> *Bioterrorism and Other Public Health Emergencies*
>
> *Tools and Models for Planning and Preparedness*
>
> Emergency Preparedness Resource Inventory (EPRI)
>
> A Tool for Local, Regional, and State Planners

***Part 1. Implementation Report***

**Prepared for:**

U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality

540 Gaither Rd.

Rockville, MD 20850

**Contract \# 290-00-0003**

**Prepared by:**

Abt-Geisinger Associates

Andrea Hassol

Gary Gaumer

Anthony Turel, MD

Cynthia Thomas, DO

**AHRQ Publication No. 05-0077-1**

**April, 2005**

**Suggested Citation:** Hassol A, Gaumer G, Turel A, Thomas C. Emergency
Preparedness Resource Inventory (EPRI), A Tool for Local, Regional, and
State Planners. Part 1. Implementation Report. Prepared by Abt-Geisinger
Associates under contract no. 290-00-0003. AHRQ Pub. No. 05-0077-1.
Rockville, MD: Agency for Healthcare Research and Quality. April 2005.

[]{#__RefHeading___Toc67118532 .anchor}Preface

Abt Associates Inc., serving as prime contractor, the Geisinger Health
System, and Relyon Media Inc. collaborated on this project. The contract
was funded by the Agency for Healthcare Research and Quality (contract
\# 290-00-003, task orders 5 and 6).

Abt staff designed the structure for the Web-based inventory tool
(called the Emergency Preparedness Resource Inventory---A Tool for
Local, Regional, and State Planners) and assisted in the pilot field
test.

Geisinger Health System assembled a project Steering Committee in
Pennsylvania, created the resource list and list of location types for
the data warehouse, and implemented the pilot field test.

Relyon Media, a Web development firm, programmed the Web-based tool
based upon input of both the Abt and GHS project staffs.

An accompanying Technical Manual is intended for System Administrators
implementing this tool in their own jurisdictions. Instructions for
downloading and installing the software appear in that report. The
software tool itself is available without cost from the Agency for
Healthcare Research and Quality; it is copyrighted and cannot be resold.

For additional information, contact:

Andrea Hassol

Abt Associates Inc.

55 Wheeler St.

Cambridge, MA 02138

617-349-2488

andrea_hassol@abtassoc.com

Carole Dillard

Agency for Healthcare Research and Quality

\(301\) 594-1358

cdillard@ahrq.gov

**Contents**

[Preface.......................................................................................................
iii](#__RefHeading___Toc67118532)

[1.
Introduction.................................................................................................
1](#__RefHeading___Toc67118533)

[2. Inventory is
Comprehensive.............................................................................
2](#__RefHeading___Toc67118534)

[Types of Locations included in the
inventory.........................................................\...
3](#__RefHeading___Toc67118535)

[Types of Resources included in the
inventory...........................................................
4](#__RefHeading___Toc67118536)

[Specific Resources included in the
Inventory.........................................................\...
5](#__RefHeading___Toc67118537)

[3. Inventory is Flexible and
Customizable...............................................................
5](#__RefHeading___Toc67118538)

[Configuring locations and resources to tailor the inventory structure
to needs/circumstances... 6](#__RefHeading___Toc67118539)

[Decide which resources to
inventory.............................................................
6](#__RefHeading___Toc67118540)

[Determine what types of locations own/control the resources you want to
inventory...\... 6](#__RefHeading___Toc67118541)

[Match resources to location
types.................................................................
6](#__RefHeading___Toc67118542)

[Periodically Updating
Data..............................................................................\...
8](#__RefHeading___Toc67118543)

[4. Inventory Has Automated and Secure
Reporting...................................................
8](#__RefHeading___Toc67118544)

[System Configuration
Reports...........................................................................
10](#__RefHeading___Toc67118545)

[Senior Planner
Reports....................................................................................
10](#__RefHeading___Toc67118546)

[Emergency Response
Reports............................................................................
11](#__RefHeading___Toc67118547)

[Region-wide
Reports....................................................................................\...
16](#__RefHeading___Toc67118548)

[Data and Report
Security.................................................................................
19](#__RefHeading___Toc67118549)

[5. Software Has Been Fully
Tested.......................................................................
19](#__RefHeading___Toc67118550)

[Steering
Committee........................................................................................
19](#__RefHeading___Toc67118551)

[County-level political
support............................................................................
20](#__RefHeading___Toc67118552)

[Selected location types, resource types and resources relevant for
pilot test...................... 21](#__RefHeading___Toc67118553)

[Outreach to solicit
participation..........................................................................
21](#__RefHeading___Toc67118554)

[Recruiting Organizations and Collecting Data: Lessons
Learned...................................
22](#__RefHeading___Toc67118555)

[Motivating
Participation........................................................................\...
22](#__RefHeading___Toc67118556)

[Test
Results.......................................................................................\...
22](#__RefHeading___Toc67118557)

[Lessons Learned About Soliciting
Participation...............................................
23](#__RefHeading___Toc67118558)

1.  []{#__RefHeading___Toc67118533 .anchor}Introduction

This report, and the accompanying Technical Manual and Appendix,
presents a software tool intended for use by local or regional planners
to develop an inventory of critical resources that would be useful in
responding to a bioterrorist attack. The Emergency Preparedness Resource
Inventory (EPRI) is a Web-based software tool for assembling such an
inventory.

