Response Team for Preparedness & Emergency Operations Coordination

State: PA Type: Promising Practice Year: 2020

The Philadelphia Department of Public Health works to keep Philadelphia healthy, serving the 1.58 million residents of Philadelphia, Pennsylvania. The sixth largest city in the nation, Philadelphia is racially and ethnically diverse: 41% non-Hispanic black, 35% non-Hispanic white, 15% Hispanic, and 8 percent Asian. Health disparities exist particularly for racial/ethnic minorities and those experiencing poverty. A 2018 hazard vulnerability assessment completed by Drexel University defined the following hazards as the top five public health planning priorities for Philadelphia: pandemic, coastal storm, flood, utility interruption, and localized infectious disease outbreak. These hazards would require strong emergency operations coordination and a trained, capable workforce to respond while still continuing PDPH's essential functions to ensure the health of the city.

The Bioterrorism and Public Health Preparedness Program, within the Division of Disease Control at the Philadelphia Department of Public Health, is charged with planning for and responding to public health emergencies in the City of Philadelphia. This includes establishing public health priorities, developing and testing response plans, training staff and volunteers to their emergency response roles, and collaborating with partners. Our Program's website is The Bioterrorism and Public Health Preparedness Team is comprised of 12 public health professionals working on all facets of preparedness and response; we know, however, that any public health emergency would require workforce needs well beyond our Program's capacity.

Following the real events of the 2015 Papal Visit and the 2016 Democratic National Convention, as well as weather events like Hurricanes Irene and Sandy, the Philadelphia Department of Public Health identified the need for surge capacity in communications, staffing, and volunteer management. PDPH uses a Public Health Emergency Coordination Center (PHECC) to act as the Health Department's Emergency Operations Center. This model includes a communications branch to manage all tactical communications, including activation, notification, and calldowns of response partners, a staffing branch to assign staff and volunteers to roles and response sites, and a medical field operations branch to manage deployed volunteers on-site at medical field sites, like first aid tents. The staffing model for the PHECC ranges from 19-27 staff for one 12-hour shift.

During a large-scale response, even a robust public health preparedness team will be spread thin. With response activities running 24 hours a day and many or all functions activated to bolster a successful response, the public health workforce will need to surge to manage the leadership and execution of all tasks. The PDPH Response Team was developed in 2016 to help address gaps in staffing at the response leadership level. It draws public health professionals from other programs at the Health Department to make up a skilled supplemental workforce to continue emergency operations coordination functions throughout a response.  

When the Response Team was established, and as it continues, the goals are:

  1. Train non-preparedness staff to fill leadership and staff roles within the PHECC, and
  2. Familiarize staff with the Incident Command Structure (ICS) that calls for the swift assembly of staff to perform key emergency response and administrative tasks associated with a large-scale event.

PDPH has established a cadre of 40 staff who can fill leadership and staff roles within the PHECC. These staff are trained on emergency response functions and ICS. Trainings are repeated regularly, and the introductory training will debut as a webinar in 2020.

Training non-preparedness staff to fill preparedness roles greatly expands the emergency workforce, which enhances the safety and health of the public. Support from other program managers and health department leadership, and willingness to support preparedness on behalf of staff, were essential factors to expand critical surge capacity to ensure continuity of emergency operations during an activation.

The Response Team vastly expands upon the Bioterrorism and Public Health Preparedness Program's ability to serve the public of Philadelphia during an emergency by providing a trained surge workforce to manage all facets of a response. Should an emergency or incident occur, seamless coordination is critical in ensuring the health and safety of Philadelphia residents.

During a severe public health emergency, the entire population of Philadelphia (1.58 million) could be affected. In order to support emergency operations coordination for response actions that may operate both day and night for weeks at a time, it is essential to have a trained, ready, capable workforce to fill roles during all possible shifts.

PDPH is the lead agency responsible for the provision of medical countermeasures during a public health emergency. Medical countermeasure dispensing is an essential capability, defined by both the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) as a priority for all local jurisdictions. PDPH's Mass Prophylaxis and immunization plan was developed to be a flexible, scalable, all-hazards plan that addresses the potential mass medication needs of the entire City population. If a city-wide emergency required mass prophylaxis of the entire population, PDPH may activate up to 40 points of dispensing (PODs) to dispense medical countermeasures. The PHECC model was created to act as a Health Department-based emergency operations center.

The PDPH Response Team expands on an existing tool that was selected as a 2014 Model Practice and a 2013 Promising Practice: the Emergency Staffing Database, a tool that enabled PDPH to effectively assign Health Department staff and volunteers to mass prophylaxis responses and medical field clinics, quickly and accurately. The Emergency Staffing Database is operated by the Staffing Branch of the PHECC. Training the PDPH Response Team to operate the Emergency Staffing Database, as well as other essential PHECC functions, vastly expands the trained, capable staff available to fill critical PHECC roles during a public health emergency or other activation.

