Proceedings of a Workshop
Exploring the Translation of the Results of Hurricane Sandy Research Grants into Policy and Operations
Proceedings of a Workshop—in Brief
The workshop Translating the Results of Hurricane Sandy Research Grants into Policy and Operations was convened on July 20, 2017, in Washington, DC, by the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. David Eisenman, professor of medicine at the University of California, Los Angeles, explained the workshop’s objectives of exploring key findings from published Hurricane Sandy research grant projects,1 examining the impact of the scientific findings on disaster policy2 and operations,3 and discussing opportunities to translate the research findings to future preparedness response and recovery efforts. The workshop included panel sessions focused on the potential policy and operational implications from research on mental health, public health, access to care, and primary care. An additional “marketplace” session gave researchers, operations agents, and policy experts an opportunity to discuss particular research findings and how they might be applied to operations and policy. In his charge to participants, Leremy Colf, director of disaster science at the Office of the Assistant Secretary for Preparedness and Response (ASPR), emphasized that exploring the operational and policy implications of the research should serve the overarching aim of saving more people’s lives during disasters. Hurricane Sandy made landfall in the New York City (NYC) area on October 29, 2012, he said, leading to disaster declarations in 11 states and affecting many others. Hurricane Sandy caused extensive damage to homes, hospitals, transportation systems, pharmacies, and general infrastructure, as well as flooding, power outages, evacuations, mold, and other long-term consequences. It was the second-costliest hurricane in U.S. history—the Federal Emergency Management Agency (FEMA) dispensed more than $16 billion in New York (NY) and New Jersey (NJ) alone—and caused 117 deaths in the United States, mostly from drowning or immediate trauma. The secondary effects and long-term health consequences were widespread. The response and recovery were hampered by lack of research evidence to inform policy and operations, he said, and thus the aim of the workshop was to explore the research that was funded by the Hurricane Sandy Grant Program and suggest ways to translate their findings to operations and policy in order to better prepare for the next disaster.
1 Research was conducted through the Hurricane Sandy Grant Program, with funding from the Hurricane Sandy supplemental, and administered by ASPR, the Centers for Disease Control and Prevention (CDC), and the National Institute of Environmental Health Sciences (all agencies are within the U.S. Department of Health and Human Services). More information can be found at https://www.phe.gov/Preparedness/planning/SandyResearch/Pages/default.aspx (accessed August 21, 2017).
2Policy is defined as the course of action adopted by a group to change a certain situation through regulations, guidelines, or other methods. Oftentimes, policy work enables future operational changes.
3Operations is defined as the boots-on-the-ground or behind-the-scenes actions that address the physical aspects of a disaster.
POTENTIAL IMPLICATIONS FOR MENTAL HEALTH POLICY AND OPERATIONS
The first panel consisted of four speakers: Andrew Rosenblum, executive director of the National Development and Research Institutes, Inc.; R. Charon Gwynn, deputy commissioner of the epidemiology division, NYC Department of Health and Mental Hygiene (DOHMH); Sarah Lowe, assistant professor at Montclair State University; and Shao Lin, professor of environmental health sciences at the University at Albany State University of New York (SUNY). The panel’s introductory moderator, David Abramson, director of the New York University (NYU) Program on Population Impact Recovery and Resiliency, began the session by saying that mental health outcomes are important population health outcomes because the chaos that every disaster generates affects populations and is most commonly demonstrated through distress and other mental health effects. He suggested five themes for policy makers and operators to consider in preparing for and responding to a disaster: (1) intervening early with mental health issues, (2) attending to vulnerable populations, (3) recognizing family dynamics as a stabilizing force to prevent the exacerbation of post-event mental health problems, (4) considering how interagency coordination can facilitate mental health services, and (5) considering how to address mental health issues at the community level to avoid overwhelming the clinical care system.
Rosenblum described research on Hurricane Sandy’s impact on methadone maintenance treatment provided by opioid treatment programs (OTPs) in NY and NJ (Elliott et al., 2017; Matusow et al., 2017). He said many patients must visit OTPs daily to receive methadone; disruption precipitates withdrawal and often leads to relapse and risk of overdosing. Only one of nine OTPs continued to operate at normal capacity post-storm, he said, and their continuity of operations (COOP) plans were generally lacking in critical provisions for communicating with patients during and after the storm, addressing transportation needs, and identifying alternative programs for “guest dosing.” Rosenblum suggested that OTPs develop comprehensive COOPs with up-to-date patient contact details, distribute patient emergency kits (including naloxone, an overdose reversal medication), and allow a flexible medication take-home policy for pending disasters. He said a secure national database with current dosage information would facilitate guest dosing and that better interagency cooperation would allow OTP staff to work during a disaster without facing licensing and regulatory barriers.
