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5. Software Has Been Fully Tested
This chapter explains how the pilot test was implemented in an eight-county region of rural Pennsylvania. This test included soliciting political support, configuring EPRI for the location types and resources relevant to the pilot test, outreach to organizations to solicit their participation, and remote data entry by participating organizations.
The Steering Committee provided input on the design of the inventory (what resources, location types, etc. should be included). Most importantly, they also provided recommendations on the types of reports they, as end users, would find most helpful in planning and response activities. Other potential users creating their own regional inventory of resources may also find a Steering Committee helpful.
Members of the project steering committee were helpful in terms of obtaining the guidance and feedback necessary to make the project successful. It was important that the steering committee have representation from emergency management, public health, healthcare providers, hospital administration, first responders, and other sectors involved in emergency planning. Individuals living and working in the pilot region who were identified as having considerable expertise and experience in these fields were invited to serve on the committee. Steering committee members included:
- Representatives of the Department of Health from district, regional and State levels.
- Healthcare providers practicing emergency medicine and representing the research community.
- Hospital administration officials.
- Emergency management agency coordinators from several pilot counties as well as regional representatives.
- Regional counterterrorism task force representatives.
- A home health nursing director.
In addition, several members volunteered to sit on the committee following presentations of the project goals and objectives at local and regional emergency management committee meetings.
Following commitment to serve on the committee, the members were assembled and an overview and explanation of the goals of the project were given. Early in the project, management of the committee members' expectations played a large role in properly directing the focus of the group. Misconceptions concerning the design and eventual purpose of EPRI were addressed and questions answered. It was useful to describe EPRI as a tool for assembling a "data warehouse" that would hold the data inventoried. It was very important to point out that the utility of EPRI was primarily for planning, although the benefits as an incident response tool were also recognized. Indeed, steering committee members felt that cooperation would be enhanced (especially among first responder agencies) if the data could become useful in their missions of emergency response. Throughout the course of the pilot project, the steering committee provided valuable feedback regarding the structure, functionality, and use of EPRI.
County-level Political Support
In addition to creating the project steering committee, which included representatives from key agencies and organizations in the eight-county area, it was felt necessary to secure acceptance and cooperation from local authorities. County government plays a strong role in Pennsylvania and our efforts were therefore directed first at County Commissioners, the elected county managers in Pennsylvania.
To familiarize officials in the pilot region with the goals and objectives of the project and obtain endorsement from county officials, a series of meetings and presentations were arranged. The county commissioners of each county were sent a letter of introduction and a request for the opportunity to present an overview of the project. Followup calls were made to each office for which no response was received within two weeks after the initial letter was sent. A presentation was subsequently made to each of the county commissioners of six of the eight counties in the pilot region. Of the two counties for which presentations were not given, the emergency management coordinators of each county served on the project steering committee and provided updates to the officials of those counties. All six counties agreed to support the pilot test, and one county contributed its director of Public Safety to serve on the steering committee.
Throughout the course of the project, the emergency management coordinators of each county provided considerable support through provision of listings of organizations and call lists, coordinating meetings, and communicating with providers in their respective counties. In addition, project staff participated in a variety of local and regional emergency management and planning groups and attended meetings of the regional counter terrorism task force, which included all but one of the pilot counties. This facilitated working relationships with the individuals responsible for planning in the communities targeted for the pilot.
Selected Location Types, Resource Types and Resources Relevant for Pilot Test
There are 33 types of locations in the inventory and over 2500 specific locations in the eight-county area that could have been included in the pilot test. To make the pilot manageable within the timeframe of the project, the location types to be inventoried were reduced to eleven. Those most immediately involved in emergency response, health care providers, and a few others that might not think of themselves as emergency resources (animal control, mortuaries) were selected, to determine what is involved in gaining cooperation from such places.3 For the purposes of the pilot test, EPRI was configured to include only these location types. All the resource types and specific resources assigned to these location types in EPRI were reviewed to select those that should be retained for the pilot test. It was decided to retain all the resource types and nearly all the resources for the 12 types of locations selected for the pilot study.
