A Systematic Review of Public Health Emergecy Operatios Cetres (EOC) WHO/HSE/GCR/2014.1 December 2013
Ackowledgemets This report was prepared by the World Health Orgaizatio (WHO) Departmet of Global Capacities Alert ad Respose, i collaboratio with the Departmet of Commuicatios ad the Departmet of Emergecy Risk Maagemet ad Humaitaria Respose. The WHO would like to thak the review team members from Emory Uiversity Rollis School of Public Health ad WHO staff from various teams at headquarters ad six regioal offices, for the hard work ad close collaboratio that made the systematic review possible withi a tight timelie ad with limited fiacial resources. Participats i ad cotributors to the systematic review are listed below: Emory Uiversity: Laure Reeves, Paige Rylad, Natalie Johso, Russell Ga, Barbara Abu- Zeid, Scott JN McNabb. WHO: Jia Li, Paul Michael Cox, Tomas Alle, Susa L. Norris, Jered Markoff, Ramesha Krishamurthy, Isabelle Nuttall, Khaled Shamseldi Abou El Azm, Richard Joh Brea, David Brett-Major, Stella Chugog, Ia David Coltart, Sophia Victoria Desillas, Patrick Drury, Deis Faix, Christie Marie Feig, Seait Tekeste Fekadu, Gaya Maori Gamhewage, Leoardo Heradez Galido, Kade-Bure O Bai Kamara, Sajeev Kashyap, Eri Maura Keey, Chi-Kei Lee, Egle Lorezi, Mark Simpso, Rajesh Sreedhara. Editig by Mark Nu (Highbury Editorial, www.highburyeditorial.com) WHO/HSE/GCR/2014.1 World Health Orgaizatio 2014 All rights reserved. Publicatios of the World Health Orgaizatio are available o the WHO web site (www.who.it). Requests for permissio to reproduce or traslate WHO publicatios whether for sale or for o-commercial distributio should be addressed to WHO Press through the WHO web site (www.who.it/about/licesig/copyright_form/e/ idex.html). The desigatios employed ad the presetatio of the material i this publicatio do ot imply the expressio of ay opiio whatsoever o the part of the World Health Orgaizatio cocerig the legal status of ay coutry, territory, city or area or of its authorities, or cocerig the delimitatio of its frotiers or boudaries. Dotted lies o maps represet approximate border lies for which there may ot yet be full agreemet. The metio of specific compaies or of certai maufacturers products does ot imply that they are edorsed or recommeded by the World Health Orgaizatio i preferece to others of a similar ature that are ot metioed. Errors ad omissios excepted, the ames of proprietary products are distiguished by iitial capital letters. All reasoable precautios have bee take by the World Health Orgaizatio to verify the iformatio cotaied i this publicatio. However, the published material is beig distributed without warraty of ay kid, either expressed or implied. The resposibility for the iterpretatio ad use of the material lies with the reader. I o evet shall the World Health Orgaizatio be liable for damages arisig from its use. Desig ad layout by Jea-Claude Fattier.
Table of cotets Executive summary... 1 1 List of abbreviatios... 3 2 Itroductio... 5 2.1 Backgroud... 5 2.2 Review objectives... 5 3 Methods... 7 3.1 Summary of review questios & categories... 7 3.2 Review protocol... 7 3.3 Study idetificatio... 7 3.3.1 Exclusio ad iclusio criteria... 7 3.3.2 Publicatio types... 8 3.3.3 Search strategy & data sources... 9 3.4 Data extractio & maagemet... 9 3.5 Quality assessmet... 10 4 Results... 11 4.1 Quality assessmet aalysis... 11 4.2 Characteristics of idetified studies... 12 4.3 Idetified stadards... 12 5 Discussio... 23 5.1 Geeral... 23 5.1.1 EOC fuctios... 23 5.1.2 Types of risks ad hazards... 23 5.1.3 Huma resource eeds... 23 5.1.4 Surge capacity... 24 5.1.5 Structure... 24 5.1.6 Decisio-makig, modellig, ad implemetatio... 24 5.1.7 Best practices... 25 5.1.8 Idicators ad performace measures... 26 5.2 Commuicatio techology ad ifrastructure... 27 5.2.1 EOC space... 27 5.2.2 Iformatio ad commuicatio techology (ICT)... 28 5.2.3 Equipmet ad techological compoets... 28