In 2002, Abt Associates conducted a review of guidance promulgated by
the Centers for Disease Control and Prevention (CDC) and other agencies
of the Department of Health and Human Services (DHHS) to states and
regions concerning preparedness to respond to bioterrorism events. The
federal guidance focused on estimating the ***demand*** for resources
needed in the event of specific bioterrorism events, and assuring that
needed resources can be quickly assembled. That is, states and
localities were advised to estimate threats and the resources that would
be needed to respond to these threats. This focus on demand for
resources continues to be the emphasis of federal initiatives. Much less
mention was found in the planning and guidance documents related to
assessing community or regional ***supply*** of resources that could be
made available to cope with bioterrorism events.

An exception to this rule was the CDC's 2001 planning guide covering
many aspects of bioterrorism preparedness and response. The planning
guide suggested that effective planning includes determining the
resource base (the supply) of resources in a community. The CDC advised
that members of planning teams should:

-   Know what resources they bring to emergency response and recovery

-   List available resources and compare against what would be needed to
    respond to an emergency, and

-   Identify shortages (i.e. where potential demand exceeds supply).

In discussions with one regional planning taskforce in Pennsylvania, it
became clear that planners had no such inventory or detailed knowledge
of available local and regional resources, and that the lack of such an
inventory was impairing planning effectiveness. This situation probably
exists in many other parts of the country.

An inventory of critical resources could be useful in a number of ways:

**Incident Response:** A major emergency, whether natural or man-made,
could require the rapid location and deployment of equipment, supplies
and personnel. First responders need to know where the needed resources
are located, how much is available, and whom to contact to get access to
those resources. An inventory that lists relevant resources and their
quantities and locations, as well as contact information, would meet
this need.

**Estimating Gaps:** An inventory would tell planners "what is"---what
exists in their jurisdiction. Planning also requires some measure of
"what should be"; with the difference between these being an imbalance,
either a surplus or a shortage. Determining "what should be" could rest
on the guidance of an expert panel, or a set of standards developed at a
federal level, or a model of a 'well supplied' community that others are
striving to match. Such standards could also revolve around specific
threat scenarios. The adequacy of community preparedness would broadly
recognize the span of threats, the likelihood of their occurrence,
distances from larger urban areas, etc. Standards could be defined for
each resource in an inventory, and might best be done on a population
basis, for example burn beds per capita or respirators per capita.

**Investment Decisions:** Having identified shortage where a community
does not meet agreed-upon standards, an inventory could have dollars
associated with each resource to guide investment decisions. If a state
or locality has a fixed budget, and a list of needed resources (possibly
prioritized based on local decisions or perceived threat likelihoods),
trade-offs among investments become more obvious.[^1]

The goals of this project were to:

1)  Create a software tool for assembling a regional inventory of
    resources that would permit better bioterrorism readiness planning
    and better response in the event of an incident, and

2)  Pilot test the software tool in an eight-county region of
    Pennsylvania.

This report presents the features and contents of the inventory software
(EPRI) and describes a pilot test conducted during the summer of 2003.
This report discusses the contents of the inventory, how state or local
authorities can customize the inventory structure to meet their needs,
security and confidentiality protections, and an extensive test of the
inventory tool.

EPRI is a software tool that can be customized to create an inventory
appropriate for any region, state or locality. It is Web-based so that
all selected organizations in an area can log in to enter information
about their resources. It creates automated reports for use in
preparedness and planning as well as incident response. EPRI also has
extensive security protections. Please see the accompanying Technical
Manual for detailed instructions for installing and using the tool.

2.  []{#__RefHeading___Toc67118534 .anchor}Inventory is Comprehensive

The list of resources to be itemized in EPRI is comprehensive and covers
resources that might be available in major urban settings, as well as in
rural areas like central Pennsylvania. Included in the tool are
virtually every type of organization, agency and location that might
have resources to contribute in the case of a major emergency, and the
specific resources each might be expected to control. Not only health
care providers and first responder agencies were included, but also
public schools, mortuaries, animal control facilities, community
pharmacies, and others. The tool's flexibility makes it possible to add
to, or subtract from, the resources currently included. A state or
region wishing to use the tool to create their own inventory might want
to restrict themselves to a smaller set of organizations, or might wish
to restrict the list of resources to those relevant only to immediate
incident response. EPRI offers full flexibility so that the inventory
structure can be tailored to the needs and circumstances unique to any
given setting or purpose. [^2]

Three terms are used in this report to explain the inventory structure
and contents:

-   **Location Types** are places (hospitals, fire stations, public
    schools) that might be expected to control useful resources.

-   **Resource Types** are categories of resources (antibiotics,
    physicians, emergency vehicles) that help to organize the inventory.

-   **Resources** are the specific sorts of equipment, personnel and
    supplies that might be needed to respond to a natural or man-made
    disaster.

    []{#__RefHeading___Toc67118535 .anchor}Types of Locations included
    in the inventory

EPRI currently contains thirty-three location types, encompassing a
large array of services (see box, where location types are listed
alphabetically).

Healthcare locations include hospitals, home health nursing agencies,
nursing homes, freestanding medical and surgical centers, private
physician offices, rehabilitation and psychiatric hospitals, blood
banks, and public health departments. Each of these location types was
chosen for inclusion based on its capacity to provide medical services,
to contribute medical supplies or patient beds, or to house or shelter
patients.

Emergency response locations include emergency management agencies,
emergency medical services, fire departments, law enforcement agencies,
the American Red Cross, and the National Guard. Each of these location
types provides unique services during any emergency situation or
disaster response. Each can contribute specially trained personnel and
equipment during an emergency and should be included in planning and
incident response efforts.

