12Th ANNUAL FEDERAL EMERGENCY MANAGEMENT HIGHER EDUCATION CONFERENCE

12th ANNUAL FEDERAL EMERGENCY MANAGEMENT HIGHER EDUCATION CONFERENCE JUNE 1-4, 2009

Innovations in Primary Care Emergency Management: Planning, GIS Mapping, and Public Health Response (2nd Breakout Session of Thursday, June 4, 2009)

Moderator Terrence B. Downes, Esq. [email protected] Executive Director, Program on Homeland Security Middlesex Community College Lowell, MA

Panel Mollie Melbourne, MPH, MEP [email protected] Director of Emergency Management National Association of Community Health Centers Bethesda, MD

Nora O’Brien, MPA [email protected] Associate Director of Program Planning and Development California Primary Care Association Sacramento, CA Innovations in Primary Care Emergency Management: Planning, GIS Mapping, and Public Health Response

Prepared by:

Sam Harvey [email protected] Graduate Student Anna Maria College Paxton, MA

Understanding Community Health Centers An often misunderstood and overlooked part of the public health system, community health centers (CHCs) play an important role in maintaining the health and well being of individuals and families throughout the country. Such centers provide comprehensive primary care, supportive services, and preventative medicine, all designed to meet the needs of their community. There are more than 7,000 sites nationwide, many located in, or serving, high need communities. As of February, 2009, 18 million patients were seen, with nearly 71 million patient visits. 91.4% of patients fall at or below 200% of the federal poverty level, while 38.9% of patients are uninsured and 35.4% have Medicaid or another public insurance coverage. Almost 2/3 of all patients come from racial and ethnic minority populations. CHCs provide services to all who seek care, regardless of their ability to pay.

Community health centers employ over 18,000 full time doctors and nurses, with 75% of their funding coming from patient fees and only 25% from federal aid. Centers are governed by a community board, many of whom are patients. Such an organizational structure allows CHCs to be sensitive and responsive to community needs, and maximize their efforts to help a many people as possible. In addition to medical services, CHCs provide training and information to community members, empowering patients to get involved in their own care.

Community Health Centers and Emergency Management Community health centers are not traditional emergency management partners, but they have much to offer the community. They work closely with local health departments and area hospitals to report and track outbreaks of infectious diseases while serving as possible points of distribution for medicine and vaccinations. Their close relationship with minority and homeless populations allow them to monitor health trends among what are traditionally underrepresented demographics as well as disseminate critical health information to those who might otherwise not receive it. They are a trusted part of the community and are mission driven to serve their communities.

During a disaster, community health centers can provide a range of support services to both the patients they serve, and the community as a whole. CHCs can increase surge capacities for local hospitals, provide triage points for first responders and EMS personnel, and provide basic health services. In the wake of disasters, CHCs can provide mental health services, in addition to providing information to hard to reach populations and translating public health information to non-English speaking individuals.

Community Health Centers and Past Experience in Emergencies Community health centers have been involved in many emergency situations in the past decade: -Treatment of respiratory and eye irritation in New York City, New Jersey, and Washington DC following September 2001 attacks. -Diagnosis and treatment of first monkeypox victims in Wisconsin and Illinois. -Treating storm related injuries and administering tetanus and hepatitis after Hurricane Katrina. -Treating patients at community shelters and dispatching mobile clinics in California during 2003 and 2007 wildfires. -Augment staff in ER and medical care shelters in Kentucky following February 2008 tornadoes. -Provide health care to flood ravaged communities in 2008 Iowa floods. -Respond to hurricanes Gustav and Ike in September 2008

In addition to response efforts, community health centers have been involved in training and mitigation efforts including TopOff 3, Strategic National Stockpile drug rotation and distribution, shelter support, and patient education.

Get Involved With CHCs The emergency management community has much to gain by working with community health centers. Area specific response plans can be improved with help from CHC information, and community strengths as well as facility and staffing limits, can be recognized.

Contact State Primary Health Care Association at: http://www.nachc.com/nachc-pca-listing.cfm

Understanding California Community Clinics and Health Centers There are 822 community clinics and health centers (CCHCs) in the state of California with 740 of them belonging to the California Primary Care Association (CPCA). These are non-profit, federally qualified health centers, rural health clinics, community clinics, free clinics, and Planned Parenthood clinics.

CCHCs serve over 4 million patients, with 12.5 million patient visits provided. 49% of CCHC patients have limited English proficiency, and 3.6 million patients are under 200% of the federal poverty level. They serve the most vulnerable patients regardless of their ability to pay, insurance, or immigration status. CCHCs can provide services where hospitals and other medical providers may not exist.

Much the same as CHCs, CCHCs can serve their communities during emergencies by providing surge capacity for hospitals and public health departments, triage points for responders and EMS, serving as points of distribution for medicine and vaccinations, and providing shelter for residents. They also are able to provide mental health services and translation services.

CPCA and H1N1 Influenza Outbreak The California Primary Care Association has been working with community clinics and health centers during the H1N1 outbreak to record community health data and reporting their findings to state and local health departments. In addition, they have been disseminating health department warnings and updates to their communities. Since CCHCs typically serve underrepresented populations, their helps provide a more accurate account of the community’s health status. As an active participant in California’s public health network, CPCA has the ability to advocate CCHC’s interests to the state and federal level as well as provide updates to the local media.

Challenges to CCHC Emergency Response While community clinics and health centers are an important asset to local emergency planning, there are many challenges to be faced. Not all CCHCs are integrated into local response plans, and the assets they provide are often lost or overlooked. Despite a state over site organization, CCHCs throughout the state are at varying levels of preparedness with many of them still working to become NIMS compliant.

One of the biggest issues facing CCHCs is a lack of consistent patient tracking systems. Few clinics have Electronic Health Recording systems, and specific patient information is often not reported from one clinic to another.

Meeting the Challenges Many CCHCs are working to improve their preparedness levels by training employees in the National Incident Management System and Incident Command System, participating in emergency exercises, and integrating new technology such as GIS mapping. CCHC leaders are committed to improving preparedness efforts, and maintain a constant relationship with key CPCA team members to find ways to fill in the gaps and provide more consistent, further reaching services. GIS mapping software provides CPCA the ability to identify and track all alternate care sites, PODs, and mobile medical sites. It also provides information about what resources are available within the community. All this allows CCHCs to be more aware of what is going on within their communities, and what resources they can rely upon to serve its population.

CHCs, CCHCs and Emergency Management With the wealth of information provided by community health centers and community clinic and health centers, the emergency management world would do well to incorporate them into response plans, and use the resources they provide to serve the entire population. From being aware of the special needs population of their community, to providing a trusted site for care during a disaster, to providing a means to educate and inform hard to reach populations, CHCs and CCHCs are an important asset, not to be overlooked.