Innovations in Primary Care Emergency Management: Planning, GIS Mapping, and Public Health Response Emergency Management Higher Education Conference June 4, 2009

1
Innovations in Primary Care Emergency Management
Planning, GIS Mapping, and Public Health
ResponseEmergency Management Higher Education
ConferenceJune 4, 2009

• Nora OBrien, MPA California Primary Care
  Association

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Presentation Overview

• Review of California Community Clinics and Health
  Centers (CCHC) and emergency response roles
• Current H1N1 Influenza Outbreak and CPCA response
• CPCA Clinic Emergency Preparedness Resources
• Application of Emergency Management Education to
  current work
• Questions

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CPCA Community Clinic and Health Centers

• 822 community clinics and health centers (CCHCs)
• CPCAs more than 740 members include
• Federally Qualified Health Centers (FQHCs and
  FQHC Look-a-likes)
• Rural Health Clinics
• Community Clinics
• Free Clinics
• Planned Parenthood Clinics
• 17 Regional Clinic Consortia

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Who CA CCHCs Serve

• Patients
• 4 million patients
• 49 of whom are limited English proficient
• Visits
• 12.5 million patient visits provided
• 1 mil uninsured and 1.4 mil Medi-Cal
• 3.6 million patients under 200 of the FPL
• All information compiled by Jeanita Harris, CPCA
  Data Analyst. Numbers are based on 2007 OSHPD
  data.

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CA CCHC Characteristics

• CCHCs serve the most vulnerable
  patients-regardless of their ability to pay,
  insurance, or immigration status.
• Health care safety net for many communities,
  counties and regions.
• Provide multitude of services to
  uninsured/underinsured where hospitals and other
  medical providers may not exist.

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Potential CCHC Emergency Response Roles

• Medical surge capacity for hospitals and public
  health departments
• Triage
• Disease surveillance
• Mental health services
• Alternate Care Sites
• Medical response staging

• Deploy mobile units and CCHC staff
• Ethnic community outreach
• Serve as Points of Distribution (POD) sites
• Translation services
• Shelter residents
• Social Services access

CCHCs can respond effectively to emergencies when
given resources, training, and equipment
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H1N1 Influenza Outbreak

• Why public health officials are alarmed
• Novel virus- no one has immunity to it
• Likely to kill more healthy adults than young and
  old
• Cases identified in outpatient settings like
  CCHCs
• One of earliest 107 confirmed cases was a member
• 1918 pandemic followed similar pattern of mild
  cases then deadly outbreaks during fall and
  winter
• Today we have greater syndromic surveillance
  capability, anti-viral meds, and instant
  communication

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CPCA H1N1Influenza Outbreak Response

• Situational awareness of local clinic and
  regional consortia response needs
• Coordinate medical response with local, state,
  and national partners
• Promote credible medical guidance from state and
  federal sources via CPCA website and snapblast
• Advocate CCHC interests on state and federal
  calls
• CCG testified H1N1 Influenza legislative hearing
• Respond to media requests- LA Times, SF Chronicle

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CCHC Emergency Response Efforts

• Hurricane Katrina (2005)
• Deployed mobile medical assets
• Triaged to hospitals
• Provided Rx primary care
• Wildfires (2003, 07, 08)
• Used Clinic practice management systems to ID
  patients at risk
• Provided mental health services
• Treated First responders and community
• Provided translation services
• Evacuation and shelter assistance
• Deployed mobile medical assets

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Challenges to CCHC Emergency Response

• No consistent patient tracking system
• Limited reimbursement for services rendered
• Not all CCHCs integrated into local response
  plans
• CCHCs at varying levels of preparedness
• CCHC leadership buy-in for preparedness efforts

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Clinic Emergency Preparedness EffortsMeeting the
Challenges

• No consistent patient tracking system!
• Few CCHCs have Electronic Health Record systems
• Limited reimbursement for services rendered
• CPCA Policy Team involved in tracking,
  monitoring, and influencing legislation that can
  positively impact reimbursement to clinics.
• Not all CCHCs integrated into local response
  plans
• CAHAN
• CPCA EOP Template

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Clinic Emergency Preparedness EffortsMeeting the
Challenges

