Health-Focused Hazard and Vulnerability Assessment Report for the State of New Jersey 2012

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1 Health-Focused Hazard and Vulnerability Assessment Report for the State of New Jersey 2012 Prepared by: Lawrence L. Heidenberg, MPH Carl P. Michaels, MA New Jersey Department of Health Public Health Infrastructure, Laboratories and Emergency Preparedness Division Christopher Rinn, Assistant Commissioner

2 Table of Contents List of Figures.iii List of Tables.....iii Executive Summary...iv Foreword Introduction....1 Background Objectives and Overview of the Hazards and Vulnerability Assessment 1 Methods Development of Drexel Tools For the Public Health Assessment....3 Description of Methods Used Assessing the Needs of At- Populations At Population Determining Priority Planning.. 8 Selection of Hazards for Public Health Assessment Results....9 Aggregate Findings for the State of New Jersey..9 Discussion 11 Mitigation...11 Conclusions and Recommendations Appendix A. New Jersey Health-Focused Hazard and Vulnerability Assessment Data Collection Tool. A-1 Appendix B. Individual County Breakdown of Priority Planning s. B-1 ii

3 List of Figures Figure 1: Breakdown of Analysis to Create the HVA...6 Figure 2: s (Probability vs. Severity) for Selected Hazards Weighted Averages for State of New Jersey List of Tables Table 1: Hazards in Order of Planning Weighted Averages for the State of New Jersey 10 Table 2: Commonalities Between Hazards 12 Table 3: New Jersey Initiatives to Improve Preparedness. 13 iii

4 Executive Summary In 2011, the Centers for Disease Control and Prevention (CDC) selected 10 Metropolitan Statistical Areas (MSA) throughout the United States to participate in a Based Funding Hazard and Vulnerability Assessment (HVA) focusing upon health related effects. New Jersey falls within two separate MSAs, with only 5 counties out of 21 that are not part of either MSA. New Jersey determined that it was critical that a Statewide HVA be created that captured information about all 21 counties to determine the risks, hazards, vulnerabilities, and preparedness efforts existing and/or necessary to protect the citizens of and visitors to the State. Working collaboratively with the New Jersey State Office of Emergency Management, the New Jersey Office of Homeland Security and Preparedness, and county level experts in the fields of emergency management, health, healthcare, special/functional needs, and mental health, the New Jersey Department of Health (NJDOH) adapted a tool created by Drexel University s Center for Public Health Readiness & Communication and collected relevant data and subject matter expert opinions. This information was transformed into New Jersey s first health-focused HVA. The HVA tool concentrated on 8 separate hazards: Power Failure, Foodborne Infectious Disease Outbreak, Extreme Weather Emergencies (excluding flooding), Pandemic, Hazardous Materials Incidents with Evacuation, Flooding, Nuclear Power Generating Facility Incidents with Off-site Radiation Release, and Terrorism (Chemical, Biological, Radiological, Nuclear, Explosive [CBRNE]). These hazards were selected based upon existing State and County HVAs along with the recommendation of HVA experts. Based upon the evidence from the HVA tool, the hazards requiring the greatest attention in the State of New Jersey are Pandemic and Terrorism, as the other hazards had a lower predicted impact. However, it is important to note that this analysis was completed in the Spring of Since then, the State has suffered the effects of two major weather events that could not have been realistically predicted nor taken into account during the data collection process. The results of the HVA are not inaccurate; they provide the best information available at the time of the assessment. Additionally, due to variations between counties, any given county s specific hazards and vulnerabilities may reflect different priorities than their neighbors or the State overall. To improve the preparedness efforts of the State, NJDOH has invested in projects involving advance registration for vaccine administration, alternate care sites, long term care facilities emergency preparedness efforts, mass evacuation efforts, mass gathering preparedness and response, medical needs sheltering, and pandemic planning. These project touch upon all 15 capabilities, as defined by the CDC, and all assist in advancing preparedness for anticipated hazards in the State. As the preparedness efforts of the State move the dial forward, reflecting improved capabilities to handle emergencies, hazards also continually evolve and change. Therefore, it is critical to ensure that the HVA be treated as a dynamic document subject to reexamination and periodic revision. It is recommended that after major events and/or every five (5) years, this assessment should be updated to reflect current conditions and to ensure that it continues to provide up to date, accurate guidance. iv

