Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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Chapter 2. Background
Incorporating Health Call Centers Into Community Emergency Responses
The overall benefit to health call center involvement in a community emergency
is depicted in Figure 1. Once
an event occurs, media outlets (newspapers, television, radio, Internet) will
devote much time and effort to reporting on it. The public will get needed
information about the event from those media sources, but there will be
limited opportunities to ask questions about how those events pertain to their
Health call centers (poison control centers, nurse advice lines, and health
hotlines) have the expert and experienced staff to address the potential
demand for more information with a range of approaches from recordings to
speaking with a trained professional. By partnering with public safety and
public health agencies, health call centers can provide information that
is accurate, up-to-date, and consistent with official messages. Call centers
can also collect information for use in situational awareness, from health
concerns to the development of illness.
Addressing Public Concern
Public concern about an event and how it may affect individuals increases
when it has potential health implications. Our previous research has shown
that calls to health-related hotlines have ranged from less than 1 percent
to 25 percent of the affected community's adult population, depending on
the nature of the event. Figure
2 depicts that concerns for emerging insect-borne
disease outbreaks in Colorado and New York City (using hotline contacts as
a percentage of the population) were much lower than concerns for an infectious
disease outbreak primarily involving children in
It has been demonstrated that the public perceives risk differently than
public health professionals do.4,6 Experiences
have shown that bioterrorism-related, child-focused, and newly emerging disease
events, in particular, prompt people to contact call centers. Though it may
be hard to predict the level of concern for any given health event, research
in the field of risk communication indicates that certain risk perceptions
increase levels of fear and concern. Covello, et al, report that levels of
concern tend to be most intense when the risk is perceived to be involuntary,
inequitable, not beneficial, not under one's personal control, associated
with untrustworthy individuals or organizations, and associated with dreaded
The Rocky Mountain Regional Health Emergency Assistance Line and Triage
Hub (HEALTH) model was developed as a partial solution to the public health
communications problems that were recognized in the aftermath of September
11, 2001 and the concern about anthrax-laced letters distributed through
the United States Postal Service.
The HEALTH model presents requirements, specifications, and resources needed for
developing a public health emergency contact center that is highly integrated with public
health agencies and that could minimize surges in the demand for health and
event information during an emergency. The model was designed with medical
contact centers (such as poison control centers and nurse advice lines) in
mind as potential implementers, and as the appropriate repositories for the
creation and maintenance of readiness for providing one-on-one health communication
in a public health event.
To further assist other agencies in developing the capabilities and functions of this
model, especially public health agencies, we created a HEALTH Contact Center
Assessment Tool Set. The tool set is a Microsoft® Excel workbook that agencies
can use to assess the potential demand they may face in a health emergency
event and to determine the resources needed to address this demand. The tool
set consists of seven simple checklists or spreadsheets, including:
- Contact Surge Calculator.
- Staffing-Resource Calculator.
- Capital Expense Calculator.
- Technology Expense Calculator.
- Surge Options Matrix.
The HEALTH model incorporates the ability to provide one-on-one health information
using the latest in technology to efficiently handle this demand through
various communication modalities. The Rocky Mountain Regional HEALTH model
report and tools are at http://www.ahrq.gov/research/health.
Our poison center established the Health Emergency Line for the Public (HELP)
pilot program in Colorado to provide information during bioterrorism and
other public health emergencies. HELP originated as a pilot or proving ground
for implementing some of the concepts and strategies that were developed
in the HEALTH model. Since then, it has been continually developed and has
responded to three major health events in Colorado: the deadliest WNV outbreak
in the United States (2003), an influenza outbreak with early increased pediatric
deaths (2003-2004), and an influenza outbreak during a vaccine shortage (2004-2005).
The HELP program provides a model for disseminating and collecting information
during health emergencies in partnership with a State health department.
The HELP service was offered to the public in January 2003 to support a
statewide smallpox vaccination program for health care volunteers in Colorado.
The vaccination program finished in March 2003. The HELP program was then
modified to provide WNV information to the public in anticipation of a second
season of that outbreak in Colorado. Since July 22, 2003, a toll-free line
has been available 24 hours a day, featuring current recorded messages and
Web site referrals for more detailed information. Trained information providers
are available from 7:00 a.m. to 11:00 p.m. daily to answer questions, collect
demographic data, and provide referrals.
Recordings are available in English
and Spanish with additional translation services available for other languages.
Information providers use FAQ scripts prepared by State health epidemiologists
to explain symptoms, treatments, and prevention measures to callers. Evolving
public concerns are identified, and applicable responses are developed within
48 to 72 hours. The HELP program has expanded information offerings to include
additional topics such mold, influenza/pneumonia, anthrax/white powder, severe
acute respiratory syndrome (SARS), hantavirus, tuberculosis, the human strain
of avian influenza, and ricin. Other topics are added as information needs
for the public and health providers are identified.
The HELP program provides the functional platform for piloting and testing
other call center strategies, technology, and applications to efficiently
provide information to the public in a health emergency. The technology infrastructure
and requirements of the HELP program were described previously in the HEALTH
model report. The essential elements that we have identified from the last
3 years of operating the HELP program service are addressed later in this
report and in Appendix 3.
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