Emergency Preparedness and Response

• Emergency preparedness and response involves preventing, protecting against, quickly responding to, and recovering from health emergencies
• This is especially focused on events that could overwhelm routine capabilities, based on scale, timing and unpredictability.
• Preparedness includes coordinated planning, implementation, performance measuring, and corrective action.

Global Rise of Incidents

• There is an increase in terrorism incidents and natural disasters worldwide that requires effective emergency preparedness and response planning
• Natural events include earthquakes, tsunamis, floods, hurricanes, typhoons, and pandemic diseases
• Over 40 countries with a combined population exceeding 1.3 billion face emergencies and humanitarian crises.

Earlier Response by the Informatics Community

• Informatics has contributed to surveillance of threat detection, biosurveillance and bio agent detection, efficiency in disaster response, as well as the use of telepresence for remote medical care givers

Emergency Operations Center (EOC)

• The EOC is a physical location where the Incident Management Team meets
• The team makes decisions, communicates, coordinates activities, and addresses patients' needs during incidents.

Effective Response

• Responding to a situation requires a moment-to-moment situational analysis
• It also needs real-time information to assess needs and available resources that can change suddenly.

New Technologies Being Used and Evaluated

• New technologies aid in improving patient care and tracking
• New technologies foster greater safety for patients and providers
• New technologies enhance incident management at the scene,
• New technologies coordinate response efforts, and enhance informatics support at the disaster scene and community resource levels
• Technologies such as smart devices, wireless connectivity, and positioning technologies, are being used.

Interagency Standing Committee (IASC)

• IASC of the United Nations Office of Humanitarian Affairs (UN-OCHA) initiated the "humanitarian reform"
• Organized clusters to assist governments with coordination of responses and impact evaluation
• The World Health Organization (WHO) is the lead agency for health, coordinating health information plus its production
• At the global level, discourages uncoordinated individual or organizational responses.

2009 H1N1 Influenza Pandemic

• The 2009 H1N1 influenza pandemic shows how informatics can support emergency response
• The pandemic potentially having significant effects on the global economy: travel, trade, tourism, food and consumption
• Investment and financial markets could suffer from widespread economic and social disruption as a result
• Countries implemented detailed pandemic plans and adopted measures like border closures and travel restrictions to delay the virus's arrival.

Pandemic Severity Index (PSI)

• PSI is used to characterize the severity of a pandemic, predicting its impact
• Helped standardize triggers for local decision-makers linked to the illness severity in a community
• It is based on the case-fatality ratio to measure the proportion of deaths among clinically ill persons
• National Retail Data is used as a monitoring system to track over-the-counter medication purchases (fever reducers, influenza treatments) in 29,000+ stores
• Provides early detection of naturally occurring outbreaks and bioterrorism threats.

Electronic Surveillance System for Early Notification (ESSENCE)

• ESSENCE is a Department of Defense (USA) tool, which is used for community-based epidemics
• Syndromic information is fused from multiple data sources, which vary in factors like medical specificity, spatial organization, scale and time
• This provides early community-level warnings

Real-time Outbreak Disease Surveillance (RODS)

• RODS has information from clinical encounters hospitals
• Clinical encounters are then classified into seven categories
• This uses Bayesian classifiers
• Storing data in a relational database, it then uses univariate and multivariate statistical detection
• Alerts are sent when algorithms detect anomalous patterns in the syndrome count.

Healthcare Consumers Contributions to Surveillance Activities

• Consumers have an increasing role and opportunity in contributing to surveillance activities now more than ever
• While in some cases, participation can be a conscious decision, consumers may also unknowingly contribute to the informatics process

Telephone Triage Data Importance

• Telephone triage data is used to track influenza in specific geographic locations
• It gives the advantage of real-time data for analysis and response.

Google Flu Trends

• It was assumed that flu searches on the internet show flu-related symptoms
• There was a consistently strong correlation in comparing CDC published search-based data

Education and Training for Nurses

• Competency-Based Learning and Informatics Needs for nurses is consistent education is critical for appropriate response
• Competency-based Education providing infrastructure internationally for nurses to address the issues involved in emergency preparedness and response
• However, there are currently no standardized requirements for ongoing disaster nursing training and education
• The International Nursing Coalition later became the Nursing Emergency Preparedness Coalition
• A list of 104 competencies for nurses responding to disasters was generated utilizing domains by the American Association of Colleges of Nursing.

Detection and Response to Bioterrorism

• Requires continuous data monitoring with standardized combining and coordinating data across different sources

Informatics and Incident Management

• Computer-based processing and analysis helps detect unusual and statistically significant patterns
• Algorithms and protocols can be centralized, along with diagnostic and therapeutic tools
• Incidents require communication technology in order to respond to infectious diseases.