5 Foreword It has been said that once is happenstance, twice is a coincidence, and three times is a pattern. The Hazard and Vulnerability Assessment (HVA) for the State of New Jersey was compiled and written during the first half of At that time, significant weather events that directly impacted the health of residents occurred less than every ten years and rarely had large-scale impact. The most recent major weather event prior to the compilation of this tool and report was Hurricane Irene in August Events have shown, however, that while weather incidents appeared to be in the category of happenstance at the time of this report, it now has quickly moved to the status of a pattern for New Jersey. In a period of only 14 months, New Jersey was struck with Hurricane Irene, the Derecho storm of June 2012, and then Superstorm Sandy in October These storms affected significant sections of the population of New Jersey in ways never seen before. This HVA tool is still valuable and this report represents a good assessment of the State of New Jersey s hazards and vulnerabilities and it is useful to identify and justify focal areas for improvement. However, as patterns continue to emerge, it is incumbent upon the State to reevaluate and reprioritize based upon experience over time. The recent events of the Derecho and Superstorm Sandy call into question the validity of the original assessments done concerning Severe Weather, Flooding, and Power Outages that were used, based upon historical data. As such, we recommend that this tool be used to reassess the state of the State in 2014 and every five years thereafter. Introduction Background In March 2011, the Centers for Disease Control and Prevention (CDC) released a new health preparedness guidance for state and local health departments entitled Public Health Preparedness Capabilities: National Standards for State and Local Planning (CDC 2011). The first capability outlined in the document, Community Preparedness, directs health agencies to identify the potential hazards, vulnerabilities, and risks in the community that relate to the health, medical, and mental/behavioral health systems. Agencies are directed to describe the impact of those risks on human health and on health, medical and mental/behavioral health services, and infrastructure. New Jersey is part of two separate Metropolitan Statistical Areas (MSA): New York City (NYC), and Philadelphia. Of the 21 counties in New Jersey, only 5 are not part of either MSA. The State of New Jersey was awarded funding by the CDC to conduct a Hazard and Vulnerability Assessment for the counties within the MSAs, but a decision was made to ensure that the HVA was conducted for the entire State of New Jersey. Both the NYC and Philadelphia MSAs created tools to assist in the creation of the HVA. After reviewing both tools, New Jersey elected to modify and use the Public Health Assessment Tool (PHRAT) created for the Philadelphia MSA by Drexel University s Center for Public Health Readiness & Communication. Objectives and Overview of the Hazard and Vulnerability Assessment The HVA had several objectives: Identify the major hazards that pose the greatest risks to the State of New Jersey with a special focus on health related consequences. Identify the hazards that may adversely impact at-risk populations in New Jersey. 1

6 Identify the preparedness capabilities that require additional effort or resources to achieve. Prioritize preparedness planning for mitigation and response throughout the State, based on hazard assessments and the current state of health emergency preparedness capabilities most relevant to priority hazards. Provide the individual counties within New Jersey with their own specific HVA results to assist them in their individual planning efforts. Emergency preparedness planning in communities is generally focused on assessments of hazards and vulnerabilities at the local and/or state level. The HVA is a fundamental starting point for all focused planning; it relies on assessments of the most likely hazards or threats that might occur in a given jurisdiction as well as the severity of their consequences or impacts. Emergency management agencies in states and counties conduct these analyses on a regular basis, as do health systems and other private sector entities that engage in preparedness planning for disasters. Few tools exist to assist in the identification of hazards that have significant health impacts and that require coordinated health response efforts. In New Jersey, we are defining the term health to include health, medical health, mental health, and all associated and affiliated sectors that directly impact individual and/or community health. The purpose of this tool is to provide planners with the information they need in order to make informed decisions about the greatest threats to their areas and to assist in the setting of local preparedness planning agendas. 2

7 Methods Many existing HVAs and risk assessment tools assess the probability and severity of disasters. The PHRAT by Drexel assesses risks that are posed by hazards in this way, but it also includes a more nuanced assessment of disaster impacts from an all-encompassing health perspective, which takes into account the physical and mental health consequences, short- and long-term impacts, community vulnerabilities, and health agency work. The Drexel PHRAT produces an estimate of risk that is based on the probability and impact severity of a hazard. It also provides an indication of adjusted risk, which takes into consideration additional planning required to address the needs of selected at-risk populations. Ultimately, the tool generates a Planning Priority. This is the final product that planners can use to determine the hazards in which they should focus their preparedness efforts. The Planning Priority is based on a combination of sub-scores that measure: the severity of its impacts, any additional planning requirements necessary to accommodate at-risk populations, and a jurisdiction s current level of preparedness for that hazard. In New Jersey, it was felt that the Drexel PHRAT was correct in its objectives and overall approach, but lacked the direct applicability to the identified at-risk populations. The PHRAT focused upon the need for specific, individualized plans that catered to the at-risk populations. Yet, due to the numerous hazardous conditions that are associated with being the most densely populated State in the Union, combined with the specific hazards that are unique to New Jersey, many of these special plans are already considered within the emergency plans throughout the State. Instead, New Jersey believes that certain at-risk populations may be disproportionately affected by certain hazards compared to the general. To that end, New Jersey modified the at-risk population assessment section by grading the d risk to each identified special population. Data from the U.S. Census (2010 edition) was used to account for the percentage of specific at-risk populations as part of the overall population. This information was then used to proportionally adjust the computations. Additionally, due to the potential supply versus demand changes that certain hazards may impose, emergency department and hospital beds were broken into separate demand and supply questions, rather than utilizing the combined question as in the PHRAT. Development of Drexel s Tool for the Public Health Assessment Existing HVAs and Assessment Tools Several tools contributed to the development of the Drexel PHRAT. The Hazard Assessment Instrument (HRAI) created by UCLA s Center for Public Health and Disasters (UCLA, 2006) provided the major framework for this tool. The UCLA HRAI defines risk as the expectation of loss (UCLA, 2006). The UCLA risk assessment relies upon a determination of the propensity of things to be damaged (vulnerability) and an assessment of the community resources that will diminish impact, or: = Hazard (Vulnerability Resources) In this equation, Hazard refers to the likelihood of a hazard occurring. The UCLA HRAI assesses vulnerability and resources by measuring baseline community conditions and resources and comparing those baseline levels to the conditions expected in the event of a disaster. This equation can also be expressed as: = Probability Severity The Drexel PHRAT also factors additional planning requirements for at-risk populations into its calculation of risk to produce an adjusted risk for each hazard. 3