Having specified location types, it was necessary to identify the specific locations that existed in the pilot region (Box 4). Project staff enlisted the help of emergency management coordinators of each county in obtaining lists of emergency medical service providers, fire departments, and law enforcement agencies in each county. Geisinger Medical Center administrative staff provided names and addresses for all hospitals in the pilot region. Various professional societies, such as the state home health nursing association, also provided lists of locations/organizations within the region. Identification of several location types, such as nursing homes and funeral homes, required use of national databases, some of which were available through online listings. A complete listing of approximately 1100 specific locations was compiled to be included in the pilot data collection effort.
|Box 4. Identifying 11 Location Types for the Pilot Test—where did lists come from?|
Home Health Agencies
Public Health Departments
Animal Care & Kennels
| Lists Obtained From:|
Local hospital staff
Medicare, State health depart. Web site
State health department Web site
County Emergency Mgmt. Directors
County Emergency Mgmt. Directors; State police Web site
County Emergency Mgmt. Directors; Regional EMS council
State Emergency Management Web site
State health department Web site
American Red Cross Web site; phone books for each county
Internet searches; county phone books
National Funeral Directors Association Web site; searches by county
Outreach to Solicit Participation
To reach each of the specific organizations and agencies identified, a letter of introduction was mailed inviting representatives to attend a presentation to be made in their county. Each letter also contained a brief overview of the project goals and objectives, the counties included in the pilot test, and contact information for project staff. These letters were mailed to each location at least two weeks prior to their planned county meeting. One individual meeting was held in each of four of the pilot counties; a combined meeting was held for two small counties, which are geographically adjacent; and two individual meetings were held in each of the two largest counties in the pilot region. In addition, two evening meetings were held to facilitate attendance by individuals unable to attend a meeting during regular working hours. For example, volunteer firefighters often work day jobs and cannot take time away to attend a meeting but may be more available in the evening to attend a meeting.
To publicize the meetings, local radio and newspaper interviews were granted and meeting dates were published. Each organization was provided with an overview of the project and, if requested, written materials regarding the project. Following provision of this information, participation was requested from each organization.
During each meeting, sign-in sheets listing each of the organizations in the county were used to track attendance. Following each meeting, those organizations that sent a representative, and those that did not, were catalogued for the purpose of followup. At the completion of all meetings, each organization not in attendance was contacted by telephone, again offering information and requesting participation.
3. During the course of the pilot, the funeral home/mortuary location type was deactivated because in this region there is a central crematory and no corpse processing or storage in a mass fatality event is handled by individual funeral homes. The same might be true in other regions of the country.
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Recruiting Organizations and Collecting Data: Lessons Learned
Having mailed letters to all selected organizations in the eight-county region, and having held meetings in each county, the next task was to contact organizations to solicit cooperation and to set them up as EPRI users so that they could submit data.
Since there was no mandated governmental or organizational directive sent to any of the contacted organizations, the pilot test was dependent upon the goodwill and trust of the various contacted organizations to participate in the project and the inventory. The pilot test enjoyed no formal support from State agencies, although there was direct contact with several levels of leadership of the Pennsylvania Department of Health, Pennsylvania Emergency Management and Pennsylvania Office of Homeland Security. Information regarding the project and EPRI were presented in several meetings to keep these organizations updated on the progress of the project. None of the State agencies was able to guarantee the necessary financial and personnel commitment to manage and maintain this inventory beyond the current year, because their resources are based on annual funding (largely grants) coming mainly from the federal government. This may be a barrier in other States as well, until more stable funding streams become available for homeland defense. The project team had no incentives to offer other than that of community preparedness and no leverage to compel cooperation.
The project staff was able to recruit and collect data from all 12 types of locations chosen for the pilot, from animal control facilities to hospitals. All types of organizations were able to log onto the system, bring up their organization's data entry pages, and enter data. Queries and E-mail were sent between participating organizations and the system administrators. Reports were generated with the contributed data. EPRI was successfully tested, all functions worked as expected, and no redesigns were required.4
Although EPRI met with great enthusiasm from many organizations, cooperation (and data) were not forthcoming from the majority of organizations selected for the pilot test. During the three summer months of 2003, approximately 15 percent of the 1100 organizations targeted in the eight-county area were recruited and provided data. Much of the difficulty in eliciting cooperation from the organizations in the pilot region had to do with the fact that the test was conducted during the summer months when many organizations were short staffed and had competing priorities. In addition, there was neither a mandate nor any incentive to participate. Inventories organized by states or regions that do have official sponsorship or mandates will perhaps be more successful in securing cooperation.