Incident Management Systems (IMS)

• IMS, originally used by firefighters for disaster scenes that span multiple jurisdictions, has a hierarchical chain with specifically assigned personnel to each job
• Incident commander or manager takes leadership role and there are job action sheets

Emergency Operations Center (EOC) Functions

• The EOC facilitates decision-making, communication, and coordination of activities when responding to incidents
• It facilitates accurate, real-time data acquisition, for information such as patient needs, rescue personnel, and available resources

Volunteers in Emergency Situations

• Volunteers need to have proper education before responding to an event
• MRC units have competency-based education requirements
• The American Red Cross has a long volunteering history
• Nurses are urged to be a part of an organized group

Future Advances in Health Information Technology (HIT)

• Necessary healthcare reform foundation: health information investments, with vaccination records and subsequent healthcare services
• Provides information when linking valuable info, such as vaccine adverse events and effectiveness

Health Information Exchange Through Grids

• Using grids to network multiple computers across the country will share/view large health information
• Grid participants can analyze data in other jurisdictions

Electronic Health Records (EHRs) During Emergencies

• EHRs should help patients and healthcare providers during emergencies and disasters
• Improved clinical data and sharing of clinical data occur for displaced patients

IT and Informatics for Effective Incident Management

• Technology: capturing and representing data for increasing situational awareness
• Informatics: use an Emergency Operations Center (EOC), while making informed and efficient decisions

Disaster Medical Assistance Teams

• Teams are willing to travel to other regions if the country is in an emergency
• Activated team members are federalized or made temporary federal workers

Medical Reserve Corps

• National network of community-based volunteer units for resilience and improve local health, safety.
• Includes physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists.

Modern Definition of Community Health

• Community health is provision of healthcare outside the hospital infrastructure.
• Public health departments are now viewed as major healthcare delivery systems.
• Federal funds are channeled through the CDC to states to strengthen the public health and infrastructure

Challenges in Hospital and Public Health

• Lack of standardization in reporting systems
• No central information access point

Informatics Solutions

• Health care members developed a bar code system to log and track victims in St Luis
• East Carolina University tested telehealth networks in place

Barriers to Electronic Health Data Access

• Accessing electronic health data is important for continuity, quality of care, cost analysis, and vulnerabilities to exposures during bioterrorism events

Goals of the National Health Information Infrastructure (NHII)

• Development of the National Health Information Infrastructure (NHII)
• Goal is an improved public health information network (PHIN).
• Data sharing must follow HIPPA

Department of Health and Human Services

• The Department of Health and Human Services (DHHS) is responsible for training the healthcare workers in emergencies, as well as potential terrorism
• Planning and response divided into 3 unit divisions

Centers for Disease Control and Prevention (CDC)

• The CDC is a lead federal agency, which provides credible information and collaboration for decision enhancement, while still protecting health and safety

National Electronic Disease Surveillance System (NEDSS)

• Initiative promoting uniform data from information system standards to further efficient surveillance at all government levels (local, state, and federal)
• Provides data/information standards use to advance integrated interoperable surveillance systems at all levels.

NEDSS Purposes

• NEDSS detects outbreaks quickly and monitors health care
• It helps electronically transfer info from CIS to public health departments
• It reduces provider burden in providing information
• It enhances the speed and quality of information given

Health Alert Network (HAN)

• HAN to develop continuous, high-speed access to public health on a state and local level
• Offers broadcast information in support to emergency communications

Laboratory Response Network (LRN)

• LRN maintains an integrated network for state/local public health, federal, military, and international laboratories which respond to bioterrorism and chemical terrorism

Division of Public Health Surveillance and Informatics

• Aims for providing data for public health
• Its web site includes multiple resources

Agencies for Healthcare Research and Quality Functions

• Provides clinicians reporting trends, the disease management and diagnosis
• They are able to use this information to report bioterrorist attacks to speed up the reporting

Syndromic Surveillance

• Detects a disease outbreak before actual disease identification

Clinician Training Programs

• The University of Alabama and Birmingham developing training
• It is a continuing education module which teaches professionals on how to recognize several various biological agents
• The Research Triangle Institute (RTI) develop simulations to assist medical providers in their response to the bioterrorist attack and other public health emergences
• Vanderbilt is conducting a study which determine the efficiency and effectiveness of learning and assisting the nurse volunteers

Health Resources and Services Administration (HRSA) Grant Management

• Bioterrorist and training programs for the state, in addition to local services.
• Provide mass immunization, isolation, diagnosis, decontantimation and so forth
• HRSA provides continuing support and better enhancement for those in the healthcare positions

Other Changes Affecting Emergency Preparedness and Response

• Competency-Based Learning and Informatics Needs
• ACEP Formed Nuclear (NBC) Taskforce to evaluate on bioterrorism.

Nurses of the Task Force:

• Cheryl Peterson: ANA
• Claudia Niersbach and Bettina Stopford: Emergency Nurses Association
• The CDC is a partner for an initiative run by Dr Kristine Gebbie, RN
• She published Centre for Health Policy
• Competency to curriculum; the toolkit resource for better response during an emergency
• INCMCE promotes for better mass education on trauma

John Hopkins University Study Findings

• Need for future studies regarding methods which improve training
• They want clinicians to be more capable during bioterrorist attacks
• They also want public health, disaster drills and best practices

Informatics and Emergency Operations Center Details

• IMS for Multijurisdictional (Used by FireFighters)
• Used in hospital: HEICS
• Volunteers and informatics in teams (DMAT) and Medical Reserve +Corps.

Details on Medical Reserve Corps and Nurses

• They provide travel for the regions or volunteer at all local levels
• NNRT: provide prophylaxis vaccination
• American Red cross with history which offer training and education to nurses in a variety of roles during a disaster

Key Aspects of Volunteerism and Informatics

• DMAT provides the teams that are willing to travel to different parts of the country to assist in an emergency
• There is the Medical Reserve which offer assistance to those in need
• NNRT consist of registered nurses which offer assistance to chemotherapy and or vaccinate.
• Also, the American red cross maintains an extensive history during a disasters in addition, it offers education

List of national volunteer nurse verification aspects for a data base

• Having license verification in multiple districts or states
• Keep updating ones education.
• certifications available
• A volunteer may be a part of various events, must be accounted prior to the event.
• Activation instructions and prior for one’s emergency experience in addition to security levels and any clearance.