Miscellaneous other types of locations have been included as well,
although we normally do not think of these as bioterrorism response
locations. Keeping in mind that any disaster, in particular one prompted
by biological agents of terrorism, may affect the animal population as
well as the human population, animal care facilities and animal
containment facilities have also been included in the inventory. Due to
the fact that a large-scale disaster may create mass fatalities, funeral
homes have also been included. Location types such as arenas, stadiums,
warehouses, gymnasiums, and community centers were included because they
have extensive space that could be used for housing or sheltering
individuals in need, creating a vaccination or antibiotic distribution
site, housing animals, or serving as a storage location for imported
equipment, supplies, or medication and have also been included in the
inventory. Due to the ever-changing nature of planning needs, the tool
was designed to be readily customizable to any region and/or any
planning and incident response need.

[]{#__RefHeading___Toc67118536 .anchor}Types of Resources included in
the inventory

A resource class designates the way data are collected. For example,
Personnel is a resource class and collects information about full time
and part time personnel. Facilities Capabilities is another resource
class and contains yes/no questions about the sorts of capabilities a
facility might have (e.g. back-up water supply, food preparation). All
types of resources are assigned a resource class so that data collection
is correctly formatted.

Resource type is a category of personnel or equipment resources. Some
examples of resource types include physicians, antibiotics, and
communication equipment.

Within each resource type are specific resources; examples include
pediatricians (within physicians), azithromycin (within antibiotics),
and mobile radios (within communications equipment). Each resource type,
and the resources specific to it, represent personnel or equipment
critical in planning and responding to large-scale emergencies. An
Internet search was undertaken to identify any list previously compiled
for the wide range of location types in our inventory, but none was
located. Emergency response directors on the project steering committee
indicated that no such list exists. As a result, project staff developed
what is believed to be the first comprehensive list of this type.
Resources were initially identified through an extensive review of the
literature, expert consultation, interviews with emergency response and
healthcare providers, and meetings of a project Steering Committee.

Rather than asking every type of location to go through the entire list
within the inventory and fill in information where applicable, each
resource has been assigned to specific location types where that
resource is likely to be found. Fire stations are not asked about
hospital beds, for example, and home health agencies are not asked about
fire trucks.

To facilitate data entry for the end user and effective use of the data
by planners and responders, resource nomenclature has been standardized
when possible. For example, personal protective equipment (PPE)
resources have been standardized in accordance with the Occupational
Safety and Health Administration (OSHA) guidelines regarding PPE.

Those resources that have been standardized are listed and defined in a
Help Guide that is incorporated into EPRI. This allows users to refer to
the help guide to ensure that data entry regarding existing resources
reflects the intent of the inventory. Due to potential differences in
planning needs across the country, resources currently included in the
inventory can easily be edited or removed, and additional resources can
be added to make the inventory specific to the needs of each community,
region, or administrative agency using the tool.

[]{#__RefHeading___Toc67118537 .anchor}Specific Resources included in
the Inventory

For every resource type (see box on previous page) there is a list of
specific resources; some resource types have just a few resources,
others have many. There are hundreds of specific resources in the
inventory, all organized by resource type. (See box for an example of
the specific resources included in the resource type: Antibiotics.)

The entire list of resource types, resources and locations types appears
in a separate Appendix accompanying this report.

[]{#__RefHeading___Toc67118538 .anchor}3. Inventory is Flexible and
Customizable

EPRI allows a state or local authority to specify precisely which
location types, resource types and resources are to be included. The
extensive lists can be readily shortened or expanded, and can be changed
whenever needed. At present, the inventory is configured for the
eight-county area of Pennsylvania where it was pilot tested; this
configuration may not be optimal for other regions. Resources or
locations currently not included may become necessary in the future and
can be added. This section explains how to customize the inventory to
meet particular needs and circumstances. Complete instructions for
installing and operating EPRI appear in the Technical Manual
accompanying this report.

[]{#__RefHeading___Toc67118539 .anchor}Configuring locations and
resources to tailor the inventory structure to needs/circumstances

[]{#__RefHeading___Toc67118540 .anchor}Decide which resources to
inventory

As discussed above, EPRI uses a hierarchy of specific resources within
resource types. A resource type might be 'antibiotics,' while resources
would be each type of antibiotic you wish to include (e.g. those useful
in response to a bioterrorism event). A resource type might be
'physicians,' while resources would be the types of physicians you want
to include (e.g. specialists in burns, trauma, infectious diseases). The
inventory is organized with this two-tiered structure as an organizing
principle to enable relatively quick and straightforward movement around
the data warehouse. Rather than searching for each individual resource,
one can drill down to the resource type, of which there are 28, and then
to the specific resource.

The Appendix accompanying this report contains the entire matrix of
resource types and resources currently included in EPRI. The Technical
Manual explains how to create new resource types and resources, to
customize the inventory as needed.

[]{#__RefHeading___Toc67118541 .anchor}Determine what types of locations
own/control the resources you want to inventory

EPRI uses the concept of a location type. An organization may have one,
and only one, location -- a stand-alone nursing home, for example. Or an
organization may have several locations -- a nursing home chain, or may
have both nursing homes and home health agencies -- two different
location types. The inventory contains fields for entering information
about the parent organization, and each of the distinct locations that
are a part of that organization. The inventory structure now includes
many types of locations, and more can be added. Some searches will be at
the level of location type -- what resources local hospitals contain,
what resources are available at fire stations, etc. Therefore an
organizing principle for location type was needed and project staff
specified 33 location types ranging from animal control facilities to
college campuses to hospitals for inclusion in the inventory.

The appendix accompanying this report contains the location types
currently structured in the inventory -- any of which can be altered by
future users. The Technical Manual explains how to create new location
types.