8 The Medical Center Vulnerability Analysis developed by Kaiser Permanente (Kaiser Foundation Health Plan, 2001) also informed the development of the Drexel PHRAT. The concept that preparedness impacts risk is important and was integrated into the development of the PHRAT. A similar approach to incorporating preparedness capacity was found in the New York City Department of Health and Mental Hygiene s Regional Catastrophic Planning Team s Worksheet Instructions for the Public Heath Jurisdictional Assessment Tool, Beta Version (Regional Catastrophic Planning Team, 2011). The New York City risk assessment tool integrated the quantitative assessment of risk used in the UCLA HRAI with the Kaiser concept of incorporating preparedness into a risk assessment. The New York City tool used the CDC s Public Health Emergency Preparedness (PHEP) capabilities to assess preparedness capacity, with the PHEP capabilities adapted to calculate a Preparedness for each hazard. The NYC tool assumes that preparedness mitigates risk in a predictable way: a Preparedness of five (the maximum) reduces risk by 50%, and a four reduces risk by 40%, etc. Rather than presuming that a specific degree of preparedness reduces risk in predictable and measurable ways, the Drexel PHRAT generates a Planning Priority. This score is a ratio of adjusted risk (risk that has been adjusted to reflect the planning requirements for at-risk populations) and preparedness for specific hazards. Community Sector Involvement and Outreach to Stakeholders New Jersey recognized early on that many government and non-government sectors and authorities would need to participate in the efforts to create a meaningful HVA. Prior to the PHRAT being developed by Drexel, the New Jersey Department of Health and Senior Services (reorganized as the New Jersey Department of Health on July 1, 2012) partnered with the New Jersey Office of Emergency Management and with the New Jersey Office of Homeland Security and Preparedness to engage county and local partners with expertise in emergency management and the at-risk populations. Additionally, the New Jersey Department of Human Services was contacted for input from the mental health sector, which is outside the jurisdiction of the Department of Health. NJDOH, in collaboration with our partner agencies, collected data that included existing County HVAs, hospital/healthcare system HVAs, mortality and morbidity data, disability demographics per county, and other available historical hazard-specific data. As the New Jersey regulatory climate and control differs from that encountered in both New York and Pennsylvania, certain data, such as Emergency Medical Services (EMS) runs, could not be reliably captured. To compensate for the lack of some objective data, subject matter experts were involved in all phases of data collection and analysis. Whenever possible, historical data surrounding relevant occurrences in New Jersey were collected and made available. Data was collected with a 100 year timeframe in mind. This information was combined by NJDOH staff and it was determined that this project would focus on eight (8) broad-based, potentially high impact, hazards. These were: 1. Power Failure 2. Foodborne Infectious Disease Outbreak 3. Extreme Weather Emergencies (including winter/summer storms, thunderstorms, hurricanes, tropical storms, droughts, but not flooding) 4. Pandemic 5. Hazardous Materials Incidents 6. Flooding 7. Nuclear Power Generating Facilities Incidents 8. Terrorism (Chemical, Biological, Radiological, Nuclear, Explosive [CBRNE]) Incidents 4

9 NJDOH hosted two regional workshops (April 17 th for the North and April 23 rd for the South) to discuss and examine hazards specific to these regions. At these meetings, the 8 hazards identified for focus in New Jersey were analyzed by representatives from each county including, but not limited to, Emergency Management, Public Health, Medical Health, Mental Health, and Special/Functional Needs experts. At these meetings, all 8 hazards were individually examined in light of each county s own vulnerabilities, demographics, and other available data, and the county then individually scored each hazard. Special guidance from subject matter experts was provided for consequence assessment and management dealing with nuclear generating station incidents with off-site radiation release. A sample of the New Jersey Data Collection Tool for Hazards can be found in Appendix A. The methodology used to analyze that data was to break the data collected into four functional sections. These sections included Human Impact, Healthcare Service Impact, Community Impact, and Public Health Service Impact. Additionally, the at-risk population information was factored into the final scores for each hazard. 5

