Limitations in achieving all-hazards preparedness: An evaluation of LHD efforts

The NC Evaluation of Local Public Health Preparedness assessed local health department (LHD) efforts to prepare for public health disasters including bioterrorism events, natural disasters, infectious disease outbreaks, mass trauma, chemical and radiation disasters. Eighty-four of 85 LHDs completed an assessment based on the CDC Local Public Health Preparedness and Response Capacity Inventory and on CDC Public Health Preparedness Project draft indicators. LHDs assessed their preparedness in nine indicator areas: planning and exercises, surveillance and epidemiology, 24/7 response capacity, communications and information technology, healthcare systems, public health laboratories, emergency and risk communications, workforce capacity, and mass interventions. LHDs indicated the extent to which personnel, equipment, organizational, and system factors limited their ability to achieve all-hazards preparedness. Seventy-four percent of LHDs said that personnel were somewhat or a major limitation. Personnel limitations included lack of an epidemiologist (90% of LHDs), lack of a FTE dedicated solely to preparedness (65%), and no preparedness coordinator membership on the management team (47%). Interviews also revealed problems with establishing a position that had uncertain funding, difficulties recruiting qualified individuals, and lack of training for biological, chemical, and mass casualty events. Thirty three percent said that equipment was a limitation; 20% said that the LHD had organizational limitations; 39% said that there were public health system limitations to achieving preparedness. Among the public health systems limitations were coordination and collaboration with other county agencies, lack of defined agency roles, and poor coordination with hospitals. State and regional responses to workforce and system issues will be discussed.