[]{#__RefHeading___Toc67118542 .anchor}Match resources to location types

EPRI allows the system administrator to specify what resource types and
resources the different location types are likely to control. Some
location types are likely to only have a few relevant resources, while
others have vast resources relevant to any sort of disaster or terrorist
event. Initial decisions were made by project staff about exactly which
resources are likely to be relevant for which location types. For
example, based on recommendations from emergency response providers and
other individuals on the project steering committee, the types of
emergency transportation vehicles that emergency medical services (EMS)
providers often have available, as well as those that might be available
through a county emergency management agency, were included in the
inventory for those location types..

The appendix accompanying this report shows an example of the location
type-resource matrix currently structured in the inventory -- any of
which can be altered by future EPRI users. The Technical Manual explains
how the matrix of resources may be customized.

The following screen shot from EPRI shows a particular type of location
(emergency medical service/ambulance), and a particular resource type
(communications equipment), and indicates which of the specific
communication equipment resources have been activated for EMS/ambulance
organizations. Steering committee members advised that five of the six
types of communication equipment are likely to be available at
EMS/ambulance locations, and EMS/ambulance companies will be asked to
report on these five. The sixth resource (specialized communication van)
is not a resource that EMS providers are likely to have and these
organizations will not be asked to report on it. System administrators
can decide which specific resources are relevant for each location type,
and can activate or inactivate any of the resources currently assigned
to that location type. A system administrator might, for example, decide
not to ask EMS/ambulance companies about their communications equipment
at all; or might even decide to omit EMS/ambulance companies from the
inventory entirely.

#### Figure 1. Resources activated for specific location types

![](media/image1.png){width="6.625in" height="3.588888888888889in"}

T

On the Web site, the administrator can open each resource type, thereby
enabling the entire list of resources within it to appear. Those
resources that the administrator wishes to activate for the particular
location type (in this case, EMS/ambulance) are checked. The
accompanying Technical Manual provides detailed instructions for
modifying any of the settings in the inventory, adding or deleting
resources or resource types, adding or deleting location types, altering
which resources are relevant for each location type, etc.

[]{#__RefHeading___Toc67118543 .anchor}Periodically Updating Data

EPRI is designed to support periodic updating. An e-mail generated
within EPRI can be sent to all participating organizations asking that
they update their data. Each participating organization would be asked
to review their data and update anything that has changed since the last
reporting. Rather than requesting that all data be re-entered, only
personnel and equipment resources that have experienced change over the
interim need to be reported, thereby minimizing the burden on
participants.

Each resource in EPRI can be set to a different periodicity for
updating. Some resources change very infrequently (e.g. fire trucks,
burn unit beds) while others resources are almost constantly changing
(e.g. personnel, drug inventories). A system administrator may decide to
seek updated information on resources that change infrequently at a
frequency of only once per year, while those resources that change
rapidly may need to be updated quarterly. Again, the flexibility
designed into the system is intended to allow the system administrator
to minimize burden on participating organizations and tailor EPRI to
unique settings and circumstances.

The data manager and data entry person designated by each participating
location have the ability to generate a report of that site's specific
resource inventory. This site specific report can be printed or
downloaded for other mandated reports or the organization's own planning
needs.

[]{#__RefHeading___Toc67118544 .anchor}4. Inventory Has Automated and
Secure Reporting

EPRI will create a number of automated reports. Some may be more useful
for planning purposes, and others may be more useful for incident
response needs. The Web-based inventory, and the reports it generates,
must be secure. If the system were breached, the information contained
within it, and the automated reports it produces, could offer abundant
information to terrorists. Institutions involved in a competitive market
place also need assurance that proprietary information will not be
accessible to their competitors. For example, hospitals in a
metropolitan area, competing for personnel, would not want to share
information about the number of nurses, physicians and technicians they
employ.

The need for utmost security necessitates a tool that can be hosted on a
secure server by any state or regional agency compiling such an
inventory. Access to EPRI is password protected and the data transmitted
between the Web server and the user are encrypted. In addition, approved
users are granted authorized access only to data at the level of
aggregation they each need to accomplish their roles in planning or
response. Those without a need to view aggregated data within a region,
or detailed data about an institution or organization, do not have such
access.

Table 1 provides a list of all automated reports that can be generated
from the inventory. Sections that follow describe the reports and who
has access to them. In addition to the automated reports, the inventory
data can be downloaded into an Access database to build customized
reports beyond those listed here.

#### Table 1. List of Automated Reports

  -------------------------------------------------- ---------- ---------------- -- --
  **System Configuration**                                                          

  **Resource List**\                                            Level 1 -           
  Each resource type with its associated resources.             Administrator       

  **Resource Location Assignments**\                            Level 1 -           
  Each location type with its associated resource               Administrator       
  types and resources. Each resource notes whether                                  
  it is active and/or assigned to the location type.                                

  **Export Access Database**\                                   Level 1 -           
  Download a copy of the entire database in                     Administrator       
  Microsoft Access format.                                                          

  **Senior Planner**                                                                

  **Location Inventory**\                                       Level 2 - Senior    
  View inventory data for one or more locations.                Planner             

  **Emergency Response Director**                                                   

  **Resources within Radius**\                                  Level 2 - Senior    
  Displays all the locations that report on                     Planner             
  resources within a certain distance from a certain                                
  city or latitude/longitude coordinates.                                           

  **Region-wide Reports**                                                           

  **Aggregate Inventory**                            Level 4 -                      
                                                     External                       
                                                     VIP                            

  **Aggregate Inventory Per 1,000 People**           Level 4 -                      
                                                     External                       
                                                     VIP                            

  **Aggregate Inventory By County**                  Level 4 -                      
                                                     External                       
                                                     VIP                            

  **Aggregate Inventory Per 1,000 People By County** Level 4 -                      
                                                     External                       
                                                     VIP                            

  **Map Reports**                                                                   

  **Inventory within Radius**                                   Level 2 - Senior    
                                                                Planner             

  **Aggregate Inventory By County**                             Level 4 -           
                                                                External VIP        

  **Aggregate Inventory Per 1,000 People By County**            Level 4 -           
                                                                External VIP        
  -------------------------------------------------- ---------- ---------------- -- --

As shown in the table above, EPRI includes mapping capabilities. In
particular, with EPRI you can:

-   Create a map showing the location of resources within a certain
    distance of a town.

