Will health agency staffing hamper disaster response?
Oklahoma is better prepared for health emergencies than it was five years ago, but the state epidemiologist worries recent layoffs could undermine some of that work.
The National Health Security Preparedness Index, compiled by researchers at the University of Kentucky, ranks states on a 10-point scale based on how well they’ve planned for a public health disaster.
Oklahoma scored 6.9 out of 10 on the index, which is within the margin of error for the nationwide average of 7.1.
The index uses 140 measures, ranging from the number of doctors in a state to whether its bridges are in good condition, to determine if states are ready for extreme weather, diseases that are new to the country, infections that resist antibiotics and man-made disasters like terrorism. It also considers whether damage to physical infrastructure, poor cybersecurity and low vaccination rates could interfere with states’ efforts to keep their people safe.
Oklahoma has improved its ability to detect and respond to disease outbreaks since 2013, but state epidemiologist Kristy Bradley said she worries layoffs and open positions at the Oklahoma State Department of Health could weaken the state’s responses in the future.
Four out of 13 epidemiology positions are open after employees retired or left for other jobs, because the department doesn’t have the funding to replace them, Bradley said.
Layoffs among nurses in county health departments also could pose a problem, she said. Nurses assist the epidemiology staff when they need to trace people who had contact with a person who has an infectious disease.
For example, five or six county health department nurses played an important role sharing the work when a child was diagnosed with measles in Cleveland County earlier this year, she said.
A list of positions slated for layoffs showed 43 registered nurses would lose their jobs in
March, not counting any who leave voluntarily. “They are very much key to responding and controlling an outbreak,” she said. “Those are times when it’s all hands on deck.”
A large epidemic could strain the health department’s resources because it couldn’t easily move employees to areas that need extra hands, Bradley said. Even the seasonal flu this year created some problems when employees had to stay home to care for their sick children.
“Our ranks are getting sort of thin,” she said. “At the (staffing) level we’re at, we can manage the day-to-day responsibilities, but we don’t have a lot of what you’d call surge capacity.”
Glen Mays, a professor at the University of Kentucky who oversees the annual preparedness report, said the decreasing number of epidemiologists in the state is a concern.
So is the state’s ability to coordinate between the Oklahoma Department of Environmental Quality, which tests for pollution that could harm human health, and the state Health Department, he said. Bradley said she thinks the report underestimates the level of coordination between the two departments, which work together on water-borne illnesses and other hazards.
Though concerns loom in the future, Oklahoma has made improvements in its ability to store and deploy medical supplies in case of emergency. The report showed Oklahoma’s biggest area of improvement was in engaging communities in planning.
Scott Sproat, director of emergency preparedness and response services at the state health department, said the department has worked to encourage planning on the state, regional and local levels.
Each medical facility should have its own emergency plan in place, and should be in touch with other facilities and government agencies in the area to coordinate if something does happen.
Planning in advance helped last week, when two hospitals, a nursing home and a dialysis clinic had to evacuate as wildfires approached, Sproat said. “What we’re trying to avoid is people trying to figure this out as it’s happening,” he said.
Oklahoma faces some challenges with improving its preparedness. States with higher rates of poverty and uninsured residents generally fare worse on preparedness, because they have fewer resources that government agencies and health systems can use to plan for disasters.
Still, it has made notable progress in recent years, Mays said.
No state has reached what the researchers consider an optimal level of preparedness.
“Every state really has strengths as well as weaknesses,” he said.