Gwynn presented research on the impact of Hurricane Sandy on mental health service use in NYC (He et al., 2016). Disasters can cause or exacerbate psychological distress, she said, so continuity of care during and after a disaster is critical. The research found that the NYC hospitals that stayed open during and after Hurricane Sandy received a substantially larger number of mental health–related emergency department (ED) visits—which persisted for up to 6 months—and had more patients with mental health hospitalizations during the 2 to 3 months post-storm. In terms of policy, she suggested that hospitals plan together to address the impact of hospital closures on other area hospitals in terms of resource allocation, as well as specific planning for increased mental health ED visits for prolonged periods post-disaster.
Lowe reported the findings of a study on the community influence on mental health among NYC residents after Hurricane Sandy (Lowe et al., 2015). In some cases, she said, community-level factors had independent, seemingly counter-intuitive effects on outcomes—for example, people living in areas where fewer residents lived alone tended to have more severe symptoms of posttraumatic stress disorder (PTSD). In other cases, community-level damage exacerbated the relationship between individual-level exposure to stressors and the perceived need for mental health services. Mental health outcomes were geospatially clustered in certain areas, she said, but there were geographically specific individual-level risk factors (e.g., being a parent was a risk factor for higher depression in Brooklyn but was protective against depression in the Bronx). She suggested that the findings could be used to target individuals at risk within a given community and improve service deployment in high-risk communities. Furthermore, she noted, the agent-based modeling suggested that a stepped-care treatment approach, with patients triaged according to symptom severity, could reduce mental health adverse outcomes like PTSD.
Lin described a study on individual, community, and environmental factors affecting health outcomes after Hurricane Sandy (Lin et al., 2016). Lin said that multiple environmental hazards occurring during a disaster (flooding, blackouts, fires, winter weather, air and water quality problems) may simultaneously intensify its health impacts. The research found a direct association between areas affected by power outages and the number of mental health ED visits during the hurricane; Lin suggested improving response planning by identifying co-environmental hazards such as power outages. The research also found that ED visits for anxiety increased significantly, as did length of stay and costs for mental health ED visits during and after the storm. Lin said that comorbidities, like alcohol and opioid abuse, increased by 17 percent. Population vulnerability analysis found that women, people aged over 65 years, and people living in mobile homes4 were at increased risk of mental health morbidities during Hurricane Sandy. These findings could inform disaster planning
4 Bruce Evans, National Association of Emergency Medical Technicians, reiterated that populations living in mobile-home complexes are hugely at risk from an emergency response perspective.
around disease burden, case management, and displacement, Lin suggested, and could lead to the development of a vulnerability-resilience index and predictive model that would be a practical tool for disaster preparedness.
Reflecting on the first panel session, Eric Carbone, director of the Office of Applied Research in CDC’s Office of Public Health Preparedness and Response, noted the importance of ensuring continuity of care during emergencies for methadone patients and other conditions that require ongoing care. Coordination and planning for surge management across health care systems could help avoid overwhelming hospitals, he said. Profiling community-level variability in population vulnerabilities could help in assessing, mapping, and planning for community-level factors, he noted. He also highlighted the issue of stigma as it relates to underuse of mental health services and stressed that mental health care providers should be trained in trauma-informed care, because prior traumatization is a major risk factor for developing PTSD during disasters. The importance of opioid research and its possible significance in future disaster response was stressed by several workshop participants during the panel and marketplace session discussions.
