Issue Category: Public Health Preparedness

Fostering Community Resilience: How one Indiana Community Meshed its Resources to Improve Preparedness

By Justin Mast, RN, BSN, CEN, FAWM, Senior Crisis and Continuity Advisor, MESH

Seven years ago, Wishard Memorial Hospital, now Eskenazi Health, was one of five organizations to receive a $5 million grant from the Assistant Secretary for Preparedness and Response to create innovative public health and healthcare emergency response and management models.

To try something new, Dr. Charles Miramonti, an emergency department physician, looked at relationships, policy and technology. Ultimately, he created a team of healthcare leaders from all of the area’s major hospitals, known as the Managed Emergency Surge for Healthcare (MESH) Coalition, based in Indianapolis.

Initially, MESH created a framework for sharing resources, a centralized cache of supplies, protocols for coordinated emergency response efforts and training opportunities. All these efforts better centralized preparedness functions across the Central Indiana region.

After building the coalition, marshalling resources and creating efficiencies in public health preparedness, to continue our work, we hosted a work group to focus on disaster planning for children, mothers and expecting mothers.

Quickly, we realized that we had to build community resiliency and that there was a significant vulnerable population that hadn’t been fully addressed when it comes to preparing for emergencies: children who are dependent on electric equipment, most notably ventilators.

During weather events, we found that families with children on ventilators were coming to the emergency room to ensure they would have electricity. They often brought other family members and stayed for the duration of the storm.

To look at the problem, we took three steps:

  1. Fact finding and research;
  2. Creating a registry of children in the state who are dependent on ventilators; and
  3. Writing an educational toolkit for families and providers (also in Spanish).

First, we wanted to see if there were places other than hospitals that would be able to maintain a power supply during an emergency. It would be beneficial to the entire community to keep people out of the hospital if they didn’t need urgent care at that moment—as long as we could safeguard their health.

We spoke with emergency personal in every county to get a sense of what resources existed and what needs there were—we needed to know if it was possible to give families another location they could go to during an emergency. Ultimately, we developed a database that includes 181 power safe facilities with nearly two locations for every county.

While having the alternate locations mapped was great, they would only be helpful if we could identify and inform the families that would need to use them. So, we built a HIPAA compliant registry that parents can use to register their ventilator-dependent children.

The third piece of the puzzle was informing and educating families and responders. We wanted to give families tools to connect with local resources because it’s far easier—in more rural areas—to get to those places during an emergency. We also wanted to empower families to reach out to these services and personnel, which would make the connections even stronger.

So, we created tools, including a video (also in Spanish), to educate families on how weather could impact the power supply their children depended on. The toolkit includes draft letters families can send to authorities—such as EMS and fire—to let them know in advance there is an electrically dependent patient in the household.

We then gave the toolkit to hospital nurses to pass along to families at discharge. And, throughout the development, we partnered with the Indiana Emergency Medical Services for Children (IEMSC), Indiana State Department of Health and other partners whom were instrumental in creating the toolkit and spreading the resources across the state.

We also worked with medical equipment providers and let them know that there are resources for families. They were extremely happy to provide information on the toolkit and registry to their patients.

It’s hard to believe that just five years ago each individual Central Indiana hospital and healthcare facility prepared to face a public health emergency on its own—completely apart from the other resources, infrastructure and partners, just down the road.

Now, the MESH Coalition is helping providers prepare for and respond to emergency events and communities remain viable and resilient through recovery.

We know that, by forging these innovative partners, we have saved millions of dollars on redundant equipment and emergency supplies. Through all of these efforts, the MESH Coalition is building resilience in the healthcare sector and improving everyday life for Hoosiers.

Collaborative Applauds HHS Move to Expand Efforts to Confront Opioid Abuse Epidemic

WASHINGTON, D.C. (March 27, 2015) – The Collaborative for Effective Prescription Opioid Policies (CEPOP) provided a ringing endorsement today for new actions to confront the opioid abuse epidemic announced March 26 by Health and Human Services Secretary Sylvia M. Burwell. The Administration’s initiative includes new funding to support health professional decision-making, the use of naloxone (a medication used to counter the effects of opioid overdose), and the expansion of medication-assisted treatment.

“Far too many families have been devastated by this epidemic,” observed CEPOP co-founder, Hon. Mary Bono. “These strategies are part of a comprehensive and coordinated effort to prevent opioid addiction and save lives. I’m encouraged by these positive steps.”

