medical surge is hugely connected to the you know medical material management distribution right because the med surge initiates a lot of patients, initiates the need for a lot of other things. And I know one thing, you know, again, I mentioned healthcare is dealing with now is, you know, we're doing some catch up. We're going, oh, geez, these plans, we're actually having to do this. And in general, having to say, okay, now let's project out when we're planning for this giant spike that may happen or is going to happen?

And how do we ramp up so we are ahead of the game now? So pre-ordering stuff, pre-positioning supplies, moving where you operate from in your environment, you know, and with, again, with tons of people virtually, with some people you have to have on site, how can I coordinate effectively if I'm not even there? All these kinds of things. So medical surge is not just extra beds. It's not just extra people. It's all the mechanisms that help support that. So consider that now when you're looking at your surge capacity, which again, a lot of folks are at or near or going to be coming up on pretty soon. Number 11 of the 15 public health emergency preparedness capabilities that all public health folks, ESF8, that's emergency support function 8, public health and medical should be planning for all the time and are touching on now all 15 of

these for sure. So some more tips, whether you're public safety, emergency management, public health, number 11 is non-pharmaceutical interactions. So this is not the vaccine, the treatment drugs, the nerve agents. These are actions that people in communities can take to help slow the spread of illness or reduce the adverse impact of public health emergencies, end quote. Should have started the quote there. So screening questions, travel history, contacts, right? So ahead of time, washing hands has been, you know, if you go to a restaurant or when we were going to restaurants regularly, there were hand washing signs from the health departments, you know, everywhere or staff must wash hands. greatest public health endeavors and advertisements and breakthroughs where someone realized, hey, if I just do this thing, all the random stuff I touched with all the random whatever's

on it won't get on me and my family and everybody else. So it cuts down on sick. So non-pharmaceutical interventions include stuff like that. It includes what a lot of 911 centers are doing now, hospitals, doctor's office. Did you travel to an area with COVID? Did you know someone that has covid do you have these symptoms that fit covid which a challenge for covid h1n1 a lot of the influenza like or ili viruses or illnesses is that they have tons of similar

symptoms right so some really good infographics out there on CDC site. Again, I keep going to the CDC because it is they are the pros, which I mentioned. But there's tons of infographics out there on what's the difference between H1N1, COVID, seasonal flu, blah, blah, blah. So you can check that out. The other thing for non-pharmaceutical interventions is behavior modification. So social distancing or physical distancing. And I saw it. I forget where, I apologize, social distancing, everybody knows what that is, but we don't want to socially distance ourselves, right? So we want to just physically distance ourselves, but we want to stay connected. So, and it's a weird time, but that's just something to consider too. I thought that was a cool way to say it.

Hygiene and sanitation and training, right? Are we training the folks that we're sending on calls in the best way to use personal protective equipment are we training the public on the fly hey here's our new procedures and i've seen some great examples of this from some of the places they used to work in central virginia so shout out to you all but training is also part of non-pharmaceutical interventions because it's here here's an example that's not even COVID, so like mosquitoes, right? It's warming up. So don't leave standing water, empty it. That's a training component of a non-pharmaceutical intervention. It's really information or behavioral change driven. So think about how, if there are gaps in some of that stuff, how you can

shore that up and where there's resources for it. Number 12 is public health laboratory testing, which is quote to detect, characterize, and confirm public health threats. So, you know, this is huge in the news now in the practical planning of COVID-19 testing. Do we have enough? Do we have to test everyone? Psychologically, everyone I'm sure would love to have a test and be told, yep, you're negative or yep, you have it. Here's your 14 day kind of clock that starts. The practicality of doing that is extremely low as we've seen both in the news and if you're involved in the planning at all and the need, right? And I'm not a doctor or epidemiologist, but having been in the emergency and public health world for a bit, you know, you don't need to test everyone. You could test everyone if they were for sure in that where you start your investigation with the sick person, then who they were near, then who they were near to a certain point.

Or now you make an assumption, oh, you're the family of this person that has it? Yeah, stay inside. So that's not a test. The test is kind of a litmus test of, oh, we know one has it, so we're going to assume you all have it or are exposed to it, so quarantine. But the ability for companies to stand up testing for certain things like COVID or whatever next disease is is tough because it's science-based. Ahead of time, our nation and who we partner with and other folks, they are always working hard for the next lab test, the ability to test samples that we send to them.

So think about the supply chain for this. And most of those, whether it's a private or public, meaning it's a state-run institution or a hospital or some of the big companies like LabCorp or other things, their whole deal is testing and specimen handling. And so they're always kind of planning for it, but I'd be curious to see their continuity operations plan, their testing surge plan, if you will. So if you're in that business, you know, does your company, does your organization have a testing surge plan? If you're on an incident management team or in public safety or emergency

management or folks that you're sending in the field where you're going to screen them, do you have a streamlined test for them? Do you have a way to get them to the front of the line to get them some peace of mind? So that's a very ground-level component of public health lab and testing. And if you're a public health person and you're partnering well with public safety and folks, then yes, you will have already kind of planned this out. Number 13 is public health surveillance and epidemiological investigation. These are the disease experts, the folks checking out, you know, what's happening. The official quote is, quote, create, maintain, support, and strengthen routine surveillance and detection systems and epidemiological investigation processes.