Abramson shared his observations of the mental health discussions that took place during the marketplace session. He noted the need for better COOP planning by all health system providers, which could be operationalized by regulating and incentivizing COOP training and drills through the vehicle of broadened health coalitions. He emphasized the importance of understanding communities and their constituent populations, as well as the need for improved screening and assessment given that vulnerability varies by event and by context. During the marketplace session, several participants discussed the use of integrated service models to embed mental health within primary care and in public health planning to ensure that patients identified through screening receive continuity of care with higher-level mental health services. To expand mental health operations, Abramson said, mobile mental health units and triage strategies for prioritizing people with mental health needs were suggested. To improve coordination among community-based providers, Abramson suggested expanding the definition of essential or critical workforce during a disaster. Ruth Schelhaus, environmental health specialist at Advancia Corporation, suggested having OTPs specifically flagged as critical infrastructure and recognizing OTP providers as emergency staff. John Osborn, operations administrator at the Mayo Clinic, suggested creating a cadre of community-based mental health providers to activate for acute intervention during response and for mid-term management of displaced patients. Don Brannen, Medical Reserve Corps unit leader, suggested merging FEMA emergency support function (ESF) #6 (mass care, emergency assistance, housing, and human services) with ESF #8 (public health and medical services) at the local level to address the lack of planning for chronic mental health care and allow for rapid mental health triage in cooperation with first responders during emergencies.5 Mitch Stripling, director of emergency planning at the NYC DOHMH, suggested several ways to operationalize disaster-related mental health care: messaging to clients pre-disaster, using targeted mental health outreach strategies, triaging mental health patients into a step-wise program, and adopting a long-term approach to mental health post-disaster.
POTENTIAL IMPLICATIONS FOR PUBLIC HEALTH POLICY AND OPERATIONS
The second panel had four speakers: Asante Shipp-Hilts, senior project coordinator in the School of Public Health, University at Albany SUNY; Amy Davidow, associate professor of biostatistics at Rutgers University; Daniel Barnett, associate professor of public health at Johns Hopkins University; and Thomas Chandler, associate research scientist at the National Center for Disaster Preparedness at Columbia University. Sandro Galea, dean of the School of Public Health at Boston University, introduced the session by saying the difficulty academics have in collecting data for their research is minor when compared to the difficulties faced by his colleagues in operations and policy, who have to take published papers and apply those ideas to their practice. He then introduced Shipp-Hilts, who presented research on the NY public health response to Hurricane Sandy that was gathered from survey responses as well as analysis of emergency and after-action reports (Shipp-Hilts et al., 2016a,b,c).
Shipp-Hilts reported that in local health department emergency reports, emergency operations coordination was the capability most often cited both as a strength (e.g., sharing information to monitor at-risk health care facilities) and a challenge (e.g., the need for standing contracts with municipalities to share resources more seamlessly). She said that in state health department emergency reports, the capability for emergency operations coordination was also the most commonly cited strength—for example, regular communication among federal, state, and local partners—and the most commonly cited challenge was environmental health protection capability. In the surveys, she said, local health department staff reported a lack of adequate resources, and both state- and local-level staff reported they had no training for weather-related emergencies. To address state-level challenges, she suggested identifying staff needs regarding equipment and information during a disaster, clearly delineating incident command roles, and developing an electronic system for sharing
5 More information about the emergency support functions can be found at https://www.fema.gov/media-library/resources-documents/collections/533 (accessed August 22, 2017).
real-time data. She said the public health staff feedback was operationalized and disseminated using information-to-action reports to help implement their recommendations.
Davidow discussed research on Hurricane Sandy’s impact on access to care in NJ (Davidow et al., 2016). She noted that chronic diseases are exacerbated by treatment disruption; moreover, access to care is often eroded during a disaster, especially among vulnerable populations. She reported that among those needing care immediately after the storm, 50 percent of U.S.-born Hispanic residents, 28 percent of U.S.-born black residents, and 28 percent of recently arrived foreign-born residents were unable to fill prescriptions or get needed medical supplies. Of the individuals surveyed, 31 percent were evacuees and 43 percent were living in high-impact areas. She said the Emergency Pharmaceutical Assistance Program (EPAP)—enacted post-Katrina to facilitate prescription refills and medical equipment replacement for uninsured persons in federally declared disaster areas—was activated in NJ 1 week after the hurricane, but only 11 percent of those eligible had heard of EPAP. EPAP was activated in NJ counties that had the greatest storm impact, she said, but it should have been activated state-wide because many evacuees were sheltered outside of those counties. She suggested publicizing EPAP more widely, perhaps through social media, during the next disaster and analyzing EPAP use data to consider expanding EPAP or creating similar programs.