Community Anti-Drug Coalitions of America Chairman and CEO and CEPOP co-founder General Arthur Dean also commented that “the organizations participating in our Collaborative are dedicated to developing and advocating for solutions like these. I am confident that CEPOP will be mobilizing support for initiatives like this both in the federal budget process and on the ground in communities that are so deeply affected by this crisis.”

Jeffrey Levi, PhD, Executive Director of Trust for America’s Health and CEPOP co-founder, said “by promoting evidence-based strategies, these actions will help coordinate and align public health’s and traditional healthcare’s efforts to reduce opioid dependence and address the overdose crisis. CEPOP will continue to build a diverse and engaged group of organizations that advocate for a wide range of policy solutions to the opioid epidemic at the local, state and national level.”

About CEPOP

The Collaborative for Effective Prescription Opioid Policies (CEPOP) brings together a broad array of stakeholders interested in the appropriate use of opioid medications. Specifically, CEPOP supports a comprehensive and balanced public policy agenda that reduces abuse and promotes treatment options, both for those living with pain and confronting addiction. CEPOP’s advocacy is focused on driving actions in the public sector that develop and deploy evidence-based solutions to these challenges.

Measles Vaccination Rates for Preschoolers Below 90 Percent in 17 States

February 4, 2015

Washington, D.C., February 4, 2015 – An analysis released today by Trust for America’s Health (TFAH) finds that fewer than 90 percent of children ages 19-to-35 months old have received the recommended vaccination against measles, mumps and rubella (MMR) in 17 states.

New Hampshire has the highest MMR vaccination rate for preschoolers at 96.3 percent, and Colorado, Ohio and West Virginia have the lowest at 86 percent. (Data based on the latest completed National Immunization Survey from 2013). No state in the Northeast was below 90 percent, while eight states in the South, five in the West and four in the Midwest had rates below 90 percent. Nationally 91.1 percent of preschoolers are vaccinated.

“Sadly, there is a persistent preschooler vaccination gap in the United States. We’re seeing now how leaving children unnecessarily vulnerable to threats like the measles can have a tragic result,” said Jeffrey Levi, PhD, executive director of TFAH. “We need to redouble our national commitment to improving vaccination rates.”

Healthy People 2020 set 90 percent as the baseline national goal for preschooler MMR vaccinations. Reaching the national rate of 91.1 percent has helped reduce measles rates by 99 percent. Achieving even higher vaccination rates would help protect even more individuals and increase “herd immunity” protection for the wider community. The U.S. Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend that every child receive a first dose of the MMR vaccine after reaching the age of 12 months old. A second MMR dose is recommended for 4-to-6 year olds.

“It is so important that communities maintain high levels of MMR vaccination—because measles is so infectious—and especially when outbreaks are occurring around them,” said Litjen (L.J) Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition. “To have pockets where community immunity is below 90 percent is worrisome as they will be the ones most vulnerable to a case of measles exploding into an outbreak.”

Rates of preschooler vaccinations are typically lower than for school-age children, since they are not yet in the school system, which require vaccinations for children to attend. Among kindergarteners, 94.7 percent have been vaccinated for measles, with a high of 99.7 percent in Mississippi and a low of 81.7 percent in Colorado. States differ significantly in policies allowing parents to “opt-out” of the attendance requirements. Within states, even states with high MMR vaccination rates, there can be communities with groups of individuals who are unvaccinated, making these communities vulnerable to measles and other preventable diseases.

In January 2015, CDC issued a Health Advisory about an ongoing multi-state measles outbreak, which has been linked to more than 102 cases in 14 states so far. Most individuals who get the measles are not vaccinated – including infants. In 2000, measles was declared virtually eliminated in the United States, when cases dropped to around 60. Measles rates remained below 100 from 2002 to 2007, with many of those cases linked to overseas travel. In 2014, there was a surge in measles, with at least 23 outbreaks and more than 600 cases.

Measles is a highly contagious, viral illness that can lead to health complications, including pneumonia, encephalitis and eventually death. Prior to routine vaccination, measles infected approximately three to four million Americans, killed 400 to 500 individuals and led to 48,000 hospitalizations each year.

Vaccines undergo rigorous review and testing for effectiveness and safety by the Food and Drug Administration (FDA) before they are released to market and safety is also tracked through several monitoring systems once they are in use. Numerous reviews, including by all of the existing studies by the Institute of Medicine (IOM), have concluded that the MMR vaccine is safe and has no causal link to developmental disorders.

