摘要：Objectives. To demonstrate how inclusion of the Centers for Disease Control and Prevention’s Community Assessment for Public Health Emergency Response (CASPER) as a tool in Public Health Preparedness Capabilities: National Standards for State and Local Planning can increase public health capacity for emergency response. Methods. We reviewed all domestic CASPER activities (i.e., trainings and assessments) between fiscal years 2012 and 2016. Data from these CASPER activities were compared with respect to differences in geographic distribution, type, actions, efficacy, and usefulness of training. Results. During the study period, the Centers for Disease Control and Prevention conducted 24 domestic in-person CASPER trainings for 1057 staff in 38 states. On average, there was a marked increase in knowledge of CASPER. Ninety-nine CASPERs were conducted in the United States, approximately half of which (53.5%) assessed preparedness; the others were categorized as response or recovery (27.2%) or were unrelated to a disaster (19.2%). Conclusions. CASPER trainings are successful in increasing disaster epidemiology skills. CASPER can be used by Public Health Emergency Preparedness program awardees to help build and sustain preparedness and response capabilities. No US state or territory is exempt from the devastation of a natural or human-induced disaster (e.g., tornado, hurricane, oil spill, water contamination). Responding appropriately and effectively to the public health consequences of environmental disasters, whether natural or human induced, requires timely access to accurate information. Public health data are especially important to provide vital situational awareness and increase public health decision support, which may significantly influence resource allocation strategies and approaches for implementing public health response priorities, including preventive and protective measures for affected populations. Epidemiological methods, including rapid needs assessments, can provide reliable and actionable data for emergency management throughout the disaster life cycle (preparedness, response, recovery, and mitigation). 1 To assist states in capturing critical epidemiological data throughout the disaster life cycle, the Health Studies Branch (HSB), part of the National Center for Environmental Health of the Centers for Disease Control and Prevention (CDC), developed the Community Assessment for Public Health Emergency Response (CASPER) methodology. 2 CASPER is a rapid needs assessment designed to quickly gather household-based information on the health status and basic requirements of communities. CASPER is modeled on the World Health Organization’s Expanded Programme on Immunization survey technique for estimating vaccine coverage. 3,4 The design is a cluster sampling methodology wherein a set number (e.g., 30) of clusters (i.e., mutually exclusive groups in a population) are selected in the first stage and a set number (e.g., 7) of individuals or households are interviewed from each selected cluster in the second stage. Although there are variations in the methodology, the CASPER toolkit recommends the 30 × 7 sampling design to gain 210 interviews in the sampling frame. Results of data obtained with the 30 × 7 sampling design are weighted during analyses to provide population estimates with a precision of plus or minus 10 percentage points. 3,4 CASPER is an important tool in public health disaster response. When a CASPER is conducted, the information it generates can be used by emergency managers to make informed decisions, allocate scarce resources, provide valid information to the news media to dispel rumors, support funding needs for recovery efforts, and plan for future disasters. 5 For example, during the 2009 ice storms in Kentucky, CDC and the Kentucky Department for Public Health conducted a CASPER and identified the community’s need for additional supplies of supplemental oxygen. 5,6 The Kentucky Department for Public Health also used CASPER data to determine the need to disseminate targeted public health messages on the dangers of carbon monoxide, educate the community on safe use of generators, and modify future emergency plans to account for gaps such as pet-friendly shelters and early communication messaging. 7 Although CASPER was originally designed to provide information during disaster responses, it is also used throughout the disaster life cycle to obtain population-representative data. CASPER is also useful for collecting community public health information unrelated to a disaster. For example, public health departments used CASPERs to identify household-level information about chronic respiratory conditions, ascertain knowledge about emerging infectious diseases such as Zika virus and H1N1, and assess community awareness, opinions, and concerns on subjects such as coal gasification plants, healthy homes, community health, and radiation emergency preparedness. 8–12 HSB developed the CASPER toolkit to provide standard criteria for implementation among public health practitioners and emergency management personnel. 2 The first edition was released in 2009 and the second in 2012. To supplement the toolkit, HSB developed an interactive CASPER Web site and provides in-person trainings, by request, for state, tribal, local, and territorial (STLT) health department staff; emergency managers; and others. HSB staff educate participants about when to conduct a CASPER, the local capabilities required for conducting an assessment, and how to appropriately implement the assessment in the field. Each 1-day CASPER training is provided by HSB subject matter experts and tailored toward the specific requesting audience. Participant evaluations are often collected at the end of the training to gauge the usefulness and efficacy of the training and to help improve future trainings. HSB also provides technical assistance to support conducting CASPERs nationwide. In 2011 CDC, in consultation with the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, developed and published standards to aid STLT health departments in prioritizing use of federal funding received under the Public Health Emergency Preparedness (PHEP) program. 13 These standards drew from directives in national public health preparedness legislation, 14–16 the Pandemic and All-Hazards Preparedness Act, 17 and the National Health Security Strategy. 18 The CDC PHEP program provides funding for STLT public health departments across the nation to upgrade their ability to effectively respond to a range of public health threats including natural disasters, infectious diseases, and biological, chemical, nuclear, and radiological events. Since 2002, the PHEP program has provided 62 STLT awardees with more than $11 billion in funding to prepare for and respond to public health emergencies. Public Health Preparedness Capabilities: National Standards for State and Local Planning (hereafter Public Health Preparedness Capabilities ) identifies 15 public health preparedness and response capabilities that serve as national standards for planning and response to public health emergencies. 13 CASPER is referenced within the community recovery (capability 2) and mass care (capability 7) capability standards as a resource to identify and monitor the care and recovery needs of public health, medical, and mental–behavioral health in the community after a disaster or public health emergency. The community recovery capability highlights specific recommendations and guidance that can help communities recover, including identifying and monitoring public health, medical, and mental–behavioral health system recovery needs. The mass care capability provides recommendations and guidance to PHEP awardees about “working with partner agencies to address the public health, medical, and mental/behavioral health needs of those impacted, and includes conducting ongoing active surveillance and community assessment.” 13 Here we demonstrate how the use of CASPER as a tool for community recovery and mass care, as described in Public Health Preparedness Capabilities , can increase state and local public health capacity for emergency response.
