As the EMS community grapples with the ongoing COVID-19 crisis, there is no better time than now to discuss the important roles of epidemiology and emergency management (EM). On Wednesday, Sept. 16, 2020, a panel of industry professionals from various disciplines tackled this critical topic at EMS World Expo Virtual.
Understanding and Managing EMS and Public Health Interactions
In his portion of the presentation, Ray Barishansky, MPH, MS, CPM, deputy secretary of health at the Pennsylvania Department of Health, discussed the importance of merging the worlds of EMS and public health. Just like EMS, the field of public health has its own litany of terminologies that need to be understood by our providers if we want to get important tasks accomplished during a public health emergency.
“EMS doesn’t always speak public health, which leaves us out of the equation in regard to critical areas such as funding, operations, and emergency planning,” says Barishansky.
He emphasizes that if you don’t speak their language, you need to learn it now. This is an important part of the response framework because you need to know how to engage the people you’re working with, their agencies, and how to contact them. When you’re in a position requiring you to make critical decisions in a timely fashion, “you don’t want to be handing out your business card on game day,” he says.
Make sure you understand public health agencies’ capacities and capabilities if you don’t already and how your agency’s capabilities play into the role of a public health response. The field has received a generous amount of money in the last 15-17 years for emergency preparedness, particularly so since the pandemic hit. “Public health agencies are seeing more funding now for preparedness than ever before—it’s your opportunity as an EMS leader to reach out to those public health agencies and find out where you fit into that funding and how you fit into their operations.”
When planning for emergency responses, utilize data from epidemiologists to help inform decisions regarding actions like PPE mobilization, patient treatment modifications, and transport protocols. “Be in constant contact with public health leadership during emergencies that are rapidly evolving and could have significant EMS impact. You want to know about that as quickly as possible.”
When an emergency unfolds, think about your place in the EOC (emergency operations center)—because you do have one and this is the moment to seize it, he says. Remember that preparedness boils down to relationships—make sure leadership from all involved agencies are well-acquainted and know how they can help each other. Take note that the mutual aid system may be limited or even nonexistent in a public health emergency depending on the circumstances, advises Barishansky, whether that be caused by provider absenteeism or a burdened healthcare system, so take this into account when planning and responding. In the crisis we’re facing now, it’s especially important to have a plan when we may be in this for another year or more.
Lastly, you must ask yourself if you have a seat at the table during a public health emergency, says Barishansky, whether that be at the EOC or with other healthcare coalitions. “Are you ready? If the answer is no, what are you going to do to make that answer a yes?”
Importance of Data During Incident Management
Morgan Anderson, MPH, an epidemiologist in clinical and research services at ImageTrend, Inc., spoke about the critical role data plays throughout an incident. For those unfamiliar, an epidemiologist’s role during incident management is to collect and analyze data to guide actionable responses and inform stakeholders and leadership while maintaining quality of that data analysis despite the need for a quick turnaround.
“Data drives change,” says Anderson. “Without data, it can be difficult to do a lot of things.” Data is essential throughout a critical incident’s duration for several reasons. First, it validates what you already know—what’s common knowledge to you and your colleagues is not to people outside of the industry. Having data on hand to back up what you’re explaining to the public strengthens your credibility. Similarly, showing data helps you explain your plans to stakeholders, which can be helpful when you need to justify a decision to continue or discontinue any program or practice. When funding is involved, it’s especially important to build a strong case. And when multiple organizations are in one room together, data helps properly allocate the available resources and funding for everyone involved.
Anderson encourages EMS leadership to have aggregated data available on an ongoing basis. “Critical incidents are not the time to start monitoring data,” she says. Preexisting data provides baselines to compare to data you collect during and after an incident. If you don’t have access to an epidemiologist, start planning what that process would look like within your agency in the event of an incident. Have the proper tools in place to collect and disseminate the information to the right people. When you receive your first data request, make sure you convey the data appropriately. Some graphs can be misleading, and you don’t want to misconstrue important information right off the bat.
In the height of a critical incident, it may feel equally critical to relay data to your leadership as quickly as possible. But this can compromise the quality of your data, says Anderson. It’s a balancing act—reduce the quantity and complexity of your information first. Identify what information is essential for leadership and the public to know now and review the remaining data later on.