10 Figure 1. Breakdown of Analysis to Create the HVA. Public Health Capabilities Assessment s As required by the CDC, the Local Information Network and Communications System (LINCS) Agencies in New Jersey annually conduct a self-assessment for each of the CDC s 15 Public Health Emergency Preparedness (PHEP) capabilities. These scores were submitted in advance to NJDOH for inclusion in this analysis. Preparedness, it is felt, can help to mitigate some of the risk while improving the response; however, preparedness does not always directly correlate to reduction of risk. Therefore, the capabilities assessment scores were used to adjust, but not remove, risk for hazards. For example, a novel virus pandemic cannot be removed through preparedness; instead, by being prepared, the epidemic s effects can be managed more efficiently. New Jersey replicated the Drexel PHRAT basic methodology, which included assigning relevancy scores to the PHEP capabilities for each hazard. While New Jersey used different metrics for the method of assessing at-risk population adjustments, the basic methodology remained the same. 6

11 Description of Measures Used Probability The probability of each hazard is assigned a score between zero and four, based on the following scoring scale. The system lifecycle used is 100 years. Severity 0 = Improbable The probability of the occurrence of the hazard is zero 1 = Remote The hazard is not likely to occur in the system lifecycle, but it is possible 2 = Occasional The hazard is likely to occur at least once in the system lifecycle 3 = Probable The hazard is likely to occur several times in the system lifecycle 4 = Frequent The hazard is likely to occur cyclically or annually in the system lifecycle The Severity is calculated by assessing the impact that a hazard incident would have on the jurisdiction in four different domains: Human (Health) Impact, Healthcare Service Impact, Community Impact, and Public Health Service Impact. A hazard s impact in each of these domains generates a score, which is derived from an assessment of specific metrics in each domain. A few examples of the metrics include: mortality and EMS transports (Human Impact), Emergency Department (ED) services and hospital beds (Healthcare Service Impact), utilities and transportation (Community Impact), and surveillance and health communication (Public Health Service Impact). The severity metrics for each of the four domains are based on the system used in the UCLA Hazard Assessment Instrument, but with several key differences. The PHRAT attempts to capture disaster impacts in addition to injuries sustained due to the hazard, such as other medical illnesses and mental health consequences. The PHRAT also assesses the impact of disasters on the services that health agencies provide: surveillance, information and communications, laboratory services, etc. Because many health emergencies produce d demand for services as opposed to an interruption of services, metrics for both the healthcare and health service domains are designed to capture service decrements as well as surge needs. The PHRAT incorporates additional metrics for community impact that have significant health consequences, such as environmental contamination, disruption of sanitation and sewage systems, and interruption of business continuity. Finally, disasters with long-term duration are assigned higher severity scores. An additional point is added to the severity score for incidents with impacts of greater than two weeks duration. The State of New Jersey is a very complex state in which to project norms. New Jersey has the highest population density of any State in the Union. Additionally, there are more miles of roadway per capita than any other State. At the same time, however, many of the counties in New Jersey are extremely rural when compared to the rest of the State. Never the less, hazards exist in all counties. One of the most rural counties in New Jersey holds a full 10% of the top 100 hazardous sites in the State. The counties were given the task to project the outcomes of the worst-case reasonable scenario for each of the 8 identified hazards in their specific county. Whenever possible, data from other, similar disasters was provided to aid in the determinations. Assessing the Needs of At- Populations At- Populations Many at-risk populations are at greater risk for negative sequelae from certain disasters than the general population. While the PHRAT scores at-risk populations based upon additional planning necessary for universal access to preparedness resources in an emergency, New Jersey felt that the d risk was of greater concern than the planning needed for that population. New Jersey has a variety of hazards, 7

12 including, but not limited to, nuclear power generating facilities and hazardous materials sites that require more expansive preparations, which include at-risk planning. Therefore, the planning and preparedness piece was already worked into the considerations. However, without recognizing that certain at-risk groups will be at greater than normal risk, the impact cannot be estimated. Therefore, an At- Population that encompasses both the potential greater risk for these identified groups and their population size was created. The At- Populations is used to adjust the risk score. Thus, disasters with relatively low severity overall may have higher Adjusted scores if the impact on vulnerable populations is high. New Jersey kept with the PHRAT s selection of the nine different populations to represent at-risk groups. However, for the defined chronic disease group, both diabetes rates and asthma rates were examined and the higher of the two were used. While diabetics have a chronic condition that requires appropriate long-term management, asthma has both chronic and acute affects that, especially in the case of some of the CBRNE and pandemic hazards, play a significant part in the group s excess vulnerability to the hazard. The Population Size is assigned based on the size of the population using the following scale: 0 = Population represents 0% of the total population 1 = Population represents more than 0% but less than 5% of the total population 2 = Population represents at least 5% but less than 10% of the total population 3 = Population represents at least 10% but less than 15% of the total population 4 = Population represents at least 15% of the total population Determining Planning Priority The final score or indicator generated for each hazard is the Planning Priority Indicator. This score allows planners to identify hazards that may require additional preparedness efforts on the part of the jurisdiction, especially relative to the degree of risk posed by that hazard. It is defined as the ratio of the Adjusted and the Preparedness for a given hazard. Planning Priority Indicator = Adjusted Preparedness Planning Priority Indicators can be ranked, producing a Planning Priority. 8

