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Assessing Risk and Strengthening Community-wide Preparedness.

Moderator:Loretta Jackson Brown

Presenters:Dena Fife, MA, and Brent Spear

Date/Time:November 14, 2013 2:00 pm ET

NOTE:This transcript has not been reviewed by the presenter and is made available solely for your convenience. A final version of the transcript will be posted as soon as the presenter’s review is complete. If you have any questions concerning this transcript please send an email to coca@cdc.gov

Coordinator:
Thank you for standing by. At this time all participants are in a listen-only mode. After the presentation, we will conduct a question-and-answer session. To ask a question, you may be press star 1. Today's conference is being recorded. If you have any objections, you may disconnect at this time.I would now like to turn the meeting over to your host for today's call Miss (Loretta Jackson-Brown). You may begin.

Loretta Jackson Brown:
Thank you, (Teresa). Good afternoon. I'm (Loretta Jackson-Brown) and I'm representing the Clinician Outreach and Communication Activity, COCA, with the Emergency Communications System at the Center for Disease Control and Prevention. I am delighted to welcome you to today's COCA webinar: Assessing Risk and Strengthening Community-wide Preparedness. We are pleased to have with us today Dena Fife from the University of Iowa and Brent Spear from Iowa Department of Health, here to discuss their partnership in developing a risk assessment tool to improve community-based planning.

You may participate in today's presentation by audio only, via the webinar or you may download the slides if you are unable to access the webinar. The PowerPoint slide set and the webinar link can be found on our COCA Web site at emergency.cdc.gov/coca. Click on COCA calls. The webinar link and slides are located under the call and number and call passcode. At the conclusion of today's session, the participant will be able to -- I'm waiting for the slide to load – discuss the importance of the risk assessment tool, describe how the risk assessment tool can be used for communitywide planning, and state the benefits of including community partners and risk assessment to development and ongoing preparedness planning.

In compliance with continuing education requirements, all presenters must disclose any financial or other association with the manufacturers of commercial products, supplies of commercial services or commercial supporters, as well as any use of an unlabeled product or products under investigational use. CDC, all planners and the presenters for this presentation do not have financial or other associations with the manufacturers of commercial products, supplies of commercial services or commercial supporters. This presentation does not involve the unlabeled use of a product or products under investigational use. There was no commercial support for this activity.

At the end of the presentation, you will have the opportunity to ask the presenters questions. On the phone, dialing star 1 will put you into queue for questions. You may submit questions through the webinar systems at any time during the presentation by selecting the Q&A tab at the top of the webinar screen and typing in your question.

Our first presenter is Dena Fife. Dena is an instructional designer with the University of Iowa's College of Public Heath Upper Midwest Preparedness and Emergency Response Learning Center. She collaborates with practice partners and content experts to develop online and face-to- face courses to meet their preparedness training and educational needs. Her collaboration with the Iowa Department of Public Health led to the development of two online risk assessment tools.

Our second presenter is Brent Spear. He is Executive Director for the Iowa Department of Public Health Center for Disaster Operations and Response. In this role he manages grant implementation and provisions for local tool development and provides technical assistance for the Department of Public Health and Emergency Preparedness programs, and hospital preparedness programs. Brent has worked preparedness since 2007. This includes serving as an antiviral coordinator and as the local emergency manager. A former U.S. Marine, Brent is also a firefighter paramedic.

Again, the PowerPoint slide set and webinar links are available from our COCA web page at emergency.cdc.gov/coca. At this time please welcome Dena Fife.

Dena Fife:
Thank you, (Loretta), for the introduction. And thank you, everyone, for joining us today. As she said, my name is Dena Fife and I'm an instructional designer. And my co-presenter, like (Loretta) mentioned, is Brent. Today we would like to talk to you about the need for a risk assessment tool, the tool itself, why it was important to collaborate with key partners when using risk assessment tools, how does it fit into community planning, and then a scenario that we developed to pair with the risk assessment tool. I'd like to give a little background about the Upper Midwest Preparedness and Emergency Response Learning Center. We're located at the College of Public Health at the University of Iowa and we are one of 14 national preparedness and emergency response learning centers funded by the Center for Disease Control and Prevention. Our mission is to ensure that the public health workforce has the skills to prepare for, promptly identify, respond to and recover from public health emergencies. We collaborate with state and local public health agencies, healthcare providers, emergency management, public safety, veterinary medicine, professional organizations, and it has led to the development of various training, tool kits, assessment tools and other products based on the needs of the workforce. We have a joint partnership with the Iowa Department of Public Health that led to the development of Training Source, which is our learning management system that houses well over 100 competency-based online courses. And the courses can be accessed by anyone at anytime from anywhere. I'm going to pass it over to Brent. He's going to kind of talk about the initial need for the risk assessment tool.

