Publications

Increasingly frequent and costly disasters in the US have prompted the need for greater collaboration at the local level among healthcare facilities, public health agencies, emergency medical services, and emergency management agencies. We conducted a multiphase, mixed-method, qualitative study to uncover the extent and quality of existing collaborations, identify what factors impede or facilitate the integration of the preparedness community, and propose measures to strengthen collaboration. Our study involved a comprehensive literature review, 55 semistructured key-informant interviews, and a working group meeting. Using thematic analysis, we identified 6 key findings that will inform the development of tools to help coalitions better assess and improve their own preparedness community integration.

The White House recently called for a “robust and broad deliberative process” to assess the risks and benefits of select gain-of-function studies, pausing current experiments and further grants until new federal policy on research funding and oversight is developed. At issue is whether and under what conditions laboratory studies that enhance the transmissibility and/or virulence of potential pandemic pathogens such as the H5N1 avian influenza virus should go forward. To date, professionals from medicine, public health, and the life sciences have dominated the debate, and each side of the controversy has cited the public's well-being as the principal motivator for their position. A major stakeholder, the general public, has not yet actively and systematically weighed in on the matter. This commentary considers in what form and with what benefit public participation may materialize in the current debate regarding the governance of gain-of-function research.

This article describes adoption by local health departments (LHDs) of federally recommended participatory approaches to public health emergency preparedness and LHD organizational characteristics associated with more intense community engagement in emergency preparedness, a top priority for US national health security.

Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding what values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises.

Over the past decade, community engagement has become a central tenet of US federal doctrine on public health emergency preparedness. Little is known, however, about how the vision of a ready, aware, and involved populace has translated into local practice, or which conditions thus far have advanced community involvement in what is typically considered the province of government authorities and emergency professionals. In 2011-12, to help close that knowledge gap, investigators carried out semistructured qualitative interviews with practitioners (N = 25) from 7 local health departments about which conditions have advanced or inhibited community engagement in public health emergency preparedness. Among the organizational factors identified as enabling local health departments’ involvement of community residents and groups in emergency preparedness were a supportive agency leadership and culture, sufficient staffing and programmatic funding, interested and willing partners, and external triggers such as federal grants and disaster experiences that spotlighted the importance of community relationships to effective response. Facing budget and staff cuts, local health departments feel increasingly constrained in efforts to build trusted and lasting preparedness ties with community partners. At the same time, some progress in preparedness partnerships may be possible in the context of agency leadership, culture, and climate that affirms the value of collaboration with the community.

The Rad Resilient City Checklist is a local planning tool that can help save tens of thousands of lives following a nuclear detonation. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the most lives following a nuclear detonation. Yet, most Americans are not familiar with correct safety measures against fallout, and many believe that nothing can be done to reduce the suffering and death inflicted by a nuclear attack. Moreover, cities have no checklist on how to prepare the emergency management infrastructure and the larger population for this hazard, despite hundreds of pages of useful guidance from the federal government and radiation professional organizations. The Rad Resilient City Checklist reverses this situation by converting the latest federal guidance and technical reports into clear, actionable steps for communities to take to protect their residents from exposure to radioactive fallout. The checklist reflects the shared judgment of the Nuclear Resilience Expert Advisory Group, a national panel led by the Center for Biosecurity and comprised of government decision makers, scientific experts, emergency responders, and leaders from business, volunteer, and community sectors.

The UPMC Center for Health Security and the Rad Resilient City Initiative commend the public health leaders of Ventura County, CA, and their partners  on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

Ventura County, CA, Launches Nuclear Response Public Information Campaign

September 18, 2013—The UPMC Center for Health Security commend the public health leaders of Ventura County, CA, and their partners today on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

These authorities have rightly trusted in the maturity of county residents to handle the issue of nuclear incident preparedness. In a potential or actual public health crisis, the dangers of alarming people unnecessarily or having them not grasp the complexity of the matter are far less than most leaders imagine. A nuclear terrorist attack, while low in probability, is still possible given present day politics and technology, and people deserve to know the correct protective actions to take.

In the interest of public health, Ventura County is taking reasonable steps by providing its citizens with life-saving information. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the greatest number of lives following a nuclear detonation. In the aftermath of a nuclear explosion, promptly finding and staying in a robust shelter will reduce exposure and save lives. Acting on the instinct to flee the affected area will result in lives lost.

Through this campaign, and the opportunity for dialogue it provides, county residents will be empowered with the information to save their own lives. Pre-incident public education is a top priority because people cannot wait to be told what to do. Fallout is the most dangerous in the first few hours after detonation, and degraded communication will keep officials from warning people in the areas that most need the information.

We encourage the citizens of Ventura County, CA, to ask questions at the planned town hall meetings and become more informed. We also invite other jurisdictions interested in learning more about nuclear preparedness to visit the . There they will find 7 clear, actionable steps for communities to protect inhabitants from radioactive fallout, thus saving many tens of thousands of lives following a nuclear blast.