5.2.4 Iformatio ad kowledge maagemet software... 29 5.2.4.1 EOC applicatios ad stadards... 29 5.2.4.2 Virtual EOCs... 29 5.3 Procedures ad plas... 30 5.3.1 Key characteristics of procedures ad plas... 30 5.3.2 Key compoets of emergecy operatios plas... 31 5.3.3 Plaig process... 31 5.3.4 Activatio criteria... 32 5.4 Risk commuicatio... 32 5.5 Operatioal iformatio miimum data sets ad stadards... 33 5.5.1 Iformatio eeds... 33 5.5.2 Types of operatioal iformatio... 34 5.5.3 Data sources, collectio, ad moitorig... 34 5.5.4 Use of operatioal iformatio... 35 5.6 Traiig ad exercises... 35 5.6.1 Idividual traiig... 36 5.6.2 Orgaizatioal traiig ad exercises... 36 5.7 Themes ad coclusios... 37 5.8 Limitatios... 37 6 Coclusio... 39 6.1 Curret status, gaps, ad impedimets i buildig, maitaiig, ad usig EOCs... 39 6.1.1 EOC fuctios... 39 6.1.2 Stadards... 39 6.1.3 Huma resource eeds... 39 6.1.4 Decisio-makig, modellig, ad implemetatio... 40 6.1.5 Commuicatio techology ad ifrastructure... 40 6.1.6 Procedures ad plas... 40 6.1.7 Operatioal iformatio miimum data sets ad stadards... 41 6.1.8 Traiig ad exercises... 41 6.2 Global best practices for EOCs for effective public health emergecy respose... 42 6.3 The coectio betwee EOCs ad risk commuicatio... 42 6.4 Idicators to moitor EOC performace... 42 6.5 Stadardised EOC termiology... 42 6.6 Research eeds for buildig, maitaiig, ad usig EOCs... 43 7 Refereces... 45
8 Appedices... 59 8.1 List of review questios... 59 8.2 Search strategy for each database searched... 61 8.3 Additioal studies, stadards ad other materials icluded i review... 70
Systematic review of public health emergecy operatios cetres Executive summary A public health emergecy operatios cetre (EOC) is a cetral locatio for coordiatig operatioal iformatio ad resources for strategic maagemet of public health emergecies 1 ad evets. EOCs provide commuicatio ad iformatio tools ad services ad a maagemet system durig a respose to a emergecy or evet. They also provide other essetial fuctios to support decisio-makig ad implemetatio, coordiatio, ad collaboratio. This systematic review examied peer-reviewed ad grey literature i order to documet global best practices for effective public health emergecy respose by EOCs; to idetify idicators to moitor EOC performace; to describe risk commuicatio i EOC settigs; to outlie research eeds; ad to idetify stadardised termiology. The stadards ad best practices idetified will be used to stregthe World Health Orgaizatio (WHO) Member State capacity for effective public health respose. Aalysis of the compoets of EOCs ad their stadards ad best practices ca assist i achievig the basic EOC fuctios ad avigatig the complexities of emergecy respose. Several categories of EOC fuctio were researched: geeral EOC fuctio ad structure; EOC commuicatio techology ad ifrastructure; procedures ad plas; miimum data sets ad stadards for operatioal iformatio; ad traiig ad exercises. A total of 291 studies were examied, ad recommedatios ad lessos leared from the peer-reviewed literature are icorporated throughout the report, orgaized by category. Stadards, guidelies, ad best practices are listed i Tables 3 ad 4 ad refereced throughout the report. Certai qualities were cosistetly oted as importat elemets of effective EOC fuctio: collaboratio; coordiatio; commuicatio; harmoisatio; respect; cooperatio; vertical ad horizotal itegratio; trust; ad leadership [5.1.7]. Evidece that these elemets are foudatioal compoets of effective EOC fuctio spaed grey literature; peer-reviewed literature; quatitative ad qualitative studies; ad case studies of both effective ad ieffective emergecy resposes. The literature showed that the biggest barriers to EOC fuctio were lack of sufficiet commuicatio ad coordiatio. Other impedimets existed, ad adequate plaig was also a essetial elemet, but commuicatio ad coordiatio cosistetly formed the basis for EOC success. EOCs are used i a variety of hazards ad emergecies, icludig atural disasters; foodbore disease outbreaks; radiouclear evets; bioterrorism; chemical icidets; mass gatherigs; blackouts; humaitaria emergecies; ad disease outbreaks or pademics. They are employed at a variety of jurisdictioal levels, ragig from field EOCs to local or regioal EOCs to atioal or iteratioal EOCs [5.1.2 ad Table 2]. Staff ad surge capacity were importat elemets of EOC fuctio i all areas [5.1.3 ad 5.1.4]. Icidet Commad Systems ad similar EOC structures were frequetly used to orgaize EOC operatios ad decisio-makig [5.1.5 ad 5.1.6]. Icorporatig lessos leared ito EOC plas ad fuctio ca improve performace. Several performace idicators are used to measure success, although clear agreemet o idicators 1 A public health emergecy is a extraordiary evet that adversely affects the health of huma populatios ad which requires a coordiated respose. Such a evet may icrease morbidity ad/or mortality, ad/or spread disease, ad may be caused by atural disasters, disease outbreaks or pademics, bioterrorism, radiouclear evets, chemical icidets, humaitaria emergecies, etc. 1