Brent Spear:
Thank you, Dena. To start with, the Iowa Department of Public Health in working with the hospital preparedness program and the public health emergency preparedness program grants, working through the capabilities that are outlined from those grant documents, it clearly outlines the community preparedness as capability one on both sides. And within that, it talks about coalitions and about understanding the risks and the vulnerabilities within your community, and looking at whole community preparedness. As we worked through these capabilities and our understanding on how to implement that in Iowa, it became very clear to us that the risk identification piece was not wholesale across the state. Some hospitals do a risk assessment for accreditation purposes. Most public health agencies would say that well our local emergency manager has a risk assessment and we take part in that. But it's a little different focus when looking at it from a healthcare perspective and taking those individuals, a hospital looking at their risk assessment essentially inside their four walls and what affects their system, public health looking at it from, in the case of our state, a countywide basis, how do we take that information and compile that with a true healthcare sector perspective and roll those together to really outline the risks for that jurisdiction so that as the entities move forward in a coalition to try to meet some of those risks.

There were many different products that Dena will talk about here in a little bit on what we worked through to come up with the tool, but it became very clear that there was a definite need to get some kind of a standardized product and a way of measurement of risks and vulnerabilities so that those products, those answers could be rolled together and eventually rolled up into the county jurisdiction and up to the state emergency management level jurisdiction to really get a good flavor of healthcare perspective. That was the need that we identified and led to our conversations with Dena and her group. Do you want to go from here, Dena?

Dena Fife:
Thanks, Brent. So after we decided that we would focus on a risk assessment tool, we then met with several key people, not only from the state health department, but also from Iowa Homeland Security and Emergency Management, and we discussed the various options, you know, what was the need, what should the tool look like, who should the tool be for, what hazards needed to be included, and would we build something from scratch or would we use existing tools. After looking at the current tools that existed, we decided that there was no need for us to reinvent the wheel so we decided that we would model our online risk assessment after the HVA tools that currently are available, and those included the Kaiser Permanente HVA tool and the UCLA Center for Public Health and Disaster Hazard Risk Assessment Instrument, and then we also Iowa-nized the risk assessment tool.

The state health department presented mock ups to the regions and after a short pilot session, we developed a tool that is specific to healthcare, and then one that was specific to local public health agencies. In total, we developed four online risk assessment tools. Two are specific to Iowa and then two are general risk assessment tools. The assessment has three main hazard categories. Natural hazards includes 14 hazards for both the local public health and the healthcare assessment.

Then we have the human-caused hazard category. There's seven hazards that are included for local public health, and then there are ten for healthcare. And then there's the technological accidental hazards, and there are 16 hazards for local public health that were identified, and then 21 for healthcare. To complete the assessment in one sitting, it would take about an hour, but the tool is set up so users could save their work and come back to the assessment at different times.

And then I do have a poll. Let me see if we can get that up. So have you or your facility used a risk assessment tool? Great. It looks like the majority of you have. So the questions that we included for the healthcare risk assessment they include - the assessment in general helps answer what is the impact to either my healthcare facility or my local public health agency and the community if a disaster strikes. Each of the questions are assigned a score that is saved in the system. And for healthcare we have eight categories that need to be answered for each hazard, which includes probability, how would you rate the likelihood this will occur in your facility. Then we have human impact, how would you assess your facility's current ability to respond to the possibility of death or injury. Property impact, how would you assess your facility's current ability to respond to the possibility of loss or damages. Business, how do you respond to the interruption of services. Training, how would you assess your facility's current abilities and your staff competency to respond to preparedness, how would you assess your facility's current abilities in pre- planning for. Internal response and external response, which include how would you assess your facility's current abilities and time effectiveness and resources. And then obtaining community resources, mutual aid, extra staff and supplies.

For public health there were six question categories. Those include, again, probability, how likely is this to happen. Human impact, how would you assess your current agency's ability to respond to the possibility of death or injury from. Business impact, how would you assess your agency's current ability to respond to the possibility of loss or damages from. Training, assess your agency's current ability to coordinate with other agencies and secure community resources from and your staff's competency to respond to, and then facility's current ability in preplanning for. After a user has completed a hazard and before moving onto the next hazard, it displays a risk score for that individual hazard based off of those questions. Then when a user has completed each section, an averages and summary report is generated for each of the three sections. And then after all three sections have been completed, they're directed to an all-hazards summary. And all of the reports can be saved as a PDF file.