-   Overlay demographic data on a map of the location of resources, so
    that you can study the relationship between resource locations and,
    say, population.

-   Obtain a map showing the route between a town and a location housing
    a particular resource.

-   Obtain driving directions between a town and a resource location,
    including the estimated travel time.

-   Create a map showing resource levels by county.

Examples of the maps are shown later in this section. See the Technical
Manual for further details on how to set up EPRI's mapping capability.

[]{#__RefHeading___Toc67118545 .anchor}System Configuration Reports

The system configuration reports display how the inventory is
configured: all of the resource types, location types, resources, and
the matrix layout for resources within location types. These reports
tell the system administrator exactly how the inventory is configured in
case changes are being contemplated. These reports generate a summary
list of what is available and can be utilized by moving through all the
screens to look at each location type and the resource types and
resources that have been activated for it.

The **resource list** report is intended for use by the system
administrator. It lists all of the resource types (antibiotics, beds,
etc.) and then all of the specific resources within each resource type.
The report lists all 28 different resource types and hundreds of
specific resources. It is a display of the structure of the inventory,
as customized by a system administrator.

The **resource location assignments** report is also intended for the
system administrator. This list goes through the specific resources that
each different type of location may control, and identifies those
resources to be included during the data entry process. Specifically it
lists each type of location; then within each location type, it lists
each resource type; and within each of those resource types, it lists
each resource. The report also indicates whether or not a resource has
been activated for that type of location. This report provides a view of
the entire matrix of location types and resources. An example of this
report appears in the Appendix accompanying this report.

The **export Access database** feature allows for the download of all of
the data contained within the inventory into an Access database. This
feature allows the system administrator to create new reports that are
separate and independent from the automated reports included in EPRI. It
could be that the automated reports created within EPRI do not meet all
the analytic needs of planners. The system administrator and other
planners may wish to work with the database themselves. This feature
allows the system administrator to use the data in any way necessary.
This is also a way to create an archive by which a copy of the database
is stored each time data are reported (annually, semi-annually, or
whatever frequency a system administrator selects).

[]{#__RefHeading___Toc67118546 .anchor}Senior Planner Reports

The **location inventory** is intended for senior planners and
administrators, who may need to see all of the information associated
with one or more locations. It will show how many staff are employed,
what equipment is available, etc. for each individual participating
location/organization. Access to this location-specific information
should be tightly controlled. Due to the proprietary nature of the
information, only those with a need to know should have access to this
level of data. Competing hospitals, for example, should not be allowed
to see each other's detailed information. This is a report that should
not be needed frequently, and may never be needed in the course of
normal operations of the inventory. The following is an example of the
first page of such a report for a home health agency.

***Figure 2. Location-specific resources***

  -----------------------------------------------------------------------
  ![](media/image2.png){width="6.25in" height="4.6875in"}

  -----------------------------------------------------------------------

[]{#__RefHeading___Toc67118547 .anchor}Emergency Response Reports

**Resources within radius** is an incident response report that would be
available to administrators, senior planners, and most importantly to
incident response commanders as a real time report. It allows a first
response commander in need of a particular resource to specify what is
being sought, and the geographic area to be queried (the area around a
disaster site). The report will list all organizations that are asked
about the resource being sought, and will show the number of personnel
or equipment resources of the specific type requested that have been
reported by each organization. In addition, the contact person
identified by that organization, their contact information, and the
distance from the incident site to the organization will be listed. In
the following hypothetical example, a first response commander needs to
locate personal protective equipment within a radius of 50 miles of a
chemical spill. The report obtained lists every location that has
reported having personal protective equipment/suits along with a contact
name/number, and how many suits are present at the site. In an
emergency, a special request could be e-mailed to these locations
requesting an update of how many such suits can be made available
immediately, in 24 hours, and in 48 hours. The incident commander could
also simply telephone the emergency contact person at each organization
and ask these questions.

#### Figure 3. Resources near the site of an emergency

#### ![](media/image3.png){width="6.25in" height="4.6875in"}

There is currently no report designated for Level 3; for security
purposes all reports that show individual facility data are designated
2. A state may, however, decide to permit wider access to various
reports and can re-designate the Resources Within Radius, or any other
report, as Level 3 if desired.

The location of resources can also be displayed on a map. Map 1 below
shows the locations of Oral Cipro within 40 miles of the town of Ashley:

#### Map 1. Resources within a specific distance of a town

![](media/image4.png){width="6.116666666666666in"
height="2.321527777777778in"}![](media/image5.png){width="6.116666666666666in"
height="3.7256944444444446in"}

![](media/image6.png){width="6.116666666666666in"
height="2.441666666666667in"}

Demographic information can also be overlaid on this map to enable users
to study the correlation between, say, population data and resource
locations, as shown in Map 2 below.

