JURISDICTIONAL INSPECTION PREPAREDNESS SORM 2014 Risk Management Symposium.
The 2018 NYC Public Health Jurisdictional Risk Assessment
Transcript of The 2018 NYC Public Health Jurisdictional Risk Assessment
The 2018 NYC Public Health Jurisdictional Risk Assessment
FINAL RESULTS
Françoise Pickart, Risk + AnalyticsDOHMH |Office of Emergency Preparedness and Response | December 2018
Goals of the JRA
• Identify and rank the top hazards to the public’s health in NYC
• Prioritize DOHMH preparedness work on the Response Inventory according to disaster risk
“…a robustness criterion often yields no single best answerbut rather helps decision makers to use available scientific and socio-economic information to distinguish a set of reasonable choices from unreasonable choices and to understand the tradeoffs implied by choosing among the reasonable options…”
Defining public health disaster risk
Hazard Occurs
(Probability)
This definition prioritizes a focus on consequences over severity alone.
Methods
5 Rounds of Surveys | May to October
• Round 1 Participants review current lists of hazards and contributors and suggest additions. Open-ended questions
• Rounds 2 & 3 Participants choose the top 9 from each list according to their relative importance. Choose 9
• Round 4 Participants weigh the relative importance of each contributor to disaster risk. Analytical Hierarchy Process
• Round 5 Participants rank hazards according to the relative influence of each contributor. Analytical Hierarchy Process
Participation by Stakeholder Group
DOHMH NYC Health Care Coalition
Total Participants
766
Also: 16 subject matter experts
from 13 universities/think tanks
Representing
100% of Divisions
99% of Bureaus
84% of Work Units
94% of ERGs
71% of ICS Leadership
Total Participants
709
Representing
50 Hospitals
132 Nursing Homes
NYC MRC
65 Other Health Care Orgs*
*Includes VA, OMH facilities, FQHCs, etc.
Other Government Agencies Non-Profits, Coalitions and Community Partners
Total Participants
110
Representing
27 NYC Agencies
11 NYS Agencies
3 Federal Agencies
Total Participants
231
Representing
142 total organizations
123 work with “at-risk”• 42 focus on people with disabilities
• 36 focus on immigrants
6680 surveys completed | 1832 participants
Public Health Hazards
• Cyber attack’s top spot driven by high probability and low manageability.
• Excessive heat is considered highly manageable but high probability puts it at #4.
• Low relative severity and high manageability put a MCI in last place.
Hazards for which we are least prepared
• Cyber Attack (Rank 1)
• Chemical Emergency (Rank 5)
• Air Contamination (Rank 8)
How do we measure the manageability of a hazard?
Response Inventory (what DOHMH does in emergencies)
→20 manageability contributors to evaluate
Round 1
→10 contributors added
30 manageability contributors evaluated
Final Manageability Contributors
See handout for full list
Round 5 Example
Pairwise comparison of hazards to create a prioritized list
Hazards that we are best able to manage
Final Severity Contributors
Severe injuries and an increase in illness.
15.5%
Deaths
15.0%
Risk of an associated disease outbreak
13.4%
Disruption to the potable water supply
12.1%%
Increase in harmful or life-threatening toxic exposures
and environmental contamination 10.0%
Loss of utility-provided power
9.7%
Diminished capacity of the healthcare system
9.2%
Food scarcity*
7.7%
Disruption of communications systems*
7.5%
*Contributors not used for ranking hazards as low weight would not affect outcome.
Hazards that are the most severe
How do we measure the probability of a hazard?
• Probability is the most difficult to measure element of risk.
• Four generic contributors chosen to estimate the probability across different hazard type.
Final Probability Contributors
Changes in the environment or threat landscape that make
it more likely to occur
38.0%
Forecast models and academic or actuarial studies
23.4%
An increasing frequency of similar events
23.2%
The number of reported occurrences
15.3%
Hazards that are most likely in the next 10 years
Hazards that didn’t make the final list
Emerging disease with epidemic potential and Large-scale release of a biological agent without
countermeasures were combined for ranking under Emerging Disease after Steering Committee review found the
two hazards were not sufficiently distinct. Both hazards represent an unknown threat with significant uncertainty.
Cut in Round 2
In order of votes
Cut in Round 3
In order of votes
Homelessness
Winter weather
Routine disease outbreaks
Mass incarceration
Civil disturbance
Earthquake
Obesity and metabolic syndrome
Space hazard impacts
Community violence
Radiological dispersion device
Food contamination
Large scale release of a biological threat
with available medical countermeasures
Nuclear explosion
“Choose the none hazards that you feel are the most critical for the city to focus its preparedness efforts on.
Not selecting one of these hazards does not mean it is unimportant to you, but it does mean it is of less concern
than those that you select.”
Hazards contributed by participants
Terrorism-focused hazards considered in the last JRA
• In the last decade, these hazards
have been focus of intense
planning resources.
• While these hazards remain a
threat, preparedness work has
reduced the disaster risk
considerably.
