• In coordination with the appropriate federal-level partners, such as the Agency for Healthcare Research and Quality, evaluate the effectiveness, design, and opportunity costs of preparedness strategies, such as exercises.

Recommendation 3:

The committee recommends that CDC should use the Evidence-Based Performance Goals for Public Health Disaster Preparedness to develop standards against which CDC, states, and localities may regularly measure their performance in exercises and in response to proxy events. Public health agency performance in exercises and proxy events should be used to identify gaps in preparedness and to improve planning, communication, and coordination at the agency and interagency levels, as part of a process of continuous quality improvement in preparedness planning and response. Preparedness drills and exercises should not be evaluated individually, but their cumulative and long-term impact on preparedness, such as generalizability to other potential hazards, must be considered in the evaluation process


The public health community has become an active partner in the world of emergency and disaster preparedness and response, joining other members in the traditional emergency management and response field who have defined roles and established ways of doing work (Landesman et al., 2001). Although public health workers and agencies have played active roles after many emergency events (and in some states, the emergency medical services [EMS] entity is part of the state public health agency), public health workers have not necessarily counted themselves or been counted among emergency responders (Landesman et al., 2001; Kahsai and Kare, 2002).

Some important conceptual issues must be considered in the process of more effectively integrating public health into the disaster preparedness and response field. These issues include (1) the history of public health disaster response, and its relevance to contemporary public health preparedness; (2) the unique role of public health in disasters and primary role in disasters that involve biological agents; and (3) the heterogeneity that characterizes the field of emergency and disaster preparedness and response.

A History of Public Health Disaster Response

History provides myriad examples of public health emergencies and disasters (e.g., cholera outbreaks, toxic spills), that wreaked destruction

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