Emergency Preparedness in California's Local Health Departments

California has gained significant capacity for public health (PH) emergency preparedness (EP) over the last 5 years. Under contract to the California Department of Health Services (DHS), in 2005-06 the Health Officers Association of California (HOAC) conducted a statewide public health emergency preparedness assessment. The purpose was to identify specific local and aggregate strengths and areas needing improvement, and the leadership, management and “political” elements for building a successful local program. HOAC developed and used a uniform, quantitative instrument keyed to the federal guidance that included HOAC-developed indicators; conducted 2-day assessments in 56 of the state's 61 LHDs using peer-level expert consultants; and produced LHD-specific reports of findings and recommendations and an aggregate final report for DHS. LHDs spend an average of 4% of the LHD budget on EP; nearly all programs are supported only with state and federal grants. EP-only positions are generally more stable than overall LHD positions; nurses and in some cases PH lab and epidemiology personnel are the likeliest shortages. Key strengths include increased visibility of PH leadership and expertise with community partners and the general public; enhanced infrastructure, particularly CD control; isolation and quarantine guidelines implemented; more LHD Public Information Officers hired with strong program established; placement of regional epidemiologists. Lack of PH surge is critical; more work is needed for readiness related to mass prophy and SNS; economic recovery/continuity of services is not well developed. Recommendations for policies, practice and additional training will be discussed.