Top 3 Hazards
Respiratory Virus with Pandemic Potential
Facilitate at-risk populations’ access
to pharmaceutical countermeasures
to reduce disaster-related morbidity
and mortality
Conduct laboratory analysis of clinical,
environmental, food, and water samples
to identify specific threats
Activities we are best at in a Respiratory Pandemic
Activities we are worst at in Respiratory Pandemic
Manage
fatalities
Situational
awareness
Cohesive
citywide
response
Access to
resources
Vulnerable
populations
Increase law
enforcement
activities
Essential
services
Resources for
pets
Other FindingsManageability contributors critical to public health led by other agencies
NYCEM• Provide accessible transportation.• Provide temporary housing for those displaced from their home • Facilitating the rapid credentialing of medical personnel (w NYPD)• Connect available financial assistance to those impacted by the
disaster• Provide resources for pets• Provide technical assistance so community groups can better respond
(w DOHMH)• Provide mechanisms for two-way communications (w DOHMH)
NYPD• Increase law enforcement activities
OCME• Manage fatalities
Why this is a model for the nation
• Inclusive. First-of-its-kind public health risk assessment with meaningful input from
four communities:
Public Health - Health Care Sector - Government Partners - Community Groups
• Focuses on consequences not hazards. Instead of a traditional scenario analysis
approach, focuses on the health consequences of disasters and incorporates
scenarios with unidentified causes. Fits within a broader public health framework
tying risk estimates to the social determinants of health.
• Operational. Results produce a ranked list of critical activities to guide public health
preparedness work. Identifies gaps in City efforts that DOHMH can help address.
• Transparent and replicable. Decision making is transparent and tied to a public
health evidence base. Entire process is accessible, scalable and replicable.
Changing the risk paradigm
Traditional Risk Management A Resilience Approach to Risk JRA Approach
Principles Preservation of the status quo, that is, to
avoid transformative change; minimize the
risk of failures.
Adaptation to changing conditions without
permanent loss of function (e.g. changing paths if
not destinations).
Acknowledgement of unknown hazards.
Objectives Minimization of probability of failure, albeit
with rare catastrophic consequences and long
recovery times.
Minimization of the consequences of failure,
albeit with more frequent failures and rapid
recovery times.
Strategies Armoring, strengthening, oversizing,
resistance, redundancy, isolation.
Diversity, adaptability, cohesion, flexibility,
renewability, regrowth, innovation, transformation.
Mechanisms for
coordinating
response
Centralized hierarchical decision structures
coordinate effects according to response
plans.
Decentralized, autonomous agents respond to local
conditions. (able to identify areas for community)
Modes of
analysis
Quantitative (probability-based) and semi-
quantitative (scenario-based) analysis of
identified hazards in context of utility-theory
(i.e. costs and benefits)
Possible consequence analysis involving
scenarios with unidentified causes.
Park et al. Integrating Risk and Resilience Approaches to Catastrophic Management in Engineering Systems. 2013. Risk Analysis.
Reporting | 2019 Hazard Mitigation Plan
Public Health Jurisdictional Risk Assessment
DOHMH
Hazard Mitigation Plan 2019
NYCEM
Chemical Emergency CBRN
Coastal Storm or Nor’Easter Coastal Storm
Cyber Attack Cyber Threat
Emerging Disease with Epidemic Potential CBRN
Excessive Heat (includes power outages) Extreme Heat
Respiratory Virus with Pandemic Potential CBRN
Air Contamination (New)
Mass Casualty Incident
Water Contamination
Not in HMP
Not in JRA Coastal Erosion
Earthquakes
High Winds
Winter Weather
CBRN
Next Steps
1 DOHMH will use results to prioritize preparedness work across the agency.
December 2018
2 Report results in NYCEM’s 2019 Hazard Mitigation Plan
April 2019
3 Develop reports for 5 audiences:
• National audience
• DOHMH-focused report
• Government partners
• Health Care Sector
• Community partners
June 2019
Extra Slides
Methods
Measuring the Severity, Probability and Manageability of Hazards (Round 5)
• To measure severity contributors for the top hazards:• We surveyed DOHMH programs and external agencies that work in the
contributor area.
Example: OVS and OCME for Deaths
• To measure probability contributors for the top hazards:• We surveyed a broad swath of analysts with experience synthesizing
various data sources to make estimates.
• To measure manageability contributors for the top hazards:• We surveyed DOHMH Emergency Response Groups and external agencies
that perform the functions.
A Steering Committee with representatives from DOHMH, NYCEM and
ORR periodically reviewed the JRA process.
Top 3 Hazards
Cyber Attack
Activities we are best at in a Cyber Attack
Protect the safety of Health Department
personnel and coordinate public health
guidance for city workers
Activities we are worst at in a Cyber Attack
Risk
communications
Cohesive
citywide
response
Adequate
staffing
Access to
resources
Vulnerable
populations
Assist the
healthcare
system
Situational
awarenessEquity
Assist
community
groups
Track the
effects
Share data
Information
to
healthcare
providers
Essential
services
Knowledge
among
Health Dept
staff
Top 3 Hazards
Coastal Storm
Facilitate access to resources to
support the public health disaster
response
Connect available financial
assistance to those impacted
by the disaster
Create widespread knowledge among
Health Department staff of the
disaster-related health impacts and
related guidance
Provide resources for pets
Activities we are best at in a Coastal Storm
Activities we are worst at in a Coastal Storm
Two-way
communications
Laboratory
analysis
Safety of
Health Dept
staff
Accessible
transportation
Health policies
Prevent the
spread of
disease
Adequate
staffing