Overall, there is a long-standing preschooler vaccination gap in the United States. More than 2 million preschoolers do not receive all recommended vaccinations on time: 27.4 percent do not receive the full childhood series (4:3:1:3:3:1:4); 27.4 percent do not receive the rotavirus vaccine; 18 percent do not receive the pneumococcal vaccine; 16.9 percent do not receive the diphtheria, tetanus and whooping cough vaccine; 9.2 percent do not receive all three doses of the hepatitis B vaccine; 8.8 percent do not receive the chickenpox vaccine; and 7.3 percent do not receive the polio vaccine.

In addition, many infants (by 13 months) do not receive all recommended vaccines: 43.2 percent do not receive the chickenpox vaccine; 12.6 percent do not receive the pneumococcal vaccine; 10.7 percent do not receive the meningitis, pneumonia and epiglottis Hib vaccine; 10.6 do not receive the diphtheria, tetanus and whooping cough vaccine; 15.4 percent do not receive all three doses of the hepatitis B vaccine; and 6.3 percent do not receive the polio vaccine.

Some key recommendations for improving vaccination rates include:

  • Increasing public education campaigns about the safety and effectiveness of vaccines;
  • Minimizing vaccine exemptions – states should enact and enable universal childhood vaccinations except where immunization is medically-contraindicated. Non-medical vaccine exemptions, including personal belief exemptions, enable higher rates of exemptions in those states that allow them;
  • Increasing provider education and vaccine standard of practice to help ensure providers are responsibly promoting the importance of vaccination to their patients and actively tracking whether patients have received all recommended vaccinations and providing them when they have not;
  • Bolstering immunization registries and tracking to help ensure children’s and adults’ immunizations are up-to-date, and providers can identify when an individual is missing a recommended vaccination. Immunizations registries should be integrated with electronic health records (EHRs) and be interoperable across providers, so, for instance, if a child goes to the doctor with a stomach virus or visits a specialist, they can easily flag if a child has not received a vaccine and can provide it then. There should also be increased education for providers to support and expand vaccinations as standard practice and to discuss and track vaccination histories with their patients;
  • Expanding alternate delivery sites – the National Vaccine Advisory Committee (NVAC) has recommended including expansion of vaccination services offered by pharmacists and other community immunization providers, vaccination at the workplace and increased vaccination by providers who care for pregnant women; and
  • Supporting expanded research and use of alternatives to syringe administration of vaccination – experiences with alternative delivery methods, such as using the nasal mist intranasal administration of live-attenuated influenza vaccine (LAIV), have been well-received by the public and have contributed to increased uptake in pediatric and adult vaccinations.

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State-by-state estimated vaccination coverage with the recommended one or more does of measles, mumps, rubella (MMR) vaccine among children ages 19-to-35 months old (Data source: National Immunization Survey, 2013).

1. New Hampshire (96.3%); 2. Washington, D.C. (96.2%); 3. North Carolina (96.0%); 4. Massachusetts (95.8%); 5. (tie) New Jersey (95.6%) and Rhode Island (95.6%); 7. New York (95.5%); 8. Maryland (95.3%); 9. Mississippi (95.2%); 10. Delaware (94.8%); 11. Iowa (94.5%); 12. Georgia (93.9%); 13. Washington (93.5%); 14. Florida (93.4%); 15. Pennsylvania (93.3%); 16. Wisconsin (93.2%); 17. South Dakota (93.1%); 18. Hawaii (92.8%); 19. Texas (92.7%); 20. Utah (92.6%); 21. Nebraska (92.5%); 22. Tennessee (92.3%); 23. Indiana (92.0%); 24. (tie) Arizona (91.4%), Connecticut (91.4%), Illinois (91.4%) and North Dakota (91.4%); 28. Vermont (91.2%); 29. Idaho (91.1%); 30. Maine (91.0%); 31. Minnesota (90.8%); 32. California (90.7%); 33. Alaska (90.5%); 34. Nevada (90.4%); 35. (tie) Missouri (89.8%) and Oklahoma (89.8%); 37. Alabama (89.7%); 38. Kentucky (89.5%); 39. (tie) Kansas (89.4%) and Oregon (89.4%); 41. (tie) South Carolina (89.2%) and Michigan (89.2%); 43. New Mexico (89.1%); 44. Wyoming (89.0%); 45. Virginia (88.6%); 46. Arkansas (88.3%); 47. Louisiana (88.1%); 48. Montana (87.3%); 49. (tie) Colorado (86.0%), Ohio (86.0%) and West Virginia (86.0%).

