The Role of Local Public Health in Healthcare Critical Infrastructure Protection

Fairfax_County_Fire_Station_440_Hazardous_Materials_truckContinuity of healthcare and public health services are critical to response and recovery following a disaster or emergency. Strengthening and protecting healthcare and public critical infrastructure requires coordinated preparedness planning and response among public and private sector stakeholders. To better understand the role of local health departments (LHDs) in healthcare and public health critical infrastructure protection, Senior Program Analyst, Katie Schemm, and Local Public Health Practice and Policy Scholar, Niharika Patel, interviewed Marc Barbiere, who leads emergency preparedness efforts at the Fairfax County Health Department in Virginia, and who chaired the Steering Committee for the Northern Virginia Emergency Response System (NVERS) for two years.

What is the overall role of Fairfax County Health Department in the protection of healthcare and public health critical infrastructure?

At the agency level, the Fairfax County Health Department has a Continuity of Operations Plan that includes procedures for all county facilities, including those that provide services to the community. Externally, the Fairfax County Health Department has built relationships with local and regional hospitals, dialysis centers, long-term care facilities, and other healthcare partners to develop and exercise our preparedness plans. These plans include the Regional Hospital Emergency Operations Plan, the Fairfax County Emergency Operations Plan, and the development of the Northern Virginia Long Term Care Mutual Aid Plan. These plans ensure the protection of public health and healthcare critical infrastructure by enhancing the ability to evacuate patients from long term care facilities during emergencies. Fairfax County has been successful in activating these plans over the years in exercise scenarios and real-world emergencies, including routine disruptions, power outages, and situations where their infrastructure is unavailable for use.

What is the role of Fairfax County in forming the local and regional relationships?  How do you leverage these relationships to support preparedness planning for healthcare and public health critical infrastructure protection?

At the local level, the health department is the coordinating agency for Emergency Support Function 8 (public health and medical services), which includes responsibility for all healthcare facilities in Fairfax County. We help these facilities build resilience and maintain services during incidents, especially through our role in the county Emergency Operations Center (EOC). Regionally, the Fairfax County Health Department participates in the Northern Virginia Hospital Alliance (NVHA) and Northern Virginia Emergency Response System (NVERS), which are coalitions of partners that focus on emergency preparedness and response across Northern Virginia. Over time, these coalitions have grown in partnership and scope, and there has been a great deal of effort focused on enhancing infrastructure preparedness for our region’s healthcare facilities. The Fairfax County Health Department continues to make it a priority to work closely with their healthcare partners to develop plans, train and conduct exercises, and coordinate responses, because their ability to provide healthcare services during disasters is essential to preparedness planning and emergency response.

Why do you think Fairfax County and the region have been successful in establishing these relationships?

I believe the foundation of the relationships is a result of the history of the Northern VA region. Northern VA is close to Washington, D.C., and a part of the National Capital Region (NCR). After September 11th, individuals in various emergency response roles would meet monthly and talk about preparedness plans to identify gaps in knowledge. Eventually, and with the support of federal grants (e.g., Urban Area Security Initiative, Public Health Emergency Preparedness, Hospital Preparedness Program), these relationships became more formal. Coordination, collaboration, and partnerships are critical for the ability to respond to incidents in the region.

How does the Fairfax County Health Department work with key stakeholders in other sectors (e.g., energy, transportation, water) and government to ensure that protection and restoration of public and healthcare infrastructure is a priority?

On the planning side, as a part of the NCR, the Fairfax County Health Department works with partners to identify and assess various threats, their potential impact to the community, and ways to mitigate any resulting damage. On the response side, during a major event, Fairfax County activates their EOC and coordinates with, among others, the NVHA, who activates the Regional Healthcare Coordination Center. These two operations centers coordinate directly, allowing information about impacts to healthcare and public health infrastructure and the community to flow seamlessly between appropriate stakeholders and decision makers, which informs the prioritization of restoration efforts.

