Section 2: Snapshots of Public Health Preparedness in States and Directly Funded Localities: Oregon

Related Website: Oregon Department of Public Health

A healthy population is more resilient in public health emergencies. People with chronic conditions may require additional care such as specialized medications, equipment, and other assistance. To develop an effective response plan, a state or locality must consider the unique needs of its own population. In Oregon, 8.6% of adults reported having asthma, 6.9% diabetes, 5.4% heart disease, and 2.4% had a stroke. In addition, 23.9% reported a limiting disability and 61.7% were overweight or obese.*
*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

All response begins at the local level. Being prepared to prevent, respond to, and recover from all types of public health threats requires that states and localities improve their capabilities in surveillance, epidemiology, laboratories, and response readiness. Facts on laboratories and response readiness activities appear below. See appendices 1 and 7 for a more detailed description of data points and data sources.

Table 1. Laboratories: General
Category of Activities	Specific Activity	Response
Maintaining core laboratory functions during an emergency	Status of continuity of operations plan (COOP):¹ State had a COOP that included laboratory operations
Ensuring availability of Laboratory Response Network (LRN) laboratory results for decision making	State had a standardized electronic data system capable of messaging laboratory results between LRN laboratories and also to CDC² Note: For a description of LRN laboratories, see appendix 1.	Yes
1APHL; 2008 2CDC, OSELS; 2008