Lessons Learned About Soliciting Participation
If a State or region decides to assemble an inventory of resources, it will need to reach out to organizations throughout the area. Direct telephone contact may be necessary to those organizations that do not respond to a mailing or an E-mail solicitation. The following guidance may be useful in making telephone contacts to solicit participation, set up user accounts, and collect data.
Preparing materials: In addition to rE-mailing and faxing the letter previously sent (which many contacts did not recall receiving), printouts were created of the data entry forms so that individuals at organizations in the pilot area could see exactly what information was being sought. These printouts were faxed or mailed, along with a form requesting contact information that would allow the creation of new user accounts (contact name, address, E-mail, and phone). Being flexible in using E-mail, fax, mail and phone was important due to the diverse array of organizations being contacted.
Creating a database for record-keeping: It was necessary to track which organizations had been contacted, which had agreed to participate, which had not yet agreed, which needed calls backs etc. With 1100 organizations to recruit during the summer months, such a tracking system was extremely useful. A Microsoft Access database was created and included identifying information for each organization and location, and notes about the status of each organization's recruitment. A report of pending cases helped staff to prioritize their daily work. A weekly status report was generated with each organization and its status (e.g. pending, recruited/agreed to participate, refused).
Efficiently Contacting Organizations: For this pilot test, 1100 organizations had to be contacted in a limited time. We arranged to have project staff make outreach calls at different times of day, including evening shifts. We found that most volunteer fire departments do not have an employee who answers the phone (or picks up the mail) and it was nearly impossible to reach anyone at these small fire stations who could provide information. This will be a challenge in any rural area where firefighting is a largely volunteer effort.
Getting past Gatekeepers: Gatekeepers include receptionists, operators, secretaries, and answering services. Some are extremely helpful in reaching the organization's executive; some are not. System administrators must be able to quickly describe the project and its relevance, obtain the name of the individual empowered to make decisions for the organization, and try to get through to that person. System administrators must make it immediately clear that this is not a sales effort and there are no costs to participate, and to give the name of the sponsoring agency to establish legitimacy. A set of Frequently Asked Questions was created so that our system administrators would be prepared to handle common questions in a consistent manner.
Explaining the usefulness of the inventory: The objection heard most often from location directors was that there is no need for this resource, or that the location's participation was not valuable. In the pilot area of rural central Pennsylvania, many people felt that the local community would not be a target of bioterrorism. It is important to reinforce the idea that this inventory can be used for any major disaster in the area, as well as serving as a resource during any evacuation of people from metropolitan areas.
Addressing concerns of validity, security, and confidentiality: Some organizations, especially those in law enforcement, were concerned about security. System administrators need to explain who will have access to data and reports and how data is secured.
Discussing the burden of participation: Once organizations understood the need for such a resource, they wanted to know what they would be required to do and how much time and effort would be involved. A few organizations had an aversion to the Web or technology, or did not have the technology available to enter data. For these few organizations, information was collected over the phone, and project staff entered the data into EPRI.
It is important that anyone implementing such inventory be familiar with similar projects that may be taking place in the same locality. Early in our outreach efforts, we learned that nursing homes and home health agencies were in the process of putting together local and county emergency preparedness programs and contact lists. It is important to be able to explain how this inventory is different and why participation in both activities is important. It may also be possible to combine efforts with others engaged in such projects, to reduce the burden on participating organizations.
Convincing organizations to enter data: Recruitment is only as valuable as the ability to capture a location's inventory data. Even when outreach was successful and organizations agreed to participate, a location did not always follow through and log in to enter data. Reminder calls, E-mails and faxes were often necessary.5
Technical assistance to participating organizations was often necessary. System administrators usually had to use the telephone to walk each location's data entry staff through the login and entry steps. Advice regarding how to locate, count and aggregate information was occasionally necessary, and we provided a toll-free number people could call for assistance. In some cases, data entry staff did not have adequate Internet access at work, but were willing to enter data from their homes after hours. We therefore staffed our toll-free helpline during the evening as well as daytime hours.
4. The reports were not tested in a 'real life' emergency or in a drill.
5. The inventory tool has a built-in capability for sending E-mails.
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AHRQ Publication No. 05-0077-1
Current as of April 2005