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health’s Statement on the Public Health Aspects of the President’s Proposed Budget

February 3, 2015

Washington, DC, February 3, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) and chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

“If adopted, the President’s budget would take a major step toward building a culture of health in the United States, as it invests in programs and policies that enable Americans to be healthier – and to be better protected from infectious diseases, foodborne illnesses and other threats.

TFAH strongly supports the President’s proposal to end sequestration. Sequestration has resulted in sharp and indiscriminate cuts to public health programs – and ending it shows a commitment to the need for a strong, effective public health system in this country.

We are pleased to see increased support for programs that can improve health in people’s daily lives – where they live, learn, work and play. Mounting evidences shows programs like the Earned Income Tax Credit, the Child Care Tax Credit, early childhood education, family home visiting and the Children’s Health Insurance Program contribute to the long-term health of children and their families and are essential building blocks to a lifetime of wellbeing.

The proposal also recognizes the need for increased resources to fight one of the country’s fastest growing, most troubling and most preventable public health epidemics – devoting more than $100 million in new investments to combat prescription drug misuse and related heroin abuse.

In addition, the budget demonstrates how important ongoing investments into a standardized set of core “foundational capabilities” for all health departments are. All Americans should be assured that their state and local health departments have the same ability to help them be healthy. To this important end, the President’s budget identifies $8 million to start down the path of this kind of assurance.

However, while this is important, it is more than offset by the zeroing out of the $160 million Preventive Services Block Grant, a mechanism that is currently used by health departments to maintain capabilities and services. We recommend restoration of the block grant funding, along with clear direction that the funding be used for foundational public health capabilities and services.

Another low-point of the budget is the proposal to significantly cut chronic disease prevention programs – including some of the most important programs that support preventing obesity, tobacco cessation and related health problems. Given the national priority to reduce healthcare costs, this is particularly ironic since we know chronic diseases are one of the biggest drivers of these costs.

Some key public health highlights in the budget include:

  • A $36 million increase to the Strategic National Stockpile, which provides medicine and medical supplies to protect the American people during a public health emergency;
  • A $264 million investment to help the Centers for Disease and Prevention (CDC) combat antibiotic resistance;
  • A $107 million increase for the Biomedical Advance Research and Development Authority (BARDA) to spark the research and development of new antibiotics, vaccines, medical treatments and medical devices;
  • The creation of a single, independent food agency to provide leadership and prevent and respond to outbreaks of foodborne illness and an increase of $109.5 million to the Food and Drug Administration to implement the Food Safety Modernization Act (though much of this increase is in the form of unauthorized user fees which Congress should enact regardless of a policy decision on user fees). The creation of a single food safety agency has been a long-standing priority for TFAH and we hope it is the start of a broader coordination of public health programs across the federal government;
  • A $31.5 million increase in programs to combat viral hepatitis, almost doubling the nation’s resources;
  • A $10 million increase for the CDC climate and health program to fund 30 additional state and local grantees, though this is offset by an $11 million cut to the National Environmental Public Health Tracking program; and
  • A $128.1 million increase in the Vaccines for Children Program, though this is offset to some degree by a $50 million cut in the discretionary immunizations program.

Some key public health low-lights include:

  • Zeroing out the $160 million Preventive Services Block Grant – which is a key mechanism state and local public health agencies use to maintain capabilities and services;
  • A $20 million cut to the Partnerships for Improving Community Health (PICH), which works to address common risk factors for chronic disease;
  • A $7.5 million cut from the Division of Nutrition, Physical Activity and Obesity for programs focused on reducing obesity in high obesity rate counties; and
  • Elimination of the Racial and Ethnic Approaches to Community Health (REACH), which helps address key chronic disease conditions in the hardest hit populations.

TFAH looks forward to working with the Administration and Congress to ensure strong and sustained funding for public health – to foster a nationwide culture of health and improve the health and wealth of the nation.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. 

“Outbreaks” Report Finds Gaps in Nation’s Ability to Respond to Ebola and Other Infectious Diseases; 25 States Reach Half or Fewer of Key Indicators

December 18, 2014

Washington, D.C., December 18, 2014 – A report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.

Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks.  Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators.  Arkansas has the lowest score at two out of 10.  The indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“Over the last decade, we have seen dramatic improvements in state and local capacity to respond to outbreaks and emergencies.  But we also saw during the recent Ebola outbreak that some of the most basic infectious disease controls failed when tested,” said Jeffrey Levi, PhD, executive director of TFAH.  “The Ebola outbreak is a reminder that we cannot afford to let our guard down. We must remain vigilant in preventing and controlling emerging threats – like MERS-CoV, pandemic flu and Enterovirus – but not at the expense of ongoing, highly disruptive and dangerous diseases – seasonal flu, HIV/AIDS, antibiotic resistance and healthcare-associated infections.”

