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The Pennsylvania Public Health Risk Assessment Tool Created by The Drexel Unive

The Pennsylvania Public Health Risk Assessment Tool Created by The Drexel University School of Public Health Center for Public Health Readiness and Communication For the Pennsylvania Department of Health January 2013 2 Instructions for Using the Pennsylvania Public Health Risk Assessment Tool Workbook Date: January 3, 2012 Table of Contents Preface .................................................................................................................................. 3 Overview of the Pennsylvania Public Health Risk Assessment Tool .............................................. 4 The Workbook ........................................................................................................................ 7 Step 1: Enter Baseline Data ..................................................................................................... 8 Baseline Health, Services, and Infrastructure ......................................................................... 8 Baseline At-Risk Populations ................................................................................................. 9 Baseline Preparedness Capabilities .................................................................................... 11 Community Characteristics ................................................................................................ 12 Step 2: Hazard Data ............................................................................................................. 12 Open a Hazard Worksheet ................................................................................................ 13 Hazard Scenario ............................................................................................................... 13 Probability ........................................................................................................................ 14 Enter Impact Data for Hazards for Severity Assessment ........................................................ 15 Completing the Severity Assessment Quantitatively .......................................................... 18 Completing the Severity Assessment Qualitatively ............................................................ 19 Risk Calculated Automatically ............................................................................................ 20 Enter Information for At-Risk Populations ............................................................................ 20 Adjusted Risk Calculated Automatically ............................................................................... 22 Enter Preparedness Data ................................................................................................... 23 Planning Priority Score Calculated Automatically ................................................................. 23 Hazard Analysis Worksheets .................................................................................................. 24 Step 3. Analysis .................................................................................................................... 28 Summary of Impacts .......................................................................................................... 29 Severity ............................................................................................................................. 30 Planning Priority Scores ..................................................................................................... 31 Summary of Scores ........................................................................................................... 32 Public Health vs. Healthcare .............................................................................................. 33 Probability vs. Severity ....................................................................................................... 34 Adjusted Risk vs. Preparedness ........................................................................................... 35 At-Risk Populations ............................................................................................................ 36 Individual Hazard Analyses ................................................................................................ 37 References............................................................................................................................ 38 3 Preface The Pennsylvania Public Health Risk Assessment Tool (PHRAT) was developed by the Center for Public Health Readiness at the Drexel University School of Public Health. The project was funded by the Pennsylvania Department of Health. This publication was supported by Cooperative Agreement Number 2U90TP316967–11 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Authors: Rachel Peters, MPH Hilary Kricun, MPH Tom Hipper, MSPH, MA Esther Chernak, MD, MPH We wish to acknowledge the substantial contributions of the following individuals to this work risk assessment tool: Shannon Callouri, MA, Pennsylvania Department of Health Tracy Wilcox, Pennsylvania Department of Health Tom Grace, RN, PhD, Hospital Association of Pennsylvania Nicholas DeJesse, OSHA Phillip DeMara, MSEd., City of Philadelphia Department of Behavioral Health and Intellectual Disabilities Services Patrick Gurian, PhD, Drexel University Department of Civil, Architectural, and Environmental Engineering Anu Pradhan, PhD, Drexel University Department of Civil, Architectural, and Environmental Engineering Mikal Shabazz, U.S. Environmental Protection Agency Region III Michael Zickler, U.S. Environmental Protection Agency Region III Charlene Creamer, U.S. Environmental Protection Agency Region III Mike Welsh, PE, U.S. Environmental Protection Agency Region III Patricia Flores, U.S. Environmental Protection Agency Region III Cathleen Kennedy, U.S. Environmental Protection Agency Region III Karl Markiewicz, Agency for Toxic Substances and Disease Registry/Center for Disease Control and Prevention David Allard, CHP, Pennsylvania Department of Environmental Protection Bureau of Radiation Protection Jim Golembeski, Philadelphia Water Department Michael Pickel, Aqua America 4 Overview of the Pennsylvania Public Health Risk Assessment Tool The Pennsylvania Public Health Risk Assessment Tool (PHRAT) was developed to help public health planners prioritize their planning