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The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Nathan Myers
March 25, 2016
The State of Florida has seen its share of disasters, from hurricanes to the recently declared Zika emergency. One positive outcome from these experiences is that it has promoted a strong interest in public health planning and preparedness. This is exemplified by numerous Florida public health departments receiving the Public Health Ready designation from the National Association of City and County Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). One of these health departments is Santa Rosa County, which originally received certification in 2009 and was recently recertified.
Michelle Hill, a nursing program specialist and public health preparedness planner for Santa Rosa County, attributes the department’s on-going commitment to preparedness to public health administrator Sandra Park-O’Hara, an advanced registered nurse practitioner. “We’re pretty unique here,” Hill said. “We have a planning team that she (Park O’Hara) created. She combined programs together. So epidemiology, Medical Reserve Corps, public health preparedness and environmental health are all in one division. We attend biweekly planning meetings to review plans, design trainings and exercises, know what is going on in the community. That was all her vision.”
The Florida Department of Health in Santa Rosa County (DOH-Santa Rosa) draws support for planning and preparedness from a diverse network of partners, including county emergency management, other health departments, state health officials, a regional domestic security task force, hospitals, mental health facilities, faith-based organizations, medical equipment companies, Medical Reserve Corps and animal services.
Collaborative relationships not only allow DOH-Santa Rosa to expand the scope of their services, they have also been important for helping the county to continue planning and preparedness activities in the face of major budget cuts since 2009. Currently, their staff consists of less than 70 people who are cross-trained to serve in multiple positions. This does limit the amount of training the department can accommodate. A number of preparedness services the department offers, such as a rabies clinic, must be offered after hours so as not to interfere with other health department functions.
Despite challenges in funding and personnel, DOH-Santa Rosa has seen its preparedness work yield dividends in recent years. Hill noted the example of a spring 2014 flood that rendered one public health facility inoperable. Santa Rosa County activated their continuity of operations plan to relocate the affected personnel to alternate locations, allowing for a smooth transition and continuation of services.
Another example was meetings and training to prepare for the Ebola virus in 2015. “We’ve always said what is done before disasters is more important than what is done after,” Hill said. “It was a very good experience for our department because staff felt comfortable in the incident command structure. The internal investigation and containment teams were activated, we knew what the points of contact at facilities were and we were able to call in and answer their questions. We were also able to run through some scenarios and training with them.”
During both the flood and Ebola response, Santa Rosa County staff also learned important lessons to apply to future preparedness efforts. The use of the continuity of operations plan highlighted the importance of documenting all response activities so that they can be reviewed later, as well as the need to make changes to the plan in regard to the functions of personnel. The need for a training exercise related to the continuity of operations plan was also identified. In the wake of preparations for Ebola, the county noted the need for more epidemiology training and surge capacity.
In addition to responding to an emergency as it unfolds, public health departments should also be prepared to aid in the recovery of the community. Planning was conducted for a long-term county recovery operation involving partners from the public, private and nonprofit sectors. Identified areas of need during a recovery operation would include mental health care and surveillance to guard against the contagion’s resurgence.
Surveillance is one area that Hill points to as becoming more innovative as a result of building planning and preparedness capacity. “I think what is unique about us is that our epidemiology and public health preparedness are married together,” Hill said. “That came about because when we were doing all this outreach, meetings, trainings and exercises, departments realized they are sharing the same community partners and issues. Those two departments work hand-in-hand on a daily basis.”
In conclusion, Hill and Deborah Stilphen, an operations analyst with the department, emphasized the manner in which building trust during the planning process can aid in the success of future responses. Strong community partnerships facilitate the pooling of resources, as well as the development of new resources. “I think this health department stands out for being so involved with the community,” Hill said. “That really helps when things come up because we know who we’re working with. They can trust us, and the community really sees our administrator as a leader.”
Both Hill and Stilphen would encourage other public health departments that have not already done so to go through the Public Health Ready process.
Author: Nathan Myers is an assistant professor of Political Science at Indiana State University (ISU). Myers is also a member of the ISU Center for Genomic Advocacy. His teaching and research interests include organizational behavior, public health policy and biotechnology policy associated with genomic research.