13 Severity Results Aggregate Findings for the State of New Jersey Summary The average of the severity and probability for the 8 hazards in the State of New Jersey, weighted based on the population of the counties, is illustrated in Figure 3. The only hazards that have both a high (>2) probability and a high (>2) severity are pandemic and terrorism, with terrorism appearing to be more severe than pandemic. However, when the preparedness and special at-risk populations are factored in, pandemic becomes the more acute problem to be dealt with (see Table 7). Figure 2. s (Probability vs. Severity) for Selected Hazards Weighted Averages for the State of New Jersey MSA Weighted Average Statewide Hazard Probability and Severity Nuclear Facility Terrorism (CBRNE) Pandemic Hazmat Weather (non-flooding) Flooding Power Outages Foodborne Outbreak Probability 9

14 Planning Priority The weighted averages of the Planning Priority Indicators for the State of New Jersey are illustrated in Table 1, listed in order of Planning Priority. Table 1. Hazards in order of Planning Priority Weighted Averages for the State of New Jersey MSA Hazard Statewide Planning Priority s Pandemic Terrorism (CBRNE) Severe Weather (excluding flooding) Flooding Power Outages 8.60 Nuclear Facility Offsite Release 8.43 Hazmat (accidental release involving population evacuation) 8.43 Foodborne Outbreak

15 Discussion New Jersey is a very diverse State. The diversity comes from geography, demographics, population density, and most importantly, the fact that it is a Home Rule State. Home Rule means that power begins at the lowest level of government available, which can result in challenges when a statewide initiative is undertaken. However, when it is important, New Jersey can and has come together to meet the needs of its residents and visitors. When we examine the results for the State overall, it is clear that the threat of pandemics and terrorism need to be foremost in mind. This does not, however, mean that they are of equal importance throughout the individual counties in New Jersey. Nuclear facility incidents have the potential to cause severe harm to the health of the. Fortunately, incidents of this nature are not common. This report intentionally did not equate the impact of the Fukushima disaster to the potential threat to New Jersey. This is due to the differences in preparedness standards, testing, and efforts between the United States and Japan. However, the consequences of Fukushima were considered during all phases of discussion surrounding nuclear facility hazards. The remaining 5 hazards (flooding, weather other than flooding, power outages, hazardous materials release, and foodborne outbreaks) are far more probable to occur in New Jersey; yet, the frequency of such incidents, and the relatively isolated nature of these incidents has led to far greater preparedness and/or resiliency for both the health sector and the community at large. Some counties have clearly demonstrated that other hazards are of equal or higher concern in their specific jurisdictions due to the make-up of the county and/or its preparedness efforts. While the State s priorities must be kept in mind at all levels and attention must be given to improving the county s preparedness and mitigation strategies, this report demonstrates that each county must prioritize its own efforts based upon the evidence presented. It is also incumbent upon the county to meet with the local agencies, responders, and partners within their jurisdiction to craft their own strategies to address their county and jurisdictionspecific evidence based priorities. County-specific numbers and planning priority scores are listed in Appendix B. This report has clear limitations that must be examined. First, this report is not and should not be used as a report card about the various counties or the State overall. Because of the methodology used, this document is strictly utilized to prioritize hazards as they relate to health (as broadly defined as possible) to identify planning areas. Moreover, as both objective and subjective data were used in every jurisdiction throughout the execution of the Assessment Tool, it is neither feasible nor accurate to use the scores of one county to be compared to another. The many factors involved in the individual scores negate the effectiveness of such comparisons. It is not appropriate, however, to assume that these variations negate the overall utility of this report. When considered for an individual county, the results are reflective of their needs and priorities. Moreover, the cumulative nature of the Statewide Planning Priorities will average out the variations to create an accurate norm for the State. Mitigation Funding is typically needed to implement successful mitigation strategies. Yet, funding opportunities are decreasing while competition for funding continues to grow. Therefore, it is critical to garner the maximum possible return on investment as scarce funds are allocated. During the review of the 8 hazards selected by New Jersey, it became apparent that many shared common preparedness capabilities. By investing in those capabilities, it is likely that preparedness for multiple hazards will be improved simultaneously while funding only one project. See Table 2 for commonalities between hazards. See Table 3 for a partial list of New Jersey Initiatives to address these commonalities. 11