World Health Orgaizatio is ot see i the literature. While o curret iteratioal stadards exist for moitorig the fuctio of EOCs, several bodies, icludig WHO, the 2005 Iteratioal Health Regulatios (IHR(2005)), ad the Uited States of America Cetres for Disease Cotrol ad Prevetio (CDC), provide performace measure idicators [5.1.8]. Best practices for buildig ew EOCs ad improvig existig oes iclude recommedatios about a EOC s locatio ad physical space requiremets, as well as suggested iformatio ad commuicatio techology compoets [5.2.1, 5.2.2, ad 5.2.3]. EOCs, whether physical or virtual, also frequetly use iformatio ad kowledge maagemet software applicatios [5.2.4]. These systems are icreasigly critical for sufficiet commuicatio withi ad betwee agecies ad EOCs durig emergecy respose. The eed for backup systems ad redudacies is also widely documeted [5.2.3]. The eed for plas is cotiually emphasized. This report lays out compoets ad characteristics of a emergecy operatios pla, providig a suggested structure for plas ad procedures [5.3.1 ad 5.3.2]. The plaig process, ad that of coductig a hazard aalysis or eeds assessmet, are also discussed as key steps [5.3.3]. Risk commuicatio is itegrated throughout may other foci ad categories i the literature. Accurate ad timely iformatio sharig that is evidece-based ad coordiated is critical. Buildig o existig relatioships ad collaboratio is particularly effective, both with the media ad with other agecies ad stakeholders [5.4]. Risk commuicatio is a importat compoet of emergecy operatios plas ad EOC operatios [5.4.1]. Operatioal iformatio ad iformatio eeds ca vary widely i EOC settigs, but eeds assessmets ad the use of existig ad baselie data are helpful to effective EOC fuctio [5.5.1]. The types of operatioal iformatio eeded by EOCs ad iformatio sources deped o the type of hazard or emergecy, but follow similar categories, outlied i Sectios 5.5.2 ad 5.5.3. These data, ad the appropriate use of commuicatio techology ad systems, are critical to decisio-makig ad respose [5.5.4]. Traiig ad exercises form a essetial compoet of emergecy respose plas ad stadards [5.6]. Idividual traiig ca improve the skills ad competecies of EOC staff for specific EOC fuctios ad for cross-fuctioal ad iteragecy skill improvemet [5.6.1]. Orgaizatioal traiig ad exercises are importat both for team ad relatioship buildig ad for the agecy s ability to fuctio effectively [5.6.2]. Future areas of research are recommeded i Sectio 6.6 ad iclude surveillace systems, the legal ad ethical issues cocerig EOCs, ad more i-depth research o risk commuicatio. Several review questios ot fully supported by the systematic review are also recommeded for future study. These iclude solutios to surge capacity; the challeges of usig iformatio maagemet software; EOC traiig programmes; ad itegratig risk commuicatio ito exercises. Fially, iteratioal stadards ad/or guidelies eed to be developed i order to: outlie a structure for the orgaizatio of EOC operatios ad decisio-makig; delieate roles ad resposibilities for staff ad surge staff; list appropriate kowledge maagemet software ad ICT i lie with messagig, privacy, ad security stadards; list data collectio, aalysis, ad iterpretatio processes ad systems to be used; ad develop cosistet schedules ad cotet for traiig ad exercises. 2
Systematic review of public health emergecy operatios cetres 1. List of abbreviatios ACM ANSI BSI CASP CASPER CDC COPSS CSA DHS DOJ ebxml ECDC EMBASE EOC EOC-NET FEMA GCR GIS HL7 HTTP IASC ICD-10 ICS ICT IEEE IEEE Xplore IHR INFOSAN ISO Associatio for Computig Machiery America Natioal Stadards Istitute British Stadards Istitutio Critical Appraisal Skills Programme Commuity Assessmet for Public Health Emergecy Respose Uited States Ceters for Disease Cotrol ad Prevetio Commo Operatig Picture Software/System Caadia Stadards Associatio Uited States Departmet of Homelad Security Uited States Departmet of Justice Electroic Busiess Extesible Markup Laguage Europea Cetre for Disease Prevetio ad Cotrol Excerpta Medica Database Public Health Emergecy Operatios Cetre/Ceter Public Health Emergecy Operatios Cetre Network Uited States Federal Emergecy Maagemet Agecy WHO Departmet of Global Capacities, Alert ad Respose Geographic Iformatio Systems Health Level 7 Iteratioal Hypertext Trasfer Protocol Iter-Agecy Stadig Committee Iteratioal Classificatio of Diseases, 10 th revisio Icidet Commad System Iformatio ad commuicatio techology Istitute of Electrical ad Electroics Egieers Digital library of the Istitute of Electrical ad Electroics Egieers Iteratioal Health Regulatios Iteratioal Food Safety Authorities Network Iteratioal Orgaizatio for Stadardisatio 3
