PPHR Frequently Asked Questions

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These frequently asked questions were selected from records of questions received by state Project Public Health Ready (PPHR) leads and NACCHO staff since the beginning of the PPHR project. The first questions are related to the entire project. The following questions are specific to the goals found in the PPHR Criteria.

»	Q: What is the primary value to a local health department (LHD) of being recognized through PPHR
»	Q: What is the most important thing for an LHD to demonstrate in its documentation for the PPHR criteria
»	Q: How long should the executive summary be
»	Q: What information does an LHD need to provide if it is not the lead agency for a particular evidence element
»	Q: What information does an LHD need to provide if an evidence element is still in the planning process or if documentation for an evidence element is not available by the deadline to submit the PPHR application
»	Q: Do you have any tips for LHDs beginning the PPHR program
»	Q: Can I list more than one document as evidence for a single evidence element
»	Goal I, Q: How should we present the information on all neighboring jurisdictions and, if applicable, tribal and/or military installations within the locality
»	Goal I, Q: What is meant by indicators that suggest that an event has occurred that could exceed the ordinary capacity of the LHD and possibly, the surge capacity of the LHD
»	Goal I, Q: What is a hazard analysis, and could more information be provided on this topic
»	Goal I, Q: What information is important to provide regarding activation circumstances and event sequence following activation
»	Goal I, Q: Can a single staff member serve as a back-up for more than one command and/or general leadership role during a response based on the National Incident Management System
»	Goal I, Q: Do all groups included in the definition of vulnerable populations in the PPHR criteria glossary need to be addressed by the plan
»	Goal I, Q: Which activities are being referred to in the evidence elements related to the agency communication plan
»	Goal I, Q: Do you have an example of an agency communication plan
»	Goal I, Q: How should we define our partners that must be notified during partner notification
»	Goal I, Q: How can an agency “assure” that communications will work during any given emergency
»	Goal 1, Q: Should we provide a point of dispensing (POD) flow chart of an actual site or of the process of emergency operations center activation, POD set-up, just-in-time training, and POD closedown
»	Goal I, Q: What is the difference between the number of volunteers necessary to support mass prophylaxis and the number of volunteers the LHD has recruited to support mass prophylaxis
»	Goal I, Q: Can we reference the state plan for laboratory data and sample testing
»	Goal I, Q: Since most LHDs will not be the lead in a mass patient care situation, is including a special needs sheltering plan sufficient
»	Goal I, Q: Do you have more information on mass patient care plans for LHDs
»	Goal I, Q: Do you have more information on mass fatality planing for a local public health department
»	Goal I, Q: In a continuity of operations plan, how can an LHD determine which LHD functions must be continued in light of a natural disaster or deliberately caused emergency
»	Goal I, Q: How can an LHD be specific about its surge capacity and its need for additional resources in emergency situations
»	Goal II, Q: Do all staff need to be assessed by the training needs assessment
»	Goal II, Q: What are rapid training curricula
»	Goal III, Q: Should applicants submit blank copies of each of the exercise evaluation tools or copies of all of the completed forms
»	Goal III, Q: In an after action report, what is the difference between the summary of the real event and an overview synopsis of the real event

Q: What is the primary value to a local health department (LHD) of being recognized through PPHR?

A: The PPHR process helps identify strengths and weaknesses in an LHD’s public health preparedness plan. PPHR recognition enhances an LHD’s credibility in the preparedness community.

Q: What is the most important thing for an LHD to demonstrate in its documentation for the PPHR criteria?

A: A continuous quality improvement process that links planning, training, and demonstration of readiness through exercises or real events. LHDs should provide a complete and thorough all-hazards response plan, evidence of a training needs assessment that informs a training plan, and evidence of an exercise or response to a real event.

Q: How long should the executive summary be?

A: NACCHO reviewers receive all of their background information regarding agencies from the executive summary document, so it is important for this document to provide a complete picture of the LHD, including its size and resources. While the document is titled executive summary, the reviewers are looking for more of a narrative summary. These documents are usually five to 10 pages in length, but are sometimes longer than 10 pages. Please see the Executive Summary Tip Sheet for more information on what to include in the executive summary document.

Q: What information does an LHD need to provide if it is not the lead agency for a particular evidence element?

A: If the LHD is not the lead agency for a particular task (evidence elements and/or sub-measure), they must provide a description that includes the following:

Identification of the lead agency.
Description of the roles and responsibilities of the lead agency.
Description of the support roles and responsibilities of the applicant.
Description of how the applicant partners with the lead agency to plan for, and prepare to deliver, the emergency service addressed in the evidence element.
Description of the applicant''s coordination and communication process for supporting the work of the lead agency.
Description of how the applicant will work with the lead agency during and/or following an emergency response.
An example of how this has worded in the past, how it was exercised, or how it is addressed in your workforce development plan.
If available, agreements between the applicant and the partner agency.