16 Table 2. Commonalities Between Hazards Capabilities Hazards Community Preparedness, Community Recovery, Emergency Operations Coordination, Emergency Public Information & Warning, Information Sharing, Medical Materials Management & Distribution, Responder Safety & Health, Volunteer Management Flooding, Foodborne Outbreak, Hazmat, Nuclear Facility Offsite Release, Pandemic, Power Outages, Terrorism (CBRNE), Weather (excluding flooding) Fatality Management, Non-Pharmaceutical Interventions Hazmat, Nuclear Facility Offsite Release, Pandemic, Terrorism (CBRNE) Mass Care Medical Countermeasures Dispensing Flooding, Hazmat, Nuclear Facility Offsite Release, Pandemic, Power Outages, Terrorism (CBRNE), Weather (excluding flooding) Foodborne Outbreak, Hazmat, Nuclear Facility Offsite Release, Pandemic, Terrorism (CBRNE) Medical Surge Hazmat, Nuclear Facility Offsite Release, Pandemic, Terrorism (CBRNE) Public Health Lab Testing, Public Health Surveillance & Epidemiology Foodborne Outbreak, Hazmat, Nuclear Facility Offsite Release, Pandemic, Terrorism (CBRNE) 12

17 Table 3. New Jersey Initiatives to Improve Preparedness Projects Capabilities Advanced Registration System for Vaccine Administration Alternate Care Sites Long Term Care Facilities Emergency Preparedness Initiative Mass Evacuation in NJ Mass Gathering Preparedness and Response Medical Needs Sheltering Pandemic Planning Emergency Ops, Information Sharing, Medical Countermeasures Community Preparedness, Emergency Ops, Information Sharing, Medical Surge, Responder Safety & Health, Volunteer Management Community Preparedness, Community Recovery, Emergency Ops, Mass Care, Medical Surge, Responder Safety & Health Community Preparedness, Community Recovery, Emergency Ops, Mass Care, Medical Surge, Responder Safety & Health, Information Sharing, Public Information & Warning Community Preparedness, Community Recovery, Emergency Ops, Mass Care, Medical Surge, Responder Safety & Health, Information Sharing, Public Information & Warning Community Preparedness, Community Recovery, Emergency Ops, Mass Care, Medical Surge, Responder Safety & Health All 15 Capabilities are affected Funding opportunities, through both governmental funding and grant opportunities, are being shifted to be more evidence driven. This report can be used, in conjunction with other capabilities assessments (PHEP, HPP, JCAHO, THIRA, etc.), to clearly define currently unmet or under-met needs that counties and/or local jurisdictions hope to address through specific project interventions. 13

18 Conclusions and Recommendations New Jersey has produced its first all-encompassing health-focused Hazard and Vulnerability Assessment. This assessment provided for the broadest possible definition of health (including, but not limited to, medical health, health, mental health, and other health-related disciplines). Moreover, the assessment took special care to consider, identify, and address at-risk populations. At-risk populations pose special challenges for planning purposes. The greatest challenge is to provide the ability to care for the at-risk population as fully as the general population, despite their unique needs. By determining which hazards most affect which at-risk populations, the tool allows for the concentration of efforts to achieve this goal. New Jersey is encouraging counties, municipalities, response agencies, healthcare providers, coalitions, non-governmental organizations, and other partners to evaluate both current and proposed projects in light of their county- and/or jurisdiction-specific HVA planning priorities to determine where a single investment can yield the largest return on multiple hazards. Utilizing an evidence-based HVA report and the current PHEP Capabilities Assessments, among other objective measuring tools, these projects may better qualify for governmental and non-governmental grant aid as all funders move toward evidencebased documented needs. As the preparedness efforts of the State move the dial forward, reflecting improved capabilities to handle emergencies, hazards continually evolve and change. Therefore, it is critical to ensure that the HVA be treated as a dynamic document subject to reexamination and periodic revision. It is recommended that after major events and/or every five (5) years, this assessment should be updated to reflect current conditions and to ensure that it continues to provide up to date, accurate guidance. The New Jersey HVA tool (electronic workbook) will also be available to external partners and affiliated state and federal governmental entities upon request. 14