World Health Orgaizatio LOINC MACS NFPA OASIS OCHA OSOCC PAHO PHIN MS PKI PRISMA PROSPERO PubMed SNOMED SSL UN WHO Logical Observatio Idetifiers Names ad Codes Multiagecy Coordiatio Systems Natioal Fire Protectio Associatio Orgaizatio for the Advacemet of Structured Iformatio Stadards The Uited Natios Office for the Coordiatio of Humaitaria Affairs O-Site Operatios Coordiatio Cetre Pa America Health Orgaizatio Public Health Iformatio Network Messagig System Public Key ifrastructure Preferred Reportig of Items for Systematic Reviews ad Meta-Aalyses Iteratioal Prospective Register of Systematic Reviews Public/Publisher MEDLINE Systematized Nomeclature of Medicie Secure Sockets Layer Uited Natios World Health Orgaizatio 4
Systematic review of public health emergecy operatios cetres 2. Itroductio 2.1 Backgroud The World Health Orgaizatio (WHO) Departmet of Global Capacities, Alert ad Respose (GCR) established the Public Health Emergecy Operatios Cetre Network (EOC-NET) i 2012. This was doe i order to stregthe global collaboratio ad WHO Member States capacity for effective public health all-hazards respose i lie with the requiremets of the 2005 Iteratioal Health Regulatios (IHR(2005)). A systematic review was udertake i order to: provide uderstadig of the curret global status ad best practices of public health emergecy operatios cetre (EOCs); documet impedimets ad gaps; ad iform the developmet of guidace ad stadards for buildig, maitaiig, ad usig EOCs for respose to public health risks ad emergecies. This systematic review aimed to address the compoets of EOCs ad their stadards ad best practices both for achievig the basic EOC fuctios ad for avigatig the complexities of emergecy respose. 2.2 Review objectives 1. Iform WHO ad EOC-NET parters of the curret status, gaps, ad impedimets i buildig, maitaiig, ad usig EOCs 2. Share global best practices for EOCs for effective public health emergecy respose 3. Describe the coectio betwee EOCs ad risk commuicatio 4. Idetify idicators to moitor performace of EOCs 5. Outlie research eeds for buildig, maitaiig, ad usig EOCs 6. Idetify stadardised EOC termiology. 5
Systematic review of public health emergecy operatios cetres 3. Methods 3.1 Summary of review questios & categories A public health emergecy operatios cetre (EOC) is the cetral locatio for coordiatig operatioal iformatio ad resources for strategic maagemet of public health emergecies ad evets. EOCs provide commuicatio ad iformatio tools ad services ad a maagemet system durig a respose to public health emergecies ad evets. They also provide other essetial fuctios to support decisio-makig ad implemetatio, coordiatio, ad collaboratio. A EOC is ofte referred to by other ames (1). Categories of possible hazards or risks icluded i this review iclude disease outbreaks or pademics (e.g., iflueza, haemorrhagic fever, meigitis, cholera, smallpox, polio, degue fever, plague, emergig ifectious diseases); bioweapo or bioterrorism evets; crises or disasters; chemical safety or toxicology evets; radiouclear safety evets; food safety evets or outbreaks; mass gatherigs; ad others. Review questios were grouped ito five categories (Sectio 8.1): 1. Geeral questios 2. EOC commuicatio techology ad ifrastructure 3. Procedures ad plas 4. Operatioal iformatio miimum data sets ad stadards 5. Traiig ad exercises. 3.2 Review protocol The review protocol followed the guidelies of the Preferred Reportig of Items for Systematic reviews ad Meta-Aalyses (PRISMA), the Cochrae Hadbook for Systematic Reviews of Itervetios, ad the WHO Hadbook for Guidelie Developmet. It specified the review s objectives, search strategy, iclusio ad exclusio criteria, data extractio methods, ad quality assessmet. The protocol was registered i the PROSPERO Iteratioal Prospective Register of Systematic Reviews [2-4]. 3.3 Study idetificatio 3.3.1 Exclusio ad iclusio criteria All articles published i Eglish betwee 1 Jauary 1993 ad 30 October 2013 that cotaied both a abstract ad full text were icluded. The abstract requiremet was waived for govermet ad idustry reports ad other grey literature sources. Articles selected for iclusio used various terms to refer to a EOC (e.g., commad ad cotrol operatios cetre, strategic health operatios cetre, commad cetre, situatio room ad crisis maagemet cetre ). To be icluded, a article must have provided iformatio relevat to oe or more of five pre- 7