• CCHCs at varying levels of preparedness
• Exercise participation
• GIS mapping
• CCHC leadership buy-in for preparedness efforts
• Ongoing meetings/discussions with leadership by
  key CPCA team members

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CPCA CCHC Emergency Management Tools and
Resources

• A robust CCHC-specific Emergency Operations Plan
• Clinic Emergency Preparedness Help Desk
• Emergency Flipchart
• Clinic Emergency Preparedness Task Force
• ACS, POD and Mobile Medical Asset GIS Mapping
• CPCA Emergency Preparedness Training Modules
• Clinic ICS/NIMS Training
• Pandemic Influenza Planning Toolkit
• Redundant Communication Training Module

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ACS, POD Mobile Medical Asset GIS
Tracking

• Why GIS is Important to Emergency Preparedness
• 9/11 Story
• Integral to any comprehensive disaster management
  plan
• Bottom line This stuff saves lives.
• Identification of Clinic Alternate Care Sites
• ACS Survey Tool
• ACS Outreach
• ACS Data Collection
• GIS Mapping
• Knowing what is in your community so that you can
  protect it
• A spatial display and analysis tool that can
  answer key questions

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CPCA Regional Outreach

• Increased visits to CPCA Clinics/Increased
  interaction with CPCA field operations
• Statewide Tabletops and expanded emergency
  preparedness exercises
• Provision of expanded information, training and
  additional resources to CPCA members
• Expanded CPCA Help Desk information and FAQs
• Establishment of a CPCA Emergency Preparedness
  Quarterly Newsletter
• Expanded opportunities for webinars, new training
  content, additional live seminars as needed

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CCHC NIMS Expectations

• Bureau of Primary Health Care (BPHC) Emergency
  Management Expectations expect FQHCs and
  Look-Alikes to move toward NIMS compliance and
  implement ICS in their EMPs- not required
• ASPRs Hospital Preparedness Program (HPP)
  requires only hospital staff to meet the 14 NIMS
  elements
• CCHCs likely required to implement some of the
  NIMS elements in future HPP guidance

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Clinic Incident Command System NIMS Training

• Modeled after the Hospital Incident Command
  System training and tailored to the CCHC setting
• Developed with input from 40 CCHC medical and
  operational staff
• Designed for three CCHC audiences
• Command Module (4 hour)
• ICS H 100, ICS H 200, and 700A CalEMA certified
• Executive Module (1.5 hour)
• General Staff Module (1 hour)

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Clinic ICS/NIMS Training Next Steps

• Final versions of the Command, Executive, and
  General staff module will be available on demand
  via CPCAs web-based Learning Management System-
  June 2009
• CPCA will host a General Staff WebEx training-
  June 2009
• CPCA will offer the Executive Module via
  videoconference- August 2009

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Emergency Management Education

• Masters of Public Affairs, Disaster and Emergency
  Management Program- Park University, KC, MO
• Rationality, responsibility, and responsiveness
  in their organizations within a framework of the
  highest ethical values
• Both Online and in-person classes
• Experienced emergency management faculty- IAEM
  and IACP past presidents
• Undergraduate and certificate DEM programs also
  available

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Application of Emergency Management Education to
Current Work

• Provided an academic framework to emergency
  management work largely focused on preparedness
  rather than response
• Firmer knowledge of in-depth emergency management
  concepts such as mitigation, business continuity,
  disaster resiliency, and vulnerable population
  response
• Modified work to reflect larger emergency
  management context, i.e., public safety, private
  sector, government, EMS

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Emergency Management Academic Research Challenges

• Paucity of emergency management research
  regarding vulnerable population preparedness and
  response
• LEP populations, resource poor individuals,
  disabled, seniors, children, etc.
• Service providers of vulnerable populations need
  EM tools and resources to plan but lack
  infrastructure to implement
• Disconnect between response to public health
  emergencies and other disasters/emergencies
• Public health departments are often not
  integrated into local emergency management
  agencies

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Questions?

• Nora OBrien, MPA
• Associate Director of Program Planning
• and Development
• California Primary Care Association
• 1215 K Street, Suite 700, Sacramento, CA 95814
• 916 440-8170 (F) 916 440-8172
• nobrien_at_cpca.org
• www.cpca.org/resources/cepp