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\f0\fs24\cf0 (Music.)\
JACK BEALL: I would now like\
to introduce our closing\
keynote speaker Rear Admiral\
Nicole Lurie , MD. Dr. Lurie\
is the Assistant Secretary\
for Preparedness and\
Response of the US\
Department of Health and\
Human Services. As such she\
serves as the secretary's\
principal adviser on\
matters related to\
bioterrorism and other\
public health emergencies.\
Her office is the lead\
agency for federal public\
health and medical\
preparedness and response.\
Helping the nation prepare\
for, respond to and recover\
from disasters. Dr. Lurie\
has a long history in the\
health services research\
field primarily in the areas\
of access to and the quality\
of care, manage care, mental\
health, prevention, public\
health, infrastructures and\
preparedness and health\
disparities. Dr. Lurie\
attended college at the\
Medical School at the\
University of Pennsylvania,\
completed her residency and\
Masters of Science in public\
health at UCLA where she was\
also a Robert Wood-Johnson\
Foundation Clinical Scholar.\
Dr. Lurie continuous to\
practice her clinical\
medicine in the healthcare\
safety net in Washington DC.\
Please welcome Rear Admiral\
Nicole Lurie, Dr. Lurie.\
(People clapping.) REAR\
ADMIRAL NICOLE LURIE: Well\
thanks Jack. I just want to\
say this is so unfair.\
(People laughing.) REAR\
ADMIRAL NICOLE LURIE: How on\
earth do you expect me to\
follow an act like that?\
That's ridiculous. So you\
can all choose to laugh as\
you like. It will be just\
fine. But it's been -- it's\
really great to be here and\
to just see amount of\
energy and excitement and\
just to hear these words of\
laughter just made this also\
ultimately worthwhile. But\
just wondering around\
talking to people and there\
isn't a person who hasn't told\
me what a terrific meeting\
this is. What they've\
learned, the people they've\
met, the people they\
reconnected with. And it's\
just great to see this\
energy and excitement. But I\
want to know why you try to\
punish me Jack. Anyway,\
Kevin Yesky open the summit\
I think most of you are\
probably here talking about\
preparedness and response as\
a system and he talked a lot\
about what being a system\
meant in all of these\
systems components mean and\
how they all fit together. In\
effect I think the whole\
premise of the integrated\
training summit like this is\
the system and to bring the\
various parts together often\
practicing each part before\
exercising it all together\
like we're going to do it in\
the national exercise in the\
next weeks and to learn how\
to make a stronger and\
better functioning hall. I\
was a little bit reminded of\
this business about planning\
and practicing all of the\
respective parts before you\
put it all together when I\
was driving in. Because in\
my prior life when I use to\
develop exercises that had a\
colleague who used to refer\
to this as Legos and\
snapping together all the\
Legos to make some big\
castle. And I was kind of\
amazed driving here to pass\
Lego Land (People laughing.)\
So I have to choose last\
night between walking to\
Lego Land and walking to\
Historic Grapevine. But I\
did choose the former that\
was good to see some of you\
who also made the trek.\
Anyway last year at this\
time I was able to share\
with you some of our\
observations from coming\
through H1N1 pandemic. And\
coming through Haiti where\
many of you were in play\
such an important role. And\
last year at this time we\
were in the middle still of\
our Deep Water response and\
had come to appreciate much\
more fully the profound\
impact and the profound\
behavioural health\
challenges that emanated\
from this disaster. We were\
just finely winding down\
from Deep Water taking a\
sigh relief, getting the\
bunch of stuff done and then\
you know another one of\
these unthinkable things\
happened obviously, an\
earthquake, tsunami or\
nuclear power plant crisis.\
And now we're just winding\
down our involvement with\
the nuclear crisis in Japan.\
And a lot of you may\
actually wonder what on\
earth that had to do with us\
here? It's a good question.\
First is in deep water, I\
think lots of people had\
concerns about something\
they don't know very much\
about. And in that case it\
was oil & dispersants in this\
case it was radiation. And\
learning that there are\
trace amounts of radiation\
detected in water and milk\