That took me a while to learn how to say that effectively. So this deal is ahead of time. You know, epidemiologists and the ones I've worked with already knew, you know, their diseases and not all of them, but, you know, the stuff that they learned getting a master's in public health and MPH, right, and focusing on diseases. They know what the diseases do. They know, you know, techniques on investigating them and pulling those together. And so a partnership with incident management and the public health emergency coordinators

was how do I wrap incident management and incident command around this to help support what you need to do operationally and safety wise. So ahead of time, when you do an exercise or you have a small outbreak like hepatitis in a nursing home, which happens, how are you running that or how are you supporting that as a health department, as an organization? You should be immediately standing up the incident command system. Why? Is it a huge disaster? No. But if you're practiced in it, you're better, right?

Probably preaching to the choir for everybody that's listening out there that understands that. If you don't, though, think about the opportunity you have. It's a public health incident. So something happened that we didn't expect. We didn't plan for it. It's not good. We need to pull together people that may or may not work together every day. And you could be in the same health department. But if, you know, I'm an environmental health person and you're a public health nurse and you're an epidemiologist, we see each other at the regular meetings and whatever. But day to day day you don't work together. But now if you have your environmental health folks that are really good at logistics and they can support transport

of specimens or having supplies ready or whatever logistical function you need while epidemiology, you know, runs the operations and looks at the safety aspects while the public health nurses draw the samples and stuff and operations are helping that is an awesome opportunity to bring everyone together to get reps using the incident command system concepts so again when something happens it's not a spin-up you don't have to do as much if any just-in-time training because you've involved all the folks in your health department or all the folks in your locality all the time, like in regular tasks. If you have a staffing change because a tuberculosis investigation ramps up and you're a tuberculosis nurse that falls under this public health surveillance

and epidemiological investigation, needs more people to help. Spin up a simple, simple, it could be a planning person, and then just operations, right? Again, ICS is modular. It's as big or small as you need it. And you don't need to make this giant chart just to look cool. You need to make the chart that's going to work for you. Number 14, responder safety and health to protect public health and other emergency responders during pre-deployment, deployment, and post-deployment. This is the concept of, and if you've been a responder, probably more so the public safety first responder, even the military, the concept of it's me, my crew, then the public, right? Same thing for this. If we are sending folks out to respond to calls,

if we are staffing up a mobile COVID testing area, if we are going to staff up a field hospital or turn something that isn't made for patient stuff into patients, the first people we need to focus on is not all the people that are going to show up. It's the people that are going to plan for that and then are going to staff it. Responder safety and health. Most folks traditionally do not think of public health people as responders. Because, as I've said before, they're not riding something that goes woo-woo or flashes. They don't have guns.

They don't have cool axes and halogen tools or trauma bandages. And so they're not sometimes brought into the fold, right? And yes, I've seen that driven by egos where public health gets laughed at because they're not tactical, if you will. I've seen it driven by silos because public health chooses not to play. Now it's too late, but it's not really too late. And responder safety and health with the public health, public safety, emergency management, private sector partnership should be the number one thing, the number one objective on anyone's, you know, coordinating action plan, incident action plan, whatever plan you have. It should be to provide for the health and safety of an insert, whatever stuff you want after that, but it should include all the people in this

organization or first responders and blah, blah, blah, staff and providers, et cetera. Put it in there. It's number one. It's number 14 on this list for some reason. Hopefully, that's random. Maybe I'm going in alphabetical order. Let me look. Yeah.

So that's cool. But as far as prioritization, it's the first thing is safety, right? So what can we do for this? So ahead of time, we're always, we always have employee health. We're always evaluating. And unfortunately, you know, an issue in public safety is mental health, suicides, also with cancer for firefighters, domestic abuse, alcoholism, all the, all the stuff that comes with being super stressed out, having to deal with horrible things. That's a regular everyday thing. And now we've got COVID.

So right now, Responder Safety and Health-focused friends, do you have a ramped-up employee health or counseling capability for folks that just need someone to talk to or cry to? Or have you increased capacity for people to exercise? I've talked about it. There's so many, you know, tons of people have talked about it. The importance of exercise, regular exercise and how that helps your brain and your body. Think about all the wellness components of your people and how can you shore them up? I spoke on another episode about the emergency responder health management or EHERMs or ERMs from the CDC too. That whole concept is

just like when I was a medical unit leader and before we were deployed, say, hey, let's do like a screening, pre-deployment screening. Do you have any chronic issues? What's an emergency contact? And then there's a whole bunch of other things. So now think about how are we doing this for COVID specifically, right? Do you have on a medical screening form for your incident management team members or public health team members, anybody, the kind of, you know, big questions you should be asking now. Do you have these symptoms? Have you traveled here? You know, which is probably less and less likely these days since travel has been restricted for a while but adapt your medical unit forms to fit this so the medical unit forms are really came from the wildfire land they're you know really focused on if someone chops their leg

open or breaks an ankle or something focus on oh did you get droplets on you you know all those kinds of things how are you managing that how are you coordinating getting your people taken care of? Are you tracking them? And some of this is probably just done by departments, depending on if you have an incident management team deployed or not. But from a public health perspective, how are you helping empower your partners in public safety and your responders? Your public health folks are responders.