Once the assessment is complete, it's encouraged that the individual agency completing that assessment review their reports individually and then meet with their local partners to review the findings and then compare notes of their individual risk assessment. In Iowa, there are 118 local public health agencies that were enrolled in our local public health risk assessment tool, and 91 of the assessments have been completed. And for healthcare, 144 have enrolled and about 51 assessments to date have been completed. In addition to the risk assessment tool, we felt it was important to include a training component that could serve as a supplement to the online risk assessment tool. The training is scenario-based and focuses on why community partnering is important especially with risk assessment tools. The online training is based on the FEMA course Developing and Maintaining Emergency Operation Plans, and the course is titled Community Partnering of Risk Assessment and Emergency Operations Planning Scenario. The scenario is set up to provide guidance on the fundamentals of community-based planning from contributing to a risk assessment to developing emergency operation plans, and then engaging the whole community and addressing all risks and hazards. The scenario takes about an hour to complete and it also addresses capability one on community preparedness. I have another poll that I'd like to pull up. So if you have used a risk assessment tool in your agency or your facility, did you use it as a planning tool to identify potential partners within your community? Great. I'm going to pass it over to Brent, and Brent's going to take over and kind of talk about all the partnerships and how important that is.

Brent Spear:
All right. Thanks, Dena. With the partnerships, within the grant perimeters we chose to implement coalitions as a joint effort between public health and the hospital program equally. That was kind of unique at the time for the state of Iowa. Most folks across the nation, one side or the other kind of took the lead and the other was a partner. And we chose to implement that very deliberately to walk down this path hand in hand. To help solidify and identify partners that should be in the coalitions, we felt that the risk assessment was a very good first place to start.

You have to understand the risks and hazards in your community to figure out where your gaps are. Once you figure out gaps, then you can start partner identification. And we'll get to it in a slide or two here, but that might be beyond your typical jurisdictional boundaries when looking for coalition partners and how to mitigate the gaps that you've identified within this risk assessment.

Those first steps that our folks took with this we asked them to individually, each hospital and each public health agency, complete their risk assessment. And as Dena outlined they were just slightly different, but they both correspond well to each other and we used the two differing models. The hospital was based primarily off of the Kaiser Permanente because that's - when we did a poll that's what most of our hospitals were currently using for those that were doing it for accreditation purposes. For the very few number of folks in the local public health side that had completed their own risk assessment, they were basing that off of the UCLA model. We asked them to complete those risk assessments, look at it from their very discipline-specific perspective of how these risk would affect them, what kind of gaps they have internally. And as they moved forward to help identify those partnerships and really highlight that the partnerships are important in mitigating these gaps, we asked them to get together as a coalition, public health and hospital and the local emergency manager, to really see what the similarities were and what the differences are between their perspectives of how they answered these risk assessments.

In most cases, those answers were similar, but where the differences crept up, it was a really good discussion point to be able say no I think this is why we need to do this and I think this is a bigger gap, which led to that discussion of how do we build that, who can help us do that. And by understanding those risks and hazards in their community and asking those questions, they say well, you know, this person or this entity over here can help us build up and we can bring them into this coalition to help better prepare our whole community. But there were so many things going on with the grant at that point that this helped focus who needed to be part of that coalition and what kind of partnerships they needed to start exploring and demonstrate.

So again what's happening next? We have done this. It's been about nine months since we first rolled out this tool to our locals for them to complete, and they did identify resources needed and gaps in resources, and they did take that information to the coalitions that were beginning to form. Some of them have moved along faster than others. Some are still identifying partners that can be able to help them in exploring that crossing of jurisdictional boundaries to be able to find the right partners to fill those gaps and to move healthcare preparedness ahead within their communities. We've been very diligent in working with our Iowa Homeland Security and Emergency Management Department, but this needs to be a whole community preparedness effort. We don't want to get so focused in on just the healthcare aspect. We want to leverage the reduction in grant dollars and make efficiencies in preparedness in general within the community so that we can really move preparedness forward.

The plan for improvement, it's our thought that within about three years, towards the end of our federal project period, we'll have them complete another risk assessment. We're using this first one as kind of an initial baseline. It's helping them identify resources and partners. It's also helping them identify places to spend grant dollars to fill gaps. And we want to do this, have them go through this process again in a couple or three years to see if we can measure the reduction in gaps and the increases in preparedness and our ability to respond to these type of hazards. So that's kind of the plan moving forward of what we're going to talk about with those folks in the upcoming years. I've got one particular group that I want to highlight. It's the Kossuth Emergency Planning team. It's one of our single-county coalitions. They have done a phenomenal job with taking this risk assessment and really looking at the gaps they have and bringing in partners and expertise to fill those gaps, to help with the emergency planning, and that has been beyond just government agencies, private business, nursing homes. They have, for one of the smaller counties within the state of Iowa, they probably have the largest coalition and are a very robust group of individuals that are all engaged. They have taken this and ran with that concept of partner identification and mitigating risk and filling gaps in resources, and they're doing a wonderful job with that. Again, all of the coalitions within the state are working on that each to differing degrees. I know I've kind of talked about coalitions off and on here, but I kind of wanted to throw this map up. There are 99 counties in the state of Iowa, 118 hospitals. The counties that are colored alike are folks that have went beyond their jurisdictional county boundaries to form coalitions based in part on the risk assessment and the partner identification that came from that. The counties that have no color, the clear, the white, those are single-county. Hospital, public health, emergency management are all working together within their jurisdiction to move this forward and look at the hazards and risks.

