Harris County, Texas, the third-largest county in the country, is located along the Gulf Coast where human health and well-being are continuously impacted by intricately intertwined man-made and natural events. Encompassing 1,777 square miles of sprawling urban and suburban landscape, Harris County is home to over 4.6 million residents and is continuing to grow at a rapid rate. With its size comes a great deal of diversity racially, ethnically, and socioeconomically Harris County is the most racially and ethnically diverse population in the country. As a result, there are quite a few vulnerable groups whose needs are not fully addressed by traditional providers or who feel they cannot comfortably or safely use the standard resources offered in preparedness, response, and recovery efforts.
On August 25, 2017, Hurricane Harvey made landfall on the Texas coast, then stalled out over southeast Houston causing widespread flooding in Harris County. The Harris County Flood Control District estimates that 70% of Harris County was flooded by at least 1.5 feet of water and that one trillion gallons of water rained on the county. Like many other federal, state, and regional agencies, Harris County Public Health sprang into action in order to respond to the disaster: enacting the Emergency Operations Plan and the Continuity of Operations Plan. The goals being to have regular essential functions up and running within 24 hours, and to begin responding to the emergent needs of the community as soon as possible, respectively. HCPH is the health department for Harris County, Texas, a jurisdiction that includes approximately 2.5 million people within Harris County's unincorporated areas and over 30 municipalities located within the county (not including the city of Houston). At HCPH, training and development is part of a comprehensive strategy toward agency quality improvement, but like many health departments, a major barrier in accomplishing these priorities is working with an extremely lean staff model.
As response and recovery activities from Hurricane Harvey began demobilizing, HCPH performed an agency-wide After Action Review (AAR) to look at the agency response. The evaluation revealed that while there was a core team of individuals trained in disaster response and the incident command system (ICS), there was a lack of depth in the number of highly trained and experienced public health professionals in disaster response at Harris County Public Health. To strengthen the HCPH workforce in disaster response, a year-long training and exercise program was created for a select group of HCPH employees to become a Public Health Incident Support Team (PH-IST). In order to build on an already strained workforce, the PH-IST program acts to provide training and exercise opportunities with minimal disruption to daily activities over a one-year period. The program is geared towards 12-15 mid-level full-time employees with basic incident command training and experience. The purpose of the program is to build the capacity of HCPH to scale up response activities while maintaining command and control with highly trained public health professionals. Once created, HCPH leadership reviewed and approved the program for implementation. Since January 2018, two teams of 13 full-time employees completed the yearlong program. Over the course of a year, employees completed in-depth in-person and online incident management courses, themed quarterly meetings with the Office of Public Health Preparedness and Response training team, exercise planning for a functional or full-scale exercise, and a final functional exercise to test and implement the skills and knowledge acquired over the year. Once completed, employees officially became part of the Public Health Incident Support Team. During a response, members of the PH-IST will hold a number of command roles within the department operations center (DOC) and the county's emergency operations center (EOC). Thereby, allowing PHEP funded staff to spread further across the response to ensure the communities' needs are met. Support from HCPH leadership, as well as our Executive Director, was crucial in the success of the program. The number of employees that are highly trained and experienced has tripled with an additional 13 employees identified for next year's program. It is only a matter of time before the next large scale emergency occurs in our community. Through lessons learned from Hurricane Harvey, HCPH has been able to advance the health department's capacity to respond to and recover from disasters in the future. Website: http://publichealth.harriscountytx.gov/