19 Appendix A: New Jersey Health- Focused Hazard and Vulnerability Assessment Data Collection Tool A-1

20 Definitions: NJDOH Hazard and Vulnerability Assessment Tool Extreme Weather Hazards Use the most realistic worst case scenario you can expect in your County Foodborne Infectious Disease Power Failure Hazardous Materials Terrorism (CBRNE) Nuclear Power Facility Incident Flooding Pandemic All potential types of severe weather except for Flooding (including but not limited to hurricane, nor easter, severe thunderstorms, severe winter weather, heat waves, droughts, etc.) Wide-spread, or potential for wide-spread, outbreak stemming from a foodborne infectious disease Wide-spread power failure Release of a hazardous material that requires resident evacuation Any chemical, biological, radiological, nuclear, or explosive incident done as a deliberate event Off-site radiation release from a nuclear power facility that is an unplanned emergent event Any flooding that causes significant impact upon health and/or welfare of the An actual pandemic outbreak that has been declared by CDC and/or WHO Improbable Remote Occasional Probable Frequent Probability Scale Likelihood over 100 year period The probability of the occurrence of the hazard is zero The hazard is not likely to occur over 100 years but it is possible The hazard is likely to occur at least once in 100 years The hazard is likely to occur several times over 100 years The hazard is likely to occur cyclically or annually over 100 years Mortality EMS Transport ED Visits Primary Care Office Visits Trauma Center Injuries Mental Health Impact Human Impact Excess daily deaths over the normal daily death rate for the County Excess daily EMS Transports over normal daily rate for the County Excess daily Emergency Department Visits over normal daily rate for the County Excess daily medical office visits to primary care providers over normal daily rate for the County Excess daily injuries requiring transportation to a trauma center for specialized treatment over normal daily rate for the County Percent of population developing psychopathology and behavioral changes after the incident, including PTSD, depression, anxiety, alcohol and substance abuse, domestic violence, and loss of social functions A-2

21 Outpatient Services Emergency Department Services Beds in Place Emergency Department Beds Demands Hospital Beds Availability Hospital Beds Demand Ancillary Services Trauma Units Mental Health Services Water Supply Sewage/Sanitation System Public Utilities Transportation Business Continuity Population Displacement Environmental Contamination Healthcare Service Impact Loss of primary care provider services due to the incident (business closure, physicians being unavailable due to their own illness, etc.) Will there be fewer emergency department beds in place (whether there is a patient in the bed or not) due to this hazard? Will there be an in demand for emergency department beds above the normal expectations due to this hazard? Will there be fewer hospital beds (excluding the emergency department beds) in place (whether there is a patient in the bed or not) due to this hazard? Will there be an in demand for in-patient hospital beds (excluding the emergency department beds) above the normal expectations due to this hazard? Will there be fewer pharmacies available due to this hazard? Will there be fewer functioning trauma center operating rooms due to this hazard? Will there be fewer mental health care service providers available due to this hazard? Community Impact Will the water supply be disrupted or will a water advisory be issued that will affect at least 25% of the population? Will sewage or sanitation be disrupted for at least 25% of the population? How large a percent of the population will experience loss of electricity due to this hazard? Will major routes or transportation means be closed due to this hazard and if so, for how long? Will disruption of at least 25% of critical businesses/services (food, financial, social services, etc.) occur due to this hazard? How large a percent of the population will need to be evacuated due to this hazard? How large an area (radius in miles) will require environmental assessment, remediation, and/or decontamination due to this hazard? A-3

22 Personnel Gaps Surveillance Health Communication & Public Information Mass Care/Sheltering Mass Prophylaxis Fatality Management Public Health Service Impact The gap between the number of personnel that would be available to handle the hazard as compared to the demand for personnel to provide service How large an in surveillance activity will take place due to this hazard? How large an in health communication and information activity will take place due to this hazard? How large a percentage of the population will require mass care and/or sheltering due to this hazard? How large a percentage of the population will require mass prophylaxis due to this hazard? How large an will in fatality management service be needed due to this hazard? Hearing Disability Vision Disability Ambulatory Disability Cognitive Disability Limited English Proficiency Poverty Chronic Diseases Children 18 years old and younger Elderly, age 65 and older At Populations Will people with hearing disabilities be more affected by this hazard than the general population and require additional assistance? Will people with vision disabilities be more affected by this hazard than the general population and require additional assistance? Will people with ambulatory disabilities be more affected by this hazard than the general population and require additional assistance? Will people with cognitive disabilities (learning and/or developmental disabilities) be more affected by this hazard than the general population and require additional assistance? Will people with limited English proficiency be more affected by this hazard than the general population and require additional assistance? Will people who live in poverty be more affected by this hazard than the general population and require additional assistance? Will people who have either (or both) diabetes or asthma be more affected by this hazard than the general population and require additional assistance? Will children (18yo and younger) be more affected by this hazard than the general population and require additional assistance? Will the elderly (65yo and older) be more affected by this hazard than the general population and require additional assistance? A-4

23 Collection Tool for Scoring Purposes Filled Out for Each Hazard PROBABILITY OF OCCURRENCE Improbable Remote Occasional Probable Frequent HUMAN IMPACT Mortality (Excess over normal daily expectations) Less than 10% 10-50% % More than 100% More than 14 day duration EMS Transports (Excess over normal daily expectations) Less than 10% 10-50% % More than 100% More than 14 day duration ED Visits (Excess over normal daily expectations) Less than 10% 10-50% % More than 100% More than 14 day duration Primary Care Office Visits (Excess over normal daily expectations) Less than 10% 10-50% % More than 100% More than 14 day duration Trauma Center Injuries (Excess over normal daily expectations) Less than 10% 10-50% % More than 100% More than 14 day duration Mental Health Impact (Excess over normal expectations) Minimal change Weak changes Less than 25% of population 25-49% of population More than 50% of population A-5