Barnett presented research on challenges faced by local public health agencies during the disaster recovery phase after Hurricane Sandy (Errett et al., 2015; Tower et al., 2016). The intervention was an experimental curriculum (Public Health System Training in Disaster Recovery [PH STriDR])6 designed to build willingness and efficacy among local public health responders in recovery phase activities. They found that barriers and facilitators to participating in recovery efforts were (perceived) inadequate training, personal safety, family preparedness, policies and planning, and efficacy. He said that post-intervention findings suggest that self-efficacy (i.e., feeling confident and comfortable to perform one’s emergency-specific role) is improved by clearly defining and communicating emergency-specific roles and responsibilities in advance of a disaster. He reported that response efficacy, which is the belief that performance of one’s emergency-specific role is important, is improved by supportive leadership and communicating the public benefit of response efforts to respondents. He suggested that from a policy and operations perspective, local responders who receive training such as PH STriDR may be more willing to participate—and work more effectively as a group—in recovery efforts if they have a shared belief in their collective ability to fulfill their agency’s role.
Chandler described a post–Hurricane Sandy interview and focus-group study among staff at health departments, nursing homes, and home health services in the NYC area (Chandler et al., 2016). Key challenges cited by interviewees, he reported, included capacity (e.g., cell tower–related infrastructure and monitoring bed occupancy without Internet), competency (e.g., lack of familiarity with the emergency operation center software platform), and capability (e.g., interaction and communication between public health agencies with related public agencies and private organizations). These three themes were applied to the Dynes typology of emergency organizational response to demonstrate that a lot of emergency response, particularly for vulnerable groups like elderly homebound residents, was being supported by emerging organizations whose responses during a disaster could not be predicted (Dynes Type IV).7 He said the researchers are using the Dynes typology to work with local public health agencies to plan and respond to the needs of emergent and vulnerable groups.
Stripling concluded the panel by noting that public health generally involves designing evidence-based interventions against a known risk, but disasters are improvisational environments requiring decisions that need to be better informed by targeted research and operations-specific considerations. He suggested research-informed changes in the preparedness phase that included shifting the focus of federal guidance from planning to evidence-based training, prioritizing preparedness of responders’ families, incorporating environmental health in the public health enterprise, and clearly defining emergency roles for every public health staff member as part of the accreditation processes for public health departments. To improve response, he suggested creating a standardized, non-disaster-specific public health emergency fund to provide surge funding; establishing clear emergency data-sharing policies, protocols, and mechanisms for health departments and partners (perhaps tied to funding); and implementing basic policy decision-making apparatuses across all levels of government to clarify decision making and establish best practices. Aligning and amplifying messaging across levels of government, he said, should extend beyond basic evacuation messaging to include information about access to care and programs such as EPAP. In the phase of secondary hazards and recovery, Stripling suggested setting policy-based
6 More information can be found at https://ncdmph.usuhs.edu/KnowledgeLearning/2016-PHSTriDRx.htm (accessed August 22, 2017).
7 In the Dynes typology Type I organizations include expected responders (such as police, hospitals, and emergency services), Type II organizations include public health and social services, and Type III organizations include parts of the emergency response system that are occasionally activated, such as transportation/evacuation services (Dynes, 1970).
means to reasonably overlook certain regulations (“rule breaking with vigilance”8) and creating a federal guidance document about evacuation-related health hazards. He advised that targeted outreach to vulnerable populations should ensure responsible and consistent duty of care across jurisdictions, with a focus on equity and reducing the factors of race, gender, and class that are associated with poorer health outcomes. He noted that although the government’s current capacity to respond to disasters is insufficient, groups that emerge to respond during the crucial first hours—such as the Occupy Sandy movement—are often mistrusted and excluded but should have access to plans, protocols, and data during a response.
