Mid-America Alliance

The Mid-America Alliance

Program Objectives

1. Develop regional cooperative programs for mutual aid and support for states responding to public health events not warranting a governor declared emergency.

Create a regional model for establishing mutual assistance programs between regional health districts and state entities that will identify and allow the sharing of resources and minimize barriers to mutual assistance.
Provide technical assistance to state and local health agencies during times of crisis for meeting readiness goals including epidemiology and laboratory services.
Create a regional database of available resources to meet surge capacity needs including investigation and response plans to achieve containment of infectious disease outbreaks and accomplish all-hazards emergency recovery strategies.
Establish model legislation to allow exchange of public health care professionals (epidemiologists, nurses) during times of crisis through a Medical Professionals Licensure Interstate Compact.

2. Establish a state-based pilot program for testing public health readiness indicators.

Define a regional, all-hazards public health response system and identify mechanisms and processes for escalating capability.
Incorporate and evaluate multiple options for establishing the prototype including the regional or a multi-state approach.
Identify obstacles and recommend solutions to achieve routine monitoring of conditions of public health importance in the region. The evaluation will include issues related to detection, response and containment.
Conduct an analysis of the regions’ capability to respond to public health emergencies and document the staffing needs required to provide an effective response. The analysis will include determining staffing needs to track cases, offer prophylaxis, and implement appropriate containment strategies.

PROGRAM DESCRIPTION AND ACTIVITIES

I. Develop regional cooperative programs for mutual aid and support between state and

local health agencies during emergencies.

The Center will establish a regional cooperative program for mutual aid and support between state and local health agencies in regions 7 and 8. The program will also identify barriers to the rapid implementation of mutual aid and support and recommend solutions that might involve changes in statutes, amendments to rules and regulations, advancements in technology and strategies to maintain long term support. The conceptual framework of the program has been approved by all State Health Officials in regions 7 and 8. The cooperative programs will include support and activities as described below and will utilize assessment information obtained from each of the health jurisdictions in regions 7 and 8. The program will be implemented by the involvement of key leaders involved with each of the Emergency Preparedness focus area activities. These functional activities will include epidemiological investigations, vaccination programs, education and alert capabilities, laboratory services and therapeutic delivery systems. States will have the option to participate in all or selected components based on their overall preparedness assessments. The program will function with direction from an Advisory committee to be chaired by the Deputy Chief Medical Officer from Nebraska. The Advisory committee will be composed of the State Health Officials (SHOs) for regions VII and VIII or their designee and federal representatives of regions VII and VIII. Each of the focus areas for Cooperative Agreement 03-04 will be represented. The Center will employ a director upon the approval of the Advisory committee who will:

Oversee the development of mutual aid programs.
Identify new funding sources
Serve as a point of contact with State Health Departments
Coordinate field activities and direct the center staff.

The Center will examine multiple options for long-term continuation of the program, including a chartered or not-for-profit entity under the University.

II. Establish resources essential for mutual assistance programs between regional health districts and state entities.

Center activities will contribute to the capability of the states to respond to health emergencies. Current EMAC statutes are in place for all participating states, and will help facilitate mutual aid in an emergency declared by the state governors. However, protocols or mechanisms for responding to a crisis or emergency not meeting the emergency threshold do not exist. Further, states possess many different types of assets that could be used in time of crisis if barriers were removed to the sharing of these resources between states. Such an agreement would augment, and not replace, the support available from the Federal government. The maintenance of essential services deemed critical to maintain continuity of operations during a local or regional crisis will minimize the possibility of disruption of the public health system infrastructure.

The collective ten states in regions 7 and 8 have large geographical areas that are sparsely populated, and the majority of the states have a limited population base. A limited number of personnel exist to draw from for public health and public service employment positions in these states. This situation limits the ability of the states to maintain essential services during a crisis of an extended length when these individuals may be needed to assist in crisis management such as receipt, breaking down and dispensing the Strategic National Stockpile. Since maintaining critical and essential services for a state acting alone would be difficult in a prolonged crisis situation, the sharing of resources including qualified personnel, laboratory capacity and communication capacities would not only assist in resolving the crisis but also assist the host state in maintaining critical and essential services to its residents not placed at risk by the sentinel event. This assistance would also help minimize mental and physical exhaustion of the requesting state’s personnel dealing directly with the situation at hand. To provide this type of assistance in a rapid fashion, while a situation is developing, requires much pre-event planning and preparation, including an analysis of each state’s current capacity, review and modification of statutes, rules and regulations as needed, and identification of fiscal responsibility and liability agreements for personnel crossing state lines. These considerations will also include procedures for achieving electronic communications, procedures for processing specimens, and continued efforts to achieve buy-in and cooperation between the states.

