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Building Infrastructure and Developing Partnerships: Public Health and Healthcare Emergency Preparedness and Response in Virginia Lisa G. Kaplowitz, MD, MSHA Deputy Commissioner, Emergency Preparedness and Response Virginia Department of Health

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Building Infrastructure and Developing Partnerships:Public Health and Healthcare Emergency Preparedness and Response in Virginia

Lisa G. Kaplowitz, MD, MSHA

Deputy Commissioner, Emergency Preparedness and Response

Virginia Department of Health


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Virginia Department of Health (VDH) Emergency Preparedness and Response Program (EP&R) Since 2002

  • Preparedness and response to all emergencies, naturally occurring as well as terrorist related (all hazards approach)

  • Rapid response to outbreak situations

  • Build public health infrastructure in VA

  • Involve all programs in VDH, all VA emergency response programs, all healthcare providers

  • Availability to respond to emergencies 24/7 at both local and state levels


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VDH EP&R Programs: Many Successes and Response Program (EP&R) Since 2002

  • 97/100 rating for SNS plan, tested with multiple statewide and annual district exercises

    • High rating for CRI and ChemPack plans

  • 10/10 rating by Trust for America’s Health in 2007, with progressive improvement over prior 5 years

  • High federal rating of state pandemic influenza plan

  • Clear evidence of progressive improvement in response to public health and healthcare emergencies: ICS for response to infectious disease outbreaks; public health/healthcare response to floods, storms and drought; response to Virginia Tech shooting in April, 2007


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Virginia Department of Health Unified Public Health System and Response Program (EP&R) Since 2002

  • 35 health districts serve entire state

    • 33/35 are part of state public health system

    • 2 are locally administered under contract to state, function same as other districts

  • Strong relationship between state and local public health – functions as partnership

    • Local input on all programmatic issues

    • Resources allocated to districts and regions


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VDH EP&R: Investment in Public Health Capacity and Infrastructure

  • Local and state levels

    • Planner and epidemiologist in each district

    • Regional teams

  • Expertise is WITHIN VDH – not with contractors

    • Development of plans, exercises, response to emergency events

    • Epidemiology, IT, laboratory response, training


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VDH EP&R: Support of Leadership Infrastructure

  • State and agency levels

  • Governor

    • Rapid recruiting of positions

    • Health dept control of federal funds

    • Engagement in issues: direct involvement in exercises, pan flu video, antiviral purchase decision

  • Commissioner

    • High level program leadership (Deputy Commissioner)

    • Ongoing access for key decisions, policies


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VDH EP&R Programs: State Agency Partnerships Infrastructure

  • Office of Commonwealth Preparedness; Depts of Emergency Management, Social Services, Mental Health, Agriculture, General Services, Transportation, Education, Environmental Quality; State Police, National Guard

  • Appropriate role definition for planning, exercises, response to emergencies

  • Example: strong collaborative state pandemic influenza plan with Governor mandated Cabinet exercise to test plan


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VDH EP&R Programs: Health System Partnerships Infrastructure

  • All components of health system: hospitals, EMS, CHCs, long terms care, individual providers

  • Contract with Virginia Hospital and Healthcare Association for management of HHS/ASPR funds

    • Hospital Emergency Management Comm (HEMC)

    • 6 planning regions with RHCC, hosp coordinator


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VDH EP&R Programs: Private/Public Partnerships Infrastructure

  • Use existing expertise (don’t reinvent wheel)

    • UPS to distribute SNS in state

    • Walmart distribution center as RSS

    • Pharmacies to dispense antivirals

  • Partner with business

    • Pan flu planning, antivirals

    • Exercises

    • Communications – including media

  • Partner with military


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VDH EP&R Programs: Set Program Expectations, Goals Infrastructure

  • Strategic planning process

  • Annual task list for districts

    • Now with annual assessment visits using standard assessment tool

  • Set high expectations, with willingness to go beyond standard public health capabilities

    • Engagement of ALL health dept employees in emergency preparedness and response

  • Understand role of ESF-8, NIMS and incident command


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VDH EP&R Programs: Future Challenges Infrastructure

  • Identifying meaningful performance metrics that accurately measure capabilities and capacity

  • Addressing healthcare provider shortages

    • Routine: nursing, other individual providers

    • During emergencies: volunteers, recognize that healthcare shortages WILL occur and WILL impact standards of care with health and legal implications

  • FUNDING: loss of funding will result in loss of capacity, loss of infrastructure and ultimately loss of capabilities


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