For example, during the Derecho storm in June 2012, the Fairfax County Health Department worked directly with the power companies (who were represented in the emergency operations center) to prioritize power restoration for healthcare facilities that had lost power. Much of the information about which facilities were impacted came from the NVHA. This sharing of information enabled decision-makers to prioritize restoration of power to hospitals and nursing homes over other less-critical facilities.

LHDs have a role in information sharing within their community and among stakeholders. How does that information sharing role relate to healthcare and public health critical infrastructure protection?

The Fairfax County Health Department plays a critical role in information sharing before, during, and after public health events.

Prior to an event, the Fairfax County Health Department has an essential role in education, outreach, and training to our partners. This role includes sharing information about available training sessions, exercises, and preparedness information to the owners and operators of public health and healthcare critical infrastructure so they can maintain situational awareness and appropriately prepare for notice-events (e.g., hurricanes, snow storms.) Through the regional coalitions, a Vulnerable Populations Coordinator has been hired, and part of their role is to educate long-term care facilities about preparedness planning, preparation, and implementation.

During an emergency, the Fairfax County Health Department utilizes the County’s emergency alert systems, mass email communication, and other electronic communication systems to share pertinent information regarding emergency response. The region has also been able to equip long-term care facilities with the same communication infrastructure as regional hospitals, 800 Megahertz MEDCOM radios that can operate when an incident occurs if all other forms of communication have been compromised.

After an incident, the Fairfax County Health Department will often convene or participate in an after-action process where the partners engage in discussions about how the emergency preparedness plans were carried out and identify areas for improvement.

The Fairfax County Health Department has a program in place for redundant transportation for dialysis patients in the event of a situation that would affect regular transportation providers – can you share a little bit about this program?        

Fairfax County has 12 dialysis centers. During certain emergencies, such as winter storms, regular transportation services may be disrupted. For events that can be anticipated, the Fairfax County Health Department works with dialysis centers and transportations services to determine if they can front-load dialysis patients or move their appointments. If this is not possible because of the patient’s healthcare needs or the nature of the event, the health department has worked with the county to develop a process that allows fire department resources to provide critical transport services to dialysis patients who cannot get to their appointments otherwise. In addition, the Fairfax County Health Department has also coordinated with local car services to provide patients with transportation. The NVHA also has a regional memorandum of understanding (MOU) with several private ambulance services that provide additional transport resources during emergencies. The key to developing and maintaining this program is good relationships with transport and public safety partners and learning from threat analyses and real life experience with major storms, events, etc.

Fairfax County and the region are developing a plan for regional surge/evacuation. In what ways are these plans designed to protect public health and healthcare critical infrastructure?

Northern Virginia has 41 long-term care facilities. Following an incident that could cause damage to one or more of these facilities, the region’s acute care hospitals and free-standing emergency departments don’t have the ability to absorb patient populations from nursing homes. Therefore, using Hospital Preparedness Program grant dollars, the regional coalitions worked with a consultant to conduct a surge evacuation assessment which included transportation needs, electrical resiliency, and communications resiliency and redundancy. The outcome was the development of a regional long-term care evacuation MOU and plan, which is currently being finalized. The MOU establishes a process and mutual agreement that, if an event occurred where patients need to be evacuated from one or more nursing homes, they would be moved to other nursing homes, instead of hospitals. When the MOU is finalized, the region is planning to exercise the plan to test their ability to move patients from one location to another. In addition, funds from this program allowed for the purchase of deployable caches of evacuation equipment that will be used to support healthcare facility evacuations in the region.

How did you navigate HIPAA regulations for moving these patients across institutions?

The authority to determine who has responsibility of these transferred patients in terms of their medical records, their care, billing, and other aspects of their health care, lies at the state level. As such, the Virginia Department of Health and the Health Commissioner were involved with the planning process. The MOU lays out the key processes which state that the sending facility should have the capability to provide a hard copy of the patient’s medical records to the receiving facility, in the event that electronic systems are not functioning or the patient is being transferred across institutions.

NACCHO would like to thank Marc Barbiere, emergency management coordinator for the Fairfax County Health Department and Fairfax County Health Department for contributing the content for this article.

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