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Building Resilient Health Infrastructure with ASPR

How does the Healthcare and Public Health Sector respond?

Friday, November 22, 2019

This episode describes how ASPR Critical Infrastructure Protection (CIP) and the healthcare and public health (HPH) sector partnership respond to real world disasters. 

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MICHAEL ELTRINGHAM: You’re listening to “Building Resilient Health Infrastructure with ASPR,” a podcast from the HHS ASPR Critical Infrastructure Protection Division. If you have any questions about this episode, please email us at CIP@hhs.gov.

Hey everyone! Thanks for listening. I'm Michael Eltringham and I am a program analyst with the ASPR Critical Infrastructure Protection Division. I'm joined by our division director, Dr. Laura Wolf. How are you, Dr. Wolf?

DR. LAURA WOLF: Great as always, Mike!

ME: Glad to hear it. Today's question that we're covering on the podcast: how does the health care and public health sector respond to disasters? We thought it would be useful today to talk about how our partnership responds. Who are the players when we talk about -  because you and I we’re so kind of ensconced in this world, we'll talk about incident response, but to someone who might be, you know, a new partner of ours, they might not know who do we have at the table. who are the players when we talk about our HPH Sector incident response.

LW: That's right and it's usually a virtual table. So we're often performing disaster response with partners who are actively assisting in their own facility’s response. And so we do a lot via conference calls and through website dashboards and other means of communication.

So who are we talking to? To start first on the government side, I mentioned in one of our previous episodes that we're in ASPR and ASPR is the lead for Emergency Support Function 8. We manage the Secretary's Operation Center and we coordinate all that healthcare specific response within in that Center. And so we're sitting in there with all the other ASPR players with a lot of the other HHS and related offices like DoD or Veterans Affairs. And so we're sitting in that operation center and making sure that private sector needs are considered as we're deploying medical staff to a disaster.

One of the main partners in that response and the coordinator for all the emergency support functions is FEMA. There's an office within FEMA that was crucial to our response, particularly in Hurricane Maria in Puerto Rico, and that's the National Business Emergency Operations Center. That's led by Rob Glenn who's a great partner of ours and I hope he'll be on one of our future podcasts to talk about what he does. But within FEMA that's the office that coordinates among all sectors and tries to assist in prioritizing resources and making those connections across sectors on the private sector side of private sector sharing information and resources with private sector. So they were critically helpful.

In many responses we also utilize our private sector partners in trade associations for amplifying our messages and also for coordinating resource requests or information requests. So for example, I've mentioned several times how there's a lot of manufacturing industry in Puerto Rico. So one of the major trade associations for medical device manufacturers is called AdvaMed. And we were in frequent contact with to learn about where the facilities were on the island what they were making what their resource needs were and what their status was. And that was incredibly helpful to us. We did that with a variety of associations in that disaster and others. We are also well connected through two of our associations: ASTHO the Association of State and Territorial Health Officials and NACCHO, the National Association of County and City Health Officials. Critical partners for us: ASTHO, NACCHO, and other members of the SLTTGCC, the State Local Tribal Territorial Government Coordinating Council which is one of the other sectors –

ME: And my favorite government acronym.

LW: isn't that great?

ME: It’s quite a mouthful.

LW: So we all talked together to share information, understand where the needs are, what the impacts might be. But those are the main partners that we work with.

ME: So, and I think that's interesting to look at like you said who's at that virtual table. What happens at that table? Talk a little bit about any I know you touched on it, kind of the actual mechanisms, but could you talk a little bit about the communications that happen? Not just the mechanisms themselves, we know those are through conference calls, through Adobe Connect dashboards, that kind of thing but what are the discussions like when we have that group together?

LW: Absolutely. We try to share information that's otherwise not available publicly. So you can get weather reports that are that are pretty clear, but you can’t always get reports on where roads are closed, for example, or what help might be coming from the federal level that you can plan for, plans of evacuations or other information that may not be available to the public. And also some of the challenges that are being seen both by the government and the private sector. So we try to have these calls have briefings that are relevant and not otherwise available. We try to share information products via email or over the web coming to us from some of our partners who can do GIS geospatial mapping of where infrastructure is and combine that with layers of SLOSH modeling - don't ask me to say that acronym!