Some key findings from the Outbreaks: Protecting Americans from Infectious Diseases report include progress and gaps in the areas of:

  • Preparing for Emerging Threats:  Significant advances have been made in preparing for public health emergencies since the September 11, 2001 and the anthrax attacks, but gaps remain and have been exacerbated as resources were cut over time.
    • 47 states and Washington, D.C. reported conducting an exercise or using a real event to evaluate the time it took for sentinel laboratories to acknowledge receipt of an urgent message from the state’s laboratory.
    • Only 27 states and Washington, D.C. met a score equal to or higher than the national average for the Incident and Information Management domain of the National Health Security Preparedness Index.
  • Vaccinations:  More than 2 million preschoolers, 35 percent of seniors and a majority of adults do not receive all recommended vaccinations.
    • Only 14 states vaccinated at least half of their population against the seasonal flu (from fall 2013 to spring 2014).
    • Only 35 states and Washington, D.C. met the goal for vaccinating young children against the hepatitis B virus (Healthy People 2020 target of 90 percent of children ages 19 to 35 months receiving at least 3 doses).
  • Healthcare-Associated Infections:  While healthcare-associated infections have declined in recent years due to stronger prevention policies, around one out of every 25 people who are hospitalized each year still contracts a healthcare-associated infection.
    • Only 16 states performed better than the national standardized infection ratio for central-line-associated bloodstream infections.
    • Only 10 states reduced the number of central line-associated bloodstream infections between 2011 and 2012.
  • Sexually Transmitted Infections and Related Disease Treatment and Prevention:  The number of new HIV infections grew by 22 percent among young gay men, and 48 percent among young Black men (between 2008 and 2010); more than one-third of gonorrhea cases are now antibiotic-resistant; and nearly three million Baby Boomers are infected with hepatitis C, the majority of whom do not know they have it.
    • 37 states and Washington, D.C. require reporting of all (detectable and undetectable) CD4 and HIV viral load data, which are key strategies for classifying stage of disease, monitoring quality of care and preventing further transmission of HIV.
  • Food Safety:  Around 48 million Americans suffer from a foodborne illness each year.
    • 38 states met the national performance target of testing 90 percent of reported E.coli O157 cases within four days (in 2011).

“The best offense to fighting infectious diseases is a strong and steady defense,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “Infectious disease control requires having systems in place, continuous training and practice and sustained, sufficient funding.  As we work with communities across the nation to build a Culture of Health, we recognize that promoting and protecting health, and readiness to respond to wide-scale health threats are essential.”

The Outbreaks report recommends that it is time to rethink and modernize the health system to better match existing and emerging global disease threats.  Priority improvements should include:

  • Core Abilities:  Every state should be able to meet a set of core capabilities and there must be sufficient, sustained funding to support these capabilities.  Some basic capabilities include: investigative expertise, including surveillance systems that can identify and track threats and communicate across the health system and strong laboratory capacity; containment strategies, including vaccines and medicines; continued training and testing for hospitals and health departments for infection control and emergency preparedness; risk communications capabilities that inform the public without creating unnecessary fear; and maintaining a strong research capacity to develop new vaccines and medical treatments;
  • Healthcare and Public Health Integration:  Systems must be improved so the healthcare system, hospitals and public health agencies work better together toward the common goals of protecting patients, healthcare workers and the public; and
  • Leadership and Accountability:  Stronger leadership is needed for a government-wide approach to health threats at the federal, state and local levels, and there must be increased support for integration and flexibility of programs in exchange for demonstration of capabilities and accountability.

The report and state-by-state materials was supported by a grant from RWJF.

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

8 out of 10: Maryland, Massachusetts, Tennessee, Vermont and Virginia

7 out of 10: California, Delaware, Nebraska, New Hampshire, North Dakota, Pennsylvania and Wisconsin

6 out of 10: Colorado, Connecticut, Florida, Hawaii, Illinois, Iowa, Minnesota, New York, North Carolina, Rhode Island, South Carolina, South Dakota and Texas

5 out of 10: Alabama, D.C., Georgia, Indiana, Michigan, New Mexico, Oklahoma, Oregon, Utah and West Virginia

4 out of 10: Alaska, Arizona, Maine, Mississippi, Missouri, Montana, Nevada and Washington

3 out of 10: Idaho, Kansas, Kentucky, Louisiana, New Jersey, Ohio and Wyoming

2 out of 10: Arkansas

 

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.