• Conducting an unannounced exercise and comparing the performance of three different groups of personnel (with the same qualifications and functional roles) who have undergone one of the following: (1) preparedness-related training only; (2) training and a tabletop exercise only; (3) training and participation in a comprehensive functional exercise.

  • Randomly assigning educational materials to various types of health personnel to determine whether the type and quality of educational materials have an effect on exercise outcomes.

  • Randomizing the method of preparing responders and the community at large before an exercise is conducted in order to determine the best way to conduct them. Outcomes to be measured would include professional participation rates, community participation, and major desired outcomes of the activity.

The committee also suggests several areas for further study:

  • A systematic assessment of all lessons learned in the course of the smallpox vaccination program (which could be considered a national-level, multisite, months-long preparedness meta-exercise);

  • Determine what knowledge is available about public health preparedness and about conducting exercises (and drills) in public health agencies with experience in this area (history of working with EMS, preparing for nuclear accidents, etc.). Many lines of questioning could be followed in gathering information from public health agencies with a variety of linkages to emergency and disaster response. For example, it may be instructive to compare the engagement of public health in emergency and disaster response in states where EMS is part of public health to states where the two agencies are separate.

  • Systematically assess the lessons learned by state and local public health agencies (perhaps organized by type according to characteristics such as size, urban or rural location, structure and governance) that have conducted exercises and drills. Such an assessment also must include an examination of any evidence that is available or is becoming available in the literature or in the reporting of public health agencies, of the effectiveness of exercises and drills conducted by public health agencies (similar to AHRQ’s recent work [AHRQ, 2004]).

  • A systematic and comprehensive research agenda for studying the response to public health emergencies and disasters be developed.

  • An evaluation of patient safety literature to consider the pre- and posthandling of sentinel events.

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