1. Southern California Risk Based Assessment and Prioritization Initiative Emergency Preparedness and Response Program Los Angeles County Department of Public Health

2. Project Background  CDC Funding to support “higher risk” CDC PHEP- recipient jurisdictions (Metropolitan Statistical Areas-MSA)  Funding through July 2013 – Boston – Chicago – Dallas/Forth Worth/Arlington – Houston – Jersey City/Newark – Los Angeles County/Long Beach/Santa Ana – New York City – Philadelphia – San Francisco – National Capital Region (Washington DC)

3. Legend Risk-based funds awarded to city Risk-based funds awarded to state No risk-based funds awarded Los Angeles/ Long Beach/ Santa Ana Dallas Houston Chicago San Francisco Boston New York City Philadelphia Newark Washington, DC

4. Project Objectives  Accelerate development of strategies to mitigate public health risks associated with higher population areas  Identify/improve risk identification and risk reduction models – Public Health – Medical Care – Behavioral Health  Promising Practices that can inform other health jurisdictions: local, state and national

5. Project Objectives  Cross Sector Approach: Coordinated & Synchronized with: – Public health, healthcare systems, emergency medical services – Emergency management/homeland security – Law enforcement – Fire services – Critical infrastructure – Other key sectors

6. Focus on Health  Hazard Assessment: Ubiquitous to many fields, industries and sectors –Impact on infrastructure, economy, business continuity, etc.  Health & Medical Emphasis –Health assessment of potential impact –Health delivery systems –Health related mitigation and response resources  Public Health, Population Based Perspective

7. Project Deliverables  Designate a lead partner in charge of submitting all deliverables and reports to CDC (LA County)  Provide high-level project description: –Convene relevant MSA partners –Status report of existing MSA risk/hazard assessments –Project plan for completion of Risk Based Project

8. Existing Hazard Assessments  LA and Orange County Emergency Management: 2005 and 2010  LACDPH commissioned Hazard Assessment from UCLA in 2007  Range of hazards  No health focus –OCHCA Hazard Mitigation Plan: 7 major hazards; –LA: Earthquake, Fire, Civil Disorder, HazMat, etc  Provide foundation for current assessment

9. Health Hazard Assessment and Prioritization (hHAP)

10. SoCal MSA  Planning collaborative formed: “SoCal MSA” –Los Angeles County Department of Public Health –Orange County Health Care Agency –Long Beach Department of Health and Human Services –Pasadena Department of Public Health  Project development, planning and execution  Monthly meetings  Engage with Agency and Community stakeholder groups

11. hHAP Model Development  Health Department focus  Composite tool, incorporates elements from existing hazard tools: Kaiser, UCLA, mining industry  Stand alone MS Excel tool and accompanying manual  Model used by CDPH for statewide hazard assessment –56 counties: Report back due July 2012

12. hHAP Model: At-A-Glance  Identify potential hazards  Define & Score Risk –Hazard Probability –Health Severity –System Impact –Response/Mitigation Resources –Response Agencies: Health, Fire, Law Enforcement, etc. –Community Based  Rank and prioritize: Develop appropriate mitigation & response plans –Agency & Community Based

13. Hazards  Southern California: Lots of potential hazards  Statewide: Even more  hHAP: 60 hazards; Assigned to four hazard types: –Biological –Natural –Chemical/Radiological –Technological

14. Define and Score Risk  No standardized definition  Reflects a complex, dynamic relationship  To qualify and quantify: Part science, part art  hHAP: Assigns a “Risk Score” to each hazard  Risk Score = Probability x Health Severity x (System Impact – Mitigation)

15. Risk Score  Represents health associated risk or threat of each hazard to jurisdiction  Specific and exclusive to each hazard  Score determined by interaction/equation between seven (7) Risk Components: 1.Probability 2.Health Severity 3.Public Health System Impact 4.Medical Care System Impact 5.Behavioral System Impact 6.Responder Agency Capacity 7.Community Agency Capacity

16. Mitigation and Preparedness Prioritized list of hazards:  Focused planning and preparedness efforts –Plan Development –Exercises, Drills and Training  Community Engagement –Expectations of government response to identified hazards –Improved community participation with preparedness and resiliency efforts

17. Whole Community Planning  Improve involvement with community based partnerships  Participate in children’s medical and mental/behavioral health care approaches.  Build and sustain volunteer opportunities for residents to participate with local emergency responders and community preparedness efforts year round.

19. Project Timeline  Sept. 2012: Assess Hazard Probability and Health Severity  Oct. - Nov. 2012: Health Systems Impact Assessment  Dec. 2012 - Jan. 2013: Community Agency Assessment  Jan. 2013: Prioritize hazard assessment  Jan – May 2013: Develop MSA and OA mitigation plans  June 2013: Finalize mitigation plan(s)

20. Step 1: Probability and Severity  2 Risk Components  Subject Matter Expert Focus Group –28 SMEs: 7 per jurisdiction  Evaluate all 60 hazards –Probability and Severity measured independent of each other  Use scores to reduce list to 30 most relevant  Complete by October 31, 2012

21. Step 2: System Impacts  3 Risk Components: Public Health, Healthcare, Mental/Behavioral Health  Impact to existing systems: Infrastructure, staff, resources, surge, etc.  Public Health –SME Focus Group (28 individuals); –Complete with Step 1, by Oct. 31, 2012

22. Step 2: System Impacts  Healthcare: –Disaster Resource Center program (LA County hospitals) –Policy/planning advisor: Hospital Association of So. California –Representation from Clinic association(s) –Representation from long-term clinics, skilled nursing facilities –Complete by November 30, 2012  Mental Health: –Representation from various County, municipal responsible agencies –Complete by November 30, 2012

23. Step 3A: Community Response Agencies  1 Risk Component  Evaluate existing resources to respond to 30 identified hazards –Status of agency/department’s current plans –Training & exercise status –Availability of back-up systems –Existence of staff resources and expertise  Complete by December 31, 2012

24. Step 3B: Community Based Agencies  1 Risk Component  Work with communities at SPA level –Correlate with Emergency Preparedness Public Health Nurses (EPPHNs) –Each SPA/EPPHN identify key community participants CBO, NGO, FBO, Community advocates, etc.  Look at scenarios that are most relevant and salient to the particular community (from list of 30)

25. Step 3B: Community Based Agencies  Types of agreements and partnerships existing within communities  Expectations of government response  Level of coordination with local & state agencies  Ability to withstand/respond to the particular hazard –Improved community participation with preparedness and resiliency efforts –Adaptable to local community metrics  Complete by December 2012

26. Rank & Prioritize  hHAP automatically determines Risk Score for each hazard  Automated ranking and prioritization  Customizable: –General (all) hazards –Hazard Type: Biological, Natural, etc.  Prioritization provides opportunity for evaluation of jurisdictional and community priorities & discussion

27. hHAP Tool: Ranking

28. hHAP Tool: Ranking & Prioritization

29. Way Forward  Results from hHAP to established planning priorities and initiatives for next 5 years  Incorporation of community feedback on existing and future capabilities: –Community Preparedness –Community Recovery  Future engagement with community groups and representatives

30. Thank You Dee Bagwell dbagwell@ph.lacounty.gov 213-637-3630 Brandon Dean bdean@ph.lacounty.gov 323-820-8773