and other things that caused\
lots and lots of fear turned\
out that there are also\
about a 180 thousand\
American citizens living in\
Japan. And they all have\
questions and concerns too.\
As did airport workers and\
other's specially having\
heard early on about a\
couple of people who\
triggered radiation\
detectors as they came back\
to the country including one\
I think at Dallas Fort Worth\
Airport. And now the\
country's had a multi-state\
outbreak of tornados so it's\
been another interesting\
kind of non-traditional year\
over last year. Each of\
these events though has\
highlighted just how far we\
have come in our\
preparedness. And even last\
week Dan Williams said who\
is the public health\
director in Alabama I'm\
going to visit tomorrow told\
me that our preparedness\
investments were what\
enabled them to deal with\
the tornado when it's in\
aftermath. And that's been\
incredibly gratifying to\
hear. In many larger and\
smaller events across the\
country we have seen states\
being able to handle things\
themselves in really\
creative ways. And many of\
them have told us so much\
about how the investments\
we've made in the public\
health and healthcare\
preparedness infrastructure,\
how the work of our regional\
emergency coordinators, how\
practice with DMATs, how\
MRC's other things, how the\
DMORT training has really\
helped them deal with those\
events. It will come as no\
surprise to you that we've\
now totally embraced FEMAs\
whole community approach to\
preparedness response and\
recovery. We are well past now\
the time of building a system\
for the average white\
English speaking adult male\
and retrofitting it for\
everybody else. For me one\
of the great things about\
this year is actually been\
working with Rich Sermino\
and the team at FEMA. We\
were supposed to go visit\
our Dallas Regional Office\
tomorrow but and actually a\
little more than a month ago\
we were supposed to visit\
the Kansas City Regional\
Office together. I woke up\
in the morning to find the\
he'd already caught the last\
seat on the first plane out\
to deal with the Japan\
earthquake. Tomorrow I guess\
he's gonna be in Alabama and\
I'll be joining him there\
but we've been doing just a\
ton of work together over\
the last year and it's\
collaboration we have with\
emergency responses are just\
getting stronger and\
stronger. Taking a systems\
approach to preparedness and\
response fits really\
perfectly I think with the\
concept of the whole\
community approach. Much of\
my time between disasters in\
the last year was talking up\
focusing on the medical\
counter measures system.\
Again stepping back trying\
to take the systems approach\
to understanding why it was\
that we didn't have the\
products we need when we\
needed them looking first at\
surveillance, working all\
the way through research and\
drug development and stock\
piling to distribution. So I\
thought now that we are\
through that in the secretary's\
counter measure report\
has been issued and we're in\
the process of implementation,\
that I take a few\
moments and share with\
you some of the other\
systems issue that had\
become priorities for me as\
we step back from each of\
those events that we've\
dealt with and look at where\
the system needs to be\
strengthened. First and\
foremost and fore front I\
think you all know in the\
national health security\
strategy is this issue of\
building resilience. And a\
lot of what all of you did\
day to day, week to week is\
help build communities\
resilience and help build\
health system resilience.\
From my office too we're\
also looking at other\
non-traditional ways to\
build resilience and I\
fundamentally believe that\
the key to this is the kinds\
of things that we can do to\
strengthen the connections\
between people day to day so\
that those connections\
between people can serve them\
well in a disaster. So with\
the help of my assistant\
Stacey Elmer whose taken a\
huge lead on this we've\
just launched a challenge on\
Health 2.0 to build a\
facebook application. And\
our goal is to have this\
facebook application work\
for people to identify those\
folks who can be their\
lifelines, people who they\
can depend on in an\
emergency. The idea will be,\
thanks, the idea will be\
that you'll designate\
probably no more than 3\
people as your lifeline. And\
to be a lifeline you have to\
agree to some terms and\
conditions. If there's an\
