Preparedness Habits

State: MN Type: Promising Practice Year: 2019

Public health is an essential responder for emergencies: we are mandated first responders for disease outbreaks, family reunification and assistance center operations, emergency sheltering and mass care, and extreme heat or cold events., Yet due to our department's limited capacity and low frequency of regularly occurring incidents. our day-to-day work doesn't give us the opportunity to hone response skills over the years many Minneapolis Health Department staff have shared that they would appreciate the opportunity to have more hands-on experience to feel grounded and prepared for their role in an emergency response. We have had to activate our entire work force three times in the past ten years. Although many responses do not require this full department activation, when they do, we must be ready to implement our responses effectively.

The Minneapolis Health Department serves the most populous city in the state of Minnesota, a 58-square mile urban center undergoing rapid growth and development. Minneapolis grew to 423,990 in most recent estimates, an 11% increase from the 2010 census, and is projected to continue growing as it is the second largest economic center of the Midwest with a large international airport, five Fortune 500 companies, a large health care system, as well as a wide variety of multi-ethnic urban city communities. As of 2010 the city is 64% White, 19% Black or African American, 11% Hispanic or Latino, 6% Asian, 2% American Indian, 6% Other and 4% Multiracial.

Maintaining readiness to respond to emerging threats, natural hazards, and outbreaks is a priority for our department. We have approximately 107 FTEs, half of whom are grant funded positions whose time may not necessarily be devoted to training for emergencies. To ensure we can respond with prepared and confident staff, we developed our Habits program, which we are nominating for the NACCHO Model Practices Award.

The program was a result of the Health Commissioner reading The Power of Habit by Richard Duhigg, which postulates that habits acquired through repetition reduce stress and mistakes. The concept was to provide the Health Department's Incident Management Team with opportunities to learn, practice, and simulate the initial chaotic setup phase of our department's most likely responses, thereby reducing mistakes and increasing staff confidence and competency in those responses.  By repeating the same functions for different likely scenarios in exercises, habits can be formed by those individuals assigned to response roles.  It also provided a chance to practice leadership and decision making during the initial pandemonium of an event.  Leadership and decision making are the critical skills that we have learned are important components for ensuring success.

The program consisted of a series of emergency response exercises conducted in multiple rounds, utilizing different scenarios and types of emergency operations, including Medical Countermeasure Medical Countermeasure Point of Dispensing, Family Assistance Center, and Mass Care Shelter. These operations are all currently designated responsibilities for our department by the City Emergency Operations Plan. For each exercise, staff were assigned to the role on the Incident Management Team that they will play in a real life-emergency.  Each person was given a position description and checklist and kit of materials applicable to their role. Everyone then received the exercise scenario and time to run through it, followed by a debrief and walk-through of the situation. Each exercise was run through in three rounds, since the Incident Management Team for any given response includes one primary and two alternate people identified for each role. With each subsequent exercise additional supplies, equipment, and complexity was added to further the skills acquired. In addition, as issues were identified, changes were made in processes and organization to improve flow and efficiency. 

In the post exercise evaluations, the staff reported they enjoyed working together to solve the problems and to be a part of the team. Many staff initially expressed anxiety about the exercises, but by the third round many stated they were looking forward to the opportunity again.  While we have heard complaints from staff that the preparedness training and exercises take too much time away from their real” work, the evaluations showed that staff found this to be a valuable use of time. Overall, the evaluations showed that staff confidence and skills were increased and our goals met to be more prepared for the next event.

Our small department has been challenged to respond to a variety of major emergencies in the City of Minneapolis.  Among them are the I35 bridge collapse, a Type 2 tornado hitting one of our vulnerable communities, and the H1N1 pandemic - all which required the full department deployment to respond.  We learned from these firsthand experiences the importance of ensuring the sustainment of a robust and reliable public health work force ready for response. Our staff expressd to us their concerns and training needs after these events and this program was in response to their requests.  We know first hand that our staff must be ready and confident in their response abilities even though the next event may not be one we have trained or planned for. Yet finding resources for providing a training and exercising program that can be sustained and meets the needs of the staff, as well as addressing the potential of emerging threats, is a huge challenge for all health departments.  

A well prepared and confident staff will benefit the community in a response by demonstrating through confident and efficient action that  effective response can be initiated to better serve the population.  We were able to use the tools that FEMA Homeland Security training programs and CDC preparedness requirementss have taught us to create the exercises and tool kits for the program.  Also, by repeating the same exercises, we are able to correct logistical suppliy and equipment needs, as well as our tool kit and deployment problems, and then retest.  This program has provided a unique opprtunity for our staff the learn and gain confindence quickly and easily with limited resources.  

While the focus of this project was internal to our department we did include a variety of community partners in the execution of different aspects of it.  For the three exercises that involved set up for sheltering, we invited the Red Cross and some of their shelter volunteers to appear” unexpectedly so they could assist our staff with planning and execution.  This provided an opportunity for them to meet each other and work together and resulted in shared learning about resources, training, and ideas.  For other scenarios we invited staff from Hennepin County Emergency Management, Human Services, and Public Health to provide subject matter expertise and assistance for training and support.  Again, since our staff do not regularly work with these outside experts it was another opportunity to share knowledge and meet staff who they would be working with in a disaster.  Such experiences don't happen regularly or naturally for staff who have jobs in areas outside of preparedness and this occasion was a positive experience for all. 

For our initial range of nine exercises we had to staff complete a pre- and post-evaluation which asked them to provide rating regarding their knowledge and confidence levels for responding to emergencies. This evaluation of the exercises found that 74% of the responding staff felt quite a bit or very much more comfortable about responding to an emergency.  In addition, most strongly agreed that our jurisdiction is better prepared to respond successfully. After the initial round of exercises, we completed a thorough After-Action Report with an Improvement Plan.  We followed through on suggestions from staff participants and the Exercise Evaluators and as a result our department continued to add subsequent exercises and training to follow up with identified gaps.  These included a full-scale site set up for dispensing operations, a workforce scheduling and activation exercise, technology and equipment training, and the implementation and practice of the Planning P elements.

We use our staff who are federally funded through the Public Health Emergency Preparedness grants to plan for and implement our departments training and exercise program.  Because of the Habits initiative, we have taken this initial program and incorporated Habits into our regular preparedness planning work on an annual basis as a part of our Multi Year Training and Exercise program.  The regularly scheduled and required Cities Readiness drills and exercises ensure we practice a variety of the skills needed and we ensure that repetition is a part of those exercises.  As staff turnover, we will instill a regular repetition of the exercises to maintain readiness.

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