#### Map 2. Demographic data overlaid on resource location data

![](media/image7.png){width="6.116666666666666in" height="2.2375in"}

![](media/image8.png){width="6.116666666666666in"
height="3.7256944444444446in"}

![](media/image9.png){width="6.116666666666666in"
height="2.441666666666667in"}

When the user clicks on one of the names of the locations in the
Matching Locations table (e.g., 'ABC Hospital' in the above screen), a
map and driving directions are displayed that guides the user from the
specified town to the location with the resource (note the 'Start' and
'End' label on the map):

#### Map 3. Driving directions to a resource location

![](media/image10.png){width="5.851388888888889in"
height="5.022222222222222in"}

![](media/image11.png){width="6.002083333333333in"
height="3.0527777777777776in"}

[]{#__RefHeading___Toc67118548 .anchor}Region-wide Reports

Four region-wide reports, which are intended for planning purposes,
aggregate information about an entire state or region.

The **aggregate inventory** report (see Figure 4) could be useful to
planners and could be shared with others external to the state or region
(a bordering state for example) to display the information about the
entire region.

#### Figure 4. Aggregate Inventory report, across counties

The **aggregate inventory per 1,000** report (not shown) presents
exactly the same information, displayed per 1,000 population in the
state or region. Such a report regarding decontamination tents, for
example, might show that there are only a few tents to cover a million
or more people, even though there are many chemical production
facilities located in the region. This in turn might prompt regional
authorities to invest in increasing the availability of this important
resource.

The **aggregate inventory by county** report (not shown) is the same
type of information, arranged by county. In the following example, the
physicians (resource type) are displayed for a single county, showing
the different types of physicians (resources) in the county. Note that
full time and part time physicians are itemized.

The **aggregate inventory by county per 1,000** (see Figure 5) combines
the previous two reports, and breaks down resources available in the
county per 1,000 population. This report allows a proportionate
comparison across counties in a region or state, so that planners can
compare one county with another. The following is a hypothetical report
comparing the emergency response equipment in two nearby counties; one
county is larger and equipment per 1,000 more abundant while the other
has a nuclear power plant.

***Figure 5. Inventory by county, per 1,000 population***

County-level resource levels can also be mapped. The map below provides
a visual display of the number of EMTs by county:

#### Map 4. Resources by County

![](media/image12.png){width="6.133333333333334in"
height="4.163888888888889in"}

![](media/image13.png){width="6.133333333333334in"
height="3.263888888888889in"}

[]{#__RefHeading___Toc67118549 .anchor}Data and Report Security

In addition to encryption and password protection, security/access
levels were built into EPRI. Each person entering data for an
organization, or using reports/data from the inventory, must first be an
authorized user with an individual UserID and password. When the system
administrator is setting up a new user's account, s/he must assign an
"input role" (entering data for one organization or not entering data at
all) as well as an "output role" (organization staff, planners, external
planners and VIPs, or emergency response commanders). These security
levels control what can be entered, and more importantly, what data and
reports can be generated and viewed. A system administrator can alter
these security levels for any individual user. Those security levels
currently designed in EPRI may not quite match the requirements of all
states or regions creating an inventory. The accompanying Technical
Manual describes how to create new user accounts and how to set the
security access level (input and output roles).

[]{#__RefHeading___Toc67118550 .anchor}Software Has Been Fully Tested

This chapter explains how the pilot test was implemented in an
eight-county region of rural Pennsylvania. This test included soliciting
political support, configuring EPRI for the location types and resources
relevant to the pilot test, outreach to organizations to solicit their
participation, and remote data entry by participating organizations.

[]{#__RefHeading___Toc67118551 .anchor}Steering Committee

The Steering Committee provided input on the design of the inventory
(what resources, location types, etc. should be included). Most
importantly, they also provided recommendations on the types of reports
they, as end users, would find most helpful in planning and response
activities. Other potential users creating their own regional inventory
of resources may also find a Steering Committee helpful.

Members of the project steering committee were helpful in terms of
obtaining the guidance and feedback necessary to make the project
successful. It was important that the steering committee have
representation from emergency management, public health, healthcare
providers, hospital administration, first responders, and other sectors
involved in emergency planning. Individuals living and working in the
pilot region who were identified as having considerable expertise and
experience in these fields were invited to serve on the committee.
Steering committee members included:

-   Representatives of the Department of Health from district, regional
    and state levels;

-   Healthcare providers practicing emergency medicine and representing
    the research community;

-   Hospital administration officials;

-   Emergency management agency coordinators from several pilot counties
    as well as regional representatives;

-   Regional counterterrorism task force representatives; and

-   A home health nursing director.

In addition, several members volunteered to sit on the committee
following presentations of the project goals and objectives at local and
regional emergency management committee meetings.

Following commitment to serve on the committee, the members were
assembled and an overview and explanation of the goals of the project
were given. Early in the project, management of the committee members'
expectations played a large role in properly directing the focus of the
group. Misconceptions concerning the design and eventual purpose of EPRI
were addressed and questions answered. It was useful to describe EPRI as
a tool for assembling a "data warehouse" that would hold the data
inventoried. It was very important to point out that the utility of EPRI
was primarily for planning, although the benefits as an incident
response tool were also recognized. Indeed, steering committee members
felt that cooperation would be enhanced (especially among first
responder agencies) if the data could become useful in their missions of
emergency response. Throughout the course of the pilot project, the
steering committee provided valuable feedback regarding the structure,
functionality, and use of EPRI.

[]{#__RefHeading___Toc67118552 .anchor}County-level political support

In addition to creating the project steering committee, which included
representatives from key agencies and organizations in the eight-county
area, it was felt necessary to secure acceptance and cooperation from
local authorities. County government plays a strong role in Pennsylvania
and our efforts were therefore directed first at County Commissioners,
the elected county managers in Pennsylvania.