These requirements are also listed under "Application Guidance #1" at the bottom of the PPHR Criteria crosswalk.

Q: What information does an LHD need to provide if an evidence element is still in the planning process or if documentation for an evidence element is not available by the deadline to submit the PPHR application?

A: If there is an evidence element and/or sub-measure that an LHD has not yet addressed or that documentation is not yet available for, the LHD must provide a description that includes the following:

Explanation of why the specific item has not been addressed.
Steps/milestones of a plan to address the item.
Timeline for steps/milestones.
Listing of partners and description of their responsibilities to address the item.

These requirements are also listed under "Application Guidance #1" at the bottom of the PPHR Criteria crosswalk. Meeting these requirements will result in a score of Partially Met.

Q: Do you have any tips for LHDs beginning the PPHR program

Read the requirements of all three goals before starting. As you work on one goal, you will be able to identify information to use for the other two goals, if you know what the other goals require.
Label everything. Label any piece of information you are going to reference with the criteria number using red bolded font (i.e., G1 M1 e1 for: Goal 1, Measure 1, Criteria e1). This makes it easy to find the information later, easier to assess what criteria have been addressed, and makes the final crosswalk process a breeze. It also makes the process easy for reviewers.
There will inevitably be a number of documents you’ll need, especially for Goal I. Therefore, create a PPHR file on your computer and then within that file, create a file for each goal. You can then drop all the documents you might need for each goal into the respective folder.
Use the PPHR Gap Analysis Tool to identify evidence elements in the criteria for which your department may not currently have plans or documentation that can be provided as evidence.
Become familiar with the tools in the PPHR Toolkit.
Begin work on any element for which you are not the lead agency. You will need to begin communicating with the lead agency as soon as possible. Ensure that you have all of the information required for when the LHD is not the lead agency for a particular evidence element, listed under "Guidance Element #1" at the bottom of the criteria crosswalk.
Ensure your computers have the most updated software for converting all documents to PDF.

Q: Can I list more than one document as evidence for a single evidence element?

A: Yes, the applicant should list multiple appropriate documents if it necessary to do so in order to answer the criteria element. The links to the documents should be listed in order of importance, with most important evidence first. It is recommended not to exceed three links unless absolutely necessary.

Goal I, Q: How should we present the information on all neighboring jurisdictions and, if applicable, tribal and/or military installations within the locality?

A: This information can be provided as a map, list, narrative, etc. There is no specific way to identify these jurisdictions. It is also acceptable to send the reviewers to the list of memorandum of understanding (MOUs) or other areas of your application, if all the information is contained there.

Goal I, Q: What is meant by indicators that suggest that an event has occurred that could exceed the ordinary capacity of the LHD and possibly, the surge capacity of the LHD?

A: Indicators are trigger events that suggest a response must be activated that will likely exceed the capacity of the LHD.

Goal I, Q: What is a hazard analysis, and could more information be provided on this topic?

A: There is a definition of a hazard analysis in the glossary of the PPHR criteria. It states that a “hazard analysis evaluates potential targets and hazards in a specific community. The analysis can be the basis both for identifying potential targets and for planning for their defense; as well as for the response capability necessary should an emergency arise.”

More specifically, a hazard analysis evaluates, in a comprehensive manner, how a potential disaster will impact a community. The potential disasters should be specific to the community, not just those present in the federal planning scenarios. Hazards can be identified using historical patterns, predictive models, and data sources (e.g., ESRI, Federal Emergency Management Agency). When conducting a hazard analysis, planners should:

Consider both seasonal and regular occurrences.
List all hazards, not just worst case scenarios.
Identify hazards that exist outside of their community that can have indirect effects on their community.
Prioritize hazards.

Goal I, Q: What information is important to provide regarding activation circumstances and event sequence following activation?

A: For this measure, it may be helpful to provide both a picture or image (e.g., a flowchart) as well as a narrative explanation to describe the response procedure. One of the most important things to include in this section is the triggers that will initiate a response.

Reviewers want to know the specifics as to when and under what circumstances certain response activities will be initiated.

Goal I, Q: Can a single staff member serve as a back-up for more than one command and/or general leadership role during a response based on the National Incident Management System?

A: Yes, each primary staff person needs to be unique, but a person can be listed as secondary or tertiary staff for more than one position.

Goal I, Q: Do all groups included in the definition of vulnerable populations in the PPHR criteria glossary need to be addressed by the plan?

A: No, the glossary definition serves to provide examples of some types of vulnerable populations.