The blue hashed counties are folks that either, A, do not have a hospital in their country; or, B, do not have a participating hospital in the county. There are four counties that you can see with the red hash mark. Those are counties that are currently choosing not to participate within either the hospital preparedness program or the public health emergency preparedness program grants.

So you can see we have very good representation. We have some four-county coalitions, several three- county coalitions that are moving this forward and really looking at the risks. And I think it highlights some of the importance of the risk assessment. For those folks that are around a large metropolitan area, Polk County is where Des Moines is and you can see Warren and Dallas are in the same coalition. Warren County has a very primarily rural county. There's not hospital in Warren County. All of their folks seek definitive care, for the most part, within the Des Moines metro area, and they're working and looking at those risks and partner identification and how to fill those gaps, working at that together. And most of the multi-county coalitions are kind of in that same boat, with a larger metropolitan hub surrounded by some rural counties that are really working together to move that forward.

The next steps. Involvement. I think this continues to be something that the coalitions are working on. I think they picked the low-hanging fruit, so to speak, with partner identification as they moved through the coalition-building process and looking at preparedness in healthcare, but I think they're starting to go back and revisit those risk assessments, where they're at now, and trying to find additional partnerships. I think that for the majority of the folks that I work with through this grant process from the state level down to the local level, I think they're just now realizing that hey I have a clinic, they really haven't been engaged within our preparedness efforts in most cases before at all. Some have correspondence for certain things, (unintelligible) things, getting out notifications, but really sitting down at the table and seeing what those folks can bring to the preparedness effort, how they can leverage those partnerships to help mitigate risks. I think that's going beyond the clinicians' roles. They're looking at long-term care. They're looking at other folks within the health and medical sector to bring in as partners because they're really embracing the concept of whole community preparedness and response to help mitigate those risks.

Those questions that Dena talked about really help drive home hey we as a single entity cannot do everything that's needed to mitigate all of these gaps, who can we get to help us. I think as you continue to see grant dollars for the hospital preparedness program and the public health emergency preparedness program go down, finding those partnerships and leveraging those partnerships is going to help continue to move preparedness forward. And I think that if you haven't, you probably will at some point in the fairly near future, almost anywhere in the nation have coalitions going hey, you know, how can we work together to increase this preparedness, whether that's with a family clinician in a small town in rural Iowa or a larger system within a metro area. But I think that those steps of mitigating risks and looking at it from a whole community perspective are really driving, at least in Iowa and I'm fairly confident across the nation, the preparedness programs from HPP to PHEP. So I think that is kind of where I'm at. Dena, do you want to continue with the links and the rest of this?

Dena Fife:
Sure. Thank you, Brent. All of our risk assessment tools and the scenario that was developed in conjunction with the risk assessment can be found on our Training Source learning management system which is www.training-source.org/learn . And then the general healthcare risk assessment tool the link is right over here. And then the public health general assessment is over here. I just want to say thank you for everyone for calling in and participating and thank you to CDC and for (Loretta) for all the work that she put into allowing us to present this information to you guys, and I think we're going to open it up for questions.

Loretta Jackson Brown:
Yes. Thank you, Dena and Brent, for providing our COCA audience with such a wealth of information. We will now open up the lines for the question-and-answer session. And also remember you can submit questions through the webinar system as well. So okay, Operator?

Coordinator:
Thank you. If you would like to ask a question from the phone lines, please press star 1. You'll be announced prior to asking your question. To withdraw your question, please press star 2. Once again to ask a question, please press star 1. One moment.

Loretta Jackson Brown:
And while we're waiting for our first question from the phone, we actually have a question through the webinar system. The question is: for partnerships, how did they first reach out to these partners, from existing coalitions, a letter or a phone call? So, Brent, can you answer that?

Brent Spear:
I'll try. Understanding that in the state of Iowa, for the most part we're talking about very rural county jurisdictions that we have 12 counties that do not have a hospital, and most of those folks know each other and have known each other for a very long time. Again like I said, I think they kind of took the easy road of we know we need public health and we know we need emergency management, and fire and EMS probably and law enforcement are a pretty good start, but where do we go from here?

