some commonalities in structure and operations (e.g., a type of emergency operations center and/or other mechanisms for interagency collaboration and coordination, communication activities, information infrastructure). It is important to ensure that planning, conduct, and evaluation of public health exercises at the federal, state, and local levels are compatible with those of DHS activities under the HSEEP. For example, HSEEP describes three levels of performance evaluation: task level performance (individual); agency/discipline/function-level performance; and mission-level performance (interagency, interorganizational, and community) (DHS/ODP, 2003).

The HSEEP Exercise Evaluation Guides for tabletop and operational exercises include public health personnel/agencies under the “response element” heading in addition to EMS, law enforcement, fire department, HazMat, hospitals, and others, and though the exercise methodology indicates that public health is one of the agencies/disciplines/functions to be evaluated in HSEEP, it understandably does not go into detail. If CDC intends to coordinate with or make its public health exercise evaluation compatible with the HSEEP model, the committee suggests that existing resources, such as the Public Health Competencies for Bioterrorism and Emergency Preparedness be utilized in customizing the individual-level evaluation and that the Local and State Public Health Preparedness and Response Capacity Inventories be included in customizing the agency-level evaluation.

In preceding pages, the committee has explored the potential of proxy events and exercises as means to performance measurement. 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 inter-agency 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.


In closing, the committee encourages CDC to learn from the experience and research available from other fields, including, but not limited to disaster research and emergency and disaster response, and to develop the evidence base specific to public health preparedness; strengthen and sustain

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