emergency it's expected that\
your lifelines will help you\
out whether they live in\
your neighbourhood or\
whether they live far away.\
We've had a terrific\
collaboration with facebook\
about this. So I'm really\
excited about it. Those of\
you who want to enter the\
challenge or who did a\
little programming on the\
side or when you're sitting\
around between responses,\
health2challenge.com is\
where you go to find out\
about it. But we are very\
very excited about it. The\
contest runners will not\
only receive a cash award\
and an opportunity but they\
will have an opportunity to\
work with us and with\
facebook and others as we\
try to implement this. Our\
goal is to have it in shape\
so that we can pilot\
test it in advance of\
hurricane season this year.\
So stay tuned. Second issue\
that we've been really\
focused on actually since\
the H1N1 is the concept\
that we're calling budget\
preparedness. You know\
during the H1N1 it took 6\
months to move from an\
emergency supplemental in\
congress through OMB to HHS\
to CDC to State to locals to\
people who might put shots\
in arms. That's not a way to\
run a public health\
emergency. It takes way too\
long. So just as we have\
preparedness for all kinds\
of other things we are\
moving forward with this\
concept of budget\
preparedness. You will see\
in the public health\
emergency preparedness grant\
guidance for this year that it\
is really encouraging states\
to think about budget\
preparedness just as we at\
the federal government are\
looking a bunch of\
preparedness looking at how\
to streamline these systems\
and to move money more\
quickly. Again it's steeping\
back and talking the systems\
approach looking at where\
the systems are not yet in\
place to support response\
and communities the way they\
need to. The third area which I\
think will be near and dear\
to many of your hearts and\
again coming of off Haiti\
and Deep Water and frankly\
this last talk is to pay\
some more attention to\
behavioural health and Dan\
Dodgen and his colleagues are\
taking the lead in putting\
together for us the\
behavioural health con-ops\
so that behavioural health\
is part of the way we\
respond to every disaster\
going forward and it's sort\
of kind of hard wired and\
baked into the system.\
Fourth area is a relatively\
new area that we're just\
getting go on. And that's\
what I would call science as\
part of response. Again we\
sort of need a con-ops\
for this and probably at the\
end of the day some\
prescripted mission\
assignments. But I was\
pretty shocked to learn as I\
did in Deep water for\
example that we've had\
something like 30 or 35 oil\
spills in history and we\
still can't tell you how bad\
the oil & dispersants are for\
you. That's kind of crazy.\
When I looked back I\
realized that we've missed\
some important opportunities\
to advance knowledge during\
H1N1, during Haiti, during\
each of our response\
recently during Japan\
because we haven't really\
been thinking -- as\
rigorously as we can about oil\
what do we need to learn\
today so that it's going to\
help us in our response\
after this? And so that's a\
piece of a system that's\
just getting going. In the\
last two I think I want to\
spend some more time talking\
about and those have to do\
with moving our healthcare\
preparedness approach from\
the individual hospital\
focus to a whole community\
focus and integrating better\
public health and healthcare\
which is I think you all\
know have long travelled on\
parallel tracts never to\
meet. We have to put an end\
to that. Today the hospital\
preparedness program\
released a terrific report\
on our country's progress in\
healthcare preparedness over\
the past decade. What I\
really like about this\
report is that it shows us\
state by state, grantee by\
grantee just where we are\
and a set of capacities and\
capabilities and honest set\
of preparedness outcomes.\
of the about 6300 hospitals\
in this country about 5400\
of them about 85%\
participate in the hospital\
preparedness program one way\
or another. States and\
hospital have used HPP funds\
along with DHS funding and\
CDC funding to purchase\
needed equipment, plan for\
medical surge, evacuation,\
mass fatalities and to test\
their preparedness in\
exercises as well as in real\
events. And as I look at\
this report, I am really\
encourages. 15 grantees were\
report that over 90% of\