Table 2. Laboratories: Biological Capabilities
Category of Activities	Specific Activity	Response
Participation in LRN for biological agents	LRN reference and/or national laboratories that could test for biological agents³	1 reference lab
Assessing if laboratory emergency contacts could be reached 24/7	LRN laboratories successfully contacted during a nonbusiness hours telephone drill³	1 out of 1 lab
Evaluating LRN laboratory capabilities	Proficiency tests passed by LRN reference and/or national laboratories³	3 out of 3 tests
Rapid identification of disease-causing bacteria by PulseNet laboratories	Rapidly identified E. coli O157:H7 using advanced DNA tests (PFGE)⁴
	Samples for which state performed tests	53
	Test results submitted to PulseNet database within 4 working days (target: 90%)	100%
	Rapidly identified L. monocytogenes using advanced DNA tests (PFGE)⁴
	Samples for which state performed tests	-
	Test results submitted to PulseNet database within 4 working days (target: 90%)	N / A
Assessing laboratory competency and reporting through exercises	State public health laboratory conducted exercises to assess competency of sentinel laboratories to rule out bioterrorism agents¹	Yes
	CDC-funded LRN laboratory ability to contact the CDC Emergency Operations Center within 2 hours during LRN notification drill³ Note: There is one CDC-funded LRN laboratory in DC and in each state, with the exception of CA, IL, and NY, which have two.	Did not participate
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Table 3. Laboratories: Chemical Capabilities
Category of Activities	Specific Activity	Response
Participation in Laboratory Response Network for chemical agents (LRN-C)	LRN-C laboratories with capabilities for responding if the public is exposed to chemical agents⁵ Note: There are three levels, with Level 1 having the most advanced capabilities. See appendix 1.	One Level 3 lab
Evaluating LRN-C laboratory capabilities through proficiency testing	Core methods successfully demonstrated by Level 1 and/or Level 2 laboratories to rapidly detect chemical agents⁵	N / A
	Additional methods successfully demonstrated by Level 1 and/or Level 2 laboratories to rapidly detect chemical agents⁵	N / A
Assessing LRN-C laboratory capabilities through exercises	LRN-C laboratory ability to collect, package, and ship samples properly during LRN exercise⁵	Passed
	Chemical agents detected by Level 1 and/or Level 2 laboratories in unknown samples during the LRN Emergency Response Pop Proficiency Test (PopPT) Exercise⁶	N / A
	Hours to process and report on 500 samples by Level 1 laboratory during the LRN Surge Capacity Exercise (range was 71 to 126 hours)⁵	N / A
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Table 4. Response Readiness: Communication
Category of Activities	Specific Activity	Response
Communicating emerging health information	State public health department had a 24/7 reporting capacity system that could receive urgent disease reports any time of the day⁷	Yes
	Responded to Health Alert Network (HAN) test message within 30 minutes⁸	Yes
	State public health laboratory used HAN or other rapid method (blast email or fax) to communicate with sentinel laboratories and other partners for outbreaks, routine updates, training events, and other applications¹	16 times
	Epidemic Information Exchange users responded to system-wide notification test within 3 hours⁹	61%
Improving public health information exchange	Participated in a Public Health Information Network forum (community of practice) to leverage best practices for information exchange¹⁰	Yes
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Table 5. Response Readiness: Planning
Category of Activities	Specific Activity	Response
Assessing plans to receive, distribute, and dispense medical assets from the Strategic National Stockpile and other sources	CDC technical assistance review (TAR) state score ^11,12	2007-08: 85
	Scoring Note: A score of 69 or higher indicates performance in an acceptable range in plans to receive, distribute, and dispense medical assets.	2008-09: 86
	Cities Readiness Initiative (CRI) location and 2007-08 TAR score¹¹ Cohort I: No sites Cohort II: Portland, OR: 58 Cohort III: No sites See Scoring Note above. CRI locations can consist of multiple jurisdictions, some located in more than one state. See appendix 6. Cohort I, II or III refers to the year when the location was added to CRI. See appendix 1.
Enhancing response capability for chemical events	CHEMPACK nerve-agent antidote containers¹¹	23
Meeting preparedness standards for local health departments	Local health departments meeting voluntary Project Public Health Ready preparedness standards¹³	0
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Table 6. Response Readiness: Exercises and Incidents
Category of Activities	Specific Activity	Response
Notifying emergency operations center staff	Pre-identified staff notified to fill all eight Incident Command System core functional roles due to a drill, exercise, or real incident¹⁴ Note: State must report 2 and could report up to 12 notifications.	4 times
	Pre-identified staff acknowledged notification within the target time of 60 minutes¹⁴	3 out of 4 times
	Conducted at least one unannounced notification outside of normal business hours¹⁴	Yes
Activating the emergency operations center (EOC)	Public health EOC activated as part of a drill, exercise, or real incident¹⁴ Note: State must report 2 and could report up to 12 activations.	2 times
	Pre-identified staff reported to the public health EOC within the target time of 2.5 hours¹⁴	2 out of 2 times
	Conducted at least one unannounced activation¹⁴	No
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Table 7. Response Readiness: Evaluation
Category of Activities	Specific Activity	Response
Assessing response capabilities through after action report/ improvement plans (AAR/IPs)	AAR/IPs developed following an exercise or real incident¹⁴ Note: State must report 2 and could report up to 12 AAR/IPs.	3 AAR/IPs
	AAR/IPs developed within target time of 60 days¹⁴	3 out of 3 AAR/IPs
	Re-evaluated response capabilities following approval and completion of corrective actions identified in AAR/IPs¹⁴	Yes
1APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these CDC efforts are provided below.

Table 8. Research, Training, Education, and Promising Demonstration Projects
Project	Location/Project Name	Amount
Centers for Public Health Preparedness¹⁵	-	N / A
Preparedness and Emergency Response Research Centers¹⁵	-	N / A
Advanced Practice Centers¹⁶	-	N / A
Centers of Excellence in Public Health Informatics¹⁷	-	N / A
Pandemic Influenza Promising Practices Demonstration Projects¹⁴	Addressing Vulnerabilities in Populations; Collaborative Planning for Delivery of Essential Health Services; Electronic Laboratory Data Exchange	$260,371 $1,034,334 $251,453
14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

Table 9. Additional CDC Resources Supporting Preparedness in States and Localities
Project	Description
Epidemic Intelligence Service
Investigations conducted by Epidemic Intelligence Service Field Officers¹⁷	1
Investigations conducted by Epidemic Intelligence Service Field Officers¹⁷	5
Deployments
Type of Incident (number of CDC staff)¹⁸	-
Career Epidemiology Field Officers¹⁵	-
Quarantine Stations¹⁹	-
14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008