a populous state. Who else can coordi- nate and help? » Many new recruits lack expertise in operational processes and norms. » Due to sta turnover, it is often di- cult to find the right point of contact. Furthermore, agency websites are often out-of-date and list people who are no longer employed. » Preparedness and response staff are often dierent people because response requires more people and many respond- ers are volunteers. » Health department leadership is often unfamiliar with the Incident Command System (ICS), which can lead to their reluctance to fully sta a response. » Local EPH sta are funded to provide fee-for-service regulatory work such as permitting and compliance enforce- ment. Operational systems and struc- tures for routine work are not condu- cive to emergency preparedness, which has repercussions for the entire disaster management lifecycle. For example, if EPH is not involved in developing haz- ard mitigation, response, and recovery plans, capability gaps will be pervasive. The capacity gaps are frequently demon- strated as a lack of formal procedures for activation, communication, and coordi- nation during an emergency. •Interpersonal challenges exist, some of which are due to the way dierent agencies and groups are structured and some result from communication breakdowns. » The ongoing process of identifying which groups are most important to build rela- tionships with is necessary for success but is time-consuming to conduct. » Interagency and interpartner coordi- nation does not frequently happen in preparedness, which translates to poor coordination in response. » Agencies do not always use the same language or terminology (e.g., job titles, roles dier by agency). » Local EPH and emergency management often do not interact. » EPH is organizationally separated from public health in many jurisdictions. Seamless integration of Emergency Sup- port Function (ESF) 8 partners (public health and medical services) is the foun- dational bedrock for the coordination
of policies and procedures upstream to operations downstream. » Roles and responsibilities are not well defined, which adds to a lack of aware- ness and understanding of the roles of EPH in disasters among the larger emer- gency management community. » The scope of each group is not well defined and often overlaps. » ICS terms are defined, but there is no enforcement of their proper use. • Technologies and tools that responders use are often incompatible with one another, including communications technology, software, and databases. » Data sharing is challenged by incompat- ible technology platforms. » Maintenance of software and online con- tent updates vary depending on the IT capacity of agencies or groups. » The continuity of IT platforms across state lines is uneven (e.g., WebEOCs [Emer- gency Operations Centers], ESSENCE [Electronic Surveillance System for Early Notification of Community-Based Epidemics]). » Job action sheets, mutual aid resource requests, and other tools are outdated or irrelevant to EPH. » Databases are not updated regularly. Fur- ther, dates are not included to indicate when the last update took place, which makes it dicult to determine how cur- rent is the information. » In most organizations, there is a lack of support for database technologies. » Problems with continuity and interoper- ability of software (e.g., incompatibility of GIS software versions). • Training challenges limit the number of qualified people working in preparedness. Initial and continuing education training to maintain certifications is challenging. » Meaningful continuing education oppor- tunities that specifically support EPH preparedness, response, and recovery professionals are lacking. » ICS curricula do not cover EPH. » There is not enough opportunity to partic- ipate in training exercises, in part because EPH professionals are often not invited. » Training exercises that require EPH expertise are infrequently held. As previously stated, a lack of funding for preparedness precludes the par-
ticipation of EPH sta in interagency exercises. » There is a disconnect between the needs of EPH professionals and the training oered by local fire departments and emergency medical services (EMS). » There is a shortage of communica- tion training for EPH preparedness professionals. » Language, definitions, and terminology are not used consistently and vary by agency, group, and geographic region. Recommendations The following recommendations were identi- fied by the panel as solutions for increasing coordination across sectors. • Perform a high-level “landscape analysis” to assess connectivity or the lack of con- nectivity within emergency preparedness. Given the consistent challenges related to a lack of coordination, mapping the existing emergency preparedness ecosystem of fed- eral, state, tribal, territorial, and local agen- cies with an honest assessment of what is and is not well coordinated is needed. •As a first step for local improvements, inventory everyone in your geographic area who works in the fields of emergency pre- paredness and management. Identify which groups and people are most important for building relationships with. Identify who is working well together and who needs to be introduced or invited to the table. • Set a regular schedule for coordination meetings of entities involved in EPH pre- paredness and response (e.g., regional response teams). Regular meetings of EPH professionals that are led by and focus more specifically on this sector can help information, ideas, and best practices transfer across the sector and demonstrates excellence and leadership to other emer- gency preparedness sectors and entities. •Leverage existing resources that help coordination. Many tools and approaches already exist and should be first considered to avoid wasted time and energy. Examples include the following: » Laboratory Response Network for Chemical Threats from the Centers for Disease Control and Prevention (https:// emergency.cdc.gov/lrn/chemical.asp). » Environmental Health Training in Emergency Response (EHTER, www.
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September 2023 • our/#l o( /7+ro/me/5#l e#l5*
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