Addressing the gap between public health emergency planning and incident response: Lessons learned from the 2009 H1N1 outbreak in San Diego County.

Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods: This study was conducted using critical case study methodology consisting of document review and 18 key-informant interviews with individuals who played key roles in planning and response. Thematic analysis was used to analyze data. Results: Several broad elements emerged as key to ensuring effective and efficient public health response: 1) developing a plan for emergency response; 2) establishing the framework for an ICS; 3) creating the infrastructure to support response; 4) supporting a workforce trained on emergency response roles, responsibilities, and equipment; and 5) conducting regular preparedness exercises. Conclusions: This research demonstrates the value of investments made and that effective emergency preparedness requires sustained efforts to maintain personnel and material resources. By having the infrastructure and experience based on ICS and EOC, the public health system had the capability to surge-up: to expand its day-to-day operation in a systematic and prolonged manner. None of these critical actions are possible without sustained funding for the public health infrastructure. Ultimately, this case study illustrates the importance of public health as a key leader in emergency response.

Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.

Public support for government actions during a flu pandemic: lessons learned from a statewide survey.

To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non-fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of the event.