ME: I don't know that one either!

LW: - to look at where the flooding might be or where very strong winds are expected and we might expect to see infrastructure be impacted. So we try to have these calls ahead time if it's a known event like a hurricane or as soon as we can after an event hits.

ME: I know that you know obviously it's participating in the responses you see a lot of not just information being shared by our partners, which is always a big valuable part to us and a necessary part for us. But also they look to us for information. So can you kind of talk about some of the more common requests for information or maybe even requests for assistance and resources that that we see?

LW: Sure. They're - the common requests for information are, “What do you know that we don't know? That is common and we're always trying to think of what we can possibly share with the private sector. We are working to be able to share as much as possible. The government has a lot of ways of not classifying information but keeping it secure. And some of those get in the way of sharing with our private sector partners and so we've been very active in making sure that we can share information with our partners, that it's not marked FOUO or “for official use only” unless it really needs to be.

We've also borrowed a practice from the cybersecurity community in using the traffic light protocol of TLP “white to red” so that we could be very clear with information coming to our partners, to be really clear if they can share it with everyone they know or if they can only share it with those in their organization or if they can't pass it beyond themselves. So we've tried to be responsive on that and making more information available. But you also talked about resource requests and there are some common themes. So in our sector many different types of facilities have generators and most of the time when you have generators you may have three days of fuel or more or less. But a majority of facilities may have three days of fuel. And response often lasts more than three days. At some point if it's a very dire situation particularly like what we saw in Puerto Rico we're getting requests where the normal contractor for generator fuel is not delivering and is their government fuel available or prioritized request for fuel. Similarly, water, or prioritized reconnection to power, or Internet services. We heard in Maria from a lot of clinics, chemotherapy clinics, radiation clinics that required that connectivity to the Internet in order to provide treatment and that was the only thing they needed. Otherwise they were up running and ready to go. So a lot of those utilities prioritization requests and some products like fuel or water are the common requests.

ME: I think to kind of close the loop on our episode today and just kind of wrap up: we talked about the response processes and there's a lot that goes into all that. This is a very high-level overview. But really quickly, could you touch on the what happens after, once the the initial response has subsided, what's the process we go through as a partnership and as a division to help us get better for future responses.

LW: Absolutely. People always talked about what were the lessons learned but that term is sometimes thrown around because we don't actually learn the lessons. We don't integrate fixes into our existing problems. We, for the first time, actually did a CIP-specific after-action report about how we do our business in communicating with our partners in government and private sector and we have already instituted changes in how we make available our dashboard, how we share information, how we format that information to be most accessible to our partners. We're also looking to some of the data coming out of studies about the hurricanes and other disasters to see what we can learn about saving lives better, being more efficient in what we prioritize and preventing cascading challenges after a disaster. So we are reading the after-action reports of others and trying to document those lessons learned and see how we can incorporate them into our work.

But I think each of the members of my team really understand how we have to build back better ourselves after a disaster, both our partnerships and their partners and their infrastructure, but also our team and our knowledge and our readiness to react to the next disaster that's going to happen whether it's something we've seen in the past or it's something novel.

ME: And we will leave you on this note sloshed modeling is sea lake and Overland surges from hurricanes I just want to make sure we close the loop thank you in case anyone hasn't heard that and gone rushing to their nearest search engine to find out but that's what we like to do we like to address the weaknesses and improve them going forward!

So that's our episode everyone! Thank you so much for listening. As always, if you have any questions on anything you heard, any more questions or information you'd like to hear on the HPH Sector Partnership or ASPR CIP division, please email us at CIP@hhs.gov. And if you have any feedback on the podcast we'd love to hear that as well. So thank you everyone, thank you Laura.

LW: Thank you Mike!

ME: See you guys next time!