The Administrative Center will provide integration and coordination of the program activities. The Center will sponsor organizational meetings of the participating states, first with the SHOs or their equivalent and then with each of the focus area groups. The Center will contract with Schools of Public Health and other professional associations or groups in the country that can provide key services such as evaluation tools or educational resources. The Center will support the development of the program in member states through the availability of project facilitators. The Center will provide training and hands on experience opportunities for public health officials. During the start up phase of the regional program, other Center activities will include creation of template agreements, identification of qualified legal advice and assistance in obtaining buy-in and support from agencies within the participating state.

Lessons learned from the Mid-America project will be incorporated into educational material for use in other states. The educational programs will be extended to emergency response personnel as well as lay people as determined by the state program managers. An important feature of the program will be an emphasis on coordinated activity within the highest levels of state government. This approach, which also extends to the inclusion of the private sector and the academic community, medical schools, federally qualified health centers, local health departments, minority populations and poison control centers, has been described as the “Nebraska Model” and provides a rich source of practical experience on which to build a regional program.

Consultation services will be provided by the Center for assistance with key strategic decisions faced by public health jurisdictions in their efforts to integrate regionally. Some of the most important issues include information technology, electronic communications and access and use of shared databases that includes contact information for personnel. The Center will share key information and experience to build a highly integrated system within regions 7 and 8 to achieve the goal of mutual assistance.

III. Early activities of the Mid America Alliance:

Objective Measure. Success of the program will be demonstrated by participation at three levels:

Conceptual agreement and participation by greater than 80% of the SHOs within regions 7 and 8,
Hire a Director-Job Description attached
Participation by 75% of the intra-state health jurisdictions within member states.
Adoption of legislation by a majority of states that facilitates the exchange of public health personnel.
Approval of epidemiology and laboratory support agreements among 50% of the states; or approval of mutual aid plans for other designated activities.

6. Model legislation for Medical Professionals Licensure Interstate Compact by participating states. An informal survey of the states participating in this Alliance identified one area for immediate activity, that is the need for regional state licensure endorsement; previously termed reciprocity. In order to accomplish this goal it is necessary to create an interstate compact – essentially a contract between states, on par with the process that lead to interstate driver’s license endorsement. While each state has public health experts that might be loaned to other states during times of crisis, a number of issues have not been addressed that would facilitate this activity. For example, liability insurance for medical practice is one obstacle to sharing of public health epidemiologists; a second issue is that of licensure for professionals who must have a state recognized license to practice, such as an M.D., D.O. or Registered Nurse. The Center has already initiated a review of critical issues to facilitate this process that will lead to the writing of a draft interstate compact for adoption by the participating states. At its preliminary stages this compact will be reviewed by all SHOs represented by the advisory committee and appropriate legal representation before being released for general comment. The principle goal of the Medical Professionals Licensure Interstate Compact will be to facilitate the exchange of public health care professionals (epidemiologists, nurses, laboratorians) during times of crisis. In support of this activity, the Center will develop an appropriate database of resources, expertise, and a process for validation of licensure in participating states.

7. Information technology development and data exchange. Many of the known obstacles to the success of a regional mutual support program include issues associated with information technology. While the adoption of Public Health Information Network (PHIN) standards goes a long way to overcoming these obstacles, several issues remain in regards to implementing a regional program.

The center will provide expertise in establishing a state based human resources inventory that is capable of being shared within the region by participating states. A regional database will be established to identify available human resources to respond to public health emergencies and accomplish an all-hazards emergency recovery strategy.

The Center will provide expertise for the implementation of a regional plan for controlling access to surge capacity related information including laboratory data. The plan will be HIPPA compliant and the process for achieving compliance will be coordinated by the Center. On a regional basis the Center will provide technical and functional expertise for electronic communication and data exchange between states and the private sector using resources and capabilities available within the Center.

8. Surge Capacity: Epidemiology and Laboratory Services.

Following assessments of regional state participant needs and capacity, the Center will establish a process for addressing surge capacity for diagnostic testing and epidemiologic investigations. In its first phase this will focus on capabilities within neighboring states of the Alliance, but in the future could address a greater number of states within the midwestern region. In situations when demand for services extends beyond the capabilities of existing facilities, the Center will coordinate the response efforts within the region.

Shared regional services will include large capacity specimen processing capability. This equipment will be capable of common accessioning, specimen centrifugation and serum separation, and storage and shipping for participating laboratories for test performance. Since all laboratories in the region will be linked, the data can be aggregated even if performed at multiple sites.

