Improving Public Health Emergency Preparedness: Narrowing the Gap Between Planning and Reality: Lessons Learned from the H1N1 Outbreak in San Diego on workforce preparedness

Public health has assumed a significant and expanded role in emergency preparedness and response. In order to be sufficiently flexible and to meet the range of potential emergency situation needs, public health has begun using adopted management structures, including Incident Command Systems (ICS) and Emergency Operations Centers (EOC). During the 2009 H1N1 influenza outbreak response in San Diego, public health assumed the lead agency role and used ICS and EOC to coordinate response with multiple agencies. This study sought to understand and describe plans and preparedness activities reflected in actual response situation and understand how ICS and EOC were used during outbreak response. This San Diego H1N1 outbreak case study examines actions at the site of the first identified US cases. It consists of 18 key informant interviews from major responding sectors, designed to understand the response actions. MAXQDA10 software facilitated thematic analysis. Results explore the gap between the pandemic response plan, training, and actual response to the H1N1 outbreak across multiple responding sectors. Specifically, results describe the misalignment of structures put in place for the anticipated role versus the actual role when public health became the lead response agency. These results focus on the importance of surge capacity by cross-trained public health responders. This study highlights the importance of public health workforce training that is broad enough to encompass the potential range of situations for surge workers. The ICS/EOC structures potentially provide a flexible framework to enable such workers to function effectively in fluid emergency response environments.