Emergency Preparedness Needs of New York State
General Background
Emergency preparedness is critical for New York State as a whole and for New York City. The real experience of this area has served to heighten awareness and increase interest in strengthening the ability of the health and public health sectors to respond. This region is a critical component of national security and national response to any deliberately caused emergencies. The state shares a 350-mile border with another country, has 17 border crossings, and New York City has both air and sea ports receiving traffic from around the globe. In addition to the immense volume of commercial traffic, this area is attractive to tourists, from other parts of the country and internationally. Over 2,000,000 individuals enter New York from other countries each month.13 Among the many industrial activities that could be cited as adding to potential risks for which workers must be prepared is the Plum Island Animal Disease Center in Long Island Sound, which is one of the nation’s most sophisticated research facilities conducting studies with hazardous micro-organisms.
While much attention has been paid to the concerns of New York City since the fall of 2001, the rest of the state cannot be ignored. Agriculture is the leading industry of the state, with 37,255 farms in 2002 covering a quarter of total land area.14 More rural Americans live in New York State than do in Idaho, Montana, Nebraska, North and South Dakota, Utah and Wyoming combined.15 The concern for resident and migrant workers, given the zoonotic threats and the potential for emerging infectious diseases affects not just rural New York but also all parts of the food supply. The President has a current initiative to open or expand 1,200 new health center sites to serve 6.1 million new individuals,16 and it is likely that some of these new sites will be in New York State since there are counties with poverty rates of up to 20% across the state.17 The President will build upon this success with a new initiative to open a community or rural health center in every poor county in America.
Current preparedness efforts
New York State has a large pool of health professionals, as identified in Table 1. There is no single source of information on the degree to which this complete audience has mastered competencies in emergency preparedness appropriate to the roles they might be expected to assume in a terrorist event or other emergency.
| Current numbers of selected health professionals in NY18 | |
|---|---|
| Registered Nurses | Over 198,000 |
| Nurse practitioners (2000) | 9,700 |
| Certified midwives (2000) | 848 |
| Certified registered nurse anesthetists (2000) | 774 |
| Patient care physicians (2000) | 49,000 |
| Active primary care physicians | 80 per 100,000 (2000) |
| Physician assistants (2000) | 4,368 |
| Dentists (2000) | 15,890 |
| Pharmacists (2000) | 67.6 per thousand |
In addition to those in practice, each year well over 5,000 newly educated members of the health professions immediately become a part of the practice community requiring community-specific, institution-specific and role-specific continuing education. Among the efforts already underway to assure that these individuals are prepared to respond to a bioterrorist event or other emergency, both the New York State and New York City departments of health have provided leadership and funding support to professional associations and organizations representing health care facilities. Through these organizations, extensive information is now available on the web sites of the state-wide medical, nursing and dental associations, and training has been conducted at regularly scheduled and special meetings.
Emergency department staff has been receiving extensive training in all hazards and mass casualty incidents, especially in the NYC region, since 2001. In addition, exercises are mandated by JCAHO, and hospitals are required to hold at least two per year. Often, the larger the institution, the more difficult the task of pushing forward training agendas onto already overworked and taxed in-hospital staff. In addition, in smaller institutions there is little flexibility in staffing to allow anyone beyond the required minimum time away from ongoing care duties. Emergency preparedness coordinators from major hospitals in the region report that substantial members of the clinical staff are not familiar with expected emergency response, and either ignore drills or report to the wrong place (e.g., emergency department rather than labor pool location).
The Center for Public Health Preparedness (CPHP) at the University at Albany School of Public Health makes extensive use of the satellite broadcast facilities at the University to reach across the state and country with 23 thousand enrollees registering for seven broadcasts in the Fall 2004-Spring 2005 broadcast series and an additional five thousand viewings of the internet archive. The Northeast Regional Public Health Leadership Institute (NEPHLI), based at the same school, has included emergency preparedness orientation for leaders in courses since 2003. The New York State Association of County Health Officials (NYSACHO) provides critical input on both needs and methods appropriate to reaching their members.
The Center for Public Health Preparedness (CPHP) at Mailman School of Public Health, Columbia University, has as its principal partner the New York City Department of Health and Mental Hygiene (NYC DOHMH), and has worked with the NYC DOHMH to provide training on ICS, workers safety and basic competencies in emergency preparedness. Some material is targeted to the DOHMH staff; other courses are used with the City’s Medical Reserve Corps. In addition to partnership with the CPHP, the NYC DOHMH has partnered with the regional hospital association, the Greater New York Hospital Association (GNYHA), and the regional association of community health centers to build the capacity of their members to participate in emergency response. Courses specific hospital staff are available at Bellevue Hospital and are coordinated through GNYHA.
Many other academic institutions and other units within the consortium universities have been or currently are recipients of research or other development funds from multiple parts of the Department of Health and Human Services (DHHS) -- including Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA) – as well as the Department of Homeland Security and others. The findings of these studies are being incorporated into planning and training as soon as they become available.
Despite the size of the state, the major developers of continuing education in areas relevant to improving emergency response comprise a relatively small community, with many intersections facilitating consistency in training approaches. However, the need for additional training is enormous. Neither the pharmacy nor the veterinary community have received significant attention beyond their roles in surveillance; community health centers and other dispersed, small agencies have often been overlooked, and the staff associated with hospitals that are not central to the emergency department or specific, detailed portions of response have not been effectively engaged.
13 Port Authority of New York & New Jersey. (2005).Airport Traffic Reports. Available at http://www.panynj.gov/aviation/traffic/coverfram.HTM
14 U.S Department of Agriculture. (2002). Census of Agriculture, New York State and County Data, Volume 1, Geographic Area Series, Part 32, June 2004, page 6. Available at: http://www.nass.usda.gov/census/census02/volume1/ny/NYVolume104.pdf May 2005.
15 U.S. Census Bureau, Statistical Abstract of the United States: 2004-2005.
Section 1, Population. Page 28. Accessed at:
http://www.census.gov/prod/2004pubs/04statab/pop.pdf May 2005.
16 The White House. (2005). Available at: http://www.whitehouse.gov/infocus/healthcare/ Accessed 5/12/05
17 New York State Department of Health. Office of Rural Health. Accessed at: www.health.state.ny.us. 5/12/05.
18 Health Resources and Services Administration. State Health Workforce Profiles. Accessed at: http://www.bhpr.hrsa.gov/healthworkforce/reports/statesummaries/newyork.htm. 4/28/05.