efforts for emergencies that impact the health of the public. In order to inform these decisions, the Pennsylvania PHRAT guides planners through an analysis of the health-related impacts of various hazards that can occur in their jurisdictions. It assesses the planning that is necessary to ensure access to emergency response and preparedness resources, taking into account the services provided by public health agencies and the healthcare system. The term risk, as it is used in this document, refers to the expectation of loss from a hazard or incident (UCLA 2006). Risk is the product of the expected severity of the event and the probability that the event will occur. To assess the public health risk that results from a specific hazard, severity is measured in five major domains: human health, healthcare services, inpatient healthcare infrastructure, community health, and public health services. This tool takes a quantitative approach to impact assessment, measuring baseline levels of morbidity, services, and activities, and comparing them to the morbidity, service impacts, and activities that result from specific hazard incidents. Each domain contains six to eight different metrics that are used to assess the impact of a hazard in that specific area (see Figure 1). In general, the metric is calculated by creating a ratio of a hazard-specific impact (e.g., number of EMS transports or number of Emergency Department beds needed during the incident) to a baseline number for the community during non-disaster times (e.g., average daily number of EMS transports of Emergency Department beds in the jurisdiction). In this way, the severity metrics take into account an increase in morbidity or mortality that may result from a disaster, as well as either a depletion of services or surge requirement. If quantitative data are not available, planners can calculate severity ratio’s based on a subjective estimate of how an incident would impact services or morbidity in a specific area. This tool can be used to generate a composite risk to the overall health of the entire jurisdiction, or it can be used to assess the risk of a hazard from the perspective of either the public health system or healthcare system, respectively, using one of the two component or sub-analyses. The two sub-analyses are the Public Health System Risk Assessment and the Healthcare System Risk Assessment (illustrated in Figures 1, 2, and 3). The Public Health System Risk Assessment examines the severity of specific hazards based on their impact on human health, healthcare services, the functioning of the community and the impact on public health agency services. The Healthcare System Risk Assessment analysis examines severity in two of these areas (human health and healthcare services), and also on inpatient healthcare facility infrastructure. The overall Public Health Risk Assessment calculates severity based on a hazard’s impact in all five of these domains. Many hazards result in disproportionate consequences for certain vulnerable or at-risk populations. Planning for the whole community requires both the recognition of potentially severe impacts of disasters on specific populations, and focused planning to mitigate or respond to those impacts. This tool introduces the concept of adjusted risk, which weights the risk of a hazard based on the additional planning necessary to ensure universal access to emergency response resources for at-risk populations. The Adjusted Risk Score thus reflects the overall health risk from a hazard in a jurisdiction (i.e., an assessment of its probability and anticipated impact on the health of a jurisdiction), viewed through the lens of the effort required to minimize the consequences to vulnerable communities. 5 In addition to generating an Adjusted Risk Score for each hazard, the Pennsylvania PHRAT can also be used to integrate an assessment of preparedness efforts into planning for public health emergencies. The prioritization of planning should be driven by the current status of preparedness for each hazard. This tool attempts to generate a Planning Priority Score for specific hazards by including a quantified assessment of preparedness into the analysis. The Pennsylvania PHRAT uses the 15 Public Health Emergency Preparedness (PHEP) capabilities enumerated by the Centers for Disease Control and Prevention (CDC 2011) and the eight Healthcare Preparedness Program (HPP) capabilities from the Department of Health and Human Services (HHS) to determine a Status Score for each capability. These Status Scores are generated through self-assessment processes conducted by public health and healthcare agencies. In the Pennsylvania PHRAT, each capability is also assigned a hazard-specific Relevance Score that is unique to each hazard, based on the relevance or importance of each capability to the public health response for that hazard. A Preparedness Score for each hazard is then calculated by using both the Status Scores and the Relevance Scores for all 15 Public Health Preparedness or all 8 Healthcare Preparedness capabilities. In the Public Health System Risk Assessment sub-analysis, only the 15 PHEP capabilities are used to calculate preparedness. In the Healthcare System Risk Assessment, the 8 HPP capabilities are used to calculate preparedness. The Adjusted Risk Score for each hazard is then compared to the jurisdiction’s Preparedness Score for that hazard. The ratio of the Adjusted Risk Score to the Preparedness Score is referred to as the Planning Priority Indicator. These scores are then ranked, and the rank is referred to as the Planning Priority Score. This Planning Priority Score reflects a relationship between preparedness efforts and hazard impact, but unlike other risk assessments, it does not propose or presume a specific reduction of risk based on achieving a certain degree of preparedness or mitigation. We believe that the ultimate impact of most disasters is difficult to predict, and it is impossible to say that a certain level of preparedness will reduce risk in knowable or quantifiable ways. Therefore, the final assessment or score generated for each hazard is intended only to prioritize planning. If jurisdictional planners wish to “buy down” actual risk with specific hazard mitigation or preparedness activities, this tool can be used to measure that by reducing the actual severity impact of specific hazards and/or increasing response capacity in uploads/Ingenierie_Lourd/ phrat-guide.pdf