World Health Orgaizatio determied review categories (geeral; iformatio commuicatios techology ifrastructure; procedures ad plas; operatioal iformatio miimum data sets ad stadards; ad traiig ad exercise). These categories were developed by WHO ad Emory Uiversity. Duplicate articles ad those with itervetios ad/or programme descriptios occurrig before 1 Jauary 1993 were excluded. Figure 1 shows the umber of records idetified durig the retrieval process ad how may were excluded because they did ot meet the criteria detailed here. Figure 1. Workflow diagram of the retrieval process for the systematic review of public health emergecy operatios cetres, Jauary 1993 October 2013 Idetificatio 6401 records idetified through searchig PubMed, EMBASE, Web of Sciece, IEEE Xplore, ad ACM 432 records idetified through searchig other sources Screeig 4502 records after duplicates removed 4502 records screeed 117 records ot i Eglish excluded Eligibility 4385 articles screeed for iclusio criteria (relevace to review questios ad review scope) 4094 articles excluded for iclusio ad exclusio criteria Icluded 291 studies ad documets icluded i data extractio ad quality assessmet 3.3.2 Publicatio types Origial peer-reviewed articles, review articles, stadards, guidelies, ad govermet ad idustry reports were icluded. The types of documets foud icluded descriptive studies ad those usig qualitative methods of data collectio ad aalysis. 8
Systematic review of public health emergecy operatios cetres 3.3.3 Search strategy & data sources Exhaustive searches were performed collectig all relevat studies, stadards, ad reports available durig the study period. The followig databases were searched: PubMed, EMBASE, Web of Sciece, IEEE Xplore, ad ACM. The followig grey literature sources were also searched: WHO, the Uited States Ceters for Disease Cotrol ad Prevetio (CDC), academic research cetres, ad the Pa America Health Orgaizatio (PAHO). PubMed was searched first; subsequet search strategies were derived from PubMed outcomes ad modified for each database. The iitial search iformed the subsequet search of the grey literature, which icluded websites of parter orgaizatios ad published stadards. A parallel search was coducted i PubMed usig additioally idetified terms ad sytax to idetify uique refereces i order to esure all relevat articles were icluded. Five hudred ad sixty five refereces were idetified. After applyig the iclusio criteria, o additioal studies were icluded i the fial review. The full search strategy ca be foud i Sectio 8.2. The referece lists of reviews or articles foud durig the search, or which were kow to the authors, were also searched (a techique ofte called sowballig). Durig the search ad study selectio process, four ivestigators idepedetly screeed ad selected studies for possible iclusio. First, titles ad abstracts of studies, stadards, ad reports idetified were idepedetly reviewed ad pooled for further screeig. Secod, each reviewer examied the abstracts of the studies, stadards, ad reports idetified i the title ad abstract screeig process. Each reviewer compiled a list of studies, stadards, ad reports that met the iclusio criteria. A secod ivestigator the compared each list; disagreemets were resolved by discussio ad cosesus o studies icluded ad excluded. Fial studies, stadards, ad reports selected were the stratified by category. Some of the fial studies, stadards, ad reports selected were eligible for more tha oe category, but data extractio ad quality assessmets were performed oly oce. 3.4 Data extractio & maagemet After coductig the search, results were exported to a idepedet database. All the refereces were merged, ad duplicates were idetified ad removed. Refereces were maaged usig EdNote. The four ivestigators idepedetly extracted data usig a stadardised data collectio istrumet developed o Google Drive usig Microsoft Excel. The followig elemets were collected: Settig (coutry ad year) Aim/objective Study desig Evaluatio method Type of hazard, risk, emergecy, or evet Size of populatio served/studied 9