Stripling observed that several public health marketplace session discussions centered on the need for better training in response leadership and decision making for public health leaders. Osborn suggested creating an evidence-informed algorithm to help guide thinking and structure complex, rapid decision making during a response. Amy Nevel, senior program officer at the Office of the Assistant Secretary for Planning and Evaluation for the U.S. Department of Health and Human Services, suggested several ways to improve response: promoting the importance of emergency response in the public health workforce, standardizing training around emergencies for all staff, creating formal public health task books for employees that cover various emergency scenarios, and making it simpler for public health employees to work across jurisdictions. Several participants discussed the need to engage communities as equal partners in public health, and federally mandated needs assessments based on community vulnerability were suggested. Eisenman emphasized that placing methadone maintenance centers under the Centers for Medicare & Medicaid Services (CMS) Emergency Medical Treatment and Active Labor Act (EMTALA) is low-hanging policy fruit; he also reiterated Davidow’s and Stripling’s ideas for improving EPAP messaging and awareness. Stripling suggested having practitioners create a list of priority areas for researchers to focus on, such as the elderly and other vulnerable populations, and amending standard data-sharing agreements to expedite certain research projects. Colf suggested identifying new and targeted questions to predevelop funding opportunity announcements and expedite research. Participants including Brannen suggested using CMS data to pre-identify vulnerable populations. Colf noted that ASPR created a program called emPOWER that uses up-to-date claims data from CMS to create a de-identified database that can be used during a disaster to support people who are dependent on electrical medical devices; early testing suggests it is highly effective.9
POTENTIAL IMPLICATIONS FOR EMERGENCY AND PRIMARY CARE POLICY AND OPERATIONS
The final panel consisted of five speakers: Lewis Goldfrank, emergency medicine physician at NYU Langone Medical Center and Bellevue Hospital Center (BHC); Silas Smith, emergency medicine physician at NYU Langone Medical Center; David C. Lee, emergency medicine physician at NYU Langone Medical Center; Tina Hershey, adjunct professor of law and assistant professor of health policy and management at the University of Pittsburgh; and Rishi Sood, director of policy and immigrant initiatives at the NYC DOHMH. In his introduction to the panel, Richard Serino, distinguished visiting fellow of the National Preparedness Leadership Initiative at Harvard University, reminded the group that research should be translated toward directly assisting people in the community, making them survivors instead of victims. He suggested that emergency management and emergency medical services (EMS) are two huge components of the system that need to be better incorporated in evidence-based preparedness and response planning and practices.
Goldfrank presented research on hospital surge capacity in NYC during Hurricane Sandy (Smith et al., 2016). Three hospitals in Manhattan closed, he said, and according to an analysis of system-wide pre- and post-disaster EMS transports to EDs, the three private hospitals that remained open faced an overwhelming burden of patients.10 In the initial response, he said, hospital staff were deployed only within the respective confines of the private system, public system, or veterans’ hospital system, even though demand did not increase in the latter two systems. Ambulances transported patients only to the open private hospitals, which were severely understaffed and massively overcrowded. Such disproportionate disaster hospital-based care burdens, he said, could be alleviated by plans to route non-critical patients to alternative care sites. More broadly, he called for cooperative planning between public and private hospital systems to appropriately and rationally deploy resources during a disaster, despite the myriad of administrative, regulatory, credentialing, capital, competitive, and legal constraints.
Smith presented work on innovating response capacity for acute care during a disaster (Caspers et al., 2016; Smith et al., 2016). When the three hospitals closed in Manhattan, he noted, the capacity problem was compounded by the criticality of interventions required, such as trauma and cardiac care. This problem was addressed through a process
8 Laura Runnels, LAR Consulting, referred to this practice as facilitative policy—having permissions and procedures in place to reasonably overlook the rules.
10 Bellevue Hospital Center, NYU Langone Medical Center, and the Veterans Affairs Medical Center closed; Mount Sinai Beth Israel Hospital, Mount Sinai Roosevelt Hospital, and New York-Presbyterian Hospital remained open.
of escalating freestanding care at BHC, he explained: first, an urgent care center opened in a usable portion of the BHC mezzanine, followed by an ED, a freestanding ED with EMS receiving, and a critical care center. This process significantly reduced the number of ambulance transports to the nearest open hospital, he said, and decreased the number of patients who required significant intensive care or other resources. He emphasized the importance of rapidly addressing the vacuum of acute care during a disaster and anticipating that most patients will self-present. This rapid assessment requires capturing and innovating any extant, usable space using flexible, adaptive, scalable care systems to stabilize and treat patients, he said.