To familiarize officials in the pilot region with the goals and
objectives of the project and obtain endorsement from county officials,
a series of meetings and presentations were arranged. The county
commissioners of each county were sent a letter of introduction and a
request for the opportunity to present an overview of the project.
Follow--up calls were made to each office for which no response was
received within two weeks after the initial letter was sent. A
presentation was subsequently made to each of the county commissioners
of six of the eight counties in the pilot region. Of the two counties
for which presentations were not given, the emergency management
coordinators of each county served on the project steering committee and
provided updates to the officials of those counties. All six counties
agreed to support the pilot test, and one county contribued its director
of Public Safety to serve on the steering committee. Throughout the
course of the project, the emergency management coordinators of each
county provided considerable support through provision of listings of
organizations and call lists, coordinating meetings, and communicating
with providers in their respective counties. In addition, project staff
participated in a variety of local and regional emergency management and
planning groups and attended meetings of the regional counter terrorism
task force, which included all but one of the pilot counties. This
facilitated working relationships with the individuals responsible for
planning in the communities targeted for the pilot.

[]{#__RefHeading___Toc67118553 .anchor}Selected location types, resource
types and resources relevant for pilot test

There are 33 types of locations in the inventory and over 2500 specific
locations in the eight-county area that could have been included in the
pilot test. To make the pilot manageable within the timeframe of the
project, the location types to be inventoried were reduced to eleven.
Those most immediately involved in emergency response, health care
providers, and a few others that might not think of themselves as
emergency resources (animal control, mortuaries) were selected, to
determine what is involved in gaining cooperation from such places. [^3]
For purposes of the pilot test, EPRI was configured to include only
these location types. All the resource types and specific resources
assigned to these location types in EPRI were reviewed to select those
that should be retained for the pilot test. It was decided to retain all
the resource types and nearly all the resources for the 12 types of
locations selected for the pilot study.

Having specified location types, it was necessary to identify the
specific locations that existed in the pilot region (see box). Project
staff enlisted the help of emergency management coordinators of each
county in obtaining lists of emergency medical service providers, fire
departments, and law enforcement agencies in each county. Geisinger
Medical Center administrative staff provided names and addresses for all
hospitals in the pilot region. Various professional societies, such as
the state home health nursing association, also provided lists of
locations/organizations within the region. Identification of several
location types, such as nursing homes and funeral homes, required use of
national databases, some of which were available through online
listings. A complete listing of approximately 1100 specific locations
was compiled to be included in the pilot data collection effort.

[]{#__RefHeading___Toc67118554 .anchor}Outreach to solicit participation

To reach each of the specific organizations and agencies identified, a
letter of introduction was mailed inviting representatives to attend a
presentation to be made in their county. Each letter also contained a
brief overview of the project goals and objectives, the counties
included in the pilot test, and contact information for project staff.
These letters were mailed to each location at least two weeks prior to
their planned county meeting. One individual meeting was held in each of
four of the pilot counties; a combined meeting was held for two small
counties, which are geographically adjacent; and two individual meetings
were held in each of the two largest counties in the pilot region. In
addition, two evening meetings were held to facilitate attendance by
individuals unable to attend a meeting during regular working hours. For
example, volunteer firefighters often work day jobs and cannot take time
away to attend a meeting but may be more available in the evening to
attend a meeting.

To publicize the meetings, local radio and newspaper interviews were
granted and meeting dates were published. Each organization was provided
with an overview of the project and, if requested, written materials
regarding the project. Following provision of this information,
participation was requested from each organization.

During each meeting, sign-in sheets listing each of the organizations in
the county were used to track attendance. Following each meeting, those
organizations that sent a representative, and those that did not, were
catalogued for the purpose of followup. At the completion of all
meetings, each organization not in attendance was contacted by
telephone, again offering information and requesting participation.

[]{#__RefHeading___Toc67118555 .anchor}Recruiting Organizations and
Collecting Data: Lessons Learned

Having mailed letters to all selected organizations in the eight-county
region, and having held meetings in each county, the next task was to
contact organizations to solicit cooperation and to set them up as EPRI
users so that they could submit data.

[]{#__RefHeading___Toc67118556 .anchor}Motivating Participation

Since there was no mandated governmental or organizational directive
sent to any of the contacted organizations, the pilot test was dependent
upon the goodwill and trust of the various contacted organizations to
participate in the project and the inventory. The pilot test enjoyed no
formal support from state agencies, although there was direct contact
with several levels of leadership of the Pennsylvania Department of
Health, Pennsylvania Emergency Management and Pennsylvania Office of
Homeland Security. Information regarding the project and EPRI were
presented in several meetings to keep these organizations updated on the
progress of the project. None of the state agencies was able to
guarantee the necessary financial and personnel commitment to manage and
maintain this inventory beyond the current year, because their resources
are based on annual funding (largely grants) coming mainly from the
federal government. This may be a barrier in other states as well, until
more stable funding streams become available for homeland defense. The
project team had no incentives to offer other than that of community
preparedness and no leverage to compel cooperation.

