Protecting Citizens During a Health Crisis

Terrorism, epidemic outbreaks of severe acute respiratory syndrome (SARS), avian influenza and weather-related disasters present major health challenges everywhere. In the midst of the post-9/11 era of national preparedness, a rural group of health and human services providers and administrators is busy planning and preparing to manage the next generation of disasters, emerging infectious diseases and public health emergencies.

In an unprecedented move, health and human service agencies throughout Indiana County, Pa., signed a memorandum of understanding and agreements to share resources and support provisional care to the residents of their communities in times of disaster. Known as the Indiana County Health and Human Services Subcommittee (HHSSC), under the Indiana County Emergency Management Agency's Community Disaster Taskforce, the group was established in 2002 and cultivated the groundwork to develop a rural response initiative.

Located in west-central Pennsylvania, the county lies in the rolling hills that descend westward from the nearby Allegheny Mountains. Freshly plowed fields of local Amish farms, major power plants, small industries and an evolving transportation system lead to downtown Indiana, home of Indiana University of Pennsylvania. Priding itself on a leading educational institution, a top-ranked medical facility, as well as progressive business and infrastructure development, the HHSSC helps protect the quality of life its citizens have enjoyed for decades.

Taking Action
Why prepare for emergencies and disasters in a rural setting? The focus of national preparedness is geared toward populous metropolitan areas. Consequently rural communities must ready themselves to deal both with the needs of citizens within their own territories as well as any projected overflow and migration of people from nearby cities. The HHSSC acknowledges that during a disaster or other emergency, state or federal resources may be delayed or reallocated. To address this potentially troublesome situation, the subcommittee recommended that the health-care system foster resilience at the community level. This group has evaluated local vulnerabilities, created response plans, and recruited, organized and educated volunteers to perform the tasks necessary for successfully accomplishing a variety of missions.

Caring for nearly 89,000 citizens, a university community and an overflow population is no small task. No single agency or organization would be able to shoulder the responsibility and resources alone. The HHSSC facilitates interagency cooperation to address the physical and social needs of Indiana County in times of small- and large-scale crises.

"This is a very strong plan to address major public health-care issues in a rural community with limited access to traditional public health resources," said Dr. Joseph Barbera, a former member of Indiana County's Special Medical Response Team, and co-director of George Washington University's Institute for Crisis, Disaster and Risk Management. He called the approach "an innovative way to bring all contributing parties together as an incident unfolds."

Indiana Regional Medical Center (IRMC), the county's only acute care facility, is dedicated to the communitywide effort and is an active member of HHSSC. "Disaster preparedness has become more collaborative over the past few years as numerous organizations have come together to anticipate and prepare a countywide response to potential events requiring a mobilization of resources," said Cindy Virgil, vice president of IRMC patient care services. "Clearly no agency can act alone to meet the county's needs in an emergency. This approach allows multiple agencies to respond in an integrated manner to maximize our efforts and serve the community." While IRMC, as with all acute care facilities, makes internal preparations for crises, it's intimately involved with community, regional and statewide planning and response efforts.

The medical center is just one part of the equation, however. The HHSSC is composed of long-term care nursing facilities, educational institutions, emergency medical services, health clinics, medical equipment suppliers, pharmacies, clergy, community nursing and mental health organizations. This collaborative approach placed the group ahead of the curve because it began prior to federal grant stipulations that require cooperation among communities, regions and agencies.

Planning to Operations
How well does it work? The HHSSC is turning its attention from planning to operations, and it has already withstood small-scale tests with much success. The group has responded to a variety of needs, from nursing home fires requiring patient relocations, to establishing vaccine sites in the aftermath of flooding in western Pennsylvania due to Hurricane Ivan in 2004. The HHSSC also has conducted several tabletop exercises, communication drills and pre-event briefings in anticipation of caring for the county's citizens during natural and man-made disasters. Group members are trained in the National Incident Management System (NIMS) and other disaster and public health programs, which aids in funneling the diversity and expertise of each agency into a singular command-and-control operation.

Though it's still a work in progress, this rural approach to disaster preparedness and response represents hundreds of hours of volunteer work on the part of every organization involved. While most participating agencies donate their time and effort, the group recently received AmeriCorps grant monies to fund clerical support to assist in further organizing and carrying out of the mission. As the HHSSC moves to formalized operations, more widespread county and regional exercises will take the work to a higher level of excellence and proficiency, making the group's work a potential template for other rural communities in Pennsylvania and across the nation.

For more information on this program, call Danny Sacco, HHSSC chair, at 724/357-7154 or e-mail him at dsacco@indianarmc.org.

Scott Rhoades has an extensive 20-year career in health care. His expertise is in the area of emergency medicine and emergency medical transport. His professional experience includes critical care, emergency flight and aerospace nursing. Rhoades is currently the Emergency Medical Services coordinator at Indiana Regional Medical Center.