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Two States Reap the Rewards of their Cross-Border Partnership

Kristi Langford and Jessica Gover go door-to-door during the CASPER exercise

If you flash back 7 years ago, it wasn’t common practice for local counties in Tennessee and Kentucky to share emergency public health information across state borders. Instead, information would travel up vertically through traditional communication channels before being shared across the state line, from one state-level office to the other. The information would then travel down a vertical line in the other state to reach affected communities. The process did not lead to the quick exchange of information at the local level, with information typically being delayed for 1 to 2 days.

However, this began to change in the fall of 2006. In Allen County, Kentucky, a newly hired preparedness planner was studying grant guidance and job responsibilities. She noticed a deliverable outlining the need to work on cross-border collaborations. Her county bordered Tennessee, so she contacted a local health department there and ultimately was put in touch with a Tennessee regional emergency response coordinator. After speaking several times, they came up with the idea of pulling together their respective preparedness counterparts. Both states’ central office staff were immediately supportive of the idea and joined the group. In January 2007, the first meeting was held, and the Kentucky/Tennessee Unified Planning Coalition was born.

The first few years of the Coalition were spent getting the border counties together and learning how each of the states operates. The meetings also included discussions of CDC deliverables and the sharing of each state’s ideas and plans. The long-term goal, which was achieved in January 2013, was the completion of the “All Hazards Cross-Border Notification Plan.” The plan outlines how information regarding events such as disease outbreaks, hazardous materials incidents, and radiological incidents can be exchanged at the local level at the same time it works its way through state channels. This new process lends itself to more timely information exchange at the local level.

Tiegang Li, Doug Thoroughman, and Karen Lynn during the CASPER exercise

The All Hazards Cross-Border Notification Plan is being used and put into action. Even before it was finalized, the two states conducted a tabletop exercise based on a pandemic influenza outbreak. With 26 staff participating, the purpose of the exercise was to increase knowledge about the plan and spur discussion about how the plan would be used to prepare and respond to a public health incident. Recommendations for improvements were taken from the exercise and were incorporated into the final plan. The states have already seen communication flowing between counties. Examples of public health incidents that have resulted in information being exchanged include influenza cases, a fungal meningitis outbreak, and MRSA infections (a strain of staph bacteria that typically occurs in people who have been in hospitals or healthcare settings).

Significantly, work on the plan has spurred even more collaboration at state, regional, and local levels. In April 2013, the Coalition conducted a community assessment of two neighboring counties – Cumberland County, Kentucky, and Clay County, Tennessee. The purpose of the Kentucky/Tennessee Community Assessment for Public Health Emergency Response (CASPER) exercise was to look at household-based preparedness levels so that county public health and emergency management in each state can plan for what is needed post-disaster. Dressed in red vests, 15 teams of 2 individuals went door-to-door to complete 226 surveys along the Kentucky and Tennessee border. The exercise also tested the ability of the Kentucky and Tennessee public health agencies to coordinate response activities through an activated Incident Command System, with the two states sharing incident command responsibilities and communication equipment.

Not only did the exercise provide essential estimates of community disaster planning and vulnerable population needs related to public health emergencies, it also served as a vehicle for the states to assess themselves via CDC’s Public Health Emergency Preparedness (PHEP) Cooperative Agreement performance measures. This exercise demonstrated the ability of two states working together for the common good of their residents, many of whom frequently have work and personal commitments that find them crossing back and forth across the shared border.

 
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