[]{#__RefHeading___Toc67118557 .anchor}Test Results

The project staff was able to recruit and collect data from all 12 types
of locations chosen for the pilot, from animal control facilities to
hospitals. All types of organizations were able to log onto the system,
bring up their organization's data entry pages, and enter data. Queries
and email were sent between participating organizations and the system
administrators. Reports were generated with the contributed data. EPRI
was successfully tested, all functions worked as expected, and no
redesigns were required.[^4]

Although EPRI met with great enthusiasm from many organizations,
cooperation (and data) were not forthcoming from the majority of
organizations selected for the pilot test. During the three summer
months of 2003, approximately 15% of the 1100 organizations targeted in
the eight-county area were recruited and provided data. Much of the
difficulty in eliciting cooperation from the organizations in the pilot
region had to do with the fact that the test was conducted during the
summer months when many organizations were short staffed and had
competing priorities. In addition, there was neither a mandate nor any
incentive to participate. Inventories organized by states or regions
that do have official sponsorship or mandates will perhaps be more
successful in securing cooperation.

[]{#__RefHeading___Toc67118558 .anchor}Lessons Learned About Soliciting
Participation

If a state or region decides to assemble an inventory of resources, it
will need to reach out to organizations throughout the area. Direct
telephone contact may be necessary to those organizations that do not
respond to a mailing or an e-mail solicitation. The following guidance
may be useful in making telephone contacts to solitict participation,
set up user accounts, and collect data.

**Preparing materials**: In addition to re-mailing and faxing the letter
previously sent (which many contacts did not recall receiving),
printouts were created of the data entry forms so that individuals at
organizations in the pilot area could see exactly what information was
being sought. These printouts were faxed or mailed, along with a form
requesting contact information that would allow the creation of new user
accounts (contact name, address, e-mail, and phone). Being flexible in
using email, fax, mail and phone was important due to the diverse array
of organizations being contacted.

**Creating a database for record-keeping**: It was necessary to track
which organizations had been contacted, which had agreed to participate,
which had not yet agreed, which needed calls backs etc. With 1100
organizations to recruit during the summer months, such a tracking
system was extremely useful. A Microsoft Access database was created and
included identifying information for each organization and location, and
notes about the status of each organization's recruitment. A report of
pending cases helped staff to prioritize their daily work. A weekly
status report was generated with each organization and its status (e.g.
pending, recruited/agreed to participate, refused).

**Efficiently Contacting Organizations**: For this pilot test, 1100
organizations had to be contacted in a limited time. We arranged to have
project staff make outreach calls at different times of day, including
evening shifts. We found that most volunteer fire departments do not
have an employee who answers the phone (or picks up the mail) and it was
nearly impossible to reach anyone at these small fire stations who could
provide information. This will be a challenge in any rural area where
firefighting is a largely volunteer effort.

**Getting past Gatekeepers:** Gatekeepers include receptionists,
operators, secretaries, and answering services. Some are extremely
helpful in reaching the organization's executive; some are not. System
administrators must be able to quickly describe the project and its
relevance, obtain the name of the individual empowered to make decisions
for the organization, and try to get through to that person. System
administrators must make it immediately clear that this is not a sales
effort and there are no costs to participate, and to give the name of
the sponsoring agency to establish legitimacy. A set of Frequently Asked
Questions was created so that our system administrators would be
prepared to handle common questions in a consistent manner.

**Explaining the usefulness of the inventory:** The objection heard most
often from location directors was that there is no need for this
resource, or that the location's participation was not valuable. In the
pilot area of rural central Pennsylvania, many people felt that the
local community would not be a target of bioterrorism. It is important
to reinforce the idea that this inventory can be used for any major
disaster in the area, as well as serving as a resource during any
evacuation of people from metropolitan areas.

**Addressing concerns of validity, security, and confidentiality:** Some
organizations, especially those in law enforcement, were concerned about
security. System administrators need to explain who will have access to
data and reports and how data is secured.

**Discussing the burden of participation**: Once organizations
understood the need for such a resource, they wanted to know what they
would be required to do and how much time and effort would be involved.
A few organizations had an aversion to the Web or technology, or did not
have the technology available to enter data. For these few
organizations, information was collected over the phone, and project
staff entered the data into EPRI.

It is important that anyone implementing such inventory be familiar with
similar projects that may be taking place in the same locality. Early in
our outreach efforts, we learned that nursing homes and home health
agencies were in the process of putting together local and county
emergency preparedness programs and contact lists. It is important to be
able to explain how this inventory is different and why participation in
both activities is important. It may also be possible to combine efforts
with others engaged in such projects, to reduce the burden on
participating organizations.

**Convincing organizations to enter data:** Recruitment is only as
valuable as the ability to capture a location's inventory data. Even
when outreach was successful and organizations agreed to participate, a
location did not always follow through and log in to enter data.
Reminder calls, emails and faxes were often necessary.[^5]

Technical assistance to participating organizations was often necessary.
System administrators usually had to use the telephone to walk each
location's data entry staff through the login and entry steps. Advice
regarding how to locate, count and aggregate information was
occasionally necessary, and we provided a toll-free number people could
call for assistance. In some cases, data entry staff did not have
adequate Internet access at work, but were willing to enter data from
their homes after hours. We therefore staffed our toll-free helpline
during the evening as well as daytime hours.

[^1]: This project did not develop standards against which to measure
    the resources available in the test area. Cost data were not
    included for specific resources.

[^2]: The accompanying Technical Manual contains detailed instructions
    for hosting the inventory tool, customizing the structure of the
    data warehouse to meet local needs, granting access to users, and
    other technical functions.

[^3]: During the course of the pilot, the funeral home/mortuary location
    type was deactivated because in this region there is a central
    crematory and no corpse processing or storage in a mass fatality
    event is handled by individual funeral homes. The same might be true
    in other regions of the country.

[^4]: The reports were not tested in a 'real life' emergency or in a
    drill.

[^5]:
    ##  The inventory tool has a built-in capability for sending emails.