Integrating Prehospital Providers into an Emergency Operations Center
Working at an EOC is about being in a certain state of mind, says Kevin Collopy, clinical outcomes and compliance manager at AirLink/VitaLink Critical Care Transport in Wilmington, N.C. While the nature of public safety requires personnel to operate in “the here and now” mindset, as we’re trained to do, a leadership role in the EOC requires a shift in that mindset. Collopy says there is very little time spent on the immediate now—that’s reserved for the teams in the field, and if you’ve done your job well at the EOC, those teams have received the appropriate resources to do theirs.
At the EOC, personnel focus on the “near” (next 24–72 hours) and “far” (5-10 days, or months, as we’re seeing with COVID-19). You need to consider questions like the following: What are your teams going to need down the road? What will the community need? What is the system going to need to address this emergency and mitigate others like it down the road?
“When you’re working in a collaborative environment, you’re not there just to serve your system—you must think of all the first responders, agencies and community members involved so everyone benefits from the resources you pool together through the EOC,” says Collopy.
Every EMS provider has gone through FEMA training on incident command structure, but not everyone working in the EOC has. You will work with people from other disciplines who have little to no knowledge of ICS or EMS, but that’s okay—they are there to provide their respective expertise critical to the operations.
“Your EMS background provides a great foundation for the work in the EOC, but it does little to prepare for the job at hand. Collaboration is key to success,” says Collopy. Though the ICS model depicts branches of different operating teams, Collopy sees it as a circle, noting that everyone is interdependent upon one another. Examine all the possible directions to see how the agencies overlap—this will help determine how you’re going to deliver your collective information to the incident commander so they can execute the best decision for everyone involved.
Keep in mind that normal operations rarely cease during EOC operations, says Collopy. Strokes and STEMIs will still strike, car accidents will happen, and dialysis patients will still need treatment. This is why data is very helpful to have on hand—you can determine what kinds and how many resources you need to allocate for the everyday operations and the EOC operations.
However, “data is only as good as how it is accessed and interpreted when you’re in the EOC,” Collopy says. While it certainly doesn’t hurt to do your own research, “Rely on true statisticians for good data analytics.”
Start to Finish: Project Management Principles for Emergency Management
Carl Cowan, MS, NRP, CCP-C, assistant director of emergency management at Harvard Medical School, refers to EM as the backend of emergencies—an approach to navigating a complex system during an extreme event with multidisciplinary personnel. The activities of an EM program are developed based on hazard vulnerability analysis, which determines your jurisdiction’s likeliest risks. Cowan discussed two main EM approaches.
One of the most vital components of EM is planning, as it serves as the foundation of the field’s tenets: mitigation, preparedness, response and recovery. ICS incident action planning (IAP) operates on a continuum, helping personnel evaluate situations, establish objectives and execute a plan while guiding your team’s completion of FEMA’s ICS forms on the event. There are five phases to planning in EM:
Understanding the situation
Establishing incident objectives
Developing a plan
Preparing and disseminating the plan
Executing, evaluating and revising the plan
“This is an incredibly tactically-focused planning tool organized around operational periods,” says Cowan. “In our industry, those periods are typically fairly short. We think of this as a ground game tool—not necessarily a long-view tool, which can lead to a degree of deficiency in the response.”
Using IAP for long-term incidents has limited benefits, says Cowan. Overall, it’s a good tool, but there is a lot of jargon to learn, there’s no designated area for stakeholders to get involved in the dialogue, and no clear avenue in which data can be delivered to leadership. You can evaluate what events have occurred and how effective your interventions are, “but it doesn’t talk about generating metrics and driving intel from the ground upward. There’s no sense of a forest picture—it’s very tree-driven. How can we get to that big picture?”
That’s a task for project management principles (“project” being synonymous to “incident” in this case), which Cowan says has a similar life cycle as the IAP but has clearer language. The phases are as follows:
Initiation: define the scope of the incident, bring relevant stakeholders to the table, and perform an analysis
Planning: develop a timeline of project completion, and identify dependencies and risks that may impact your response
Execution of plan
Performance control: determine through metrics if you’re successfully executing a response plan
Incident closure: termination of activity followed by creation of an after-action report (these should be done regularly for ongoing crises like COVID-19)
At the end of the day, just pick what methods work best for your jurisdiction. Just remember that communication will make or break you—don’t put yourself in a silo. Stay in contact with the public, stakeholders and collaborating agencies.
Valerie Amato, NREMT is associate editor of EMS World. Reach her at firstname.lastname@example.org or follow her on twitter @ValerieAmato2.