The LHD should only address those groups it recognizes as vulnerable populations within its jurisdiction and that it has created (or will create) specific plans for in emergency events. It may be helpful to provide demographic information regarding vulnerable populations in the jurisdiction in order to justify the planning efforts of the LHD.

Goal I, Q: Which activities are being referred to in the evidence elements related to the agency communication plan?

A: These activities are response activities. For example, LHDs must document when and where staff must report so that they can begin response activities.

Goal I, Q: Do you have an example of an agency communication plan?

A: There are several examples of communications plans in the PPHR Toolkit. The most recent example is here: http://www.naccho.org/toolbox/tool.cfm?id=1301
Older examples are here:
http://www.naccho.org//toolbox/tool.cfm?id=352
http://www.naccho.org//toolbox/tool.cfm?id=351

Please note that these plans were selected as best practices using earlier versions of the PPHR criteria and they may not contain all evidence elements required in more recent versions of the criteria.

Goal I, Q: How should we define our partners that must be notified during partner notification?

A: Partners refers to the broad categorization of response partners that require communication capability with your LHD/region during potential or actual incidents of public health significance or any agency with which the LHD might work or communicate during an emergency in an effort to meet the health needs of the population in a jurisdiction. Examples of partners include hospitals, morgues, social service providers, private pharmacies, mental health organizations, volunteer organizations, and neighboring health districts. Partners exist at the local, state, and federal level. Any agency that acts as the lead agency for any evidence element that is not the primary responsibility of the LHD is also a partner agency. See pages 5-10 in this PPHR tool for an example: http://www.naccho.org/toolbox/tool.cfm?id=351.

Please note that this document was created to fulfill an older version of the PPHR criteria. While the document still provides an example of a best practice, it may not meet the requirements of the most recent version of the PPHR criteria.

Goal I, Q: How can an agency “assure” that communications will work during any given emergency?

In this case, “assurance” means to give confidence or the state of being without uncertainty—an effort to guarantee that communications will function during an emergency. While it is understood that no system can be 100 percent secure, the reviewers are evaluating the steps the LHD has taken to limit the uncertainty around communications during an emergency. Such steps to limit communication failure may include the regular updating of contact lists and call-down lists, redundant communication systems, testing emergency communication equipment, and regularly scheduled drills and exercises using the communication system.

Goal 1, Q: Should we provide a point of dispensing (POD) flow chart of an actual site or of the process of emergency operations center activation, POD set-up, just-in-time training, and POD closedown?

A: Please provide a POD flow chart for an actual site. An example from the Toolbox is located here: http://www.naccho.org/toolbox/tool.cfm?id=1249.

Goal I, Q: What is the difference between the number of volunteers necessary to support mass prophylaxis and the number of volunteers the LHD has recruited to support mass prophylaxis?

A: One is the number of volunteers that would be necessary to support mass prophylaxis and the other is the number of volunteers an LHD has recruited already.

The answers do not need to be the same in order to meet this criteria element. However, if an LHD needs more volunteers than they have recruited already, they may want to include a strategy for recruiting additional volunteers.

Goal I, Q: Can we reference the state plan for laboratory data and sample testing?

A: Yes, it is acceptable to link to the state plans for laboratory data and sample testing. However, it is important to explain the agency’s role in the state plan.

Goal I, Q: Since most LHDs will not be the lead in a mass patient care situation, is including a special needs sheltering plan sufficient?

A: If the LHD is not the lead agency for a mass patient care situation, the LHD must provide all information that is required when an LHD is not the lead agency for an evidence element (see below). If a special needs sheltering plan would be considered part of an LHD’s mass patient care plan, then include it as evidence for this sub-measure.

If the LHD is not the lead agency for a specific evidence element, the PPHR process allows the applicant to provide a description of the LHD’s roles and its plan to cooperate with the lead agency. However, the applicant must provide detailed information that addresses all of the following:

Identification of the lead agency.
Description of the roles and responsibilities of the lead agency.
Description of the roles and responsibilities of the LHD.
Description of how the LHD partners with the lead agency to plan for, and prepare to deliver, the emergency service addressed in the evidence element.
Description of the LHD’s coordination and communication process for supporting the work of the lead agency.
Description of how the LHD will work with the lead agency during and/or following an emergency response.
An example of how this has worked in the past, how it was exercised, or how it is addressed in your training plan.
If available, agreements between the LHD and the partner agency.

Goal I, Q: Do you have more information on mass patient care plans for LHDs?

There are likely some parts of mass patient care that the LHD leads and other parts that are led by other agencies. If your agency is completing a PPHR application and another agency is the lead for a particular evidence element, then the LHD must provide all of the information under #1 of the PPHR tip sheet (http://www.naccho.org/toolbox/tool.cfm?id=1826).

