Inclusive Emergency Preparedness:

Lessons Learned from Points of Dispensing inColorado

The community IS the hazard. The community is the response.

Planning for Public Health Emergencies

PresenterPresentation NotesAssembly line /= POD operations because people are not widgets.

Vulnerable Populations Community Inclusion

PresenterPresentation NotesWhat if I knew that a large proportion of my jurisdiction were people who had difficulty moving – how does it change the emergency systems I need to build?

C M I S T

OMMUNICATION

EDICAL/HEALTH

NDEPENDENCE

AFETY, SUPPORT, SERVICES

RANSPORTATION

Hazard-based?Daily conditions?

Economics

Housing

Isolation• geographic• social• cultural

PresenterPresentation Notes[SLIDE

Public Health Planning Context

PHED Ex Objectives:• Information Sharing: Demonstrate the ability to effectively

collect, synthesize, and share information with local and state partners throughout the duration of the incident.

• Emergency Operations Coordination: Demonstrate the ability to activate an operations center, develop a coordinated response strategy, and manage and sustain response to a public health incident.

• Medical Countermeasures Dispensing/Medical Material Management and Distribution: Demonstrate the ability to support and participate in Colorado’s medical supply chain procedures.

PresenterPresentation NotesWe have corresponding PHEP capabilities that align with these objectives:  Public Health Emergency Preparedness (PHEP) Capabilities PHEP Capability 1:  Community Preparedness Promote awareness of and access to medical and mental/behavioral health 2 resources that help protect the community’s health and address the functional needs (i.e., communication, medical care, independence, supervision, transportation) of at-risk individuals Provide guidance to community partners, particularly groups representing the functional needs of at-risk populations, to assist them in educating their own constituency groups regarding plans for addressing preparedness for and recovery from the jurisdiction’s identified risks and for access to health services that may apply to the incident. PHEP Capability 4:  Emergency Public Information and Warning Disseminate information to the public using pre-established message maps in languages and formats that take into account jurisdiction demographics, at-risk populations, economic disadvantages, limited language proficiency, and cultural or geographical isolation. Written plans should include a process to provide information to help at-risk individuals understand personal preparedness, be knowledgeable about available services, and understand where they can obtain services.62 (Considerations should include the use of multiple media, multilingual and alternative formats, and age-appropriateness of information.) PHEP Capability 8:  Medical Countermeasure Dispensing Number and location of people affected by the incident, including a process to collect and analyze medical and social demographic information of the jurisdiction’s population to plan for the types of medications, durable medical equipment, or consumable medical supplies that may need to be provided during an incident, including supplies needed for the functional needs of at-risk individuals. Plan for functional needs of at-risk individuals (e.g., wheelchair access for handicapped) North Central Region Access & Functional Needs Sub-Committee The mission of the AFN Sub-Committee is to collaborate with coalitions, agencies and individuals to address the planning, training, education and resource needs necessary to assist those with access and functional needs in preventing, preparing for, responding to and recovering from any type of disaster.

PHED Ex 2017Inclusion Activities

Colorado Community Inclusion Workgroup

Planning Activities

LPHA’s exercise planning included

• Grant activity for inviting non-traditional community observers• Developing mobile/closed POD plans with trusted groups & places

In the year preceding this statewide full-scale exercise, the Colorado Community Inclusion workgroup brainstormed strategies and developed resources to promote inclusion activities.

• GIS Resources – Community Inclusion Maps

• Suggested Participant List

• Community Inclusion Injects

• Plain language “Save the Date”

http://bit.ly/communityinclusionmapshttps://www.colorado.gov/pacific/sites/default/files/OEPR_FSE_ParticipantList.pdfhttps://www.colorado.gov/pacific/sites/default/files/OEPR5_CommunityInclusionInjects.pdfhttps://www.colorado.gov/pacific/cdphe/colorado-community-inclusion-and-health-workgroup-meeting-archive

Operational Inclusion Strategies• Community Inclusion Strategies

• Just-in-Time Community Inclusion Discussion

• Budget for functional services & support, • On-site or telephonic interpretation (including ASL), literacy and health

educators

• Resources for kids who accompany single-parent heads of household

• Alternative information formats (picture-based, large print, non-English)

• Plan for people with personal mobility difficulty onsite• Alternative flow or places to sit for people who cannot stay standing.