Lee described research using geospatial analysis to identify vulnerable, disaster-prone patient populations by using administrative claims data from Hurricane Sandy evacuation zones (Doran et al., 2016; Lee et al., 2016a,b). Based on significant increases in ED use for primary diagnoses, Lee said, disaster-prone populations included patients with chronic conditions (including people dependent on electronic medical equipment and patients with diabetes); patients with acute conditions such as hypothermia; and patients with other vulnerabilities such as homelessness, lack of access to prescriptions, and drug dependencies. Lee said there was a 10-fold increase in homelessness as a primary diagnosis for ED use that he attributed to the substantial number of people who were temporarily (rather than chronically) homeless, which included a much larger number of elderly people than before the storm. He suggested that ED use data are effective in identifying vulnerable populations and informing preparedness. For example, by equipping EDs with more workers and resources they would be able to preemptively reschedule non-emergency surgical procedures, enhance pharmacy services post-disaster by using mobile pharmacy units, and respond to post-disaster housing needs, especially among vulnerable older adults.
Hershey described a study aimed at minimizing disruptions to primary care services during recovery from major disasters by examining access to primary care in the Rockaway Peninsula in Queens (Guclu et al., 2016). They used an agent-based model to simulate the population and its primary care providers—with behavior contextualized by legal data (e.g., scope of practice)—to test the effect of expanding the capacity of operating health care facilities by 50 percent and randomly deploying six mobile health clinics. She reported that the expanded capacity had little effect on access to care immediately after the disaster (as many providers would be closed), but it had some impact later in the recovery period. Mobile clinic deployment did improve access to care, especially within the first month. Hershey suggested that agent-based modeling could be applied to aid post-disaster decision making and increase access to care. She also highlighted the importance of law and policy in preparedness, for example, with respect to expanding scope of practice, licensure portability, and volunteers’ liability.
Sood described a related study to assess the impact of Hurricane Sandy on primary care practices and providers on the Rockaway Peninsula through a survey of primary care practice conditions, storm impact, and support and coordination (Sood et al., 2016). The hurricane had a prolonged impact in the area, he said, and severely disrupted the transportation system. He reported that most primary care practices were closed temporarily; all practices experienced electrical issues, three-quarters had heat loss, and many had water damage, structural damage, and mold issues. Two-thirds of practices took more than 2 weeks to reopen, he said. Around 40 percent reported coordinating with other practices or with pharmacies, but very few coordinated with a mobile medical unit or community-based organizations. Sood advised that the primary care sector needs improved emergency response and recovery planning with an all-hazards and scalable approach. He suggested coordinating reopening dates among practices, pharmacies, and government agencies in order to reduce primary care access deficits.
The closing panel moderator, Thomas Kirsch, director of the National Center for Disaster Medicine and Public Health, said Hurricane Sandy was unique because it took down a significant portion of the health care system, demonstrating its fragility. He said preparedness must extend beyond individual hospital facilities and toward building a resilient health care system that can simultaneously absorb the loss of facilities and patient surges. He called for more research on patient outcomes and primary care during hurricane preparedness and response (e.g., how morbidity and quality of care are affected).
Serino shared his observations of the emergency care discussion that took place during the marketplace session. He said several participants discussed the need for better integration and communication across health care systems and made the economic case to incentivize collaboration. Improved patient messaging could include proactive information on self-triage for specific health conditions (“if this, go here; if that, go there”), he added. Monica Schoch-Spana, senior associate at Johns Hopkins Center for Health Security, suggested that triage lines could be supported by poison centers and insurance company nurses. Ruvani Chandrasekera, public health analyst with ASPR, suggested messaging the public based on syndromic surveillance during a disaster (e.g., carbon monoxide poisoning caused by generators inside homes). Sarah Alcala, senior management analyst and Aveshka contract support to ASPR, suggested using a social work coordinator to actively assist people who are chronically or temporarily homeless in finding safe shelter. Several participants discussed
the importance of translating “big data” and using real-time data in preparedness, response, and recovery, Serino said, including further leveraging CMS data and thinking about how new technology, like artificial intelligence, might be used in the near future to turn data into real-time adjustments to response. Mike McClendon, director of the Office of Public Health Preparedness in Harris County Public Health, said Texas has a robust system for tracking evacuated families (and pets) using armbands with barcodes. At all levels, staff should be included in preparedness and training exercises, Serino said, and leaders should be empowered with information needed to make decisions. Sean Andrews, policy analyst at ASPR, noted that EMS staff are branching out into public health paramedicine and primary care paramedicine; he suggested leveraging paramedics’ primary care training in disaster response to assist with providing mobile care. Schoch-Spana noted that the majority of care is actually provided by family caregivers rather than in formal facilities, but they are rarely formally acknowledged in disaster response plans; she suggested including family caregivers as part of the health care system and making accommodations specifically for them in future response policy.
