State Category: Indiana

Half of States Scored 5 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Report Finds Funding to Support Base Level of Preparedness Cut More than Half Since 2002

 

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 25 states scored a 5 or lower on 10 key indicators of public health preparedness. Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH.  “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
  • The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
  • In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
  • Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
  • 47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
  • Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
  • Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks.  Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
  • Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance. 
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
  • Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable.   Sometimes the aftermath of an emergency situation may be more harmful than the initial event.  This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Massachusetts and Rhode Island

8 out of 10: Delaware, North Carolina and Virginia

7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington

6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia

5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee

4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania

3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming

2 out of 10: Alaska

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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Fostering Community Resilience: How one Indiana Community Meshed its Resources to Improve Preparedness

By Justin Mast, RN, BSN, CEN, FAWM, Senior Crisis and Continuity Advisor, MESH

Seven years ago, Wishard Memorial Hospital, now Eskenazi Health, was one of five organizations to receive a $5 million grant from the Assistant Secretary for Preparedness and Response to create innovative public health and healthcare emergency response and management models.

To try something new, Dr. Charles Miramonti, an emergency department physician, looked at relationships, policy and technology. Ultimately, he created a team of healthcare leaders from all of the area’s major hospitals, known as the Managed Emergency Surge for Healthcare (MESH) Coalition, based in Indianapolis.

Initially, MESH created a framework for sharing resources, a centralized cache of supplies, protocols for coordinated emergency response efforts and training opportunities. All these efforts better centralized preparedness functions across the Central Indiana region.

After building the coalition, marshalling resources and creating efficiencies in public health preparedness, to continue our work, we hosted a work group to focus on disaster planning for children, mothers and expecting mothers.

Quickly, we realized that we had to build community resiliency and that there was a significant vulnerable population that hadn’t been fully addressed when it comes to preparing for emergencies: children who are dependent on electric equipment, most notably ventilators.

During weather events, we found that families with children on ventilators were coming to the emergency room to ensure they would have electricity. They often brought other family members and stayed for the duration of the storm.

To look at the problem, we took three steps:

  1. Fact finding and research;
  2. Creating a registry of children in the state who are dependent on ventilators; and
  3. Writing an educational toolkit for families and providers (also in Spanish).

First, we wanted to see if there were places other than hospitals that would be able to maintain a power supply during an emergency. It would be beneficial to the entire community to keep people out of the hospital if they didn’t need urgent care at that moment—as long as we could safeguard their health.

We spoke with emergency personal in every county to get a sense of what resources existed and what needs there were—we needed to know if it was possible to give families another location they could go to during an emergency. Ultimately, we developed a database that includes 181 power safe facilities with nearly two locations for every county.

While having the alternate locations mapped was great, they would only be helpful if we could identify and inform the families that would need to use them. So, we built a HIPAA compliant registry that parents can use to register their ventilator-dependent children.

The third piece of the puzzle was informing and educating families and responders. We wanted to give families tools to connect with local resources because it’s far easier—in more rural areas—to get to those places during an emergency. We also wanted to empower families to reach out to these services and personnel, which would make the connections even stronger.

So, we created tools, including a video (also in Spanish), to educate families on how weather could impact the power supply their children depended on. The toolkit includes draft letters families can send to authorities—such as EMS and fire—to let them know in advance there is an electrically dependent patient in the household.

We then gave the toolkit to hospital nurses to pass along to families at discharge. And, throughout the development, we partnered with the Indiana Emergency Medical Services for Children (IEMSC), Indiana State Department of Health and other partners whom were instrumental in creating the toolkit and spreading the resources across the state.

We also worked with medical equipment providers and let them know that there are resources for families. They were extremely happy to provide information on the toolkit and registry to their patients.

It’s hard to believe that just five years ago each individual Central Indiana hospital and healthcare facility prepared to face a public health emergency on its own—completely apart from the other resources, infrastructure and partners, just down the road.

Now, the MESH Coalition is helping providers prepare for and respond to emergency events and communities remain viable and resilient through recovery.

We know that, by forging these innovative partners, we have saved millions of dollars on redundant equipment and emergency supplies. Through all of these efforts, the MESH Coalition is building resilience in the healthcare sector and improving everyday life for Hoosiers.