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Research Priorities in Emergency Preparedness and Response for Public Health Systems

A Letter Report

Committee on Research Priorities in Emergency Preparedness and Response for Public Health Systems

Board on Health Sciences Policy

Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill, and Kenneth I. Shine, Editors



Washington, D.C.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

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Research Priorities in Emergency Preparedness and Response for Public Health Systems A Letter Report Committee on Research Priorities in Emergency Preparedness and Response for Public Health Systems Board on Health Sciences Policy Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill, and Kenneth I. Shine, Editors

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 200-2005-13434, TO #10 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, For more information about the Institute of Medicine, visit the IOM home page at: Copyright 2008 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: Institute of Medicine. 2008. Research priorities in emergency preparedness and response for public health systems: A letter report. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

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COMMITTEE ON RESEARCH PRIORITIES IN EMERGENCY PREPAREDNESS AND RESPONSE FOR PUBLIC HEALTH SYSTEMS KENNETH I. SHINE (Chair), The University of Texas System, Austin MARTHA HILL (Vice Chair), Johns Hopkins University School of Nursing, Baltimore, Maryland DAN BLAZER, Duke University Medical Center, Durham, North Carolina THEODORE CHAN, San Diego Metropolitan Medical Strike Team, and University of California–San Diego School of Medicine VINCENT T. COVELLO, The Center for Risk Communication, New York ED GABRIEL, The Walt Disney Company, Burbank, California JULIA GUNN, Boston Public Health Commission, Massachusetts SHARONA HOFFMAN, Case Western Reserve University, Cleveland, Ohio PAUL JARRIS, The Association of State and Territorial Health Officials, Washington, DC ÂNA-MARIE JONES, CARD: Collaborating Agencies Responding to Disasters, Oakland, California RICHARD C. LARSON, Massachusetts Institute of Technology, Cambridge JOHN LUMPKIN, The Robert Wood Johnson Foundation, Princeton, New Jersey RICARDO MARTINEZ, The Schumacher Group, Kennesaw, Georgia JOANNE NIGG, University of Delaware, Newark PATRICIA QUINLISK, Iowa Department of Public Health, Des Moines DAVID ROSS, Public Health Informatics Institute, Decatur, Georgia IOM Staff Bruce Altevogt, Study Director David Butler, Senior Program Officer Erin Hammers, Research Associate Amy Haas, Administrative Assistant Andrew Pope, Director, Board on Health Sciences Policy Rose Martinez, Director, Board on Population Health and Public Health Practice v

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INDEPENDENT REPORT REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Edward Baker, University of North Carolina School of Public Health Frederick M. Burkle, Jr., Johns Hopkins University Medical Institutions, and Harvard School of Public Health Bruce Calonge, Colorado Department of Public Health and Environment Linda C. Degutis, Yale Center for Public Health Preparedness and Yale University Section of Emergency Medicine Baruch Fischhoff, Carnegie Mellon University Lynn R. Goldman, Johns Hopkins Bloomberg School of Public Health Michelle A. Gourdine, Maryland Department of Health and Mental Hygiene Maureen Lichtveld, Tulane University School of Public Health and Tropical Medicine Judith Monroe, Indiana State Department of Health vii

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viii INDEPENDENT REPORT REVIEWERS Eric K. Noji, The Pentagon Peter Sandman, Risk Communication Consultant Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the letter report before its release. The review of this letter report was overseen by Don Detmer, American Medical Informatics Association, and David R. Challoner, University of Florida. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this letter report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this letter report rests entirely with the authoring committee and the institution.

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CONTENTS BACKGROUND 5 Origin of the CDC-Funded Centers for Public Health Preparedness 7 METHODS 9 Definitions 9 FINDINGS 13 Guiding Principles for the Organization of Centers and Evaluation of Proposals 15 RECOMMENDATIONS 16 Enhancing the Usefulness of Training 18 Improving Timely Emergency Communications 20 Creating and Maintaining Sustainable Preparedness and Response Systems 22 Generating Effectiveness Criteria and Metrics 25 CONCLUSIONS 26 APPENDIXES A References 29 B Public Meeting and Workshop Agenda 31 ix

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