The PDPH Response Team training model aligns well with NACCHO's Statement of Policy 12-02: Preparedness Workforce Development and Training. This policy statement highlights the benefits for training all staff regardless of their specialty and area of expertise on key concepts within public health preparedness and emergency response (NACCHO, 2017). As nearly all response activities will exceed the number of preparedness staff members that LHDs possess, the training of staff using the PDPH Response Team model will help to close a number of gaps in staffing and leadership in future large-scale emergencies and special events.

Similarly, NACCHO's policy statement notes the benefits of regular training workshops that align well with LHD needs and incorporate lessons learned from past activations and exercises. The Response Team was designed and continues to address workforce surge and public health preparedness, a gap that was identified following the 2015 Papal Visit and 2017 Democratic National Convention (DNC) events hosted by the City of Philadelphia. In an effort to ensure that this gap remains closed in future responses, members of the PDPH Response Team attend trainings on a regular basis that introduce new topics in preparedness and revisit tasks that would be necessary to complete at any and all responses.

The goals for the PDPH Response Team are to:

  1. Train non-preparedness staff to fill leadership and staff roles within the PHECC, and
  2. Familiarize staff with the Incident Command Structure (ICS) that calls for the swift assembly of staff to perform key emergency response and administrative tasks associated with a large-scale event.

Through the implementation and fulfillment of these objectives, LHD staff become well acquainted with emergency operation coordination and preparedness topics.

The PDPH Response Team is internal to the LHD; thus, the initiative's success relies on the support of the DDC Director, program managers and other program staff who serve in the supervisory and specialist positions on the Response Team. All work is done in-kind as a part of the Bioterrorism and Public Health Preparedness Program and the Division of Disease Control's mission. In an effort to ensure that all necessary roles within the PHECC model can be sustained for a large-scale event, new staff are identified immediately following any turnover that occurs. New staff must attend a one-hour in-person training that introduces them to the Response Team's mission, vision and structure as well as delves deeper into key topics within the realm of public health preparedness, including ICS, key hazards and the distribution of medical countermeasures (MCMs) using a point-of-dispensing (POD) approach.

Following their introduction to the PDPH Response Team, members are enrolled in a course that further reviews public health emergencies on the Department's Learning Management System, a portal through which City and LHD staff can participate in and attend professional development trainings and webinars related to their role and areas of interest. General members were initially asked to attend four trainings each year; the frequency of all-team trainings has since been changed to six per year as requested by Response Team members through responses provided in an annual feedback survey. Additionally, specialized trainings in tactical and risk communications have been offered during gap months to provide general members with opportunities to learn more about topics that would not be as frequently reviewed and discussed during all-team trainings.

Within the Response Team model, staff are broken into three groups: Coordinators, Leads and General Members; each group possesses a different level of participation and the number of trainings that they must attend. The Response Team Coordinators are the Health Communications Coordinator, the Workforce Coordinator, and the Assistant Program Manager for the Bioterrorism and Public Health Preparedness Program. Coordinators are responsible for developing and delivering trainings and producing supplemental materials specific to their area of expertise, as well as scheduling these trainings with members of PDPH Response Team. Leads are individuals that have been identified by program managers within DDC to attend additional trainings that discuss upper-level topics in staffing, logistics and tactical communications. These individuals are trained to serve in the supervisory roles within the PHECC in the event that the Health Communications and Workforce Coordinator are unavailable and unable to respond. General members are asked to attend all-team trainings and would be called upon to serve as specialists within the PHECC and perform tasks under the guidance and supervision of a Response Team Coordinator or Lead.

Selection of Response Team members for supervisory and specialist roles within each branch is based on their primary program and job responsibilities. In doing so, those with skills and responsibilities that align well with the tasks branch to which they are assigned may be able to easily complete the emergency response tasks at hand. As this cannot be guaranteed during a large-scale emergency response, members are cross-trained to serve in each of the four branches within the PHECC. All-team trainings are designed to introduce and review core tasks from each of the PHECC branches at least two times every year.

In an effort to simulate what Response Team members and other just-in-time emergency response personnel might be called upon to do during an emergency, 30 of the 40 Response Team members were approved by program managers to participate in the PHECC Functional Exercise that was conducted on March 7, 2019. The scenario was an airborne anthrax attack that called for the activation and assembly of LHD staff to assume both supervisory and specialist roles in the Communications, Staffing and Supply/Logistics branches. The exercise took place in two phases; each phase was intended to simulate a 12-hour shift. Participation in the PHECC Functional Exercise in March 2019 as well as the PCW-MSA Full Scale Exercise in October 2019 allowed Response Team members to be acclimated with what a response would look like both internally as a member of the PHECC's Tactical Communications, Risk Communications, Staffing and Logistics branches and externally when staffing an open point-of-dispensing.