• Space and accommodations for people with personal equipment (walkers, wheelchairs, oxygen tanks, other durable medical equipment and service animals)

PresenterPresentation NotesCollaborate with delivery systems that function for the community everyday (i.e. Meals on Wheels)Plan POD locations close to communities with limited transportation access or mobility difficulty

https://www.colorado.gov/pacific/sites/default/files/OEPR5_FSE_CommunityInclusionStrategies.pdf

Community Inclusion POD

Rocky Mountain MRCCore function: Support public health emergencies

Members are trained on Community Inclusion throughout the year as part of their core training requirements

Community Inclusion Project

We have members who identify as having access and functional needs

Tri-County Health Department

• Point of Dispensing (POD) – Use the Medical Reserve

Corps to set up, operate and demobilize a POD**

– MRC trainers conduct the Are You Ready? emergency preparedness course

– Incorporate other volunteer agencies

• Community Inclusion– Involve in planning– Get emergency

preparedness training– Walk through a POD– Provide feedback on POD

operations– Focus group on emergency

preparedness

PresenterPresentation Notes** MRC POD team leaders were responsible for providing a short summary to each participant/group of what happens at each station. This is not typically what happens at a real POD

Community Engagement

• Invited – Immigrants– Refugees– Deaf– Blind– Bilingual– Senior Citizens– Physical / DME

• Participated– Immigrants– Refugees– Deaf– Blind– Bilingual– Senior Citizens– Physical / DME

Community Inclusion PODJune 17, 2017• Planning Session

– Talked about how plans are developed– Asked for input on planning and the POD plan

• Training Session– Are You Ready? Course

• POD Walk Through and Feedback– Info at each station, reviewed forms and signage

• Focus Group– Questionnaire– Emergency Preparedness Starter Kit

Feedback/Lessons Learned - POD

• Even though groups were separated the feedback was generally the same across the board regarding PODs– Use pictograms vs. wordy signs– Use plain language vs. medical / government words– Let us know what is going on– “I didn’t know PODs were a thing”

Feedback / Lessons LearnedEmergency Preparedness• Please do more of this

– Include us in planning– Offer training for my community– Offer training for caregivers

• Include information about service animal and companion pets• MESSAGING is crucial (we need to link this function during future

exercises)• More information about shelters, evacuation, etc.

Next Steps

• Continue to offer planning and training sessions to the community• Develop a way to collect measurable data so that no matter who

does this the information is collected and analyzed the same way• Encourage other emergency preparedness officials/organizations

to do this type of event across the state

PresenterPresentation NotesGet in! Get in! Did that feel like a warm welcome? Would you greet first time clinic visitors like that? Well, during PHED EX, we learned that we welcomed Vietnamese citizens with that translation at the entrance.

Public Health Emergency Dispensing Exercise (PHED EX)

PresenterPresentation NotesWhen Colorado hosted the Public Health Emergency Dispensing Exercise in June, several of the Local Public Health Agencies, opened a Point of Dispensing (or POD). This allowed us to test our ability to dispense medication to the public during a potential emergency. Denver Public Health and Denver Environmental Health chose to invite people with Access, Functional and Medical needs to come through the Denver POD to test the accessibility of the site.Most emergency preparedness plans are what’s called an “All Hazard plan” so they can be adapted to different scenarios. But it can be difficult to target populations with special needs. Also, Denver Public Health has made “health equity” a priority so this project also aligned with that initiative.

Gil and Shirl are amazing!

PresenterPresentation NotesI also recruited an evaluator to judge us on that. I won the lottery and had the great fortune of recruiting Shirl Garcia and her husband, Gil, to serve as evaluators at our POD.

PresenterPresentation NotesThis is a photo of Dr. Jeff Cain who is a family physician. He is also on faculty at the University of Colorado and the past president of the American Academy of Family Physicians. He was great during the POD and never let on with the volunteers that he is a doctor. He was testing volunteers and asking them questions about allergies and the medication. He is also a double amputee below the knee so he uses a wheelchair at times. He did so on this day and was able to visit the POD in his wheelchair and provide feedback about that.The Denver POD flow had visitors entering at the main entrance and exiting out a rear exit which was effective to keep traffic flowing in one direction. However, there were stairs at the exit and the two people who used wheelchairs had to backtrack and exit out the main entrance. This worked okay but it also could signal that they were somehow different.

PresenterPresentation NotesIn follow up conversations, I was told by a participant who uses a wheelchair that this was not an issue. He noted that he generally adapts to “what works” and the flow did work well for him in the POD. This same respondent noted that our staff crouched down to meet him at eye level which he appreciated. Although this did not happen during our exercise, his advice afterwards is to treat a wheelchair like you would a person. Try not to touch it unnecessarily or invade that personal space, just as you would with another human being.

PresenterPresentation NotesI recruited a man, Steve, who is deaf and who uses American Sign Language or ASL. Unfortunately we were not able to provide ASL interpretation during the exercise. Eventually the volunteers and Steve wrote down instructions so they were still able to relay information back and forth.However, in a follow up conversation with Steve, he noted that we should have had ASL interpretation available as it was difficult for him to navigate the exercise without it. But overall and in spite of that omission, our evaluators rated Denver “very good” in terms of our accessibility at the POD. I know Aimee will talk a little more about the range of ratings received at PODs throughout the state.