World Health Orgaizatio Qualities, compoets, jurisdictio, ad fuctioal capacity of cetre Stadards, requiremets, or guidelies icluded or oted Adverse evets, challeges, or barriers Outcomes, lessos leared, after actio report coclusios, best practices Recommedatios Limitatios (study & outcome level) Bias Geeralisability. Assessmet of the qualities, compoets, jurisdictio, ad fuctioal capacity of the EOC icluded iformatio about whether a EOC was public or private; temporary or permaet; operatioal ad at a city, state, atioal, regioal, or local level. It also icluded the fudig source; the chai of commad ad/or level of oversight; staff size; ad the types of public health emergecies to which the EOC was able to respod. Additioal iformatio, where relevat, was extracted i order to iclude ay regioal, atioal, or iteratioal EOC stadards i use or recommeded, as well as their implicatios for practice or policy. 3.5 Quality assessmet The data ad the studies outcomes were evaluated. Because most studies did ot fit the quality assessmet stadards of cliical quatitative research, the Critical Appraisal Skills Programme (CASP) (5) was used to evaluate the research based o the followig criteria: 1. Relevace to review objectives ad review questios 2. Clarity of the research questio 3. Appropriateess of the study desig 4. Samplig 5. Data collectio 6. Potetial for bias 7. Rigour of data aalysis 8. Clarity of results. 10
Systematic review of public health emergecy operatios cetres 4. Results 4.1 Quality assessmet aalysis Studies that were more geeralisable were give a higher quality ratig tha those that were ot geeralisable. Geeralisability i this review meat the ability of a study s fidigs to be applied to other circumstaces, emergecies, evets, ad EOCs. Studies were scored yes or o for geeralisability, or, whe certai quality assessmet measures were ot applicable, a ot applicable score was assiged. May studies icluded i this review were articles usig either quatitative or qualitative research methods. Rather, they were case studies, peer-reviewed versios of after actio reports, retrospectives of emergecy respose situatios, or govermetal reports. For example, documets that retrospectively examied a EOC s respose durig a particular emergecy ad described the challeges ad lessos leared did ot cotai data collectio or aalysis, ad therefore could ot be evaluated accordig to these measures. I istaces like these, the documet was give a ot applicable score for data collectio ad aalysis methods. Each article was evaluated o the basis of relevace, appropriateess of study desig, aalysis methods, clarity of results, ad geeralisability whe applicable. A COUNTIF formula i Excel was used to calculate the umber of yes, o, ad ot applicable resposes i each criterio, ad their correspodig percetages (Table 1). Based o these results, oly the criteria for which less tha 50% of resposes were ot applicable were kept: clarity of research questios, appropriate methodology, clarity of fidigs, ad geeralisability. The data aalysis criterio was also kept, as this is a importat marker for those studies that icluded data aalysis. Table 1. Quality assessmet process results of studies yielded from the systematic review of public health emergecy operatios cetres, Jauary 1993 October 2013 Quality assessmet respose Criterio Yes (%) No (%) Not applicable (%) Total Clarity of research questio 209 (72) 22 (8) 60 (21) 291 Geeralisability 202 (69) 37 (13) 52 (18) 291 Clarity of fidigs 185 (64) 21 (7) 84 (29) 291 Appropriate methodology 136 (47) 15 (5) 140 (48) 291 Appropriate research desig 109 (37) 17 (6) 165 (57) 291 Data collectio 89 (31) 18 (6) 184 (63) 291 Data aalysis 65 (22) 29 (10) 197 (68) 291 Appropriate samplig 58 (20) 11 (4) 222 (76) 291 Researcher bias 27 (9) 34 (12) 230 (79) 291 11
World Health Orgaizatio Because a sum of the yes resposes ad a traditioal summary of fidigs table would ot accurately portray study quality ad would iappropriately weight the ot applicable resposes, a quality ratio was calculated for each study, ad a overall mea quality ratio was derived. Quality assessmet resposes for the five criteria (clarity of research questios, appropriate methodology, clarity of fidigs, ad geeralisability) were coded. Yes resposes were coded 1, o resposes were coded 0, ad ot applicable resposes were ot coded. These scores were summed to produce umerators for each study; ot applicable resposes were ot icluded i this umerator, as they were ot give a umerical score. To calculate the deomiator, the yes ad o resposes were summed. Not applicable resposes were excluded from the deomiators so they would ot artificially weight the ratio scores. The umerator (the sum of all coded yes ad o resposes) was divided by the deomiator (the total umber of applicable criteria, maximum 5) to produce ratio scores for each study. A score of 0 would idicate that a study had all o resposes for the applicable quality assessmet criteria ad was of low quality. Likewise, a score of 1 would idicate that a study had all yes resposes for the applicable criteria ad was of high quality. Ratio scores for the 291 icluded studies raged from 0 to 1, with a mea of 0.87. This mea idicates that, i the cotext of a possible perfect ratio of 1, the overall quality of the icluded studies was very high. 4.2 Characteristics of idetified studies A total of 291 studies were icluded i the review (Table 2). 