2010 Summary Report. Annual Test of the 24/7 Response System in Local Health Jurisdictions of Washington State. March /10/10
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1 2010 Summary Report Annual Test of the 24/7 Response System in Local Health Jurisdictions of Washington State March 2010 Office of Epidemiology, Health Statistics and Public Health Laboratories
2 Introduction The annual test of the 24/7 response system is conducted to assess the time required to reach a knowledgeable public health professional capable of assessing an event of urgent public health consequence and initiating an appropriate response in each of Washington State s 35 local health jurisdictions. The contact time benchmark is 15 minutes or less. The test is derived from the Centers for Disease Control and Prevention s (CDC) Public Health Emergency Preparedness funding opportunity announcement (2005) 1, CDC s 8-City Enhanced Terrorism Surveillance Project 2, and the Standards for Public Health in Washington Standard 2.2L (Communication to the Public and Key Stakeholders; Local Health Jurisdiction Measures) 3. Methods This test of the 24/7 emergency response system was carried out during March Test calls were made by a representative from the Washington State Department of Health (WA-DOH) to the 24 hour emergency telephone numbers identified by Washington State s local health jurisdictions as of February 9, Test calls were placed on weekdays after business hours between 6:30 and 8:30 PM. The WA-DOH caller used the following scripted scenario for each test call: This is the Washington State Department of Health. This is a drill. I need to speak with someone from your local health jurisdiction/department who can answer a question about a communicable disease situation involving botulism. This is a drill. I need someone to call back within 15 minutes. The time required to reach a knowledgeable public health official, as well as other details and anomalies associated with the calls, was recorded. Each of Washington State s 35 LHJs participated in the drill, including the three counties comprising the Northeast Tri-County Health Jurisdiction (at their request), for a total of 37 jurisdictions contacted. Results During the initial call, 92 percent (34 out of 37) of calls were returned within 15 minutes (Table 1). The three counties unable to be reached were contacted the next day to verify 24/7 emergency phone number information and make corrections. All three counties responded within 15 minutes to a follow-up call after implementing corrections to their 24/7 emergency response systems. 2
3 Table 1. Test of the 24/7 emergency contact number, call-back times, and answering method Local Health Call Back Time Answering Method Emergency Phone Jurisdiction (minutes) Number Called Adams 4 Sheriff s Office (509) Asotin 0 Immediately answered (509) Benton-Franklin 8 Answering Service (509) Chelan-Douglas 6 Answering Service (509) Clallam 12 Pager (360) Clark 3 Answering Service (888) Columbia 6 Sheriff s Office (509) Cowlitz 4 Answering Service (360) Garfield 6 Sheriff s Office (509) Grant 0 Immediately answered (509) Grays Harbor 0 Immediately answered (360) Island 5 Sheriff s Office (360) Jefferson 12 Pager (360) King 0 Immediately answered (206) Kitsap 12 Pager (360) Kittitas 7 Answering Service (800) Klickitat 0 Immediately answered (509) Lewis 9 Sheriff s Office (360) Lincoln 4 Sheriff s Office (509) Mason 1 7 Sheriff s Office (360) Ferry* 12 Sheriff s Office (509) Pend Oreille* 12 Sheriff s Office (509) Stevens* 2 Sheriff s Office (509) Okanogan 13 Sheriff s Office (509) Pacific 4 Sheriff s Office (360) Pierce 6 Answering Service (800) San Juan 2 0 Immediately answered (360) Skagit 6 Sheriff s Office (360) Skamania 6 Crisis Line (509) Snohomish 8 Answering Service (425) Spokane 3 Answering Service (509) Thurston 10 Voic (360) Wahkiakum 4 Answering Service (360) Walla Walla 3 11 Answering Service (509) Whatcom 6 Answering Service (360) Whitman 6 Sheriff s Office (509) Yakima 2 Answering Service (509) *Emergency phone numbers were provided to DOH to test the three counties comprising the NE-Tri Health District. 1 The initial call was unsuccessful because the Sheriff s Office thought the tester was phishing for confidential information and claimed they did not have any contact information for the LHJ. 2 The initial call was not answered because the cell phone was out of reception range. 3 The initial call was sent to a pre-recorded message, which did not have instructions for LHJ after hours contact. 3
4 Discussion The foundation for recognizing public health emergencies and early disease detection is establishing and maintaining a 24/7/365 disease reporting mechanism. The CDC recommends telephone calls as the preferred method for public health agencies to receive urgent case reports. One of the more efficient ways to validate if reporting systems are properly functioning is to test them. This year, 100 percent of the tests conducted after business hours succeeded in responding via phone within 15 minutes of the scripted public health emergency drill after corrections had been made. Thirty-four of 37 (92%) participating jurisdictions responded within the 15 minute benchmark during the initial call while the remaining three jurisdictions responded within the established timeframe during the second call. Although the goal of 100 percent participation in the tests was met, this year s tests revealed a few deficiencies that should be evaluated by all local health jurisdictions. Test results and other response indicators should be reviewed in order to improve readiness to manage real incidents. Special attention should be paid to the few reasons calls were not successful including having area wide cell service, Sheriff s office personnel being familiar with public health emergency procedures and location of numbers, and voice messaging systems with updated and accurate information. In future reports, on-call WA-DOH epidemiologists unsuccessful attempts to reach LHJs after hours will be recorded and reported in the annual summary report. The local health departments employed a number of methods to be reachable 24/7/365 (Table 1). The most common method (38%) of being reached was using the Sheriff s Office (Dispatch, 911, Communications) followed by an answering service (32%). The mean time between when a test call was placed to when a call was received back from a knowledgeable public health person for all answering methods was 5.8 minutes. The Washington State Department of Health maintains local and tribal contact information, including 24/7 emergency contact numbers at LHJ emergency after-hours (24/7) contact information updates should be directed to tiffany.escott@doh.wa.gov. 4
5 References 1. Centers for Disease Control and Prevention. Fed Reg 70(101), (May 26, 2005). Available at Accessed on April 12, Centers for Disease Control and Prevention, National Center for Public Health Informatics, Performance Criteria for Public Health Disease Reporting Systems Operating Twenty-four Hours per Day, Seven Days per Week. Available at Accessed on April 1, Washington State Department of Health. Standards for Public Health in Washington: A Collaborative Effort by State and Local Health Officials. January Available at Accessed on April 1, Washington State Department of Health. Local Health Jurisdiction (LHJ) Contact Numbers At-A- Glance, Updated February 9, Available at Accessed on May 26, For additional information, please contact the Washington State Department of Health, Communicable Disease Epidemiology Section at (206) This report was prepared by Tracy Powell, MPH, Epidemiologist, Washington State Department of Health 5
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