Empower Others

PresenterPresentation NotesWe were focused on empowering others at our POD. There were several times when I was drafting emails to recruit volunteers with AFN when I first wrote, “Would you be willing to walk through the POD?” Luckily I stopped myself from writing that since some of the contacts cannot walk and it’s important to use inclusive language. Our community volunteers were great on site at our POD. People were incentivized to go through the POD multiple times to get a small giveaway. We asked some volunteers to come through and speak Spanish the next time to interact with our Spanish translator. One woman came through again and pretended that she was upset and wanted to seek behavioral health support. Although we did not have behavioral health providers on site, our team was able to practice using psychological first aid in that scenario.

Empower Others

PresenterPresentation NotesI think having Shirl on site as an evaluator was empowering for her, for attendees and I know it was for me. Volunteers saw her sense of humor and her ability to communicate well in spite of some challenges. I hope that witnessing that makes it easier for others to comfortably interact with people with communication challenges in the future. Other feedback received was the importance of using people first language. For example, saying a “woman who is blind” is preferable to “a blind woman.” “People first language” means that an individual is identified as a person, not by their disability.

PresenterPresentation NotesIn closing, here is a group photo of Denver Public Health and Denver Environmental Health volunteers, our fantastic evaluators, and some community volunteers. In summary, we were able to provide prophylaxis to about 120 people from all walks of life.

Inclusion Evaluators

• Area Agencies on Aging, Senior Centers

• Local Housing Authority

• Long Term Care Facility

• Home care services

• Community members

• Public Health programs

• Independent Living Centers

• Community Mental Health Centers

• Multicultural organizations

• Community Center Boards

• Early Learning

• Inclusion Evaluators [x] [x] [x]• 22 evaluations from 16 open POD sites

PresenterPresentation NotesBring us back to the top of the triangle – people’s experiences and well-beingWebinar training about CMIST, POD environments and the Community Inclusion Evaluation form and guidance

https://www.colorado.gov/pacific/sites/default/files/OEPR5_Statewide_POD_Inclusion_EvaluatorsProposal.pdfhttps://www.colorado.gov/pacific/sites/default/files/OEPR5_CommunityInclusionEvaluationForm2017.pdfhttps://www.colorado.gov/pacific/sites/default/files/OEPR5_CommunityInclusionParticipantSurvey2017.pdfhttps://www.colorado.gov/pacific/sites/default/files/OEPR5_Access_Functional_Needs_one_pager.pdf

CMIST Themes and Lessons• C: Inclusive communication is the hardest to practice

consistently and comprehensively. Low tech solutions can fill small, temporary gaps.

“Personnel well trained, but when there were many people, one interpreter is not enough”

• M: Behavioral health and paramedics on site. How to ensure people understood instructions for taking medicine.

“Just handing folks a sheet of paper with directions and a bottle of meds isn’t enough.”

CMIST Themes and Lessons• I: Minimal representation. People given support tailored to

their requests and needs.

“When triage saw a pin on participant saying “face me to speak” she made sure to.”

• S: Volunteer to community member staff ratio adequate.

“Runners on board to assist if needed and to help with flow. Forms filled out for many community

members.”• T: Generally good flow through POD stations. Entrance,

exit, and signage is where inclusive difficulties arose.

Other Inclusion Lessons• For inclusion evaluators, more CMIST guidance was

sometimes needed

• Hard to test effectiveness with low flow, lack of attendance or representation.

• Presumptions about separate PODs for AFN• The importance of inclusion in pre-POD public

information

• Community willingness to help and novel resources!• Learning along the way…

PresenterPresentation NotesOverall, the IE perception of AFN inclusion around the state averaged between “Good” and “Very Good.” We need more opportunities to share best practices, train one another in AFN, and exercise for consistency – especially when community participation is higher and more representative.

Questions?

Inclusive Emergency Preparedness:Planning for �Public Health EmergenciesVulnerable Populations Community InclusionSlide Number 4Public Health Planning ContextPHED Ex 2017�Inclusion Activities Planning ActivitiesOperational Inclusion StrategiesCommunity Inclusion PODRocky Mountain MRCTri-County Health DepartmentCommunity EngagementCommunity Inclusion POD�June 17, 2017Feedback/Lessons Learned - PODFeedback / Lessons Learned�Emergency PreparednessNext StepsSlide Number 17Public Health Emergency Dispensing Exercise (PHED EX)Gil and Shirl are amazing!Slide Number 20Slide Number 21Slide Number 22Empower OthersEmpower OthersSlide Number 25Inclusion EvaluatorsCMIST Themes and LessonsCMIST Themes and LessonsOther Inclusion LessonsQuestions?