National Preparedness Month: Arizona Department of Health Services Shares Lessons Learned

September 28, 2017|12:51 p.m.| ASTHO Staff

Teresa Ehnert, MSPublic health preparedness aims to prevent adverse health outcomes through planning, training, and exercising for emergencies, and increasing the public’s awareness of the need for individual preparedness. Since it launched in 2003, the Federal Emergency Management Agency’s Ready Campaign has sponsored National Preparedness Month, which occurs every September and shares public messaging on how individuals and communities can prepare for, respond to, and mitigate emergencies.

ASTHO spoke with Teresa Ehnert, MS, bureau chief of public health emergency preparedness for the Arizona Department of Health Services (ADHS) and chair of the ASTHO Directors of Public Health Preparedness peer group, to discuss Arizona’s approaches to public health preparedness and response.

This year’s theme for National Preparedness Month is “Disasters Don’t Plan Ahead. You Can.” How is the Arizona Department of Health Services sharing this message, both with staff in your department and Arizona residents?

Now more than ever before, public health needs to spread the word and provide tools to help the public improve their individual preparedness. We are sharing this year’s National Preparedness Month theme through ADHS’ social media channels and are retweeting FEMA’s national preparedness messages. We also share the theme internally among staff through advertisements on our lobby televisions. Our department director, Cara Christ, MD, has a director’s blog that also highlights the importance of this month as a reminder not only of the need to integrate different sectors into emergency preparedness, but also of the impact our work has on our communities.

This past summer, your department responded to a large number of wildfires, approximately 190,000 acres burned. As a public health leader, what lessons have you learned while responding to the wildfires in Arizona that may help other health officials with natural disaster preparedness and response efforts?

We are frequently asked how public health fits into a wildfire response, and our reply is that it fits in pretty much every aspect of the process. We coordinate preparedness and response efforts with many different entities, including environmental health, women, infants, and children, behavioral health, pharmacy, food safety, and access to care. Through a collaboration with state, local, and tribal partners, we provide key pieces of communication on what to do before and after a wildfire to the public. When multiple fires are happening in the state at the same time, we have to brainstorm some out-of-the-box ideas to help those who are impacted, such as using telemedicine for consults on pharmacy refills and overrides. We also learned that it is crucial to stay consistent with messages statewide when educating the public on resources that are available to them during an emergency. Working together on these various tactics allows response efforts to be efficient and effective.

How has the field of public health preparedness evolved in the time you have been in public health? And how does the Public Health Emergency Preparedness/Hospital Preparedness Program impact your agency?

In our recent history, national catastrophic events such as the 9/11 attacks, anthrax attacks, Hurricane Katrina, and the threat of pandemic influenza have led to a new era in public health emergency preparedness. Policymakers from across the nation saw the need to further integrate public health into the emergency management, first responder, and healthcare sectors. Through congressional action, such as the Pandemic and All Hazards Preparedness Act, many state public health departments (including Arizona) began to strengthen their old “civil defense” programs. Since 2001, these programs have evolved into the modern public health emergency preparedness programs we have today.

These programs provide the resources that enable the public health and healthcare system to respond to a variety of potential situations. In Arizona, some of these situations include primary hazards like a potential terrorist attack to a nuclear plant, chemical storage facilities, large capacity venues, defense manufacturing, or dams; secondary hazards include floods, wildfires, severe storms causing loss of power, and earthquakes in nearby states requiring assistance from Arizona to handle patient loads. Arizona shares a 378-mile border with Mexico, which challenges the security of our state and the preparedness of travelers moving through our borders. In the 2016 fiscal year, Customs and Border Protection processed 25.2 million travelers and seized 58.7 percent of the total amount of narcotics involving marijuana and cocaine on the southwest border. Arizona is responsible for 19.3 percent of the total southwest border apprehensions. These statistics show the number of people legally visiting the state, which creates a challenge for the preparedness of the healthcare system. The PHEP and HPP program have allowed us to build the infrastructure that this is necessary to maintain resiliency, and to sustain a communication system and robust training and exercise program statewide.

How can partnerships aid in strengthening public health preparedness efforts?

As we have experienced in our health department, an emergency situation can happen quickly and without warning, and there may not be much time to act. Depending on the severity of the emergency and how long it lasts, people may have difficulty getting access to services and supplies, such as food, water, or medicines. We rely on partnerships in these situations to ensure the timely delivery of supplies and services. The partnerships we create with associations, coalitions, schools, tribes, disability groups, local health, and emergency management, have enhanced statewide planning efforts, which has proven to be the key component in response. A recent example is the relationship we have with the emergency medical services community; this partnership aids to enhance the responsiveness during an emergency to provide portable oxygen to residents without power. Knowing what to do and who to coordinate with in advance of an emergency can determine the success of the response.

As one example of a key partnership in preparedness, Arizona works closely with tribal populations. What recommendations do you have for states who want to engage tribal groups in preparedness work?

In Arizona, we have worked with tribes on preparedness planning, training, and exercises for many years. Having tribal inclusion from the onset in strategic planning sessions, and building a program where all have an equal voice, has proven to be a successful approach.

A key to our success was the establishment of an Arizona Tribal Executive Committee (AzTEC).

The committee is comprised of representatives from participating tribes and the ADHS tribal liaison. The Arizona Tribal Public Health Emergency Preparedness (PHEP) coordinators, in coordination with consultative policy from CDC, ADHS, and through joint tribal leadership of AzTEC, developed a Tribal Strategic Plan in 2010 and has a recently updated plan that shares best Public Health Emergency Preparedness (PHEP) practices. This is a living document to address tribal needs in preparing for and responding to bioterrorism, infectious disease outbreaks, and other public health threats and emergencies. The Tribal Strategic Plan is aligned to the ADHS strategic plan for fiscal years 2015 through 2020. The goal was to align Tribal PHEP programs to enhance their respective programs through common goals and long-term expected outcomes to address tribal issues and improve the health of tribal people on their lands. Jointly, these strategic plans are purposed to strengthen Arizona’s public health system through alignment and coordination.

Given your experience, what are key actions state or territorial preparedness directors should take to raise awareness and increase statewide efforts of public health preparedness in their jurisdictions?

My experience has shown me that we need to continue to educate and promote the scope and the value of public health. As the World Health Organization puts it, public health is about the promotion of health for the whole population, not just individuals within it. Key actions a state or territorial preparedness director could take are to continue to educate on what we do to protect and promote the public’s health. Our programs need to continue to tell the story of the impact all of the planning, training, and exercises has on ensuring we are able to respond to emergent events.

Teresa Ehnert has worked in Arizona Department of Health Service’s Public Health Emergency Preparedness Bureau since 2005. As the chair of the Directors of Public Health Preparedness (DPHP) peer group, Ehnert has played a key role as a representative of state and territorial preparedness directors in a number of ways, including participating in a discussion with the Office of Management and Budget on the importance of continuing to fund all 62 Hospital Preparedness Program awardees in the 2018 fiscal year, and identifying priorities for state and territorial public health preparedness as a member of the ASTHO Preparedness Policy Committee.

ASTHO’s annual DPHP meeting will be held in Chicago on Oct. 24 – 26. For more information on what ASTHO’s preparedness team is doing to support state and territorial preparedness programs, visit