The implementation of annual feedback surveys as well as evaluations following each functional exercise allows for members of the PDPH Response Team to reflect on what has been taught during a given calendar year and to provide insight into what could have been more clearly defined when asked to perform the tasks during the exercise simulations. In doing so, Response Team Coordinators are able to better identify the topics that may need to be reviewed another time as well as make changes to the format and structure of the team itself.

In an effort to expand the breadth of knowledge that PDPH Response Team members have surrounding emergency preparedness and response, Coordinators plan to implement a new initiative in 2020, the What's in a Response” series, which will allow members from different programs within DDC to share best practices from responses that have been organized and managed by their program as well as to draw connections and differences between emergency response processes. This concept was also noted by a group of PDPH Response Team members in one of the annual feedback surveys and will soon be incorporated into the team's structure and curriculum.

The goals for the PDPH Response Team are to:

  1. Train non-preparedness staff to fill leadership and staff roles within the PHECC, and
  2. Familiarize staff with the Incident Command Structure (ICS) that calls for the swift assembly of staff to perform key emergency response and administrative tasks associated with a large-scale event.

In order to evaluate the effectiveness of Response Team trainings as well as to gauge the level of comfort and confidence among members that would likely be called upon to fill both supervisory and specialist roles in an emergency, staff were asked to complete annual surveys and provide feedback following participation in any exercises or events that required activation of the PHECC.

Following the PHECC Functional Exercise in March 2019, a total of 28 Response Team members that participated in the exercise provided feedback via SurveyMonkey. Given the tasks that each was tasked with performing during the exercise, staff believed that they would be able to remain at their assigned post for up to 9 hours. Although 60% of staff felt that past response team trainings had sufficiently or completely prepared them for participation in the exercise, 94% shared that they would be comfortable with responding during a real emergency. In addition to these surveys, feedback is collected from Response Team staff at trainings, and from Program Managers at management meetings.

Feedback from surveys has resulted in a number of changes in both the format and structure of the PDPH Response Team. All team trainings were originally 90 minutes in length and took place on a quarterly basis. Respondents to the PHECC survey expressed interest in decreasing the length (45-60 minutes) and increasing the frequency (every other month) of trainings.

As described in the previous section, the What's in a Response” series will debut in 2020 Response Team trainings, allowing members from different programs within DDC to share best practices from responses that have been organized and managed by their program as well as to draw connections and differences between emergency response processes. This concept is being added as a direct result of member feedback.

The qualitative and quantitative evaluations described above are performed to assess the Response Team's functions in supporting the following public health emergency preparedness capabilities:

  • Emergency Operations Coordination
    • Function 4: Manage and sustain the public health response
  • Mass Care
    • Function 3: Coordinate public health, health care, and mental/behavioral health services
    • Function 4: Monitor mass care population health
  • Medical Countermeasure Dispensing and Administration
    • Function 3: Activate medical countermeasure dispensing/administration operations
  • Medical Materiel Management and Distribution
    • Function 3: Distribute medical materiel
    • Function 4: Monitor medical materiel inventories and medical materiel distribution operations
  • Volunteer Management
    • Function 2: Notify, organize, assemble, and deploy volunteers

The continued use of feedback surveys and the development and implementation of new evaluation tools will help to ensure that Response Team members remain confident and prepared to respond to a variety of different emergencies and disease control responses in the future, and guide staff on what can be done to improve and expand upon the training opportunities that are being offered.

The PDPH Response Team has proven to be a successful, sustainable model for addressing concerns related to workforce surge capacity as well as training local health department staff on topics in public health preparedness. As new staff are onboarded, they are able to be easily integrated into the training schedule. As PDPH experiences staff turnover, the Response Team managers recruit and train new PDPH staff to join the team. Because building emergency workforce capacity is priority for the Public Health Preparedness Program, staff continue to dedicate hours to engage others in meaningful training and exercise opportunities to ensure readiness.

Through a continuous feedback loop, Preparedness Program staff are able to adjust and improve the Response Team trainings and offer new opportunities to engage members. In order to expand the Response Team, while solidifying it as an essential team within our workforce of 1,400 staff, PDPH plans to expand Response Team functions to support other critical disease control functions. Further embedding the Response Team into response plans across the Department will solidify the sustainability of the Team and continue to ensure that workforce surge capacity can be maintained for large-scale events of the future.

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