Improving publlic health preparedness through enhanced decision-making environments: lessons learned from preparing for and responding to the Novel...

Improving publlic health preparedness through enhanced decision-making environments: lessons learned from preparing for and responding to the Novel... Improving publlic health preparedness through enhanced decision-making environments: lessons learned from preparing for and responding to the Novel... In late March and early April 2009, cases of human infection with the influenza A (H1N1) virus were first reported in Southern California and Texas. On April 26, 2009, the Department of Health and Human Services declared a public health emergency in the United States, and on June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of novel H1N1 flu was underway (WHO, 2009). As of Aug 31, 2009, the WHO has reported 209,438 lab-reported H1N1 cases and at least 2,185 H1N1 deaths from 102 reporting countries worldwide (WHO 2009). Although the US continues to report the largest number of novel H1N1 cases of any country worldwide, most people who have become ill have recovered without requiring medical treatment. Consequently, due to the relatively mild severity of the H1N1 outbreak (relative to initial concerns) and the slow progression of the disease through the summer months (in the northern hemisphere), the H1N1 outbreak presents a unique opportunity to study the decisions made by public health organizations and institutions, and the behaviors exhibited by individuals, given the real-time information environment in which we live. The public health response to this novel influenza outbreak has included increased surveillance, rapid testing of influenza, distributing medications from the Strategic National Stockpile, invoking school closures and social distancing policies, data sharing, and rapid communication tools such as social-networking sites and real-time news feeds to advise the American population of the realities of this rapidly changing outbreak. Recently, Trust for America's Health, in collaboration with the Center for Biosecurity at the University of Pittsburgh Medical Center and the Robert Wood Johnson Foundation, published an evaluation of the US response to the H1N1 outbreak entitled, Pandemic Flu Preparedness: Lessons from the Frontlines". The report addressed lessons learned from the 2009 H1N1 outbreak, and recommendations for addressing core vulnerabilities in US public health preparedness (Trust for Americas Health 2009). One of the recommendations for addressing core vulnerabilities was that continued work is needed in communities around the country to develop and test effective policies for slowing the spread of infection that also minimize the known social and economic consequences associated with these measures. The ASU Decision Theater, in collaboration with the Arizona Department of Health Services (ADHS), Division of Public Health Services (PHS), Bureau of Public Health Emergency Preparedness (PHEP) is engaged in a number of influenza preparedness and education activities which are designed to systematically evaluate influenza community mitigation strategies. Key to these exercises is an interactive simulation model that facilitates decision-maker interactions around emergency-response scenarios (Araz et. al in prep). Participants are prompted, for example, to decide when to close schools and for how long to close them in response to an emergency outbreak. The simulation gives policy makers the ability to see the real-time impact of their decisions (e.g., percentage of the population infected with influenza, duration of outbreak, costs of school closures). Outcomes from the exercise will include metrics such as mortality, morbidity, severity, and specific dates of actions (Lant et. al in press, Araz et. al in prep, Araz et. al in sub). Although tabletop exercises are routinely used in public health to identify gaps and shortcomings in emergency planning, measures of the impact of participating in an exercise on the participants knowledge of and level of confidence in public health systems functional capabilities are less common. Research on the interaction of decision making and emergency preparedness that focuses on the best-practices in real-time decision-making settings is a critical, unmet need in the field. For this proposal,