Additional services will include the identification of epidemiologists and nurses who have specific expertise in public health as well as the advance positioning of a limited number of epidemiologists within the region. During non-crisis periods, these epidemiologists will focus on regional health problems such as antibiotic resistance, heavy metal poisoning, etc.

9. Strategy development for achieving readiness

In this world of globalized epidemics, the United States will likely be faced with situations exceeding the resources of the Federal government. The required emphasis on responding to an immediate threat will necessarily dilute resources that can be allocated to each state. The Mid America Alliance and the Center will be available as a central repository of preparedness plans of the participating states that will facilitate planning at the local level, including counties and cities. For example, a number of cities within regions VII and VIII are located on the border of neighbor states, and city authorities would benefit from knowing what the emergency response plans are of the adjoining health jurisdictions. Accurate impact assessments are integral to planning activities.

10. Needs and Resource Identification.

Due to the experiences gained over the past two years, several of the states in regions 7 and 8 have gained valuable experience in facing the variety of challenges to developing a comprehensive preparedness program. This collective experience will be captured during organizational meetings of the regional cooperative programs and in comprehensive interviews of state participants. The primary goal of this activity will be to eliminate barriers to mutual cooperation and assistance. Several of these obstacles have been identified based on information gained to date but, undoubtedly, many remain unrecognized and undocumented. In addition, certain resources of the states have been identified during preliminary planning discussions.

Examples of potential resources for sharing within regions VII and VIII.

Mobile laboratory: The state of South Dakota has developed a high-level containment mobile laboratory within a 16-wheel truck and trailer unit.
Biocontainment hospital facilities: The State of Nebraska has contracted with a large hospital to remodel a unit to house highly infectious patients.
Additional examples of state assets are described in the shared resources section.

The Alliance will demonstrate how a geographic region impacted by a public health emergency can utilize regional resources to maintain essential services and recover full function. Preparedness strategies will be evaluated and refined as a primary focus of the project.

11. Testing public health readiness indicators in a state-based pilot program.

The Mid America Alliance will be evaluated by the Center as a prototype for an all-hazards public health response system for addressing regional needs during a crisis. While it is recognized that the approaches and strategies used in the Mid America project may not be applicable in all states of the Union, it is expected that the concepts and principles will be applicable at least in part to all 50 states and 7 territories. This concept will be explored through an evaluation of the participation by states in regions 7 and 8. The Kansas Health Institute has established a pilot program for testing of public health preparedness readiness indicators. The program will specifically emphasize one approach to escalating capability through use of inter-state cooperative agreements. In addition to assessing the impact of the program on intra-state public health emergencies, the program will address problems associated with cities or population centers that are located on the borders between adjacent states. The program’s ability to address issues of surge need and capacity will be documented.

IV. Benefit to partners

Corporate – Major US corporations will directly participate in programs focused on the application of information and technology for protection of national infrastructure such as roads, bridges, airports and railroads. Corporate leaders will be recruited for participation in resource sharing activities. The goal of the program will be focused on maintaining and improving the health and productivity of workers and protecting them from a health emergency, thereby maintaining business activity.

Academic – The program will interface with, but not duplicate, the activities of Schools of Public Health within regions VII and VII. The Center will augment the academic activities by generating and monitoring high quality data sets of public health professionals and health care partners. The program will increase opportunities for University leaders to participate in public health preparedness programs.

State and Local Government – The Center will emphasize opportunities to broaden the scope of public health within government to include integration of emergency management, agriculture, veterinary medicine and non-traditional partners in bioterrorism preparedness activities thus leveraging state resources to achieve cost savings, and cooperative programs that utilize information technology.

The sharing of resources and programs between participating states will bring a variety of efficiencies, freeing up bioterrorism preparedness dollars and allowing for new or expanded programs. One example is that of bioterrorism education programs where librarians that serve one program could be shared among all states. Similarly, the concept could be applied to internet sites, symposiums, and speaker’s bureaus.

Local Health Departments – The center will work in conjunction with State Health Officials and local health departments to identify resources within the region that can be brought to bear on addressing needs of the state. This activity will be a key component of the Mutual Aid program. Examples of such resources include transportation of supplies for emergency management, computer software, pharmacy administration for emergency stockpile organization, high capacity communications, vaccine distribution, information tracking and resource management. The program will emphasize examples from states where public health challenges have been successfully addressed, where the use of existing computer software, shared databases, scientific expertise and excess shipping capacity reduced the cost of building essential infrastructure.