Emory Preparedness and Emergency Response Research Center

Emory Preparedness and Emergency Response Research Center The Emory Preparedness and Emergency Response Research Center (Emory PERRC) focuses on the comparative analysis of public health systems to produce practical and sustainable outcomes that serve to improve our nation's public health systems in the event of a disaster. The Emory PERRC addresses the third theme within the IOM's 2008 Research priorities in emergency preparedness and response for public health systems: A letter report: "creating and maintaining sustainable preparedness and response systems throughout US public health network." Led by Ruth Berkelman, MD and an interdisciplinary team of project directors and staff from epidemiology, health policy and management, emergency medicine, and medicine, the Emory PERRC examined state and local health departments' systems of preparedness to identify factors that affect a community's ability to successfully respond to a crisis with public health consequences and documented the systems and infrastructure needed to foster constructive responses in a sustainable manner.

During the first four years of the Emory PERRC, we pursued research that examined the organizational characteristics, response capacity, and interoperability of key community assets, including, but not limited to emergency operations centers, immunization registries, academic institutions, private providers, and state and local public health agencies. Emphasis was placed on specific systems that protect vulnerable populations, such as nursing homes, home health care agencies and vaccine providers. We explored how these assets can be integrated and exploited to better prepare for, detect, respond to, and recover from public health crises.

  • Assessing the Utility of Incident Command Systems (ICSs) and Emergency Operations Centers (EOCs) in Public Health Crises. Under the direction of Kathleen Miner, PhD, this project identified the attributes of ICSs or EOCs that strengthen the capacity of public health officials to assess and respond to public health emergencies and determined how the structure and implementation of ICSs and EOCs can be improved to enhance the capacity and capability of public health agencies to prevent or control disease and injury during emergency events.

  • Academic-Community Partnerships in Preparedness. Led by Alexander Isakov, MD, MPH and Anne Dunlop, MD, MPH, this project examined the role of academic institutions in community disaster response and the facilitators and barriers to collaborative response efforts by academic institutions and public health systems. This project sought to facilitate effective and sustainable preparedness and response systems by illustrating the potential role and contribution of academic-public health partnerships and successful preparedness, mitigation, and response initiatives that resulted from these partnerships.

  • Improving Disaster Planning for Nursing Home, Home Health, and Dialysis Providers. This project, led by David Howard, PhD and Sarah Blake, PhD, responds directly to the CDC priority of protecting vulnerable populations in emergencies. The goals of this project were to assess the current preparedness plans of nursing homes, home health agencies and dialysis centers. The researchers conducted comprehensive interviews and surveys of providers, gathering information on providers' evacuation plans, ability to "shelter-in-place", and coordination with local and state preparedness planners. The project provided preparedness planners with a better understanding of the capabilities of these providers and a comprehensive set of recommendations to improve coordination, planning, and response.

  • Immunization Systems and Public Health Preparedness. Led by Saad Omer, PhD, MPH, MBBS, this project focused on determining how public and private immunization systems can be leveraged to combat vaccine-related and other types of public health emergencies. Retrospective analyses of lessons learned from previous vaccine shortages, such as the 2008 - 2009 Haemophilus influenza type-B vaccine shortage and the 2009 - 2010 H1N1 vaccine shortage, and the pertussis vaccine shortage, were assessed to determine how states can effectively utilize immunization systems to address emergencies in which mass vaccinations or countermeasure distribution must occur. Through collaborations with the Association of Immunization Managers, the American Immunization Registry Association, and the Task Force for Global Health, the project incorporated surveys of city, state, and territorial immunization program managers and vaccine providers to gather data useful to public health officials and practitioners interested in improving the U.S. immunization system for future vaccine shortages and large-scale public health emergencies.

During year five, we focused on three research projects, which built on findings of prior years.

  • Nursing Home Preparedness Assessment
    Based on interviews with nursing home administrators and survey of nursing homes, the Emory PERRC project, "Improving disaster planning for nursing home, home health and dialysis providers" developed a disaster planning self-assessment tool for nursing home administrators. The tool consists of 11 questions interspersed with results from a survey of 298 nursing homes and tips and pointers about improving preparedness. The content of the tool was developed by identifying vulnerabilities in nursing homes' plans that may escape the attention of nursing home administrators, who are not necessarily thinking about how a large scale disaster may affect the health care system and make it difficult to access common resources. Emory PERRC disseminated the Nursing Home Preparedness Assessment tool to nursing home directors in Florida and tested its impact on nursing homes' plans. We anticipate that the tool will make nursing home administrators aware of vulnerabilities and that administrators will use the assessment as an opportunity to revisit their plans and address specific weaknesses.