their hospital received I\
mean achieved all 8 outcomes\
reported on. 8 of those\
actually were the 100%\
across the board, which is a\
terrific achievement. You\
can see the impact of these\
efforts clearly as I said\
last week and in the storms\
last week. For those of you\
in NDMS who have been\
anxiously waiting for that\
phone call telling you to\
deploy and really\
disappointed with the fact\
that it didn't come, I have\
to tell you that in a lot of\
ways this was a real good\
news story for us is because\
no federal assistance rally\
needed. Certainly in talking\
to folks on the ground there\
in the state what they tell\
us is the work that you've\
all done, the funding, the\
practice, all of those other\
things that made it possible\
to deal with this without\
federal assistance.\
Communities called on\
pre-registered medical\
volunteers such as the\
Medical Reserve Corps.\
Hospitals using emergency\
response plans to cope with\
this surge in demand and\
they told us time and time\
again that they couldn't\
dealt with the mass\
fatalities without the work\
that we all done together.\
In some cases they use\
mobile units purchased with\
federal grants possible to\
submit able to communicate\
with first responders using\
operable equipment also\
purchased with federal\
funds. Training in the\
incident command structure\
has been key and it helps\
with communication and\
integrated response between\
the public health,\
healthcare and emergency\
management communities. A\
huge success and in fact I\
think you should give all of\
your selves a big hand for\
this accomplishments.\
(People clapping.) REAR\
ADMIRAL NICOLE LURIE: We\
also see reports in the HPP\
report of early pilots of\
what have been referred to\
as healthcare coalitions. I\
think they are familiar to\
many of you. These aren't\
just individual hospitals\
but multiple hospitals and\
other healthcare entities in\
the community coming\
together for preparedness\
and response. They all\
understand that our private\
healthcare entities\
compete all the time. But\
that around preparedness and\
response we are not to\
compete we are to cooperate.\
I lived for 16 years or so in\
Minnesota and when I lived\
in Minnesota we used to call\
it coopetition so I would\
like to see coopetitions\
spread across the country.\
The report has really\
encouraging examples of how\
these coalitions have\
worked. I'd like to call out\
and an example of the one in\
Indianapolis as a great\
model. And there are others.\
As you'll see from the\
report the funding\
opportunity announcement for\
HPP on the advice of our\
stake holders many of you\
will be moving to strengthen\
community level healthcare\
preparedness and response as\
the program moves into its\
next phase by 2011 and\
beyond. And to do that we\
going to need to bring not\
only -- we're going to need\
to bring the hospital and\
the non-hospital based\
elements together. These are\
going to range from the\
primary care practices to\
dialysis centers to skilled\
nursing facilities and\
others along with hospitals\
to build these coalitions to\
build this preparedness\
system. To do this we have\
to strengthen day to day\
system so that they can\
function optimally in\
emergency. It doesn't change\
the central role of the\
hospital here but it does\
recognize that the hospital\
is no longer in a stove\
pipe of it's on it has many\
interdependencies with other\
healthcare entities in a\
community. It is in fact\
part of a healthcare system\
and what we are talking\
about here is building\
systems. Many of you\
probably heard me say it I\
known my staff here may say\
it endlessly that if you\
can't do it day to day you\
can't do it on game day.\
This is what you're all\
about. This is what your\
practice is all about. This\
is what your day to day work\
is all about. But from the\
healthcare system side if\
your emergency department is\
packed full of borders\
everyday clearing them out\
in a mass casualty event is\
likely going to be not going\
so well. If you've got\
people on hospital beds who\
are better served in the\
community but the community\
system isn't in place,\
clearing out your hospital\
beds in a hurry is going to\
be really hard and maybe\
even dangerous. If your\
healthcare entities and\
coalitions systems aren't\
connected to you and joined\
at the hip with public\
health and emergency\
management systems in your\