Your nurses, your environmental health, your epidemiologists, your admin folks, you are all responders right now. We are all in one giant incident. So think about all those components and some of the things I mentioned. They all have great resources, links. If you have questions about screening or forms or stuff that I've used, I'm going to really do a big update this weekend to the peopleprocessprogress.com site and put a bunch of resources out there.

They're all free. I didn't invent the ICS forms I put up there or the medical plans that I put together. I just kind of worked to make them a little better in partnership with some other folks, but I'll make sure to get that done. Number 15 of the 15 public health emergency preparedness capabilities that exists all the time that are now being enacted in some aspect, fully in other areas, etc., is volunteer management. This is to coordinate with emergency management and partner agencies to identify, recruit, register, verify, train, and engage volunteers.

On a day-to-day basis for public health, that's the Medical Reserve Corps. And there are, which is great, I can speak to Virginia, and this is also, you know, goes across the country, but for us in the state of Virginia or Commonwealth of Virginia, there's a huge database of Medical Reserve Corps volunteers that range from purely administrative to physicians that are retired or active to the whole gamut of people, just great people that want to still be involved, still help. And on a regular basis, we should be engaging them. We should be tracking them and keeping their certifications updated. We should have regular meetings with them, regular trainings for them.

All the incident management, incident command system scenarios, medical countermeasures, non-medical, whatever that I talked about before. In addition to the people that are getting paid to be there with us, that are responders and general government and public health, we should include our volunteers. And then we should empower them to be in leadership positions there. And I've seen this, unfortunately, where volunteers are looked at as not being as good as some other folks. Well, if we look at the history of volunteerism in America, a lot of volunteerism has helped, right?

FIRE started out as volunteers. Now there's that whole wackiness in the fire service. But I've seen when you stand up incident command systems, I guess, and you do incident management, you have volunteer management in there from the public health perspective. There's points of dispensing exercises you're doing that are under the guise of a flu vaccination. Staff like half of your 10 stations with volunteers right and the other was staff or pair them up get them trained up there are volunteers that have knowledge i mean they're they're folks that are volunteering to do this that could be retired from things but they're folks that have had successful careers or getting started maybe they're new but there are great resources. And right now on the fly, in the midst of COVID, they're a critical resource, right? So if you have managed your database of volunteers and you know how to contact them and you know what they're

up to date, you're already leveraged to request those folks, to deploy them, train them up, account for their safety, just like the other responders. If you're not, then think about how you can shore up your volunteer databases, right? You know, do your community emergency response teams, do you have a database of who's who and what their certs are and when they've been trained? Can you empower some of them to train others? Do just-in-time training. Think about how we can leverage our resources because right now, there's not enough stuff. We're getting short on people. We're changing spaces we can use for public health and healthcare work. We're trying to catch up on information and it's so fast now it's hard to not be lagged. We're looking at who gets what materials from the SNS. We are, you know, I feel like almost there's too much public

information and warning, but so how do we keep that to a good level? There's also good examples of it. How do we manage fatalities if fatalities start becoming an issue of practical space planning? And that sucks, but it's real. How do we continue to keep our communities prepared in the midst of this? How do we manage the surge of people, whether they're sick or not, whether they have COVID or not, in our facilities, in our communities, in non-traditional spaces? How do we staff for that? How do we keep it safe from a, you know, there's still bad guys out there. So how do we keep a security standpoint? How do we keep an infection control standpoint?

There's a lot to think about. If you really Google or look up public health emergency preparedness and response capabilities, you'll get way more detail than I touched on. I mean, podcasts, again, they give you the advantage of giving you two cents for free and you can push it out on the internet. I hope you'll consider some of the perspective that I've given. I hope it's helpful. Again, if you have questions, whether you're public health or not, reach out to me at peopleprocessprogress at gmail.com or on LinkedIn. Happy to help. There's actually a LinkedIn group that's COVID-19 incident management, excuse me, knowledge

sharing. So reach out. It's an area to share what people are doing, what we're doing, and help each other be more productive. It's not a you know a sales place to just get a deal so but it's a place that i know i'm going to post more information more resources to close i'm going to quote someone that is way more learned than me and it speaks to i hope unfortunately through this covid pandemic and all the stuff we're all going through a new normal consideration. This is from Herbert Hoover. Public health service should be as fully

organized and as universally incorporated into our governmental system as is public education. The returns are a thousand fold in economic benefits and infinitely more in reduction of suffering and promotion of human happiness. Friends, that is from 1929 from Hoover's inaugural address. It is wax and wane. I've touched on that between funding and attention and taking seriousness. It's pretty serious now. I would urge all of us to just stay together take breaths together, work together realize this is pretty unprecedented but also that there's been a lot of preparation for this

scale as you need to don't think it has to be perfect but don't work in silos, share information do the best that you can and stay safe Godspeed