  • Georgia Geomapping Tool of Academic Institutions Key Contacts and Capabilities
    Building on the successful achievements of the Academic-Community Partnership Project, the Emory PERRC developed a set of practice tools that center around relationship-building between public health response agencies and academic institutions. Each of the tools is intended for use by the public health agency in conjunction with the academic institutions during the relationship-building phase to foster collaboration. During year five, we developed a template for the geographic mapping of academic institutions in a given jurisdiction with integration of key contact and capability information related to that academic institution and overlay of public health agency boundary lines. A 'survey assessment of academic institutions' capabilities for preparedness and response' tool was also developed to measure the resources and capabilities of academic institutions (within a particular jurisdiction defined by public health) in terms of their capacity to partner for improved community emergency preparedness and response. Emory PERRC in collaboration with our practice partner, the Georgia Department of Public Health has piloted the tools.

  • Assessing the impact of a comprehensive influenza/Tdap vaccine promotion package in Georgia obstetric practices: A group-randomized trial (MOMVAX)
    Increasing vaccination coverage against influenza and pertussis among pregnant women has become a national priority both in regards to routine disease prevention and public health emergency preparedness. Recently, there has been a call for increasing the rates of these immunizations in pregnant women as well as successful approaches for doing so. National organizations like the CDC's Advisory Committee on Immunization Practices (ACIP) and the National Vaccine Advisory Committee (NVAC) have highlighted the importance of addressing these issues. The national professional organization, the American Congress of Obstetricians and Gynecologists (ACOG) has recently undertaken several initiatives in an effort to promote immunization of pregnant women. Led by PhD student, Allison Chamberlain, MS, under the guidance of Saad Omer, Ruth Berkelman, and Walt Orenstein, the primary objective of the "Increasing Influenza and Pertussis Immunization among Pregnant Women in Georgia: a Randomized Evaluation of a Comprehensive Intervention Package" is to evaluate the effectiveness of the comprehensive practice-, provider-, and patient-based "P3" intervention package on increasing influenza and Tdap vaccine acceptance among pregnant women in Georgia. Our study will test the effectiveness of a comprehensive vaccination intervention "package" in OB/GYN offices aimed at increasing coverage of influenza and pertussis vaccination during pregnancy among women in Georgia. Using a cluster-randomized trial design, we recruited 10 OB/GYN practices in Georgia, randomizing 5 to receive the intervention package and 5 to serve as control practices. Unvaccinated pregnant women from each participating practice were enrolled. Participants were surveyed at enrollment and at 2 – 3 months post-partum to assess prenatal vaccine receipt and changes in knowledge, attitudes and beliefs about vaccination. Our intervention package has components tailored at the practice-level, the provider-level, and the patient-level, with all components being evidence-based from previous research on barriers to vaccinating pregnant women. By developing and testing a comprehensive vaccine promotion package that targets known challenges to vaccinating pregnant women, we hope to create a generalizable (and practical) set of "solutions" that obstetric practices can adopt to increase influenza and Tdap coverage among their pregnant patients.

With the year 5 supplement, the Emory PERRC will conduct two research projects that utilize technology and innovation to implement our research findings in a practice setting furthering our goal of creating and maintaining sustainable preparedness and response systems.

  • Long Term Care Preparedness Portal
    Led by Sarah Blake, PhD and David Howard, PhD, the project involves the development and pilot-testing of the only known web-based long-term care emergency preparedness portal housed on the state health department level. This electronic information resource will enable the Emory PERRC to extend the reach of its completed research by translating existing tools, such as the Nursing Home Self-Assessment Tool, to a broader community. State health departments, preparedness officials, and the long-term care community (nursing homes, assisted living facilities, home health agencies) in Florida, Georgia, and West Virginia will be able to access these products and share other relevant emergency preparedness policies, guidance, and regulations. There is currently no such repository for emergency preparedness information among these public health practice partners, but there is great interest among these partners for having such a resource.

  • READYVAX
    Led by Saad Omer, PhD, MPH, MBBS the READYVAX project focuses on rapid dissemination of vaccine-related information in the event of a public health emergency or pandemic; timely dissemination is critical to ensure appropriate messages are promulgated widely, especially given the possibility of quickly evolving knowledge and recommendations. One method to address these information needs is through mobile (e.g., smartphone, tablet computer) applications. The objective of this project is to develop and evaluate the multi-platform, multi-audience READYVAX tool as designed for use by healthcare providers (physicians and pharmacists) and patients, in multiple states (California, Georgia, Oregon, and Washington) for use as a routine vaccine communications tool while also providing an effective way to disseminate targeted messages during a vaccine-related emergency.