The primary driver of a mass patient care plan is the need to expand capacity rapidly. Not only will there need to be pre-hospital triage and hospital care, but if the surge is so great that it overwhelms the full capacity of the hospital, the LHD may need to set up alternative care sites. Common LHD lead roles in mass patient care include operating community-based or alternative mass care centers for less severe patients, including setting them up and tearing them down, and requesting additional resources from the state. LHDs also sometimes provide resources, such as nurses, through the EOC.

Some basic elements of a mass patient care plan include:

Concept of operations;
Command and control;
Communications;
Staffing and training;
Clinical standards, protocols and operations;
Infection control;
Fatalities/morgue (This should relate to the mass fatality plan.);
Facilities;
Equipment and supplies;
Security; and
Transportation.

There is a toolkit on planning for a mass medical care during an influenza pandemic that may be useful: http://www.naccho.org/toolbox/tool.cfm?id=1550.

Goal I, Q: Do you have more information on mass fatality planing for a local public health department?

A: Yes, "Public Health has key roles in mass fatality management that include, at a minimum, health surveillance; worker health/safety; radiological/chemical/biological hazards consultation; public health information; and vector control." (From an APC tool by Santa Clara County Public Health Department)

Information contained in a Mass Fatality Plan Annex for a local health department should be very specific to the LHD and the roles that its specific staff members will play during mass fatality events.

Because LHDs are rarely the lead in mass fatality events, planning for mass fatality events presents an opportunity for the development of public/private partnerships with funeral homes and cemeteries.

NACCHO has a toolkit for planning for managing mass fatalities, created by the Santa Clara County Public Health Department through the APC program. The toolkit is available here: http://www.naccho.org/toolbox/tool.cfm?id=1595.

Goal I, Q: In a continuity of operations plan, how can an LHD determine which LHD functions must be continued in light of a natural disaster or deliberately caused emergency?

A: Essential functions vary among LHDs. One approach is to list all health department functions and then to rank them by priority and note whether each function would be expanded, continued, reduced, or removed in the event of an emergency. There is an excellent tool that can help an LHD work through this process, located here: http://www.naccho.org/toolbox/tool.cfm?id=1696. Similarly, each function could be marked as critical, essential, priority, or non-essential, and a column could be created documenting when each function would be resumed after an emergency (i.e., 24 hours, 72 hours, and/or 96 hours). This tool, http://www.naccho.org/toolbox/tool.cfm?id=286, offers an example of another type of delineation, beginning on page nine.

Goal I, Q: How can an LHD be specific about its surge capacity and its need for additional resources in emergency situations?

A surge capacity annex should be a cohesive answer to these three questions:

What are the limits of your response capacity, including both staff and resources?
When this threshold is met, how are you going to get the additional resources you need?
Who are you contacting to make these requests and what protocols do you have in place to receive the additional resources necessary to continue facilitating your response?

An example surge capacity annex is available in the PPHR toolkit at this link: http://www.naccho.org/toolbox/tool.cfm?id=340.

Please note that tools in the toolkit may have been reviewed against earlier versions of the criteria. While this document still provides an example of a best practice, it may not meet all of the requirements of the most recent version of the PPHR criteria.

Goal II, Q: Do all staff need to be assessed by the training needs assessment?

A: It is recommended that 70% or more of staff is assessed in a reliable and valid manner. However, it is acceptable to assess a sample of the staff if there is justification provided for the selection of the sampling size (i.e., methodology for number of staff participating in assessment and/or staff type).

Goal II, Q: What are rapid training curricula?

A: Rapid training curricula are the same as just-in-time training. The curricula should be just-in-time/rapid training, which often spans from about 15 minutes to one hour in length and ideally should not last longer than 30 minutes. You should be able to use these curricula in a real emergency. It is acceptable to include some online trainings that provide a general overview of a procedure; however, the trainings should last no longer than one hour. Rapid training curricula should describe job responsibilities and information on how to perform the duties associated with a specific job and should reflect the agency’s all-hazards plan.

Goal III, Q: Should applicants submit blank copies of each of the exercise evaluation tools or copies of all of the completed forms?

A: Applicants should submit a single blank copy of each of the exercise evaluation tools. Applicants do not need to include the completed forms in their submission.

Goal III, Q: In an after action report, what is the difference between the summary of the real event and an overview synopsis of the real event?

A: The summary provides the basics of the after action report (where, when, etc.). It covers the scope but with little or no detail. The synopsis is more descriptive and more in depth; it is the narrative part of the after action report that really gets into the nuts and bolts of what happened and the response. One analogy for PPHR purposes could be that the summary would align with general information provided about the real event in the executive summary document, whereas the synopsis would provide an overview of the information provided in an after action report.

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