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Adapting Community Call Centers for Crisis Support

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 1. Final Products

This report describes the development, testing, and implementation of the Health Emergency Line for the Pubic (HELP)—a model to enable community health call centers, such as poison control centers, nurse advice lines, and other hotlines, to support home-management and shelter-in-place approaches in certain mass casualty or health emergency events.

The report presents four products, introduced here, to help community health call centers and public health and public safety agency planners adapt their call centers for surge response during a public health emergency. Following chapters provide the background, methodology, and results of the project as well as some recommendations.

1. National Planning Scenarios Analysis Matrix

We reviewed the Department of Homeland Security (DHS) National Planning Scenarios and developed a matrix that summarizes the 15 scenarios for which emergency planners should develop response capabilities. Using the same set of scenarios will allow for a common language of response planning and capabilities development, so that best practices can be shared and adapted between agencies and localities. After summarizing each scenario, the matrix shows the six response capabilities that community health call centers can provide. The National Planning Scenarios Analysis Matrix (Appendix 1) lists each scenario and indicates which health call center capabilities correspond to the expected response needs of communities.

Call centers can use the matrix to determine whether they are prepared to provide response capabilities for the scenarios most likely to occur in the communities they serve. The matrix can help frame discussions among public health and public safety agency planners so that community health call centers can be integrated into planning and responses, both as a resource and as critical infrastructure.

2. Potential Health Call Center Capabilities for Four National Planning Scenarios

We determined four National Planning Scenarios for which we determined that call centers had the best capabilities and developed a detailed list of all the applicable capabilities (Appendix 2). This document can assist call centers and public health agencies in determining the expected health needs for each scenario and selecting those for which they may want to plan.

3. Suggested Elements for Public Health Information and Decision Support Hotlines: the Health Emergency Line for the Public (HELP) Model

Appendix 3 describes many of the essential components of the HELP model. The HELP program serves as Denver Health's operational platform for disseminating and collecting consistent, accurate, and up-to-date information, in partnership with public health agencies, during bioterrorism and other public health emergencies. The goal is to provide self-service information to the public so that they can make informed decisions about their health concerns. The structure and adaptability of the HELP model have allowed Denver Health to effectively respond to major health events, such as West Nile Virus (WNV) and influenza outbreaks. Community health call centers can use Appendix 3 begin to develop similar capabilities within their existing infrastructure.

A more complete discussion of the requirements for general call center infrastructure (people, processes, and technology) can be found in the Health Emergency Assistance Line and Triage Hub (HEALTH) Model. The HEALTH model is discussed in Chapter 2 and Chapter 3, and the full report is available at

We strongly urge any call center attempting to provide these community services to do so in cooperation with the appropriate public health authority. That is, the authority that, by statute, is responsible for coordinating health and medical services following a major disaster or emergency or during a developing potential medical situation. Coordination with the health authority will help ensure overall consistency with other response measures in the community.

4. Interactive Response (IR) Applications

Appendix 4 provides the blueprint for other call centers to develop similar capabilities within their own infrastructure and using their own equipment. It includes full details of the planning, analysis, design, implementation, and evaluation of the four IR applications that we developed:

  • Quarantine/Isolation (QI) Monitoring (outbound application).
  • Drug Identification (DI) (inbound application).
  • Point of Dispensing (POD) (inbound application).
  • Frequently Asked Question (FAQ) Library (inbound application).

An IR system with applications such as these allows callers to use their touch-tone phones to automatically retrieve information during a public health emergency. Since we had previously purchased an IR system, we designed the IR applications to use the available features of our equipment. We contracted with an IR consultant and developer to oversee the development of the applications in accordance with our business requirements and specifications. The IR consultant developed the applications, provided administration and maintenance training for our internal technology staff, and assisted with modifications to the applications after testing in two exercises. Our internal technology staff made the appropriate programming changes to our telephone switch to support the IR applications. Through this process, our technology staff acquired some training on IR programming and can make certain modifications to the applications without requiring an IR consultant.

Call centers that have an IR system can contract with an IR consultant or use internal technology staff to program similar tools. Planners can review the Appendix 4 with internal technology staff to determine how best to develop the desired capabilities with available resources. Call centers that want to purchase an IR system can use the information in this appendix to help select equipment to meet their business needs and specifications. Call centers that cannot invest in such technology can still use the appendix to develop call handling procedures that their staff can use to provide the same capabilities to the public.

These four products were developed for the four specific planning scenarios but can be adapted to others as appropriate. Together, they cover the full range of capabilities that community health call centers can provide.

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