24 HEALTHCARE SERVICE IMPACT Outpatient Services (Primary Care Availability) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration Emergency Department Services (Total ED Beds vs. normal usually in place) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration Emergency Department Services (ED Bed Demand over normal expectations) Less than 10% 10-50% % More than 100% More than 14 day duration Hospital Beds Availability (Total Hospital Beds vs. normal usually in place) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration Hospital Beds Demand (Demand over normal expectations) Less than 10% 10-50% % More than 100% More than 14 day duration Ancillary Services (Pharmacy Availability in Community) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration Trauma Units (Functioning Trauma OR's only) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration Mental Health Services (Community Availability) Less than 10% decrease 10-50% decrease % decrease Complete loss of service More than 14 day duration A-6

25 COMMUNITY IMPACT Water Supply disrupted or requiring water advisory for at least 25% of population Sewage/Sanitation System disrupted for at least 25% of population None < 1 day 1-7 days 8-14 days > 14 days None < 1 day 1-7 days 8-14 days > 14 days Public Utilities (% of population with disruption of electrical supply) 0% 1-5% 6-25% > 25% More than 14 days duration Transportation (major routes closed) None < 1 day 1-7 days 8-14 days > 14 days Business Continuity None < 1 day 1-7 days 8-14 days > 14 days Population Displacement 0% 1-5% 6-10% > 10% More than 14 days duration Environmental Contamination (radius in miles needing assessment, remediation, or decontamination) 0 miles 1 mile or less 1-10 miles > 10 miles More than 14 days duration A-7

26 PUBLIC HEALTH SERVICE IMPACT Personnel Gaps (gap between number of personnel that would be available to handle incident vs.. demands for personnel to provide services) Less than 10% 10-50% % More than 100% More than 14 day duration Surveillance Less than 10% 10% to 100% 100% to 200% More than 200% More than 14 day duration Health Communication & Public Information Less than 10% 10% to 100% 100% to 200% More than 200% More than 14 day duration Mass Care/Sheltering (percent of population) 0% 1-5% 5-10% > 10% More than 14 day duration Mass Prophylaxis (percent of population) 0% 1-10% 10-25% 25-50% > 50% Fatality Management Less than 10% 10% to 100% 100% to 200% More than 200% More than 14 day duration A-8

27 AT RISK POPULATIONS Hearing Disability the same as general slightly more than general moderately more than general considerably more than general extremely more than general Vision Disability the same as general slightly more than general moderately more than general considerably more than general extremely more than general Ambulatory Disability the same as general slightly more than general moderately more than general considerably more than general extremely more than general Cognitive Disability the same as general slightly more than general moderately more than general considerably more than general extremely more than general Limited English Proficiency the same as general slightly more than general moderately more than general considerably more than general extremely more than general Poverty the same as general slightly more than general moderately more than general considerably more than general extremely more than general Chronic Diseases (Diabetes + Asthma) the same as general slightly more than general moderately more than general considerably more than general extremely more than general Children 18 and under the same as general slightly more than general moderately more than general considerably more than general extremely more than general Elderly 65 and older the same as general slightly more than general moderately more than general considerably more than general extremely more than general A-9

28 Appendix B: Individual County Breakdown of Priority Planning s B-1

29 Hazard Probability Severity Atlantic County At Population Adjusted Preparedness Planning Priority Weather (excluding flooding) Flooding Terrorism (CBRNE) Pandemic Power Outages Foodborne Outbreak Nuclear Facility Offsite Release Hazmat (accidental release involving population evacuation) B-2

30 Bergen County Hazard Probability Severity At Population Adjusted Preparedness Planning Priority Pandemic Terrorism (CBRNE) Weather (excluding flooding) Flooding Nuclear Facility Offsite Release Hazmat (accidental release involving population evacuation) Power Outages Foodborne Outbreak B-3

31 Hazard Terrorism (CBRNE) Probability Severity Burlington County At Population Adjusted Preparedness Planning Priority Pandemic Weather (excluding flooding) Flooding Foodborne Outbreak Nuclear Facility Offsite Release Power Outages Hazmat (accidental release involving population evacuation) B-4

32 Hazard Probability Severity Camden County At Population Adjusted Preparedness Planning Priority Weather (excluding flooding) Pandemic Terrorism (CBRNE) Hazmat (accidental release involving population evacuation) Nuclear Facility Offsite Release Power Outages Flooding Foodborne Outbreak B-5

33 Cape May County Hazard Probability Severity At Population Adjusted Preparedness Planning Priority Pandemic Flooding Weather (excluding flooding) Power Outages Nuclear Facility Offsite Release Foodborne Outbreak Hazmat (accidental release involving population evacuation) Terrorism (CBRNE) B-6

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