community you can be certain\
key parts of that system\
are going to break down in\
an emergency. So following\
your advice we will be\
supporting the development\
of these coalitions and\
these changes through\
realistic standardised\
exercise programs and the\
development of metrics for\
coalitions. We welcome your\
input into that process. At\
the same time we're backing\
up our whole community\
systems approach with much\
more of a whole of\
government approach to\
preparedness and response.\
Its actually been pretty\
amazing to me in each of\
these events to sit in the\
situation room with all of\
the partners across the\
government and really see a\
whole of government approach\
a very deliberately and\
thoughtfully at work in\
response and we have to do\
that before as well. It\
turns out that Rich Sermino\
at FEMA, Tom Freed at CDC\
and I all worked a lot on\
these issues before we came\
into our current positions.\
Frankly we all came into our\
current jobs determined to\
create a more rational\
system in which funding\
streams were aligned. The\
policies, plans, business\
processes requirements are\
aligned & synergistic with\
each other and certainly are\
not in conflict. Under the\
leadership of Admiral Clair\
Hominiac who's here and Admiral\
Ali Khan of CDC we are\
working to ensure that the\
FEP & HPP grants are aligned.\
Our goal is for a single\
funding opportunity\
announcement for the 2012\
grants cycle, a single\
application & reporting\
process and a shared\
consistent aligned set of\
capabilities and metrics.\
We've been working toward\
this with FEMA, the\
Department of Transportation\
as well and I'm pleased to\
tell you that the MOU\
between all of us ASPER,\
CDC, HRSA, Transportation,\
FEMA has been drafted and is\
winning its way through the\
infamous clearance process\
for signatures. But I expect\
it to be signed quite soon.\
And it really signifies our\
dedication to a\
collaborative approach to\
advance national\
preparedness and to more\
effectively focused on and\
use preparedness grant funds\
which I think we all know\
are getting increasingly\
scarce. So we can't waste\
some money on the silly\
stuff. We have to spend it\
and use it on the important\
stuff. A lot of the focus\
of this alignment is to get\
us exactly there. So under\
the MOU we'll work together\
for an innovative solutions\
that will reduce the\
administrative burden, the\
silly stuff, as well as\
have improved metrics that\
will going to allow us like\
the HPP report is doing to\
share our success stories\
more proactively and to\
measure our progress as we\
move forward in this decade.\
Truth is we've been really\
hard at work on alignment\
across government all year.\
I think this MOU really\
formalize it signals to all\
our staffs that we've got to\
get this done. Frankly it\
also signals to all of you\
that we want you to hold our\
feet to the fire here in\
getting it done. And if it's\
not happening we want to\
hear from you. So you can\
hear that we've bitten off a\
lot we have a pretty\
ambitious agenda for this\
next year and so do you. At\
the end of the day none of\
this happens unless America\
comes together one community\
at a time to weave a web of\
preparedness that ensures\
that no matter where you\
live you and your community\
are health secured, that you\
are protected from and\
resilient in the face of\
public health emergency. I'm\
sort of feeling like I\
should close with a joke but\
I don't have one. So I would\
just close by telling you\
that it's an honor to be\
able to share this vision\
with you in a week of what I\
think has been much needed\
national unity. One in which\
our country is reminded of\
the importance of this kind\
of work as it pays tributes\
to the heroes who are the\
victims and responders to\
September 11 and that we all\
understand ones again that\
when we as a country put our\
mind to something we will\
succeed. Thank you very\
much. (People clapping.)\
JACK BEALL: Ladies and\
gentlemen this concludes the\
2011 Integrated Training\
Summit. And I would like to\
thank everyone for taking\
the time out of your busy\
schedule to attend the\
events of this week. Please\
mark your calendars for the\
next year's event which I've\
been advised will be\
scheduled at Nashville,\
Tennessee. I officially\
close this 2011 Integrated\
Training Summit. Thank you\
and have a safe trip home.\
(People clapping.)\
(Music.)\
}