I think now we're getting to the point at least in Iowa that they're reaching out to these other partners.

Most of them have either some kind of a personal or a professional existing relationship so it's mostly just a phone call. There are some that are reaching out beyond commonly identified response partners that are actually going out and doing community activities, explaining the program and what they're trying to do with the coalition and looking for partners. So some of it's also by word of mouth. Hey I went to this presentation and I think you could help these folks or they could help you, but that's very much a rural Iowa thing. But I think a letter and phone call are also very good ways to reach out to partners, clearly stating the need that you're trying to fill by getting them to partner with you.

Loretta Jackson Brown:
And, Brent, another part to that question: can you talk about ways to keep them freshly engaged, and if you have an example of how that is actually done or has been done in Iowa.

Brent Spear:
Sure. We have a coalition that has reached out to what I'll call nontraditional partners, nursing homes, long-term care facilities, home health, private clinicians. They're again a very rural hospital, fairly far away from any major metropolitan area for definitive care for anything other than a critical access hospital. As they looked at surge when you talk about a hospital that runs a daily census of two or three patients, getting ten or twelve people in their ER is a big deal to them. In some places, that wouldn’t even be a blip on the radar, but for those folks it's a big deal and how do we surge and purge our hospital to be able to accommodate that. And they've created a workgroup that looks at working with the clinicians to quickly discharge folks out of the hospital but maybe not quite ready to go home into a long-term care facility and having some protocols, working through as a subcommittee to work through protocols to get that done quickly and to not allow a drop off of care so that we can continue to provide care to these patients yet still manager the surge that in some cases is very overwhelming that could be nothing more than a simple car crash with a van and eight or ten people. So it's all about perspective.

But those folks have really identified that need that those partners can help fill and given them the autonomy to help create a solution to fix that problem. So they're working through all of those things and it's, especially when you're talking about hospital surge and how all of the partners fit into that, that's nothing that's going to be accomplished very quickly but they have ownership of it so they keep engaged because they want the system to work.

Loretta Jackson Brown:
Thank you. Operator, do we have a question from the phone?

Coordinator:
Yes. (Frank Pascarelli) your line is open.

Frank Pascarelli:
Yes. Good afternoon. Two questions, one with the stockpile and the community resumes the activity dealing with rural populations. And the first question I have is what do you have in place for patients who have become recently diagnosed as disabled as part of the discharge planning? Over the years as a clinician, I've seen the typical discharge planning summary about their ADLs and what have you, but now it takes the next step and we have an all-hazard situation whether it's an evacuation, power failure or what have you. And the second part of that question, do you have a mechanism in place to encourage disabled individuals to register with EMA, the power company and et cetera? And then I have one last question after that.

Brent Spear:
Okay. Do you want me to take that, Dena?

Dena Fife:
If you would, Brent.

Brent Spear:
Thanks. I'll kind of go backwards a little bit on this. As far as a requirement for folks that are disabled potentially to notify the emergency responders, there's no requirement for that. It is always highly encouraged, and as we work through with the public health and hospital grants that's a very large component, looking at special needs populations and how do we make sure that we account for those folks within our planning efforts and our response efforts. It's one of those things that sounds really simple and easy to accommodate, but when you really start digging into it it's very hard to come up with the right answer. And the local coalitions are working on that, but mostly it's a little bit unique to some of the state of Iowa. Being so small and rural, everyone knows who everyone is and we know as local rural responders where our vulnerable populations are at. So it's a factor if you can get those folks that deal with that population sector to the table as a coalition to be able to ensure that the planning for them has been taken into account. Does that kind of answer that second part?

Frank Pascarelli:
Yes, sir. I was going to say looking at the requirement is that something that the hospitals have in place at rehab facilities in the state as part of the discharge plan and is there a requirement to encourage them to register or let their emergency manager know that hey I'm being discharged and I have this recently diagnosed disability and these are some of my functional limitations?

Brent Spear:
Yes. I don't know that I'm really the best person to answer that, but I can do some investigation and we can - I know that (Loretta) said that we can continue to answer questions as they come in. And I think, (Loretta), if you could capture that, I could talk to some folks that more at the local level that would be able to help answer his question better than I can at his point.

Loretta Jackson Brown:
Yes, we invite you to continue this conversation offline. If you have additional questions related to today's webinar, please mail us at coca@cdc.gov. That's coca@cdc.gov.

Operator, do we have another question from the phones?

Coordinator:
Yes. (Assanti Cory), your line is open.

Assanti Cory:
Yes, hi. This (Assanti Cory) from the Louisiana Department of Health and Hospitals. We're developing our risk assessment tool, and I had a question about how you formulated your risk equation to assess the risk in your jurisdictions. Did you include critical infrastructure and key resources?

