Chapter 2. Background

Incorporating Health Call Centers Into Community Emergency Responses

The overall benefit to health call center involvement in a community emergency is depicted in Figure 1. Once an event occurs, media outlets (newspapers, television, radio, Internet) will devote much time and effort to reporting on it. The public will get needed information about the event from those media sources, but there will be limited opportunities to ask questions about how those events pertain to their individual circumstances.

Health call centers (poison control centers, nurse advice lines, and health hotlines) have the expert and experienced staff to address the potential demand for more information with a range of approaches from recordings to speaking with a trained professional. By partnering with public safety and public health agencies, health call centers can provide information that is accurate, up-to-date, and consistent with official messages. Call centers can also collect information for use in situational awareness, from health concerns to the development of illness.

Addressing Public Concern

Public concern about an event and how it may affect individuals increases when it has potential health implications. Our previous research has shown that calls to health-related hotlines have ranged from less than 1 percent to 25 percent of the affected community's adult population, depending on the nature of the event. Figure 2 depicts that concerns for emerging insect-borne disease outbreaks in Colorado and New York City (using hotline contacts as a percentage of the population) were much lower than concerns for an infectious disease outbreak primarily involving children in Florida.^1-5

It has been demonstrated that the public perceives risk differently than public health professionals do.^4,6 Experiences have shown that bioterrorism-related, child-focused, and newly emerging disease events, in particular, prompt people to contact call centers. Though it may be hard to predict the level of concern for any given health event, research in the field of risk communication indicates that certain risk perceptions increase levels of fear and concern. Covello, et al, report that levels of concern tend to be most intense when the risk is perceived to be involuntary, inequitable, not beneficial, not under one's personal control, associated with untrustworthy individuals or organizations, and associated with dreaded adverse, irreversible outcomes.⁴

HEALTH

The Rocky Mountain Regional Health Emergency Assistance Line and Triage Hub (HEALTH) model was developed as a partial solution to the public health communications problems that were recognized in the aftermath of September 11, 2001 and the concern about anthrax-laced letters distributed through the United States Postal Service.

The HEALTH model presents requirements, specifications, and resources needed for developing a public health emergency contact center that is highly integrated with public health agencies and that could minimize surges in the demand for health and event information during an emergency. The model was designed with medical contact centers (such as poison control centers and nurse advice lines) in mind as potential implementers, and as the appropriate repositories for the creation and maintenance of readiness for providing one-on-one health communication in a public health event.

To further assist other agencies in developing the capabilities and functions of this model, especially public health agencies, we created a HEALTH Contact Center Assessment Tool Set. The tool set is a Microsoft® Excel workbook that agencies can use to assess the potential demand they may face in a health emergency event and to determine the resources needed to address this demand. The tool set consists of seven simple checklists or spreadsheets, including:

• Instructions.
• Contact Surge Calculator.
• Staffing-Resource Calculator.
• Capital Expense Calculator.
• Technology Expense Calculator.
• Surge Options Matrix.
• Glossary.

The HEALTH model incorporates the ability to provide one-on-one health information using the latest in technology to efficiently handle this demand through various communication modalities. The Rocky Mountain Regional HEALTH model report and tools are at http://www.ahrq.gov/research/health.

HELP

Our poison center established the Health Emergency Line for the Public (HELP) pilot program in Colorado to provide information during bioterrorism and other public health emergencies. HELP originated as a pilot or proving ground for implementing some of the concepts and strategies that were developed in the HEALTH model. Since then, it has been continually developed and has responded to three major health events in Colorado: the deadliest WNV outbreak in the United States (2003), an influenza outbreak with early increased pediatric deaths (2003-2004), and an influenza outbreak during a vaccine shortage (2004-2005). The HELP program provides a model for disseminating and collecting information during health emergencies in partnership with a State health department.

The HELP service was offered to the public in January 2003 to support a statewide smallpox vaccination program for health care volunteers in Colorado. The vaccination program finished in March 2003. The HELP program was then modified to provide WNV information to the public in anticipation of a second season of that outbreak in Colorado. Since July 22, 2003, a toll-free line has been available 24 hours a day, featuring current recorded messages and Web site referrals for more detailed information. Trained information providers are available from 7:00 a.m. to 11:00 p.m. daily to answer questions, collect demographic data, and provide referrals.

Recordings are available in English and Spanish with additional translation services available for other languages. Information providers use FAQ scripts prepared by State health epidemiologists to explain symptoms, treatments, and prevention measures to callers. Evolving public concerns are identified, and applicable responses are developed within 48 to 72 hours. The HELP program has expanded information offerings to include additional topics such mold, influenza/pneumonia, anthrax/white powder, severe acute respiratory syndrome (SARS), hantavirus, tuberculosis, the human strain of avian influenza, and ricin. Other topics are added as information needs for the public and health providers are identified.

The HELP program provides the functional platform for piloting and testing other call center strategies, technology, and applications to efficiently provide information to the public in a health emergency. The technology infrastructure and requirements of the HELP program were described previously in the HEALTH model report. The essential elements that we have identified from the last 3 years of operating the HELP program service are addressed later in this report and in Appendix 3.

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