After the marketplace session David Prezant, chief medical officer at the Fire Department of the City of New York, offered his observations. He said many participants of the primary care marketplace session discussed how joint credentialing that crosses networks and state lines would allow staff to be deployed where they are most needed during a disaster. Pre-registering and credentialing volunteers and providing clear personal liability insurance could resolve concerns and improve participation, he said. Executive orders could be prewritten and prepositioned, he said, and enforceable—and modifiable—by knowledgeable decision makers. Access to prescription medications could be improved by loosening regulations, added Prezant. Nicole Lurie, senior advisor to the Director for the Indian Health Service, said ASPR is working with retail pharmacy chains to robo-call medication pick-up reminders prior to expected storms, as well as waiving the window for refills. Health care coalition plans could include primary care (including nursing homes), Prezant said, because the sector needs economic support and government assistance to recover post-disaster. Elizabeth Marshall, associate professor at Rutgers School of Public Health, suggested coordinating with electricity companies to prioritize power restoration and access to generators at certain facilities. Schoch-Spana suggested offering financial incentives or continuing medical education credit to private primary care providers who engage in COOP planning. Rashi Venkataraman, executive director of prevention and population health at America’s Health Insurance Plans, noted that private urgent care clinics could play a role in response. Goldfrank suggested using the NYC Post-Emergency Canvassing Operations program as a model for other jurisdictions.11 Many participants discussed how interoperable electronic medical records (EMRs) would allow better access to primary care providers’ records during a disaster and noted that billing and invoicing are generally integrated in EMR systems, which may affect providers’ willingness to offer services when the system is inaccessible. Osborn suggested implementing reimbursement or insurance portability schemes to enable private payer reimbursement for primary or emergency care when contracted facilities are unavailable.
Eisenman closed the workshop by reflecting on the remarkable and unusual opportunity this workshop provided for a discussion among the medical and public health research, policy, and operations communities. He said the workshop amounted to “closing the loop” from the researcher perspective because they finally got to talk directly with operations and policy people about their research implications. Throughout the day it became apparent that more opportunities were needed for these groups to meet and discuss how response research could best be conducted, interpreted, and implemented. Many participants and speakers commented on how glad they were for the chance to talk with the research, policy, and operations representatives attending the workshop. Eisenman said the workshop would be a catalyst for the translation of disaster research in the future.♦♦♦
11 More information about this program can be found at http://dralegal.org/press/new-york-city-and-disability-advocates-reach-historic-agreement-providing-for-comprehensive-improvements-to-new-york-citys-disaster-planning (accessed September 6, 2017).
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DISCLAIMER: This Proceedings of a Workshop—in Brief was prepared by Anna Nicholson, Claire Giammaria, and Justin Snair as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual meeting participants and do not necessarily represent the views of all meeting participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.
PLANNING COMMITTEE FOR TRANSLATING THE RESULTS OF HURRICANE SANDY RESEARCH GRANTS INTO POLICY AND OPERATIONS: A WORKSHOP*
David Eisenman (Chair), University of California, Los Angeles; David Abramson, New York University; Eric Carbone, Centers for Disease Control and Prevention; Amy Nevel, U.S. Department of Health and Human Services; David Prezant, Fire Department of the City of New York; Richard Serino, Harvard University; Kandra Strauss-Riggs, National Center for Disaster Medicine and Public Health; and Mitch Stripling, New York City Department of Health and Mental Hygiene.
* The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the rapporteurs and the institution.
REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by David P. Eisenman, University of California, Los Angeles, John Hick, Hennepin County Medical Center, and John Osborn, Mayo Clinic. Lauren Shern, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.
SPONSORS: This workshop was supported by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSO100201550005A).
For additional information regarding the workshop, visit http://nationalacademies.org/hmd/Activities/PublicHealth/DisastersScienceCommittee/2017-JUL-20.aspx.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Exploring the translation of the results of Hurricane Sandy Research Grants into policy and operations: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24889.
Health and Medicine Division
Copyright 2017 by the National Academy of Sciences. All rights reserved.