202 (69%) were from the peer-reviewed literature ad 89 (31%) were from the grey literature. Some studies were characterised ito more tha oe review category, jurisdictio, or type of evet durig the data extractio process. The most frequetly reviewed categories were geeral (157); procedures ad plas (124); ad operatioal iformatio miimum data sets ad stadards (116). The atioal level was the most commo jurisdictio (123), although may studies did ot specify a jurisdictioal level (72). May articles (162) were about geeral emergecy respose. Of those specifyig a type of hazard, most dealt with disease outbreaks (43) ad disasters/crises (29). Not all icluded studies are refereced specifically i this report, but all may be foud i the list of additioal studies, stadards, ad other materials i Sectio 8.3. 4.3 Idetified stadards Stadards exist at local, atioal, ad iteratioal levels to provide cosistecy i the buildig, maiteace, ad use of EOCs. Servig as guides or requiremets, stadards are created by bodies icludig the America Society for Testig ad Materials (ASTM) Iteratioal; the America Natioal Stadards Istitute (ANSI); the British Stadards Istitutio (BSI); the Caadia Stadards Associatio (CSA); the IterAgecy Board; the Istitute of Electrical ad Electroics Egieers (IEEE); the Iteratioal Orgaizatio for Stadardisatio (ISO); the Natioal Fire Protectio Associatio (NFPA); ad the Orgaizatio for the Advacemet of Structured Iformatio Stadards (OASIS) (Table 3). 12
Systematic review of public health emergecy operatios cetres Table 2. Characteristics of the studies yielded from the systematic literature review of public health emergecy operatios cetres, Jauary 1993 October 2013 Type of study Peer-reviewed Grey Total (=202) (=89) (=291) Review category Geeral 109 48 157 Procedures ad plas 79 45 124 Operatioal iformatio miimum data sets ad stadards Commuicatio techology ad ifrastructure 56 60 116 72 10 82 Traiig ad exercise 40 18 58 Jurisdictio Natioal 84 39 123 Type of hazard, risk, or evet Regioal 63 19 82 Local 61 18 79 Iteratioal 21 32 53 Field 14 6 20 Not Specified 44 28 72 Other 4 0 4 Geeral 99 63 162 Disease outbreak 34 9 43 Disaster/Crisis 28 1 29 Bioweapo/Bioterrorism 12 0 12 Radiouclear evet 11 1 12 Mass gatherig 6 1 7 Chemical icidet 4 0 4 Foodbore disease outbreak 1 3 4 Not applicable 5 26 31 Other 2 2 4 Stadards help establish global criteria for emergecy respose facilities ad equipmet; busiess cotiuity programmes; data exchage; commuicatio systems; icidet maagemet systems; risk maagemet; assessmet exercises; ad resposes to specific types of emergecies [6-12] (Table 3). Large govermetal bodies resposible for emergecy operatios, such as the Europea Cetre for Disease Prevetio ad Cotrol (ECDC) or the Uited States Federal Emergecy Maagemet Agecy (FEMA), recommed stadards developed by other orgaizatios, such as ASTM or CSA. Alog with stadards, govermets ad orgaizatios rely heavily o guidelies ad best practices to iform their work (Table 4). This review lists stadards i Table 3 ad guidelies ad best practices i Table 4. Recommedatios ad lessos leared from the peer-reviewed literature are refereced throughout the text but excluded from the table of stadards. 13
Table 3. Stadards applicable to the buildig, maiteace, ad use of EOCs Geeral Commuicatio techology ad ifrastructure Procedures ad plas Operatioal iformatio miimum data sets ad stadards Traiig ad exercise Issuig body Stadard ASTM ANSI BSI CSA IEEE E2601-08 Stadard Practice for Radiological Emergecy Respose E2668-10 Stadard Guide for Emergecy Operatios Ceter (EOC) Developmet E2770-10 Stadard Guide for Operatioal Guidelies for Iitial Respose to a Suspected Biothreat Aget INCITS 398-2008 Iformatio techology - Commo Biometric Exchage Formats Framework (CBEFF) PAS 200:2011 Crisis maagemet. Guidace ad good practice Z1600-08 - Emergecy Maagemet ad Busiess Cotiuity Programs 1512 - Family of Stadards for Icidet Maagemet Message Sets x x x x x x x x x x x x x x x x x ISO 11064-7:2006, Ergoomic desig of cotrol cetres Part 7: Priciples for the evaluatio of cotrol cetres 22324, Societal security Emergecy