The National Institutes of Health has been saving the lives of patients diagnosed with Ebola virus. At the same time, Walter Reed Army Institute has been developing and testing a new Ebola vaccine. Montgomery County, Maryland, is home to these world-renowned facilities as well as a leading healthcare coalition that continually prepares for emerging public health threats.
Created in response to the 11 September 2001 attacks and anthrax attacks later that year, the Hospital Preparedness Program (HPP) has increased hospital emergency preparedness nationwide. After Hurricane Katrina in 2005, the U.S. Department of Health and Human Services’ Assistant Secretary for Preparedness and Response heavily promoted hospital coalitions as an integral part of community emergency preparedness across the nation, and there are now nearly 500 healthcare coalitions across the country. These coalitions play a critical role in preparing for and responding to public health crises.
More Than a Decade of Collaboration Like many healthcare coalitions, the Montgomery County Healthcare Collaborative for Emergency Preparedness (MOCEP) in Maryland was crucial in responding to the Ebola crisis in Fall 2014. Founded shortly after 9/11 in 2001, MOCEP brings together representatives from local hospitals, public health, emergency management, fire rescue services, and other organizations to prepare for and respond to emergencies. Through more than a decade of collaboration, MOCEP partners developed strong working relationships and worked together to increase the county’s response capacity to health-related emergencies. For example, MOCEP hospitals have utilized mutual aid agreements to share resources – such as linens or personal protective equipment – during events ranging from hospital fires to severe weather. Through more than a decade of collaboration, MOCEP partners found it easy to work together in responding to the Ebola crisis and beyond.
The core strength of MOCEP is its ability for facilities and departments to share information and best practices. During the 2009 H1N1 pandemic, the coalition quickly recognized the need for open and consistent communication so that all partners could convey a unified message to the public. For example, during the pandemic, many hospitals enacted visitor restrictions to control the spread of the diseases, but it was not a uniform policy. By sharing each hospital facility’s visitor policy, the MOCEP partners were able to explain the differences in policy to the public and help quell public concern.
After the H1N1 pandemic in 2009, MOCEP integrated discussions of emerging infectious diseases into the coalition’s monthly meetings. Although the general public did not hear much about the Ebola outbreak in West Africa until Fall 2014, MOCEP first discussed the outbreak at its June 2014 monthly meeting, relatively early in the crisis. These proactive discussions focused on monitoring the situation and assessing the likelihood of Ebola reaching the United States. Through these conferences, hospital emergency managers were able toentify their gaps in knowledge about the disease, request more information from trusted partners like the county’s public health department, and begin thinking of how to respond if Ebola reached the United States. This pre-planning enabled Montgomery County, which is home to the federal critical healthcare facilities National Institutes of Health and Walter Reed Army Institute, to effectively and quickly respond to the Ebola crisis.
In addition to MOCEP, many of the Montgomery County agencies and hospitals also participate in the Maryland Region V Hospital Emergency Preparedness Coalition. The Region V Emergency Preparedness Coalition includes both urban and rural jurisdictions, only a portion of which are part of the well-resourced National Capitol Region. During the Ebola crisis, both Region V and MOCEP facilitated coordination phone calls between healthcare providers and public health officials. Early in the crisis, Montgomery County Department of Health and Human Services convened a meeting of the local hospitals, Emergency Medical Services, Emergency Management, and other partners to inform them about the course of the disease and establish a coordinated response. This coordination led to several beneficial operational changes in the county.
The Creation of the Ebola Phone In Montgomery County, one such operational change was the creation of the Ebola phone. The Montgomery County Department of Health and Human Services Public Health division began operating the Ebola phone in October 2014. It is a simple cellphone that is passed between managers in the Public Health Emergency Preparedness and Response Department, with a number only provided to first responders and hospital personnel. During the height of the Ebola fears in Fall 2014, many healthcare providers and emergency responders were unsure of best practices forentifying Ebola and preventing transmission of Ebola if and when they were to encounter a patient with symptoms or a positive travel history. This concern was quicklyentified through the coalition partners, leading to the implementation of a dedicated phone line for first responders/receivers to reach public health officials with specialized knowledge of Ebola infection and mitigation.
Through these phone calls, first responders were able to quicklyentify whether or not a patient with whom they are interacting carries a risk of Ebola. For example, early on in the crisis law enforcement encountered a disruptive individual in at a shopping center that claimed to have Ebola. Law enforcement was then able to quickly contact Public Health to discuss the actual risk of Ebola exposure the individual had and Public Health was able to then check with the Maryland Coordination and Analysis Center (MCAC) to verify the individual’s travel history. MCAC verified that the individual in question had not left the country within the time of concern and public health officials were able to assure the law enforcement officers that the individual in question did not pose a public health risk.
This consistent communication line among healthcare providers, first responders, and public health has already shown benefits outside of the Ebola crisis. For example, partners have used the line to reach public health officials about measles and other emerging infectious diseases in the region. Having a dedicated communication line from public health to other coalition members has further strengthened relationships between hospitals, fire rescue services, and law enforcement. Quick, consistent access to public health specialists have assured these coalition partners that they will be provided with the information necessary to safely and effectively carry out their duties.
Although news reporting of the Ebola crisis has lessened, public health officials are still actively responding to individuals potentially exposed to the diseases as they return to the United States from impacted West African countries. In Montgomery County, the crisis has tested the public health response capabilities of the county and led to an even stronger collaboration between first responders, public health, and hospitals.
Margaret (Maggie) Davis is a Senior Law and Policy Analyst with the University of Maryland Center for Health and Homeland Security (CHHS). Before working for CHHS, she volunteered in the state of New York, helping with Superstorm Sandy recovery efforts and community mobilization. She holds a Juris Doctor degree from the University of Maryland Francis King Carey School of Law, and Bachelor and Master degrees from Case Western Reserve University.