Definition And Connotation Of EOC
For EOC, different organizations / agencies have different definitions. However, FEMA, USCDC and WHO all emphasize that EOC is a place to provide emergency response for professionals dealing with public health emergencies. It can command and coordinate relevant information and resources, and manage emergencies. We all believe that an effective EOC should be an organic combination of infrastructure and functionality.
In China, The EOC is a place where CDC organizes and conducts the related emergency response work. It is the place for emergency preparedness, daily operation and emergency response. It can be a dedicated place, or a space that is used in conjunction with other agency functions, or it can be a virtual place realized through information-based facilities. The China CDC’s EOC could be used for daily emergency preparedness duty. During the emergency response, the working group personnel are centralized in different functional areas. EOC is an important part of the comprehensive planning and construction of emergency response management.
The Practice Of China CDC
In China, we focused on building the following core elements of the EOC, including sites/places and facilities, information and data, plans and procedures, training and exercises and logistics.
Sites/places And Facilities
The EOC is an important part of public health emergency system construction. According to the 13th Five-year Plan for the prevention of infectious diseases (2016–2020), China has clearly put forward the practice for the construction of EOCs. In the years leading up to 2010, China CDC initially established the EOC which contains a main hall and some function area for small meetings and discussions, and introduced the Remote Conference System to realize the remote consultation. In addition, the Teleconference System and LED information displaying system are also introduced to further the information display environment.
Plans And Procedures
Based on SARS, H7N9, and other infectious diseases outbreaks, as well as various natural disasters and man-made disasters, China CDC has its own model of incident detection, reporting and response processes. According to different events, we developed different technical, hazard-specific response and support plans, manuals and handbooks. In order to maintain consistency with WHO and other countries, China CDC compiled and issued a comprehensive plan at the end of 2016, called Administrative Measures for Health Emergency Operations (2016 Edition), which is like the combination of the emergency operation plan (EOP) and PHEOC plan. It contains the incident management and the standardized response procedures. The EOC can be activated in response to natural or manmade disasters, infectious disease outbreaks, and other public health emergencies. Besides watching level and alert level, there are three different levels of activation, depending on the scale of the event. In addition, the China CDC is also developing a series of incident action plan (IAP) and the standardized forms for each incident.
Data And Information
Information is the lifeblood of an EOC [3–7]. According to the activities and tasks, EOC has specific information needs and require various sets of data. EOC also need to collect and analysis data and information for operation. Three types of data ,including event-specific data, context-specific data and event management data, are usually obtained. Event-specific data can reflect information on what, how, where, who, and the current status of events. The sources of information may come from public health emergency management system, which focused on emergencies and health risk factors information, and the field investigation recourses. Context-specific data can reflect background information such as geographical information, demographic information, environmental information, health resources information, emergency shelter, the incidence of related diseases and health services. Event management data are organized for the functional domains (management, operations, planning, logistics, finance and administration) in the EOC. Such data may include human equipmental resources, the status of interventions, partner activities, resource deployments, expenditure progress on achievement of objectives, and so on. Besides, we also keep abreast of the current situation of staff information, expert database and logistics supplies.
In China CDC, branch for logistics takes the responsibility to the information supply and update for EOC. With the support of the logistic department, EOC can coordinate the relevant personnel and other resources timely and efficiently in the emergencies. Moreover, the Emergency Operations Management Information System (EOMIS) of China CDC is about to be online. In the future, it will be more conveniently and efficiently to manage the emergency resources.
Training And Exercises
The function and staffing of the EOC should be assessed through an ongoing series of training and exercises [2–5]. Well-trained professionals are the key to the operations of EOC. Trained experts who know what to do are critical to building a functioning EOC [7–10]. Training should be purposefully conducted according to the capabilities required by the EOC. In China CDC’s EOC, how to use the incident management system, special post training for working group of EOC, and professional technology, skills and practical training are the most three important training content. In addition, all personnel should have the information and communication technology (ICT) skills required to work in the EOC. The training targets of EOC mainly include all kinds of personnel who may participate in emergency response. The training can be carried out according to different professions, positions and levels. Training methods can be used in a variety of styles including face-to-face or online teaching, internships, etc. The training frequency is determined by the needs. Before and after the training, the trainees should be assessed to confirm whether the training objectives are achieved and whether their abilities meet the needs of participating in emergency operations. According to the evaluation results, the training program can also be improved.
Exercises are a primary training tool. The abilities of professionals should be consolidated and improved. The two types of exercises - discussion-based exercises and operations-based exercises are usually used in the daily activity in the EOC[11–14]. In practice, the various exercise types may be modified or combined in order to meet specific objectives, especially when resources are limited.