Dena Fife:
We used the equation that was with the UCLA HVA as well as the UCLA equation and then.

Brent Spear:
Kaiser?

Dena Fife:
Yes, Kaiser Permanente. And because we did that online, our programmers had to kind of deconstruct the equation, which was a little bit challenging in how we rate the questions. But we essentially just used the same equation from those risk assessment tools.

Assanti Cory:
Thank you.

Loretta Jackson-Brown:
I have another question through the webinar system. What were some of the gaps identified by the coalitions? Brent, maybe you can answer that.

Brent Spear:
Sure. I'll give it a shot. As always, resources being very limited, whether that would be personal protective equipment, whether that would be people, supplies when you start looking at alternate care sites, those are some of the major gaps within the state. A vast majority of our hospitals are critical access, 25-bed facilities and you could be an hour away from a level one or two trauma center and looking at supplies and those kind of gaps and expertise. Understanding what's out there I think was another gap that was identified. It sounds kind of funny but there were resources within their communities that they didn’t really know about, and by asking these questions and looking at these partners, something that was initially perceived as a gap within let's say the public health assessment when they actually talked to the hospital and to the emergency management folks and to the private business, maybe that didn't turn out to be a gap because there were actual resources there and understanding where they're at and how and whom to contact to be able to utilize those resources in a time-sensitive situation. But again, you know, it's all about the resources. And as always, there's never enough people when these bad things happen. You can always need more people and things, and that just kind of runs the gamut. For those of you that have been involved in any kind of disaster or a response to a disaster, it's what I would consider the normal things

Loretta Jackson Brown:
And hey, Brent, another piece to that question. American Indian tribal health departments, were they involved at all -- engaged?

Brent Spear:
Yes. We have one tribe within the state, and they are an active participant within one of the multi-county coalitions actually and so that's been a good perspective. Those folks have been working through to continue to build that relationship. The tribe has always been part of the preparedness program, but now through this process they've really kind of stepped out and engaged with a larger community rather than just their one singular county where they're located in. So they are engaged and moving that process forward very well.

Loretta Jackson-Brown:
Thank you. Operator, do we have additional questions from the phone?

Coordinator:
There are no further questions at this time.

Loretta Jackson Brown:
Thank you. I have an additional question for today's presenters. Who has typically completed the assessment? Maybe, Dena, you can speak to that.

Dena Fife:
Typically it's the local public health agency. They have been the -- when we ran the numbers – they have completed more assessments than the healthcare, but I think part of that reason is that healthcare facilities are required to complete their Kaiser Permanente HVA tool. And so the one that we were offering was in addition to that. But like I said, there was 144 that were enrolled and about half of those have been completed by healthcare facilities. And then for our general, we've got about 17 that have been completed, and most of those are public health as well.

Loretta Jackson Brown:
Okay, thank you. Excellent. Operator, I'm going to go to you again one more time for the phone before we close today's presentation. Do we have any additional questions?

Coordinator:
Once again if you'd like to ask a question, please press star 1. One moment.

Loretta Jackson Brown:
Okay. And while we're waiting for the question from the phone, we just had one through the webinar system. It says, "Our coalitions are based in public health areas and include six to eight counties. They're just now beginning to organize. Did you approach your assessment as a statewide or allowed the coalitions to develop the assessment?"

Brent Spear:
I guess I'll take that to start with at least, Dena. We pushed the assessment from the statewide level. We felt that as our coalitions were forming and creating their identities, that they needed to understand the risks and the hazards within whatever jurisdiction they chose to form in. We allowed a great deal of flexibility to our coalitions as they got started to stay within their single counties and then use the tools such as the risk assessment to help them identify where they needed to go to either enlarge or partner with folks to be able to meet their coalition's mission. But we felt that that was probably the best solution, kind of the get your own house in order, understand what's going on, what resources, what gaps. Those you can't fill, start talking with your neighbor and try and figure out if they can help you and if you can help them, and that's how we kind of laid that out.

But it was definitely a statewide push that even if you didn't use this online tool, if you were a hospital that was using your own tool for accreditation purposes, you still had to complete that, provide that summary of your hazards and work with your local public health and EMA to roll that up into a whole community risk assessment because when you start looking at a risk assessment that's outside of your wheelhouse, so you have a different perspective of looking at it, you can ask the same question on preparedness training to a hospital and to a public health and to an emergency manager, and they're going to color their answer with their own perspective of their own discipline. And really fostering that communication between those disciplines to really look at what true gaps and resources and things are out there, again it fostered those communications, a better understanding to what's available to them within their jurisdiction.