maagemet Colour-coded alert 22322, Societal security Emergecy maagemet Public warig 22320:2011, Societal security Emergecy maagemet Requiremets for icidet respose NFPA 22398, Societal security Guidelies for exercises ad testig PAS 22399:2007, Societal security Guidelies for icidet preparedess ad operatioal cotiuity maagemet 11320:2011, Nuclear critical safety Emergecy preparedess ad respose 31000:2009, Risk maagemet Priciples ad guidelies, for the developmet of emergecy preparedess plas ad processes IEC 24762:2008 Iformatio techology Security techiques Guidelies for iformatio ad commuicatios techology disaster recovery services IEC 27031:2011 Iformatio techology Security techiques Guidelies for iformatio ad commuicatios techology readiess for busiess cotiuity 1600 Stadard o Disaster/Emergecy Maagemet ad Busiess Cotiuity Programs 2013 Editio 1561 Stadard o Emergecy Services Icidet Maagemet System 2008 Editio 1221 Stadard for Istallatio, Maiteace, ad Use of Emergecy Services Commuicatios Systems x x x x x x x x x x x x x x x x x x x x x x x x x x x x x OASIS Commo Alertig Protocol Versio 1.2 x Emergecy Data Exchage Laguage (EDXL) Distributio Elemet, v1.0 x 14
Table 4. Grey literature best practices applicable to the buildig, maiteace, ad use of EOCs. Issuig body Guidace documet Key compoets Australia Emergecy Maagemet Istitute Australia Emergecy Maagemet Hadbook Series: Maagig Exercises, Hadbook 3 Desig idividual ad orgaizatioal traiig from a evidece base ad iclude thorough assessmet ad evaluatio Esure traiig is meetig objectives ad that idividuals ad orgaizatios are properly prepared for emergecy respose Califoria Goveror s Office of Emergecy Services SEMS Approved Course of Istructio Specify a protocol for whe to activate the EOC Use ICS as the stadard all hazards respose system Five primary fuctios of ICS: commad, operatios, plaig/itelligece, logistics, ad fiace/admiistratio; oly the SEMS Field level uses commad, all other levels use the term maagemet Use uit of commad to form authority relatioships Stadardized list of titles ad roles of EOC fuctios Columbia Uiversity School of Nursig Ceter for Health Policy, Uited States Ceters for Disease Cotrol ad Prevetio, ad Associatio of Teachers of Prevetive Medicie Bioterrorism ad Emergecy Readiess: Competecies for All Public Health Workers Trai idividuals to do the followig: recogize threats ad abormal coditios; access ad use commuicatio systems; coduct emergecy operatios plaig; implemet specific resources, tools, ad procedures; rapid assessmet ad surveillace; ad have a basic familiarity with icidet maagemet systems ad similar structures Coucil of Australia Govermets. Workig Group o Australia Iflueza Pademic Prevetio ad Preparedess Natioal Actio Pla for Huma Iflueza Pademic Commowealth, State, Territory ad local govermets must work together Provide busiesses ad the commuity with accurate ad timely iformatio All govermet levels support busiess cotiuity plaig Use the phases of pademic developmet to describe the global situatio Trigger poit defied for activatio of a coordiated respose (both iside ad outside Australia) Emergecy Maagemet Australia Australia Emergecy Maual Series: Multi-Agecy Icidet Maagemet Model the EOC o a ICS Esure that staff are i place i all EOC fuctios, icludig leadership ad maagemet, operatios, iformatio maagemet, logistics, media, safety ad security, admiistratio, techology support, ad liaiso positios Defie roles ad resposibilities for Icidet Maagemet Esure sufficiet ad accurate iformatio is used for decisio-makig Guide for multi-agecy respose to facilitate atioal iteroperability Operatios Cetre Maagemet Provide professioal staff with a clear set of resposibilities ad expectatios based o their disciplies Esure that staff are i place i all EOC fuctios, icludig leadership ad maagemet, operatios, iformatio maagemet, logistics, media, safety ad security, admiistratio, techology support, ad liaiso positios Use stadard compoets recommeded for the EOC Use stadard operatig procedures ad checklists for idividual staff resposibilities to idicate who should complete a task, ad whe ad how it should be doe EOC staff, other agecies, commuity members, ad situatio reports about the emergecy or evet are all sources of iformatio durig EOC activatio Collect ad iterpret iformatio o a ogoig basis throughout EOC activatio Allocate resources, activate services ad respose activities, seek outside assistace, ad commuicate as eeded oce iformatio about the emergecy has bee processed appropriately 15