Initiatives In Public Health Emergency Management
Through the adjustment of health emergency practice and EOP in 2016, China CDC’s EOC established the new IMS response procedure. In 2017, the China CDC’s EOC had been launched three times for emergencies. The activations illustrating improvements in time to activation are as follows:
Table. The practice of China CDC’s EOC in 2016–2017
Date
|
Outbreak/Disaster
|
Type
|
Location
|
Response level *
|
Comments/action taken
|
2017 Jan-Jun
|
H7N9
|
Infectious disease outbreak
|
Many provinces, China
|
Ⅲ
|
Coordinated departments to develop the epidemiological and lab test strategy.
|
2017 Aug-Oct
|
Earthquake
|
Nature disaster
|
Sichuan and Xinjiang, China
|
Ⅱ
|
Deployed team to the field for the public health prevention and control
|
2017 Nov-2018 Jan
|
Plague
|
Infectious disease outbreak
|
Madagascar
|
Ⅱ
|
Deployed team to the field for the public health prevention and control
|
2018 Jul-Sep
|
Flood
|
Nature disaster
|
Several provinces, China
|
Ⅲ
|
Deployed team to the field for the public health prevention and control
|
2018 Jul-Oct
|
Vaccine
|
Infectious disease outbreak
|
Several provinces, China
|
Ⅰ
|
Assess the risk of problematic vaccine and develop reseeding strategies
|
2018 Jul-Oct
|
Polio virus
|
Infectious disease outbreak
|
Xinjiang provinces, China
|
Ⅲ
|
Strengthen sampling and case monitoring, formulate vaccination strategies
|
* There are three different levels of China CDC’s response depending on the scale of the event. |
Level Ⅲ is the lowest level of response. Only one or two subject matter department lead to the response with their staff. However, EOC would not be activated.
Level Ⅱ involves more than two departments staff, or the relevant area and resources from the China CDC. Time-sensitive tasks and needs may extend beyond core business hours. EOC staff may lead or assist with the response
Level Ⅰ is the highest level, requiring all agency-wide effort.
H7N9 Avian Influenza Epidemic
The reported H7N9 case number has been significantly higher since December 2016 than the same period in the past in China. As of January 8, 2017, 169 confirmed cases and 44 deaths have been reported. The epidemic has spread to 10 provinces. The confirmed cases have increased by 6.34 times compared with the same period in last two years, as well as the number of deaths has increased by 5.29 times. Given the current situation, it is expected that China CDC will continue to carry out intensive surveillance, situation analysis, field investigation, laboratory testing and technical support services for human infection with H7N9 avian flu. After risk assessment, China CDC’s EOC has been activated with a levelⅢ response for the H7N9 influenza outbreak. The PHEC of China CDC subject matter experts to lead the response with their program staff. And EOC staff participated the response. According to the event scale, we set up Plan and Coordination (P&C), Epidemiology, and Laboratory detection functional team. It is deployed to enable the early detection of human cases, respond rapidly to interrupt human transmission, and oversee case management. The Chinese Field Epidemiology Program(CFETP) fellow served as the liaison between the EOC and field provinces. The PHEC coordinated seamless communication between the CDCs’ laboratory and the China CDC’s EOC. When the EOC was deactivated in June 2017, none of the human contacts had tested positive. Through our 6-month epidemiological action, the epidemic had been controlled.
Jiu Zhaigou And Jing He Earthquake
On Aug 2017, a 7.0 and a 6.6 magnitude earthquake hit JiuZhaigou county( belongs to Sichuan province) and Jing He county(belongs to Xinjiang province) separately. The two natural disasters caused hundreds of people died and injured.
The day after the earthquake, China CDC take the levelⅡresponse and dispatched the Post-disaster Rapid Response Team (PRRT) to the earthquake site immediately. Since then, the EOC organized three workgroups (including P&C, Situation awareness, Technology& Logistics) to do the surveillance, field investigation and risk assessments. And did preparation for the several different threats of post disaster, including infectious disease, concerns about the importation of foodborne and waterborne disease. The EOC also conducted and coordinated several training sessions and exercise for CFETP fellows and Public Health Emergency team to take part in the response. Some comprehensive operational handbook was developed according to this response process. Besides, EOC also provides other related hardware services and integrated coordination. For example, the video conference system and teleconference system had been provided for this disaster risk assessment. GIS map had been described for the situation and risk display. EOC also coordinated logistics branch of PHEC to provide emergency supplies and equipment for field teams.
The whole response process only last one month. After the disaster, EOC leaded the after action review (AAR) on what worked well, what could be improved, and prepares after action reports and improvement plans. And developed the reports on how well the response operations met objectives, recommendations for correcting gaps or weaknesses, and plans for improving response operations.
Plague Outbreak In Madagascar
Since August 2017, Madagascar had experienced a human plague outbreak which spread to a wide area of the country including the capital. As of October 30, 1,801 confirmed and suspected cases of plague had been reported, of which 62 percent cases reported as pneumonic plague. Obstacles to efficient containment of outbreaks include reporting lags from the field, delays in information sharing of outbreak data through the public health system, inefficient coordination of outbreaks, and slow response at the central level. Notification came via NHCPRC, public health partner briefings and worldwide declaration of a Public Health Emergency of International Concern. According to the situation, on October 28, China CDC decided to activate levelⅡresponse and the EOC set up four functional workgroups(including P&C, Situation awareness and JIC, Experts, and Logistics). Besides, we sent a six-expert team to Madagascar to assist in the prevention and control and provide health services for the Chinese living in Madagascar. The EOC provides the technical support to the field team to develop the integrated disease surveillance strategies and reporting mechanisms for Madagascar MOH and helped them redefine new case definition and the standard for the case identification. In addition, the field team and the medical team assisted a Chinese tourist suffered from suspected pneumonic plague infection in Madagascar. The EOC supplied the teleconference system to support the remote video meeting on the discussion of the treatment plan of patients. When the EOC was deactivated in January 2018, the trend of case increasing has been shut down.