And that's how we rolled that out from the statewide perspective, do it as an individual, get together as a group, hospital, public health, EMA at a minimum and discuss and see if there were large differences or similarities to help truly identify those gaps and what steps need to be taken as you move forward as a coalition to help mitigate those gaps. That's the other part of this. By looking at what gaps and resources that you have can help you plan how you move forward with projects, spending grant dollars, looking for partners to help fill those gaps, that was our focus when we pushed this out from the state.

Loretta Jackson Brown:
Okay, thank you. Operator, do we have a question from the phone?

Coordinator:
Yes. (Anita Fall), your line is open.

Anita Fall:
Thank you. My question is in your risk and all the activities, have you looked at children and youth and their families? Has anything come up around that?

Brent Spear:
I guess I'll try and answer that, and feel free to hop in here, Dena. Again as I kind of outlined before, when we rolled this out from the state level we asked them to look at that from each of their discipline's perspectives, and I think public health, at least in the state of Iowa, has a pretty good perspective of looking at that county jurisdiction and the health risks and the folks that they are responsible to take care of in this type of a disaster. And I think that would include children and the at-risk population that was discussed in a previous question. And I think that's where some of that was captured, but there's not a specific question that asks about children or at risk within the assessment. It's all based upon their perceptions of the discipline that's completing that, and I think public health that falls into theirs by how they answer the questions, bring that children and at-risk population discussion to the table with emergency management and hospitals.

Loretta Jackson Brown:
I'm going to ask that question, Brent. We have one through the webinar from (Jennifer) and she wanted to know did you develop scenarios for each of the hazards similar to the national planning scenarios but more kind of public health-focused certification-ish?

Dena Fife:
I can answer that, Brent. We didn't develop specific scenarios, but what we did do is we took the - when you come to a hazard, it has the hazard such as active shooter and then we have the general description of what the definition of what that would be, the same for floods and tornadoes. For any of the hazards we just took the general descriptions, and some of that again we used from the current tools that were out there and then I also looked at general descriptions that were defined on CDC's Web site as well as FEMA's Web site. So we defined the hazards in that.

Brent Spear:
And I think the other part to that is when we got ready to roll this tool out and open that up for our folks, local public health and hospitals to complete, we did that with a couple of statewide webinars. And we talked a lot about answering those questions from your perspective of your discipline and being able to have discussions to roll that out. I think we did three statewide webinars and really talked through the tools and what the hazards were and how they could affect - how different discipline perspectives can affect how you answer the question. So we did a fairly significant educational campaign on what a risk assessment is and how to utilize it and how to take the results and start those discussions with everyone before we rolled that out. That was part of our statewide rollout of the actual tool.

Loretta Jackson Brown:
Thank you. Wonderful. Operator, I'm going to go back to you. Anymore questions on the phone?

Coordinator:
Randy Branson your line is open.

Randy Branson:
Hi. Good afternoon, guys. This is (Randy Branson) from Alabama. I'm the brand new appointed healthcare coalition coordinator for the state working in the department of public health, we are just now getting off the ground with BP2 on the HPP grant, and I'm trying to get a handle on how to get a handle on how to get these assessments done. Of course we've got each individual county within the state has a hazard mitigation assessment, our plan and as well as the statewide (FIRA). We're organizing geographically by our public health regions, which there are 11 of them in this state including multiple counties, but after a long explanation to get to the question, I’m trying to determine what is the best way short of just of copying the mitigation assessments or the mitigation disaster plans and whatnot, is the best way to come up with a good gap analysis based on the HVA?

Brent Spear:
I think I'll start, Dena, if that's okay and then you can talk more about the reports and what's available. Again, we're in kind of the same boat. We have those county jurisdictional mitigation plans and the state (FIRA) and so on in place. What we found and what I guess part of my knowledge as a background, I was a local emergency manager. I know that when we did our risk assessment finding out and getting public health and hospital folks to really spend the time to look at that and give me a good health and medical flavor to my local risk assessment was difficult.

Randy Branson:
Yes, I agree. I was also with the Alabama Emergency Management Agency as a mitigation planner and doing those assessment, so yes I agree.

Brent Spear:
So that's why we took the approach of we wanted them to individually complete those tools. But that next step of really getting into a room and discussing them, a lot of folks found that when they sat down, I'll just take tornado as an example, an emergency manager might rank that a very high probability because they've done a lot of response and research into actual events and what's happened, whereas sometimes hospitals and even public health, they hear about them but they don't really stick in their mind as something they have to deal with. So they view the probability as low, and really getting those folks to sit down at a table and talk why did you rate this as a high and why did I rate this as low and really working at trying to figure out what the true gap is and what the true likelihood is, you know, that was the key for us was to very strongly encourage -- not require -- but very strongly encourage those folks to sit down at the table together and discuss the differences within how they answered that based upon their perspectives. And there were a lot of folks that I've talked to over the last few months that they had completely different answers and they had to work through them together as a group how they wanted that what the true answers really were to roll up into that county jurisdictional EMA level.

And it was a good eye-opening process for folks. It really - and again not 100% everybody engaged to that level, but a vast majority did once they knew the right questions to ask, and fostering that communication and really looking at the differences and holding that to how you answer it is not wrong, it's your perspective. But the communications and the conversations you have as you work through together that's just the key to this thing and to look for partners and so on and so forth, but that's how we tackled that problem. We asked them very specifically do it for your hospital, inside your four walls, county you do it for your jurisdiction, the EMA has theirs in place, now really look similarities and differences. And that's how we helped them start down that road of truly looking at gaps and gap analysis. They had to figure out where they were different based on perception.

Randy Branson:
At what stage in your coalition development did you do this and was that getting together and talking was that at the coalition/county level or was that at the state level?

Brent Spear:
It was at the county level, and they had not formalized their coalitions at that point. We were in the beginnings of BP1 where they were starting down that road, and we told them that this was a good opportunity to help identify what you need in your coalition and who can help fill that. So no, they were right in their infancy of their coalition, and most of them hadn't even formalized and created bylaws or operating instructions or MOUs. These were individual agencies just starting to work together, but we felt that this was a really good first step that they could all get value out of irregardless (sic) of where they ended up in the coalition because each entity knowing their own hazards and vulnerabilities is key. So it was right at the infancy stage.

Randy Branson:
That's pretty much where we're at, and like I said I'm brand new to this side of emergency management so I may be calling you.

Brent Spear:
Feel free. Like you said, it's a learning experience and every time we work through these risk assessments and have these discussions, it just betters everyone because everyone has a different perspective and communication is the key to all of this. So I look forward to that.

Randy Branson:
Thank you.

Loretta Jackson Brown:
Great. And, Operator, we have time for one more question.

Coordinator:
Do you have another question. The name was not recorded; however, your line is open. Your line is open at this time.

Man:
Hello?

Loretta Jackson Brown:
We can hear you. Go ahead. We can hear you. Ask your question.

Coordinator:
We do have another question. The name was not recorded. Your line is open. Your line is open at this time.

Greg Sunshine:
Hi. Can you hear me?

Brent Spear:
Yes.

Greg Sunshine:
Okay. This is (Greg Sunshine). Did you consider any laws or regulations that could affect response in your development of the assessment or include them as considerations for the assessment itself? And did you also consider laws or regulations that could impede or benefit the formation of coalitions?

Brent Spear:
Truthfully I would say no. No we did not consider any laws or regulations to foster the coalitions or remove barriers. I’m not sure we're that far along yet. It was our position that if folks - if we could put the right tools and give folks the right information to help them foster their own partnerships within the coalitions that they would be useful. It's kind of like what we discussed with the engagement with keeping folks engaged in activities in the coalition. We want them to be sustainable, and really the only way to be sustainable with the absence of federal grant dollars is to make it useful to them. And at this point, our coalitions are buying into the process and the program and are forming those irregardless (sic) of boundaries. They're looking at the coalition partners to increase preparedness within their community. Yes they have challenges and yes they have barriers, but as they work through them together, that also creates ownership, and I think that leads to better sustainability than creating regulation, at least at this point.

Loretta Jackson Brown:
Thank you, Brent. Thank you, Dena and Brent, for providing our COCA audience with such a wealth of information. On behalf of COCA I would like to thank everyone for joining us today. We invite you to communicate to our presenters after the webinar. If you have additional questions for today's presenters, please e-mail us at coca@cdc.gov. Put November 14 COCA call in the subject line of your e-mail and we will ensure that your question is forwarded to our presenters for a response. Again, the e-mail address is coca@cdc.gov.

The recording of this call and the transcript will be posted to the COCA Web site at emergency.cdc.gov/coca within the next few days. Free continuing education is available for this call. Those who participated in today's COCA conference call and would like to receive continuing education should complete the online evaluation by December 13, 2013 using the course code EC1648. That's E as in echo, C as in Charlie and the numbers 1648. For those who will complete the online evaluation between December 14 and December 31, use course code WD1648. All continuing education credit and contact hours for COCA conference calls are issued online through CCE Online, the CDC training and continuing education online system at www2a.cdc.gov/TCEOnline/ online.

To receive information on upcoming COCA calls, subscribe to COCA by sending an e-mail to COCA at coca@cdc.gov and write "subscribe" in the subject line.

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Thank you again for being a part of today's COCA webinar. Have a great day.

Coordinator:
This concludes today's conference call. Thank you for your participation.

END

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